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Obstructive Sleep Apnoea

Co-morbid Insomnia & OSA

OSA and insomnia commonly coexist.

Approximately 30-50% of OSA patients report clinically significant insomnia symptoms, which contribute to increased morbidity, and reduced acceptance and use of CPAP therapy.1, 2 Therefore, patients with co-morbid insomnia and OSA may require nuanced treatment considerations.

Cognitive behavioural therapy for insomnia is the recommended ‘first line’ treatment for insomnia in Australian general practice. 3 Among OSA patients with insomnia symptoms cognitive behavioural therapy for insomnia improves insomnia symptoms and may increase subsequent acceptance and use of CPAP therapy.4 Patients should be monitored for increased daytime sleepiness during the first 2-3 weeks of cognitive behavioural therapy (following the initiation of ‘bedtime restriction therapy).5 Therefore, it is recommended that patients with OSA are screened for insomnia symptoms with simple self-report measures,6 which if present, should be treated with non-pharmacological cognitive behavioural therapy strategies.


AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. Sweetman A, et al. Developinga successful treatment for co-morbid insomnia and sleep apnoea. Sleep Med Rev 2017;33:28-38
  2. Sweetman A, et al. Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials. Brain Sci 2019;9(12):371
  3. RACGP: Prescribing drugs of dependence in general practice, Part B: Benzodiazepines 2015
  4. Sweetman A, et al. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with co-morbid insomnia: A randomized clinical trial. Sleep 2019;42(12)
  5. Sweetman A, et al. The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in insomnia patients with co-morbid moderate and severe sleep apnea: A randomized controlled trial. Sleep 2020
  6. Bastien CH, et al. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2001;2(4):297-307