Better way to treat insomnia and sleep apnea

OSA patients—who comprise around 10% of the general population—suffer from frequent airway narrowing events during sleep which leads to poor quality of sleep and reduced daytime functioning.

About one-third of OSA patients also report clinically significant insomnia symptoms, including long-term difficulties falling asleep at the start of the night, or long awakenings during the night.

Previous research has shown ‘Co-Morbid Insomnia and Sleep Apnoea’ (COMISA) is a debilitating disorder that can improve by identifying and treating insomnia separately.

In a study from Flinders University in Australia, researchers found that non-drug targeted psych interventions could help treat the ‘double whammy’ of co-occurring insomnia and obstructive sleep apnea (OSA).

By following simple new guidelines, people with concurrent sleep problems reported great improvement to both their sleep and their health.

There was about 50% improvement in insomnia severity and night-time insomnia after six months.

The study is published in Sleep. The lead author is Dr. Alexander Sweetman.

The team examined 145 patients and aimed to work out better treatments for ‘COMISA’.

These patients had shown poor results from using continuous positive airway pressure (CPAP) therapy, compared to patients who do not report symptoms of insomnia.

They were advised to be treated first with a targeted, 4-10 week program of cognitive and behavioral therapy for insomnia (CBTi) – before using CPAP machines to reduce the effects of sleep apnea.

The researchers found that treating COMISA patients with non-drug CBTi before commencing CPAP significantly improved insomnia symptoms.

They also found increased use of CPAP therapy by about one hour every night in patients treated with CBTi and CPAP therapy, compared to a group receiving treatment with CPAP alone.

At six months, combined CBTi and CPAP therapy led to significant improvements of 52% in insomnia severity, compared to 35% in the control group; 48% in night-time insomnia complaints, compared to 34% in control; and 30% in dysfunctional sleep-related cognitions (compared to 10% in control).

The team says the findings are important because heart disease, obesity, and depression have been connected to insomnia and sleep apnea.

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