Understanding COMISA: When Insomnia Meets Sleep Apnea
COMISA is a complex condition with significant impacts on patients' sleep quality and overall life quality. It requires a nuanced approach that considers the bidirectional relationship between insomnia and sleep apnea.
Welcome to our latest blog post, where we delve into the complexities of Co-Morbid Insomnia and Sleep Apnea (COMISA), a condition first recognized by Christian Guilleminault and his colleagues in the early 1970s. This condition reflects a co-morbid prevalence rate between 30% and 50%, as reported in studies from 1999 and 2001.
What is COMISA?
COMISA stands for Co-Morbid Insomnia and Sleep Apnea, which represents a dual challenge involving chronic insomnia and obstructive sleep apnea (OSA). Chronic insomnia includes difficulties in falling asleep, maintaining sleep, or waking up too early, occurring at least three times a week for more than three months. On the other hand, OSA is characterized by partial or complete upper airway blockages during sleep, leading to breathing interruptions.
Overlapping Symptoms and Their Impact
Patients with COMISA often experience greater impairments in daytime functioning and quality of life (compared to those suffering from either insomnia or OSA alone. Symptoms of COMISA can include increased fatigue, which may worsen the effects of OSA, leading to further complications such as irritability, reduced concentration, depressive symptoms, and anxiety. This bidirectional relationship suggests that insomnia can exacerbate OSA symptoms and vice versa, in addition to lowering compliance with treatment for OSA.
Managing COMISA
Managing COMISA effectively often involves addressing insomnia first, which can improve adherence to Continuous Positive Airway Pressure (CPAP) therapy, especially in high-risk patients. Cognitive Behavioral Therapy for Insomnia (CBTi) has shown efficacy in these cases but may initially worsen daytime sleepiness due to sleep restriction.
While less desired amongst sleep specialists like myself, there do exist pharmacotherapy options like zolpidem have been shown to improve sleep efficiency by 10% without significantly changing OSA severity. Safety has also been demonstrated with the dual orexin receptor antagonist daridorexant in mild-moderate OSA.
Conclusion
COMISA is a complex condition with significant impacts on patients' sleep quality and overall life quality. It requires a nuanced approach that considers the bidirectional relationship between insomnia and sleep apnea.
Be sure to check out my podcast episode with Dr. Alex Sweetman (you will see his research in the references throughout this post) on Defining COMISA with Alex Sweetman, and sign up for our newsletter for new episodes and blog posts!
Have insomnia and are interested in CBTi to solve it? Come work with me! Go to oak.care/sleep to schedule an appointment today.
