Can’t Sleep or Stay Asleep? How OSA and Insomnia Overlap

Quick takeaways

• Insomnia and obstructive sleep apnea (OSA) are common sleep
  disorders. OSA causes repeated breathing pauses during sleep, and
  insomnia involves difficulty falling or staying asleep.
• Up to 50% of people with OSA also have insomnia. This distinct
  disorder is known as comorbid insomnia and sleep apnea
  (COMISA).¹
• Treating insomnia and sleep apnea together with cognitive
  behavioral therapy for insomnia (CBT-I) and continuous positive airway
  pressure (CPAP) can help improve sleep, mood and overall
  health.¹
• If you’re struggling to sleep or feel tired after a full night’s
  rest, talk to your doctor for professional guidance.

Understanding sleep apnea and insomnia

Many people struggle to get a good night’s rest. Nearly 48% have
difficulty falling asleep, men are experiencing a similar trend at
42%.²¹

Chronic insomnia and obstructive sleep apnea (OSA) are two of the
most common sleep disorders, each affecting between 5%- 20% of the
population.¹ Some people experience both conditions at the
same time, which can make treatment more complex. Learning about the
causes and symptoms of these disorders and how they overlap may help
guide conversations with your doctor and your treatment options.

This article is for educational purposes only and is not a
substitute for medical advice. If you have trouble sleeping or suspect
sleep apnea, talk to your doctor about testing and treatment
options.

What is obstructive sleep apnea (OSA)?

Sleep apnea is a condition where breathing stops and restarts many
times while you sleep, making it harder for your body to get enough
oxygen.²

The most common type of sleep apnea is obstructive sleep apnea, where
the muscles around the throat relax to the point of collapse. This
blockage restricts airflow during sleep. Breathing may become shallow or
stop for seconds to minutes at a time.

These breathing pauses cause you to wake up, preventing restorative
sleep. OSA can lead to symptoms such as:

• Excessive daytime sleepiness
• Morning headaches
• Irritability
• Difficulty concentrating
• Inability to feel present during the day
• Snoring or gasping for air while you sleep

What is insomnia?

Insomnia is a sleep condition that makes it difficult to fall or stay
asleep. If you have insomnia, you might:³

• Lie in bed for a long time before falling asleep.
• Wake during the night and have trouble going back to
  sleep.
• Wake up too early in the morning.

Two types of insomnia exist: short-term and long-term.³
Short-term insomnia may resolve itself after a few days or weeks. It’s
typically caused by stress or your environment. For example, you might
have trouble sleeping because you’re worried about a friend or are
traveling and away from home. Your doctor may diagnose long-term
insomnia (also referred to as chronic insomnia) if you have trouble
sleeping for at least 3 nights a week for more than 3 months, without an
apparent cause.

Insomnia can affect your quality of life. Because you’re not waking
up refreshed, you may experience symptoms such as: ³

• Fatigue
• Low mood
• Memory problems
• Difficulty focusing
• Anxiety
• Depression

If left untreated, chronic insomnia can lead to health problems and
increase your risk of heart disease, high blood pressure, diabetes and
cancer.³

How OSA and insomnia differ

When you spend your days tired and on edge, it can be hard to know if
this is caused by a sleep disorder such as insomnia or obstructive sleep
apnea (OSA). However, understanding the difference between the
conditions can help.

• Insomnia is characterized by difficulty falling or staying
  asleep, while OSA is characterized by breathing pauses during sleep that
  cause you to wake up.
• Insomnia may be caused by stress, environmental factors, life
  events and health problems. OSA, on the other hand, results from the
  airway repeatedly narrowing or collapsing during sleep.
• If you are living with OSA, you may wake up during the night,
  feel tired during the day, or find it difficult to concentrate — all of
  which can mimic symptoms of insomnia. If this happens to you, talk to
  your doctor.

Your doctor may recommend a sleep test, an overnight study used to
determine if you have a sleep condition.⁴ It provides a
picture of your health by collecting information such as oxygen levels,
heart rate, brain waves and breathing patterns while you sleep. Your
doctor can use this information to help determine if you have a sleep
disorder, and the results may explain why you’re not waking
refreshed.

Some people experience OSA and insomnia at the same time. About
30-50% of people with OSA also have insomnia symptoms.¹ This
condition is known as comorbid insomnia and sleep apnea syndrome
(COMISA). COMISA isn’t just having two sleep disorders at the same time.
It’s a condition where the two conditions affect each other, often
making symptoms worse and impacting mood and daytime functioning.

The two conditions reinforce each other, creating a continuous loop.
Sleep apnea may contribute to worsening insomnia symptoms.
^1,5 The repeated breathing pauses can wake you up and may
train the brain to be more alert at night. Consecutive nights of sleep
loss from insomnia may affect your nervous system and breathing control,
which can make OSA symptoms worse. A specialized treatment plan may help
you manage both conditions and reduce their impact over time.

Why COMISA affects more than your sleep

People living with COMISA tend to experience more intense symptoms
than those who have either obstructive sleep apnea (OSA) or
insomnia.⁶ Compared to people living with one condition,
people with COMISA generally experience worse:

• Mental health
• Physical health
• Daytime functioning
• Memory and concentration
• Sleep disturbances
• Quality of life

Without the right care, COMISA can have significant health effects,
including increased risk of depression, anxiety, hypertension and
stroke.⁶ Fortunately, research suggests that early diagnosis
and a treatment approach targeting both OSA and insomnia can help
improve sleep quality, mood and overall well-being for people with
COMISA.⁶

How doctors diagnose obstructive sleep apnea and insomnia

Before your doctor can help treat your symptoms, you need an accurate
diagnosis. Insomnia and obstructive sleep apnea (OSA) have distinct
treatments, so pinpointing the source of your sleep problems can help
guide appropriate treatment.

Recognizing symptoms

Begin by tracking your symptoms so you can discuss them with your
doctor. Symptoms that result from lack of quality sleep, such as daytime
sleepiness, low mood and difficulty focusing, are common in people
living with both insomnia and OSA.

Signs that are more likely to indicate OSA are related to reduced
airflow during sleep. These include:

• Frequent snoring that disrupts your bed partner.
• Gasping or choking for air while you sleep.

People with insomnia typically have trouble falling and staying
asleep. They may:

• Toss and turn because of racing thoughts or
  worries.⁷
• Sleep only for short periods.
• Stay awake for a long time after climbing into bed.

How doctors diagnose obstructive sleep apnea and insomnia

A health care professional can use various methods to narrow down the
cause of your sleeping challenges. In addition to discussing your
symptoms, your doctor may ask questions about your health history or
order a sleep test.

Sleep diary

You may be asked to keep a sleep diary to give your doctor a clearer
picture of your daytime routine and sleep habits. A sleep diary is a
daily record of:⁸

• When you go to bed
• How long it takes to fall asleep
• The number of times you wake up during the night
• The time you wake up in the morning

You can also track how you feel when you wake up, daytime sleepiness,
exercise, naps and caffeine, or alcohol intake. This information helps
your doctor identify patterns in your sleep routine that may indicate
insomnia.

Actigraphy

Another tool for diagnosing insomnia is actigraphy, which involves
wearing a small device on your wrist for up to 14 days.⁹ The
device collects information about your movements and the quality of your
sleep.

Sleep test

Since some symptoms of insomnia overlap with those of sleep apnea,
your doctor may also recommend a sleep test. Only a sleep study can
confirm a diagnosis of sleep apnea.⁴

Your doctor may recommend:

• A home sleep apnea test (HST) if you’re showing
  symptoms of a sleep disorder and haven’t been diagnosed with any other
  chronic medical conditions. This test is completed from the comfort of
  your own bed.
• An in-lab sleep test, or polysomnogram (PSG), if
  you have a complex medical history and need comprehensive sleep
  monitoring. These tests usually take place overnight in a sleep lab,
  where a trained technician monitors your sleep.

Treatment options for sleep apnea and insomnia

Once you’ve identified the reasons you’re not sleeping well, you can
work with your doctor to manage your symptoms. Your treatment plan
should be based on whether you have obstructive sleep apnea (OSA) or
insomnia and the condition’s severity.

CPAP therapy for sleep apnea

Continuous positive airway pressure (CPAP) is a device that delivers
mild air pressure to keep your breathing airways open while you
sleep.¹⁰ It is highly effective and is the most used and
understood method for treating sleep apnea.¹¹ When used as
directed, it can help alleviate OSA symptoms after the first night of
use. ¹²

Consistent CPAP use can help restore deep, uninterrupted sleep and
may reduce insomnia symptoms over time. In one study, people with severe
OSA reported improvements in daily functioning, reduced daytime
sleepiness, and emotional well-being after 1 month of CPAP
use.¹³

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is a first-line
treatment for insomnia.¹⁴ This therapy may help people build
habits that support and promote natural sleep patterns, helping deliver
sleep improvements even after treatment ends.¹⁵

A standard CBT-I program consists of six to eight weeks of treatment
sessions. Some of the tools you learn include:¹⁶

• Reframing how you think about sleep. Instead of
  dwelling on how tired you’ll be if you don’t fall asleep, you assure
  yourself that even if your sleep isn’t perfect now, you’ll soon
  progress. This eases some of the stress that can build up around
  sleep.
• Developing good sleep habits. Modifying your
  lifestyle and environment can promote better sleep. You might set a
  regular sleep/wake schedule, reduce screen time before bed and expose
  yourself to light in the morning to adjust your circadian
  rhythms.
• Limiting the amount of time you spend in bed.
  Instead of staying in bed late because you didn’t sleep well, sleep
  restriction therapy keeps you on a schedule. You may be tired
  short-term, but eventually you’ll be able to fall asleep
  quicker.
• Using your bed only for sleeping. Also known as
  stimulus control therapy, this technique helps you associate your bed
  with sleep instead of wakefulness.

Combined treatment approach

Combining continuous positive airway pressure (CPAP) therapy and
CBT-I can be especially helpful if you have comorbid insomnia and sleep
apnea (COMISA). This blended approach addresses the:

• Physical aspects of obstructive sleep apnea (OSA), reducing
  breathing pauses.
• Psychological aspects of insomnia, helping you fall and stay
  asleep.

Treating OSA with CPAP can help reduce insomnia symptoms by 20-50% in
people who have COMISA.¹ That’s why a combined approach is
important. Research suggests that treating insomnia through CBT-I can
make using CPAP a more positive experience and help you stick with your
treatment plan.¹

Managing insomnia and obstructive sleep apnea long-term

Treatment isn’t a one-time fix when you’re dealing with sleep
disorders. The key to consistent, quality sleep is consistent management
and care. Even though your symptoms may improve during treatment, it’s
important to maintain healthy habits over time.

Lifestyle and self-care strategies

In addition to following your treatment plan, be aware of how your
daily routine can impact sleep quality. Consider laying the foundation
for quality sleep by changing how you do things. Some healthy sleep
habits include:¹⁷

• Waking up around the same time every day, even on
  weekends
• Getting exercise every day, but not too close to bedtime
• Creating a relaxing bedtime routine that may include journaling
  and quiet music.
• Avoiding bright, artificial light close to bedtime, such as your
  phone or computer screen
• Practicing mindfulness and relaxation techniques to prevent
  racing thoughts at night
• Using blackout curtains to darken your bedroom
• Maintaining a cool temperature in your room that makes it
  comfortable to sleep
• Avoiding caffeine, alcohol and other stimulants in the late
  afternoon or evening
• Refraining from eating heavy meals or spicy food close to bedtime
  to avoid digestive discomfort

If you have obstructive sleep apnea (OSA), certain lifestyle changes
may reduce upper airway inflammation and collapse and help you breathe
better at night.¹⁸ These strategies include:

• Maintaining a healthy weight
• Limiting alcohol and sedatives that relax the airways
• Quitting smoking
• Changing your sleep position
• Managing allergies¹⁹
• Practicing myofunctional therapy with a certified professional to
  strengthen the tongue, mouth and jaw muscles²⁰

Ongoing monitoring

Your sleep quality can change over time depending on your lifestyle
and health. Do your best to monitor your treatments to catch and respond
to problems early. Sometimes, it just takes a little fine-tuning to get
things back on track.

If your doctor prescribes continuous positive airway pressure (CPAP)
for obstructive sleep apnea, make sure you’re using your CPAP device
consistently. Some machines have built-in technology to monitor sleep
settings and help your doctor spot sleep disruptions early. If you start
tossing and turning at night again, review your cognitive behavioral
therapy for insomnia (CBT-I) techniques and continue to practice
them.

Track your symptom severity and schedule regular follow-up
appointments with your doctor. They can help identify what’s working and
recommend an appropriate adjustment to your treatment.

Get support for your sleep challenges today

Deep, restorative sleep is an important part of living a healthy life. If you’re finding it tough to get a good night’s rest, learn more about your sleep habits. Take the sleep assessment and discuss the results with your doctor.

References:

1. Source: Sweetman, A. Co-morbid Insomnia and Sleep Apnoea (COMISA): Latest
   Research from an Emerging Field. Curr Sleep Medicine Rep 9, 180–189
   (2023). https://doi.org/10.1007/s40675-023-00262-9
2. Source: National Heart, Lung, and Blood Institute. Sleep apnea – what is
   sleep apnea? NHLBI, NIH. https://www.nhlbi.nih.gov/health/sleep-apnea
3. Source: Insomnia—Symptoms | nhlbi, nih. (2022, March 24). https://www.nhlbi.nih.gov/health/insomnia/symptoms
4. Source: Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice
   Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An
   American Academy of Sleep Medicine Clinical Practice Guideline. J Clin
   Sleep Med. 2017;13(3):479-504. Published 2017 Mar 15. https://pubmed.ncbi.nlm.nih.gov/28162150/
5. Source: Cruz, M. M. e, & Sweetman, A. (2025). Comorbid insomnia and
   sleep apnea: From research to clinical practice. Seminars in Respiratory
   and Critical Care Medicine, 46, 113–124. https://doi.org/10.1055/a-2591-5664
6. Source: Popovici C, Steiropoulos P, Mihaicuta S, et al. The Hidden Burden
   of COMISA: Clinical Implications and Treatment Challenges. Pulm Ther.
   2026;12(1):25-38. https://pubmed.ncbi.nlm.nih.gov/41219669/
7. Source: Weiner L, Martz E, Kilic-Huck Ü, et al. Investigating racing
   thoughts in insomnia: A neglected piece of the mood-sleep puzzle?. Compr
   Psychiatry. 2021;111:152271. https://pubmed.ncbi.nlm.nih.gov/34555554/
8. Source: Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus sleep
   diary: standardizing prospective sleep self-monitoring. Sleep.
   2012;35(2):287-302. Published 2012 Feb 1. https://pubmed.ncbi.nlm.nih.gov/22294820/
9. Source: What is actigraphy? (n.d.). Cleveland Clinic. Retrieved August 4,
   2026, from https://my.clevelandclinic.org/health/drugs/25196-actigraphy
10. Source: Cpap—Cpap | nhlbi, nih. (2022, March 24). https://www.nhlbi.nih.gov/health/cpap
11. Source: Understanding pap | sleep medicine. (n.d.). Retrieved August 4,
    2026, from https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-37
12. Source: Before and after cpap: How your body changes. (2022, October 27).
    Sleep Foundation. https://www.sleepfoundation.org/cpap/before-and-after-cpap-machine-body-changes
13. Source: Milinovic K, Pavlinac Dodig I, Lusic Kalcina L, et al. Adherence
    to CPAP Therapy in Obstructive Sleep Apnea: A Prospective Study on
    Quality of Life and Determinants of Use. Eur J Investig Health Psychol
    Educ. 2024;14(9):2463-2475. Published 2024 Aug 27. https://pmc.ncbi.nlm.nih.gov/articles/PMC11431498/#sec4-ejihpe-14-00163
14. Source: Muench A, Vargas I, Grandner MA, et al. We know CBT-I works, now
    what?. Fac Rev. 2022;11:4. Published 2022 Feb 1. https://pmc.ncbi.nlm.nih.gov/articles/PMC8808745/
15. Source: Rossman J. Cognitive-Behavioral Therapy for Insomnia: An
    Effective and Underutilized Treatment for Insomnia. Am J Lifestyle Med.
    2019;13(6):544-547. Published 2019 Aug 12. https://pmc.ncbi.nlm.nih.gov/articles/PMC6796223/
16. Source: Insomnia—Treatment | nhlbi, nih. (2022, March 24). https://www.nhlbi.nih.gov/health/insomnia/treatment
17. Source: Sleep disorders and problems (Insomnia): Learn More – What can
    you do if you have trouble sleeping? (2024). In InformedHealth.org
    [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG).
    https://www.ncbi.nlm.nih.gov/books/NBK279320/
18. Source: Kaleelullah RA, Nagarajan PP. Cultivating Lifestyle
    Transformations in Obstructive Sleep Apnea. Cureus. 2021;13(1):e12927.
    Published 2021 Jan 26. https://pmc.ncbi.nlm.nih.gov/articles/PMC7920220/
19. Source: Zheng, M., Wang, X., Ge, S., Gu, Y., Ding, X., Zhang, Y., Ye, J.,
    & Zhang, L. (2017). Allergic and non-allergic rhinitis are common in
    obstructive sleep apnea but not associated with disease severity.
    Journal of Clinical Sleep Medicine, 13(8), 959–966. https://doi.org/10.5664/jcsm.6694
20. Source: Camacho M, Certal V, Abdullatif J, et al. Myofunctional Therapy
    to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.
    Sleep. 2015;38(5):669-675. Published 2015 May 1. https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/
21. Source: https://sleepsurvey.resmed.com/