Insomnia and OSA
Obstructive sleep apnea (OSA) and chronic insomnia are two of the most common sleep disorders, and they coexist frequently in the same patient. Although OSA is associated with drowsiness and chronic insomnia with hyperarousal, they both can lead to cognitive issues and fatigue. They also have been associated with higher incidence of cardiovascular morbidities. The shared mechanism among the complications associated with both disorders is likely the overactivation of the hypothalamic-pituitary-adrenal axis. Chronic insomnia can be a symptom of OSA, and it can also interfere with an OSA patient’s ability to tolerate CPAP, the gold standard for treatment. CPAP can ameliorate the insomnia symptoms of someone with OSA, and cognitive behavioral therapy for insomnia can improve CPAP adherence. Therefore it is important for clinicians to recognize the overlap between these two disorders and the impact both have on the patient’s overall well-being.
KeywordsObstructive sleep apnea Insomnia CBT-I CPAP Apnea-hypopnea index (AHI) Hypothalamic-pituitary axis