Comorbid insomnia and sleep apnea assessment and management approaches

Approximately 30% to 50% of patients with obstructive sleep apnea (OSA) in sleep clinics report comorbid insomnia symptoms. Patients with comorbid insomnia and sleep apnea (COMISA) have worse sleep, mental health, physical health, and quality of life, compared with patients with either insomnia or sleep apnea alone. Patients with COMISA use positive airway pressure (PAP) therapy for fewer hours per night, compared with patients with sleep apnea alone. Consequently, it is important to identify and manage insomnia symptoms among patients with OSA. Cognitive behavioral therapy for insomnia (CBTi) is recommended as the "first-line" treatment for insomnia. CBTi is an effective insomnia treatment in the presence of untreated OSA. CBTi may also reduce the severity of OSA and improve adherence to PAP therapy in patients with moderate and severe OSA. Many sleep clinics worldwide currently specialize in the diagnosis and management of OSA alone. Sleep clinics should incorporate insomnia assessment tools, and evidence-based insomnia treatment and referral pathways, to provide personalized care for patients with COMISA. Potential CBTi options include self-guided digital programs, brief behavioral treatment programs, and provision of CBTi from trained therapists or psychologists.