Sleep should help you feel rested, but sleep apnea can make that hard. Many people with sleep apnea also have insomnia.

When someone has both sleep apnea and insomnia, the two conditions can make each other worse. Breathing pauses can break up your sleep. Trouble falling or staying asleep can leave you feeling drained, even if you spend enough time in bed.

Here’s what to know if you have both sleep disorders.

How Do Symptoms of Sleep Apnea and Insomnia Overlap?

Research shows up to 50 percent of people with sleep apnea also have insomnia, and the reverse is just as true. When someone has both sleep apnea and insomnia, it is referred to as comorbid insomnia and sleep apnea (COMISA).

What Are the Symptoms of Sleep Apnea and Insomnia?

The most common form of sleep apnea (called obstructive sleep apnea or OSA) happens when your airway collapses or gets blocked during sleep. This causes pauses in breathing that last seconds or longer.

You or your partner might notice loud snoring, snorts, or gasping as your body starts breathing normally again. During the day, symptoms may include extreme fatigue, morning headaches, dry mouth or sore throat, and trouble focusing on tasks like reading or driving. These and other symptoms can help you recognize sleep apnea episodes.

Insomnia feels different — it’s that frustrating battle to fall asleep despite being exhausted, stay asleep through the night, or get back to sleep after waking too early.

Daytime signs may include irritability, low energy that affects home or work, and feeling “wired but tired,” even when you want to relax.

Can Sleep Apnea and Insomnia Be Confused?

Confusion can arise from how much these common sleep disorders overlap. Both rob you of deep, refreshing sleep, leading to poor sleep quality, so mornings feel groggy and days drag on endlessly.

Sleep apnea can cause sudden awakenings when breathing briefly stops, which can resemble the broken sleep seen in insomnia. At the same time, insomnia-related anxiety can increase muscle tension, potentially worsening apnea episodes.

People often notice these conditions blending together, with loud snoring and restless nights happening at the same time. For example, one MySleepApneaTeam member said, “I snore so bad it can be heard way in the next room. Sometimes it wakes me up. I have a hard time winding down at night. I don’t stay asleep.”

Why Do Sleep Apnea and Insomnia Team Up?

Sleep apnea and insomnia make each other worse. With apnea, sudden drops in oxygen trigger your brain to jolt you awake, sometimes hundreds of times a night, even if you don’t fully remember it. These tiny disruptions leave your brain on edge, triggering insomnia.

Insomnia worsens sleep apnea by ramping up hyperarousal — those racing thoughts and stress hormones like cortisol make it harder for throat muscles to relax properly, inviting more apnea events.

This back-and-forth means breathing problems can make it harder to relax, while trouble relaxing can make breathing problems worse. Research confirms single treatments often fall short — you need strategies addressing both physical blockages and psychological barriers to rest.

What Are the Signs You Might Have Both?

Start paying attention if you snore loudly or gasp for air at night but also have trouble falling asleep or wake up much earlier than you want. Do you also feel very sleepy during the day or have trouble concentrating? That combination can be a sign that you have sleep apnea and insomnia.

If sleeping pills for insomnia aren’t helping or if using your continuous positive airway pressure (CPAP) machine feels like a constant struggle even after being diagnosed with sleep apnea, COMISA may be part of the problem.

Watch for clues such as dreading bedtime, lying awake for hours, or a partner noticing that you stop breathing during sleep — even if your main complaint is simply, “I can’t sleep.”

According to the American Medical Association, paying attention to these clues can be especially important for women, who often experience sleep apnea with more insomnia-type symptoms, which can delay the correct diagnosis.

It can help to keep a simple sleep diary. Write down when you go to bed, when you wake up, how much caffeine you have, and how you feel each morning. Over time, these notes can help reveal patterns in your sleep.

How Do Doctors Diagnose Sleep Apnea and Insomnia?

Doctors start by asking you questions about your symptoms. They’ll ask about snoring, night wakings, how long it takes to drift off, and how it affects your days, often using quick quizzes like the Epworth Sleepiness Scale or Insomnia Severity Index. Talking with your doctor can reveal sleep apnea and insomnia overlaps that questionnaires might miss.

From there, testing starts. An overnight sleep study called polysomnography (PSG) takes place in a lab and is the best way to confirm apnea. A PSG watches brain waves, oxygen, heart rate, and breathing all at once. For simpler cases, a home sleep apnea test (HSAT) tracks airflow and oxygen without the lab hassle.

The American Academy of Sleep Medicine recommends using HSAT along with your health history, especially for COMISA.

If insomnia seems to be the main problem, your healthcare provider may suggest starting with cognitive behavioral therapy for insomnia (CBT-I) or using a wrist-worn sleep tracker called actigraphy to track your sleep patterns over time.

The goal is to get a clear picture of what’s happening, rather than guessing. When symptoms overlap, a thorough evaluation helps make sure all parts of the sleep problem are treated properly.

Why Does Getting the Right Diagnosis Matter?

Getting the right diagnosis for your sleep disorder ensures you get the best treatment possible and avoid potential health complications.

Research suggests that treating both insomnia and sleep apnea together often leads to better results than treating just one condition alone and may help people improve faster and stick with CPAP therapy.

Treatments for Sleep Apnea

There are many obstructive sleep apnea treatment options. CPAP machines are the most common treatment. Other options include devices like auto-adjusting positive airway pressure and bilevel positive airway pressure machines, oral appliances, and surgeries.

Losing weight may also help make sleep apnea less severe. Sleeping on your side instead of on your back and avoiding alcohol before bed can also help.

Treatments for Insomnia

Cognitive behavioral therapy for insomnia is an effective way to treat insomnia without medication. It teaches sleep restriction to build tiredness, stimulus control so bed means sleep only, relaxation to quiet your mind, and ways to rethink sleep worries.

Medications are also available to help in the short term.

Best Ways To Treat COMISA

Research has shown that CBT-I with a machine like a CPAP significantly speeds up improvement in sleep and daytime functioning compared to using a machine alone.

One trial with 118 people found that both positive airway pressure (PAP) alone and PAP combined with CBT-I improved sleep and daytime functioning. However, adding CBT-I helped people improve faster. People reported better sleep and better daytime performance sooner, no matter when CBT-I was started.

Sleep specialists and therapists can create a customized approach that works for you.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

Do you have sleep apnea and insomnia? Let others know in the comments below.