The double whammy of co-occurring insomnia and obstructive sleep apnea (OSA) is a complex problem best managed with non-drug targeted psych interventions, an Australian study has found.
By following simple 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.
The new Australian study of 145 patients aimed to work out better treatments for COMISA (comorbid insomnia and sleep apnea) 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.
As a result, the investigators advise people living with both conditions to be treated first with a targeted, 4-10 week program of cognitive and behavioral therapy for insomnia (CBTi) before using CPAP machines to reduce the effects of sleep apnea.
“We found that treating COMISA patients with non-drug CBTi before commencing CPAP significantly improved insomnia symptoms,” says lead researcher Alexander Sweetman, PhD, BPsyc (Hons), from the Adelaide Institute for Sleep Health at Flinders University, in a release.
“Importantly, we 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.”
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 apnea, so getting the best therapies are important to health and wellbeing for millions of people around the world, says co-author Doug McEvoy, MBBC, FRACP, a professor at Flinders University.
“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,” McEvoy says. “This latest study suggests that sleep physicians and clinics should screen for insomnia symptoms and, if present, treat the insomnia with CBTi to improve subsequent acceptance and use of CPAP therapy. This will improve outcomes for both disorders.”