Having insomnia is a risk factor for sleep apnea. The reverse is also true. Scientists think this link might arise due to many factors. For instance, sleep apnea can cause significant sleep disturbances and make people worry about not getting enough sleep.

Likewise, insomnia may worsen symptoms of sleep apnea by reducing oxygen saturation or prompting more sleep apnea events.

Chronic insomnia affects roughly 1 in 3 people. By contrast, 25–30% of men have sleep apnea, alongside 9–17% of women.

When insomnia and sleep apnea co-occur, doctors call this comorbid insomnia and sleep apnea (COMISA).

This article explores the link between these sleep conditions before discussing the risks of having both. It then looks at how doctors treat COMISA and provides tips for better sleep.

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There is good evidence of a link between insomnia and sleep apnea.

According to a 2019 review, any individual who has one of these conditions has a 30–50% chance of having the other.

A 2021 review estimates that insomnia symptoms are 40–60% more common among people with sleep apnea compared with the general population.

Scientists are not completely sure how to explain these associations. However, the 2019 study notes that symptoms of one condition could predispose people to develop the other or worsen existing symptoms.

Some possible links between insomnia and sleep apnea include the following:

  • Sleep deprivation from insomnia may reduce upper-airway muscle tone.
  • Sleep deprivation from insomnia may reduce oxygen saturation.
  • If insomnia causes consecutive nights of poor sleep, this may predispose people to more obstructive sleep apnea events.
  • If insomnia causes someone to sleep lightly, they may wake up more easily when they stop breathing if they also have sleep apnea.
  • Sleep apnea can cause sleep disturbances and may cause people to wake up.
  • Sleep apnea may make it harder for people to gauge how long they have been awake, which could cause or worsen insomnia.

Within any given case of COMISA, many of these relationships could be at work. Scientists continue to investigate the link between insomnia and sleep apnea.

According to the 2021 review mentioned above, insomnia and sleep apnea have several symptoms in common.

In people with COMISA, these symptoms could be more serious than in people who have only insomnia or sleep apnea. The common symptoms include:

  • feeling unrefreshed by sleep
  • fatigue, or daytime sleepiness
  • problems with falling asleep, staying asleep, or waking up
  • problems with attention, concentration, and memory
  • mood or social dysfunctions

These symptoms can lead to a reduced quality of life and may increase the risk of accidents.

Additionally, there is mounting scientific evidence that poor quality sleep may be a risk factor for several serious health conditions. According to a 2017 review, these include:

Given these possible consequences of COMISA, it is important for people with this condition to receive a diagnosis and treatment.

Since COMISA is when someone has both sleep apnea and insomnia, a COMISA diagnosis requires doctors to diagnose both conditions in the same individual.

There is no standardized diagnostic protocol for COMISA. Doctors must make separate sleep apnea and insomnia diagnoses.

According to a 2022 paper, doctors can use the following methods to diagnose insomnia:

  • questionnaires
  • consulting their patient’s sleep diary
  • actigraphy, which is the use of a wristwatch-like device to measure a person’s sleep habits over multiple days

Doctors do not generally use a polysomnography test alone to diagnose insomnia.

However, if doctors suspect that someone with insomnia also has another sleep disorder, they might do so. Since polysomnography tests are the best diagnostic tool for sleep apnea, a COMISA diagnosis will require one.

Treatment for COMISA will involve both insomnia and sleep apnea treatments. However, as the 2021 review explains, the combination of insomnia and sleep apnea creates some unique treatment difficulties.

For instance, continuous positive airway pressure (CPAP) therapy is typically the treatment of choice for moderate to severe sleep apnea.

However, there is some evidence that people with insomnia have greater difficulties tolerating this treatment. This could be because using a CPAP machine can be uncomfortable.

For this reason, some scientists recommend that people with COMISA begin treatment for insomnia before treatment for sleep apnea.

In particular, many health professionals recommend a special form of cognitive behavioral therapy (CBT) for insomnia called CBT-I.

There is increasing evidence of the efficacy of starting CBT-I before CPAP therapy and for starting both therapies at the same time.

However, scientists are still unsure about the best overall combination of CBT-I and CPAP therapy. Research into the topic continues.

Aside from seeking treatment, there are some things an individual can do by themselves to get better sleep.

According to the British National Health Service (NHS), the following lifestyle modifications could relieve sleep apnea:

The NHS also details some lifestyle modifications that could improve insomnia. These include:

  • going to bed and waking up at the same time every day
  • creating a dark and quiet bedroom
  • relaxing for at least 1 hour before bedtime

Some other useful tips include avoiding caffeine late in the day, exercising earlier in the day, and not taking naps.

This section answers some frequently asked questions about insomnia and sleep apnea.

Can sleep apnea give you insomnia?

There is evidence that sleep apnea can both cause insomnia and worsen it.

Will CPAP help with insomnia?

If sleep apnea is causing a person’s insomnia or making it worse, then CPAP therapy could help with insomnia by treating the underlying sleep apnea.

How do you sleep with sleep apnea and insomnia?

Some useful tips include sleeping on the side, regularly exercising, and maintaining good sleep hygiene.

Sleep apnea and insomnia are both disorders that affect a person’s sleep.

The former occurs when an individual stops breathing while asleep. The latter is when an individual cannot achieve or maintain restorative sleep. COMISA is when an individual has both these sleep disorders.

Scientists know that sleep apnea is a risk factor for insomnia and vice versa. Each condition can also worsen the other.

Many factors could explain this link. For example, sleep apnea can cause sleep disruption, and insomnia could make it harder for an individual to breathe.

The main form of treatment for sleep apnea is CPAP therapy. However, insomnia can make this treatment harder to tolerate.

For this reason, some healthcare professionals recommend that an individual start treatment for COMISA with CBT-I, a form of CBT that specifically targets insomnia.

There is good evidence that CBT-I and CPAP therapy work well together. Some lifestyle modifications, such as regular exercise, could also improve symptoms of COMISA.