COMISA: The Insomnia and Sleep Apnea Double Whammy

Lately, more people seem to be getting diagnosed with co-occurring insomnia disorder and obstructive sleep apnea (OSA). According to 1 study, 30 to 50 percent of people with OSA report symptoms of insomnia. And 30 to 40 percent of people with chronic insomnia also meet the criteria for OSA. Comorbid insomnia and OSA have become so common that researchers have developed a new acronym: COMISA. Somewhere between 1 and 7 percent of the adult population suffers from COMISA, co-occurring insomnia and sleep apnea.¹

Symptoms of COMISA

Not surprisingly, people with COMISA tend to have more difficulties than people who have only 1 condition or the other. COMISA is linked to:²

• Worse sleep quality
• Shorter sleep duration
• More daytime impairments
• Greater risk for motor vehicle accidents
• Poorer quality of life
• Overall higher risk of death

Why do insomnia and OSA co-occur so frequently? Researchers think there are a few ways that each disorder makes people more likely to develop the other.¹

Symptom overlap

One reason for the high number of COMISA cases is that some symptoms are common to both insomnia disorder and OSA. These include:¹

• Frequent awakening from sleep
• Poor sleep quality
• Daytime fatigue
• Difficulty concentrating
• Mood changes

It is possible that people can have COMISA in the same way that people with a stuffy nose and itchy throat can have both a cold and allergies at the same time.

A bidirectional relationship

Another possible explanation for high COMISA rates is that each disorder raises the risk for and worsens the other one.¹

For example, waking up due to a blocked airway (OSA) may make someone feel panicked or alarmed. And people with OSA tend to wake up many times during the night. Over weeks and months, that panic becomes associated with the bed and bedroom and can contribute to insomnia.¹

On the other hand, poor sleep quality and short sleep duration (insomnia) can trigger disruptions in breathing during sleep. This is true even for people who don’t have OSA. And people with insomnia may be more likely to be woken up by small changes in their breathing.¹

Coping and risks for COMISA

Finally, it is possible that how you cope with each disorder could also increase your risk for COMISA. For example:¹

• People with insomnia may be less likely to exercise due to daytime fatigue. They may also eat more fattening foods due to hormonal changes. The resulting weight gain increases the risk for OSA.
• People with OSA are more likely to nap or doze off during the day due to excessive daytime sleepiness. But dozing during the day can zap your natural sleep drive. This makes it harder to fall asleep at bedtime.

Living with the double whammy

Living with COMISA can be exhausting (pun intended). Researchers are still learning about the connection between insomnia disorder and OSA, but what we already know is alarming. Fortunately, effective treatments exist for both insomnia and OSA. If you have been struggling with COMISA, talk with a sleep medicine specialist to make sure both conditions are being treated.

If you have been diagnosed with COMISA, let our community know how you are coping with it.

Please share your COMISA story or comment below.