Obstructive sleep apnoea (also spelt ‘apnea’)(OSA) is a sleep disorder that can eventually kill (it killed Carrie Fisher of Princess Leia/Star Wars fame).

OSA patients comprise around 10% of the population and suffer from frequent airway narrowing events (i.e. they stop breathing) during sleep. This leads to poor quality sleep, difficulties functioning during the day due to sleepiness, and a host of heart, weight, and other medical problems. 

About one-third of OSA patients also report clinically significant insomnia symptoms.

This is a problem because individuals experiencing both insomnia and sleep apnoea together tend to have poorer results from continuous positive airway pressure (CPAP) - the main treatment for obstructive sleep apnoea - than those with OSA and no insomnia.

But other than that, there’s not a lot of research into how best to treat what sleep experts call ‘Co-Morbid (co-occuring) Insomnia and Sleep Apnoea' (COMISA). 

Which condition do you treat first?

Could treating one before the other be better? 

Or worse? 

Given that heart disease, obesity, & depression are linked to insomnia and sleep apnoea, knowing the answer to those questions is important to the health and wellbeing of millions of people around the world.

Now a recent Australian study has made some important findings.

Why You Should Treat Insomnia Before Sleep Apnea

The study, a randomized controlled trial, looked at 145 newly diagnosed, untreated individuals with moderate or severe OSA & co-occuring insomnia. Study participants were randomly allocated to either:

1. a 4-week course of CBT-i then CPAP therapy; or

2. a 4-week wait period then CPAP therapy.

The study found that by treating insomnia with CBT-i first resulted in:

At four months

• 87% increase in the acceptance of CPAP devices;

• Increased long-term CPAP use by one hour each night.

At six months the significant findings were:

• 52% improvement in global insomnia severity, compared to 35% in the control group;

• 48% improvement in night-time insomnia complaints, compared to 34%;

• 30% improvement in dysfunctional sleep-related cognitions (compared to 10%).

The study’s lead author  Dr Alexander Sweetman stated:

"We found that treating COMISA patients with non-drug CBT-i before commencing CPAP significantly improved insomnia symptoms,"....

”we also found increased use of CPAP therapy by about one hour per night in patients treated with CBT-i and CPAP therapy, compared to a group receiving treatment with CPAP alone."

The takeaway from this?

The study’s authors are pretty clear - they write:

"This latest study suggests that sleep physicians and clinics should screen for insomnia symptoms and, if present, treat the insomnia with CBT-i to improve subsequent acceptance and use of CPAP therapy. This will improve outcomes for both disorders."

If you are worried you have insomnia you can check out the severity of your symptoms and get instant feedback using our insomnia test online.

Tried suggestions for sleep you found online and found they didn’t work? Here’s why standard sleep hygiene instructions don’t work for insomnia.

If you need advice on science-backed treatments for insomnia that work, talk to us.

The study was published in the journal SLEEP, (Sweetman et al, 2019)