The ‘double whammy’ of co-occurring insomnia and obstructive sleep apnea (OSA); is a complex problem best managed with non-drug targeted psych interventions, a new Australian study has found. By following simple new guidelines; people with the concurrent conditions reported great improvement to both their sleep; and their health with about 50% improvement in global insomnia severity; and night-time insomnia after six months.
‘Co-Morbid Insomnia and Sleep Apnoea’ (COMISA) is a little studied; and debilitating disorder which can improve by identifying and treating insomnia separately. The new Australian study of 145 patients aimed; to work out better treatments for ‘COMISA’ patients who, in the past, have shown poor results from using continuous positive airway pressure (CPAP) therapy; compared to patients who do not report symptoms of insomnia.
Effects of sleep apnea
As a result, the sleep experts are advising people living with both conditions to be treated first with a targeted; 4-10 week program of cognitive and behavioural therapy for insomnia (CBTi) before using CPAP machines to reduce the effects of sleep apnoea. “They found that treating COMISA patients with non-drug CBTi before commencing CPAP significantly improved insomnia symptoms;” says lead researcher Dr Alexander Sweetman, from the Adelaide Institute for Sleep Health at Flinders University.
“Importantly, they also found increased use of CPAP therapy; by about one hour per night in patients treated with CBTi and CPAP therapy, compared to a group receiving treatment with CPAP alone.” OSA patients who comprise around 10% of the general population suffer from frequent airway narrowing events; during sleep which leads to a 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.
Night-time insomnia complaints
The study found the new routine resulted in CBTi patients increasing acceptance of CPAP devices; by 87% and increased long-term CPAP use by one hour each night over the first four months. At six months, combined CBTi and CPAP therapy led to significant improvements of: 52% in global insomnia severity; compared to 35% in the control group, 48% in night-time insomnia complaints, compared to 34% 30% in dysfunctional sleep-related cognitions (compared to 10%).
Heart disease, obesity and depression have been connected to insomnia and sleep apnoea; so getting the best therapies are important to health and well being for millions of people around the world, says co-author Professor Doug McEvoy. “Long-term cardio-metabolic benefits for patients with COMISA is an important consideration; independent of those debilitating symptoms which can be relieved with the right treatment,” Professor McEvoy says.