Insomnia Secondary to Sleep-Related Breathing Disorders

  • Brooke G. Judd
Part of the Current Clinical Neurology book series (CCNEU)


Patients with sleep-disordered breathing, particularly obstructive sleep apnea, may present with insomnia-predominant symptoms rather than classic sleep apnea symptoms. As polysomnography is not typically performed in the evaluation of insomnia, it is the challenge of the clinician to obtain a thorough history to determine if there are other signs or symptoms that may lead one to consider the diagnosis of sleep-disordered breathing in this group of patients. Treatment of concurrent sleep-disordered breathing and insomnia may also pose a challenge, as both disorders may need to be addressed for successful resolution of symptoms.


Insomnia Obstructive sleep apnea Sleep-related breathing disorders 


  1. 1.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  2. 2.
    Krakow B, Melendrez D, Ferreira E, Clark J, Warner T, Sisley B, Sklar D (2001) Prevalence of insomnia symptoms in patients with sleep-disordered breathing. Chest 120:1923–9CrossRefPubMedGoogle Scholar
  3. 3.
    Smith S, Sullivan K, Hopkins W, Douglas J (2004) Frequency of insomnia report in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Sleep Med 5:449–56CrossRefPubMedGoogle Scholar
  4. 4.
    Chung KF (2005) Insomnia subtypes and their relationship to daytime sleepiness in patients with obstructive sleep apnea. Respiration 72:460–5CrossRefPubMedGoogle Scholar
  5. 5.
    Guilleminault C, Palombini L, Poyares D, Chowdhuri S (2002) Chronic insomnia, postmenopausal women, and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort. J Psychosom Res 53:611–615CrossRefPubMedGoogle Scholar
  6. 6.
    Shepertycky MR, Banno K, Kryger MH (2005) Differences between men and women in the clinical presentation of patients diagnosed with the obstructive sleep apnea syndrome. Sleep 28:309–14PubMedGoogle Scholar
  7. 7.
    Guilleminault C, Kirisoglu C, Poyares D, Palombini L, Leger D, Farid-Moayer M, Ohayon MM (2006) Upper airway resistance syndrome: a long-term outcome study. J Psychosom Res 40:273–9CrossRefGoogle Scholar
  8. 8.
    Quintana-Gallego E, Carmona-Bernal C, Capote F, Sanchez-Armengol A, Botebol-Benhamou G, Polo-Padillo J, Castillo-Gomez J (2004) Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 89:984–989CrossRefGoogle Scholar
  9. 9.
    Krakow B, Melendrez D, Pedersen B (2001) Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD. Biol Psychiatry 49:948–53CrossRefPubMedGoogle Scholar
  10. 10.
    Krakow B, Melendrez D, Warner T, Dorin R, Harper R, Hollifield M (2002) To breathe, perchance to sleep: sleep-disordered breathing and chronic insomnia among trauma survivors. Sleep Breath 6:189–202CrossRefPubMedGoogle Scholar
  11. 11.
    Lichstein K, Riedel B, Lester K, Aguillard R (1999) Occult sleep apnea in a recruited sample of older adults with insomnia. J Consult Clin Psychol 67:405–10CrossRefPubMedGoogle Scholar
  12. 12.
    Gooneratne N, Gehrman P, Nkwuo N, Bellamy S, Shutte-Rodin S, Dinges D, Pack A (2006) Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects. Arch Int Med 166:1732–8CrossRefGoogle Scholar
  13. 13.
    Guilleminault C, Palombini L, Poyares D, Chowdhuri S (2002) Chronic insomnia, premenopausal women and sleep disordered breathing: part 2. Comparison of nondrug treatment trials in normal breathing and UARS postmenopausal women complaining of chronic insomnia. J Psychosom Res 53:617–23CrossRefPubMedGoogle Scholar
  14. 14.
    Krakow B, Melendrez D, Lee S, Warner T, Clark J, Sklar D (2004) Refractory insomnia and sleep-disordered breathing: a pilot study. Sleep Breath 8:15–29CrossRefPubMedGoogle Scholar
  15. 15.
    Coyle MA, Mendelson WB, Dercheck A, James SP, Wilson MG (2005) Ventilatory safety of zaleplon during sleep in patients with obstructive sleep apnea on continuous positive airway pressure. J Clin Sleep Med 1:97PubMedGoogle Scholar
  16. 16.
    Berry R, Patel P (2006) Effect of zolpidem on the efficacy of continuous positive airway pressure as treatment for obstructive sleep apnea. Sleep 29:1052–56PubMedGoogle Scholar
  17. 17.
    Rosenberg R, Roach JM, Scharf M, Amato DA (2007) A pilot study evaluating acute use of eszopiclone in patients with mild to moderate obstructive sleep apnea syndrome. Sleep Med 8:474–70CrossRefGoogle Scholar
  18. 18.
    Kryger M, Wang-Weigand S, Roth T (2007) Safety of ramelteon in individuals with mild to moderate obstructive sleep apnea. Sleep Breath 11:159–64CrossRefPubMedGoogle Scholar
  19. 19.
    Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Tomlinson G, Floras JS (2005) Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 353:2025–33CrossRefPubMedGoogle Scholar
  20. 20.
    Fleetham J, West P, Mezon B et al (1982) Sleep, arousals and oxygen desaturation in chronic obstructive pulmonary disease. Am Rev Respir Dis 126:429–33PubMedGoogle Scholar
  21. 21.
    Klink M, Quan S (1987) Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airway diseases. Chest 91:540–46CrossRefPubMedGoogle Scholar
  22. 22.
    Saaresranta T, Irjala K, Aittokallio T, Polo O (2005) Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease. Respir Med 99:856–63CrossRefPubMedGoogle Scholar
  23. 23.
    George CF, Bayliff CD (2003) Management of insomnia in patients with chronic obstructive pulmonary disease. Drugs 63:379–87CrossRefPubMedGoogle Scholar
  24. 24.
    van Manen JG, Bindels PJ, IJzermans CJ, van der Zee JS, Bottema BJ, Schade E (2001) Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol 54:287–93CrossRefPubMedGoogle Scholar
  25. 25.
    George CF (2000) Perspectives on the management of insomnia in patients with chronic respiratory disorders. Sleep 23(Suppl 1):S31–S35PubMedGoogle Scholar
  26. 26.
    Cormick W, Olsen LG, Hensley MJ, Saunders NA (1986) Nocturnal hypoxemia and quality of sleep in patients with chronic obstructive lung disease. Thorax 41:846–54CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Calverley PM, Brezinova V, Douglas NJ et al (1982) The effect of oxygenation on sleep quality on chronic bronchitis and emphysema. Am Rev Respir Dis 126:206–10PubMedGoogle Scholar
  28. 28.
    Martin RJ, Bartelson BLB, Smith P, Hudgel DW, Lewis D, Pohl G, Koker P, Souhrada JF (1999) Effect of ipratropium bromide on oxygen saturation and sleep quality in COPD. Chest 115:1338–45CrossRefPubMedGoogle Scholar
  29. 29.
    Chaout A, Weitzenblum E, Krieger J, Ifoundza T, Oswald M, Kessler R (1995) Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am J Respir Crit Care Med 151:82–6CrossRefGoogle Scholar
  30. 30.
    Bradley TD, Rutherford R, Lue F, Moldofsky H, Grossman RF, Zamel N, Phillipson EA (1986) Role of diffuse airway obstruction in the hypercapnia of obstructive sleep apnea. Am Rev Respir Dis 134:920–4CrossRefPubMedGoogle Scholar
  31. 31.
    McNicholas WT (2000) Impact of sleep in COPD. Chest 117:48S–53SCrossRefPubMedGoogle Scholar
  32. 32.
    Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, O’Connor GT, Punjabi NM, Shahar E (2003) Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 167:7–14CrossRefPubMedGoogle Scholar
  33. 33.
    Dellaca RL, Rotger M, Aliverti A, Navajas D, Pedotti A, Farré R (2006) Noninvasive detection of expiratory flow limitation in COPD patients during nasal CPAP. Eur Respir J 27:983–91PubMedGoogle Scholar
  34. 34.
    Vanpee D, El Khawand C, Rousseau L, Jamart J, Delaunois L (2002) Effects of nasal pressure support on ventilation and inspiratory work in normocapnic and hypercapnic patients with stable COPD. Chest 122:75–83CrossRefPubMedGoogle Scholar
  35. 35.
    Stege G, Vos PJE, van den Elshout FJJ, Dekhuijzen PNR, van de Ven MJT, Heijdra YF (2008) Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med 102:801–14CrossRefPubMedGoogle Scholar
  36. 36.
    Girault C, Muir JF, Mihaltan F, Borderies P, De La Giclais B, Verdure A, Samson-Dollfus D (1996) Effect of repeated administration of zolpidem on sleep, diurnal and nocturnal respiratory function, vigilance, and physical performance in patients with COPD. Chest 110:1203–11CrossRefPubMedGoogle Scholar
  37. 37.
    Steens RD, Pouliot Z, Millar TW, Kryger MH, George CF (1993) Effect of zolpidem and triazolam on sleep and respiration in mild to moderate chronic obstructive pulmonary disease. Sleep 16:318–26PubMedGoogle Scholar
  38. 38.
    Murciano D, Armengaud MH, Cramer PH, Neveux E, L’Héritier C, Pariente R, Aubier M (1993) Acute effects of zolpidem (Z), triazolam (T), and flunitrazepam (F) on arterial blood gasses and control of breathing in severe COPD. Eur Respir J 6:625–9PubMedGoogle Scholar
  39. 39.
    Kryger M, Roth T, Wang-Weigand S, Zhang J (2008) The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease. Sleep Breath 13:79–84CrossRefPubMedGoogle Scholar
  40. 40.
    Kryger M, Wang-Weigand S, Zhang J, Roth T (2008) Effect of ramelteon, a selective MT(1)/MT(2) -receptor agonist on respiration during sleep in mild to moderate COPD. Sleep Breath 12:243–50CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Brooke G. Judd
    • 1
  1. 1.Departments of Medicine and PsychiatryDartmouth Medical SchoolHanoverUSA

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