If I have two disorders, which one should be treated first?

Usually, they are treated simultaneously. However, life-threatening conditions like severe sleep apnea are often prioritized for immediate medical intervention, while behavioral therapy for insomnia begins alongside it.

Can one sleep disorder cause another?

Yes. As seen with 'COMISA,' the physical stress of sleep apnea can lead to the psychological and behavioral patterns of chronic insomnia.

How common is it to have multiple sleep issues?

Studies suggest that up to 30-50% of people diagnosed with sleep apnea also meet the clinical criteria for insomnia.

Can You Have More Than One Sleep Disorder? | Comorbidities

Yes, it is very common for an individual to suffer from two or more sleep disorders simultaneously. This is known in medicine as 'comorbidity.' For example, it is quite frequent for someone to have both obstructive sleep apnea and chronic insomnia, a combination often referred to by specialists as 'COMISA.'

Having multiple sleep disorders can make diagnosis and treatment more challenging, as the symptoms of one can mask or exacerbate the other. A comprehensive evaluation by a sleep specialist is often necessary to identify all the contributing factors and create a holistic treatment plan.

The 'COMISA' Connection

The coexistence of chronic insomnia and obstructive sleep apnea is perhaps the most common comorbidity. Apnea can trigger insomnia because the gasping for air and the resulting adrenaline spikes can lead to 'learned' wakefulness and a fear of falling asleep.

Conversely, insomnia can make it harder to treat apnea. Someone who already struggles to fall asleep may find the sensation of a CPAP mask and pressure unbearable, leading to poor compliance with their apnea treatment. Treating both conditions concurrently is usually the best approach.

Overlaps with Movement Disorders

Restless Legs Syndrome (RLS) frequently occurs alongside other sleep issues. Many people with RLS also have Periodic Limb Movement Disorder (PLMD), where their legs twitch involuntarily during the night. Both of these can lead to secondary insomnia as the person struggles to find a calm state for sleep.

RLS is also found more frequently in people with sleep apnea. The physiological stress and inflammation caused by apnea may worsen the symptoms of RLS, creating a multi-layered disruption to the sleep cycle.

Circadian Rhythms and Insomnia

Many people who believe they have simple insomnia actually have an underlying circadian rhythm disorder, such as Delayed Sleep Phase Disorder. If you are a 'night owl' forced into an 'early bird' schedule, you may develop insomnia symptoms as you struggle to sleep when your body isn't ready.

This mismatch can lead to a reliance on sleep medications or alcohol, which then creates a new set of sleep problems, further complicating the clinical picture. Identifying the root circadian issue is key to resolving the secondary insomnia.

The Challenge of Complex Diagnosis

When multiple disorders are present, a single sleep study might not reveal the full story. For instance, if someone has severe insomnia, they may not sleep enough during a lab study for the specialist to see their sleep apnea. This is why a detailed patient history is so critical.

Treatment must also be carefully coordinated. Some medications used to treat one disorder could worsen another. For example, some sedative medications for insomnia can relax the throat muscles and make sleep apnea more severe, requiring close monitoring by a physician.

Frequently Asked Questions

References

[1]Sweetman, A., et al. (2019). The co-morbid insomnia and sleep apnea (COMISA) syndrome.
[2]Sleep Foundation. (2023). Comorbid Sleep Disorders.
[3]Journal of Clinical Sleep Medicine. (2021). Managing Multiple Sleep Disorders.

The information on this page is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.