Sleep Apnea And Insomnia: Know The Difference And How To Treat Both

Sleep apnea and insomnia are both sleep disorders, but there are key differences between the two:

  • Sleep apnea: The airway is totally or partially obstructed during sleeping, resulting in breathing difficulties

  • Insomnia: Having trouble falling asleep or staying asleep

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Sleep apnea

Obstructive sleep apnea (OSA)¹ is the most prevalent form of the disorder. It occurs when the soft tissues at the back of the neck collapse, restricting airflow. It wakes people up due to a decrease in oxygen levels.

Patients who suffer from sleep apnea are sometimes confused by their symptoms since they assume they are receiving enough sleep. Sleep deprivation² may cause tiredness even if you've slept an adequate number of hours. A patient may get eight hours of sleep every night, but if their body keeps jolting them awake, this disturbed sleep will have negative effects.

Sleep apnea's most common symptoms include:

  • Continuous or loud snoring

  • Coughing, gasping or choking throughout the night

  • Breathing stopping and starting or observed episodes of stopped breathing during sleep

  • Excessive daytime sleepiness

  • Poor concentration due to tiredness

  • Heavy head in the morning

  • Mood fluctuations, irritability, or sadness

  • Waking up with a painful throat or dry mouth

  • Bed-wetting

Insomnia

There are two distinct types of insomnia:

  • Acute

  • Chronic

Stress³ is a common cause of acute insomnia, which may persist from a few days to many weeks. In contrast, chronic insomnia lasts for three months or longer.

The following signs and symptoms often accompany insomnia:

  • Inability to get to sleep or maintain a regular sleep schedule

  • Waking up several times during the night

  • Lying awake at night

  • Waking up early and not being able to get back to sleep

  • Feeling tired after waking up

  • Mood fluctuations, irritability, or sadness

  • Poor concentration

  • Making mistakes in everyday life

It's termed chronic insomnia⁴ if these sleep symptoms persist at least three nights a week for three months or longer and harm daytime functioning.

Are insomnia and sleep apnea connected?

Even though insomnia and sleep apnea are independent conditions, research⁵ indicates that they commonly co-occur. With a frequency of over 50%⁶ among OSA patients, "sleep-disordered breathing-plus" has been coined to describe those who suffer from both OSA and chronic insomnia.

If you have sleep apnea, your brain will actively prevent you from falling asleep so that you don't have apneas — pauses in breathing — while you sleep. Apneas are life-threatening; the brain recognizes this and tries to avoid them by preventing sleep. Insomnia caused by another condition is known as secondary insomnia.

Despite the high prevalence of co-existing sleep apnea and chronic insomnia, the connection between the two is not well understood. It is thought that sleep apnea can lead to insomnia with the intermittent pausing of breathing, resulting in increased brain arousal/activity, which is perceived as awakening. If this happens frequently enough, it can lead to insomnia.

On the other hand, there is early evidence that the underlying cause of some types of chronic insomnia could be related to very early signs of obstructive sleep apnea.

A small population study⁷ found that in patients with chronic insomnia without known OSA, nighttime awakenings were often caused by previously unidentified breathing events and that this group had higher respiratory muscle sensitivity than those without insomnia.

While the exact cause of the link between the two illnesses is still up for dispute, one thing is certain: if one problem isn't treated, the chances that the other will follow are quite high.

How do you treat both conditions at the same time?

There are a few reasons why treating insomnia and sleep apnea together might be complex.

Treatment for both illnesses may need the collaboration of many professionals since one condition may impede the other's care. Wearing a mask while you sleep is an example of the most popular OSA treatment: continuous positive airway pressure (CPAP).⁸ However, comfort and fit issues with a face mask might lead to repeated awakenings, which can lead to or worsen insomnia.

Treating the underlying cause is the most effective strategy for alleviating secondary insomnia. Yoga and other forms of relaxation and cognitive behavior therapy (CBT) may also be beneficial, regardless of the kind of insomnia you suffer from.

According to research published in the European Respiratory Journal Open Research,⁹ participants with insomnia and obstructive sleep apnea (OSA) had a 15% reduction in OSA severity after receiving cognitive behavior therapy for insomnia (CBTi).

If you have both conditions, benzodiazepines will often be avoided in the treatment of insomnia, as this drug can negatively affect breathing at nighttime.

The lowdown

When sleep disorders go untreated, they can impact your physical and mental well-being. Obstructive sleep apnea (OSA) patients often have insomnia, significantly impacting their quality of life and ability to function.

If you have OSA, ask your doctor to check for insomnia since it is linked to a worse quality of life than OSA alone and may affect CPAP therapy. Your treatment for both conditions may be managed by different health professionals, so good communication is essential.

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