Trouble Sleeping - Even with CPAP?
It's not just you.
Up to 50% of people with sleep apnea also struggle with insomnia, a condition called COMISA.When sleep apnea and insomnia occur together, sleep can feel impossible.
Learn what COMISA is, why it matters, and how to treat both together.
COMISA: The Missing Link between Insomnia and Sleep Apnea
What is COMISA?
“Insomnia + Sleep Apnea = COMISA”
COMISA (Co-Morbid Insomnia and Sleep Apnea) is a complex sleep problem where insomnia and sleep apnea overlap. Studies show as many as half of all people with sleep apnea also struggle with insomnia.Though it is both a recognized and treatable condition, it is frequently unrecognised and undiagnosed.
COMISA is more than just two sleep problems at once
It's a medically recognized sleep condition where a person has both chronic insomnia and obstructive sleep apnea (OSA). Having both conditions together can make sleep feel impossible, leaving you exhausted but unable to rest.
Common Signs of COMISA include:
Even with sleep apnea treatment, co-existing insomnia is a common problem. If these symptoms sound familiar, COMISA may be why your nights feel restless and your days exhausting.To help you take the first steps toward better sleep, download our free PDF guide on managing insomnia and sleep apnea, and
COMISA Creates a Frustrating Cycle
It’s frustrating: You’ve been diagnosed with sleep apnea, started CPAP, but you still can’t sleep!
You're Not Just "a Difficult Case"
Sleep apnea causes fragmented sleep, mood changes, and daytime exhaustion
Insomnia causes difficulty falling or staying asleep, often with anxiety or overthinking at night.
CPAP, while often medically necessary for apnea, can feel uncomfortable, intrusive or even triggering if the nervous system is already on high alert.
The problem?
Most people aren’t told what to do beyond "Use Your CPAP.”
Many clinics treat only one condition, leaving those with both insomnia and sleep apnea without proper support. This gap in care perpetuates the frustrating cycle of COMISA.
Those with COMISA are:
x2 more likely to discontinue CPAP therapy if insomnia is not treated
More likely to experience chronic fatigue, mood disturbances, and fragmented sleep
x2 times more likely to feel low mood or anxiety
More likely to suffer from daytime impairment and poorer quality of life
Because of its complexity, COMISA requires a different kind of support, one that goes beyond CPAP therapy or basic sleep hygiene tips.Watch our short 5 minute video to better understand COMISA: 'The Overlap of Insomnia and Sleep Apnea'
Why COMISA Matters
COMISA—coexisting insomnia and sleep apnea, is far more common than many realize, yet it’s often overlooked.Research shows:
30–40% of people with insomnia also have sleep apnea (OSA)
30–50% of people with sleep apnea report clinically significant insomnia symptoms (Sweetman et. al, 2021)
This overlap matters because having both conditions significantly worsens sleep quality, daytime fatigue, and overall health compared to having just one.
COMISA is linked to more serious long-term risks:
Increased risk of Depression and Mood Distubrance
Lower Quality of Life
Poorer Physical and Mental Health
More Difficulties with Treatment — especially CPAP.
Higher Cardiovascular Risks
50-70% higher risk of Early Mortality
In short, COMISA isn’t just two sleep problems. It’s a serious, compounding condition that requires a coordinated approach.
The Good News?
Effective Treatments exist for COMISA
Studies show that when both conditions are addressed together, people experience significant improvements in sleep quality, daytime energy, and overall well-being.Cognitive Behavioral Therapy for Insomnia (CBT-i) with Positive Airway Pressure (PAP) therapy has been shown to:
Reduce insomnia severity by up to 50%
Improve PAP adherence by addressing insomnia symptoms that often interfere with consistent use
Enhance sleep efficiency and reduce daytime sleepiness, leading to better mood and cognitive function
By targeting both insomnia and sleep apnea simultaneously, you can achieve more restful sleep and a better quality of life.
We offer a deeper, more personalized approach in our sleep clinic, a 'Dose of Rest'. Our Nurse-led practice offers Sleep Consultations and tailored coaching for insomnia, sleep apnea, and CPAP / BiPAP difficulties.
Take the first step toward restful nights and energized days.
Why CPAP Alone May Not Be Enough
The Missing Piece in Most Sleep Treatment Plans
While a sleep apnea diagnosis can be a relief, starting CPAP therapy does not always guarantee a perfect night's sleep, especially if you have undiagnosed insomnia.As a result, nights can remain restless, and CPAP may feel overwhelming or, at times, even counterproductive! This doesn't mean CPAP isn't working - it means you need support for both conditions.
Those with Co-occurring Insomnia and Sleep Apnea (COMISA):
Dread bedtime because they “know” they won’t sleep
Are twice more likely to stop CPAP therapy if insomnia remains untreated
Often feel as if they are doing something wrong, or that CPAP simply won't work for them.
Suffer greater physical and mental health challenges than those with either condition alone
You're Not Imagining It.
These are known parts of the condition, and they are manageable with the right kind of support.
Take Control of Your Sleep
Download our e-book:"The First 3 Weeks: A CBT-i Based Guide to Managing Insomnia and Sleep Apnea"
A Step-by-Step Plan to Managing Sleep Apnea and Insomnia (with or without CPAP).
Designed to give you proven strategies and practical tools you can begin using tonight to finally move toward restful sleep.The E-Book includes:
What Readers Are Saying
"After months of restless nights on CPAP, trying a multitude of masks, and spending hundreds on sleep reviews, I finally feel in control of my sleep. My CPAP has even become my friend!" — Alan"I used to get so much anxiety at night just looking at my CPAP machine, knowing I'd still be restless. I didn't realize how much my thoughts and poor sleep habits were affecting me! This guide completely changed my mindset and helped me build a routine that has truly transformed my sleep. The dread is gone." — David P."My husband was so supportive, but my sleep apnea and insomnia were taking a toll on our relationship. The constant worry about not sleeping was just as bad as the sleepless nights themselves. This book explained it all and brought a lot of peace back to our home." — Emily W."My sleep apnea was diagnosed, but the sleepless nights and constant anxiety just wouldn't go away. I was exhausted all day at work, and my relationships were suffering. This guide helped me finally treat my insomnia and get my life back." — Chris A."When I was diagnosed with sleep apnea, I thought my problems were solved, but I was wrong. I was still so tired and fatigued. This book explained why and gave me a clear, simple plan that finally brought me the restful sleep I was looking for." — Rachel V."I was trapped in a cycle of waking up at 3 AM and just lying there, worried sick about getting back to sleep. I couldn't focus at work and felt like my brain was in a fog all day. The strategies in this book helped me break that cycle and get my nights back." — Maria R."My CPAP helped, but I was still waking up every hour. This book explained it all and finally solved the real issue behind my broken sleep." — Kevin F."Struggling with CPAP was frustrating and exhausting. This book was the missing piece to my sleep puzzle. It helped me understand why I was still struggling, create a routine that works for me, and gave me a clear path forward." — Mike
Preview of Book
Insomnia symptoms are mistaken for stress or anxiety, while underlying sleep apnea goes undiagnosed.
Sleep apnea is treated with CPAP or other devices, but insomnia persist, leaving patients frustrated and exhausted
Clinicians often don't screen for both conditions together, so COMISA remains invisible in standardsleep assessments.
Take your first step toward better, more restful today.Button - "Start The 3 Week Plan'
What's Included in the book
Diaries, Worksheets, Cheatsheets, Full structured program. Includes CPAP advice and guidance.
Why COMISA Is So Often Missed
Many people struggle with both insomnia and sleep apnea, but most clinics focus on treating just one condition at a time. This means:
Insomnia symptoms are mistaken for stress or anxiety, while underlying sleep apnea goes undiagnosed
Sleep apnea is treated with CPAP or other devices, but insomnia persists, which can feel frustrating and exhausting
Clinicians often don't screen for both conditions together, so COMISA remains invisible in many standard sleep assessments
The Result?
People with COMISA often spend years struggling with poor sleep, bouncing between treatments, that only address part of the problem. Without a coordinated approach, the cycle of sleepless nights and daytime fatigue continues.
COMISA is often missed not because it's rare, but because traditional care isn't designed to catch both conditions at once.
Should Insomnia Be Treated Before Sleep Apnea?
It's a common misconception that treating sleep apnea with CPAP will also resolve a person's insomnia.
A recent landmark study challenges this notion and found that addressing insomnia first can actually improve outcomes for both conditions.The study followed 145 people with both moderate-to-severe obstructive sleep apnea (OSA) and insomnia. One group started with four weeks of Cognitive Behavioral Therapy for Insomnia (CBT-I) before beginning CPAP therapy. The other group went straight to CPAP therapy after a four-week waiting period.
The Results Were Significant
The group that received CBT-I first was 87% more likely to accept their CPAP devices and used them for an average of one hour longer each night.
After six months, those who started with CBT-I saw a 52% improvement in overall insomnia severity (compared to only 35% in the control group).
They also had better improvements in nighttime insomnia complaints and dysfunctional or unhelpful sleep-related thoughts.
According to lead author Dr. Alexander Sweetman, treating insomnia with CBT-I before starting CPAP therapy significantly improved insomnia symptoms and increased CPAP use.
If you have symptoms of both insomnia and sleep apnea, it's crucial to address the insomnia before or alongside starting CPAP. This can lead to greater acceptance and use of your CPAP machine, improving outcomes for both disorders.
Worried you might have insomnia?
Check your symptoms with our online insomnia test for instant feedback, or book a consultation in our nurse-led sleep clinic to address the root causes of insomnia with our structured CBTi programs.
The Best Strategy for COMISA?
A Combined Approach.
The emerging consensus among sleep medicine specialists is clear: the most effective strategy for managing COMISA (Co-morbid Insomnia and Sleep Apnea) is a combined, integrated approach using CBT-I and PAP Therapy. Because these two conditions are so interconnected, addressing only one is often not enough to achieve truly optimal outcomes.When used together, these two treatments create a powerful therapeutic synergy.
Why it Works
CBT-I targets the root cause of insomnia, helping to quiet anxious thoughts and address behaviors that make sleep difficult. Meanwhile, CPAP physically resolves the breathing issues caused by sleep apnea. This dual-approach leads to better sleep quality and makes it easier to tolerate and benefit from CPAP, since the underlying insomnia is no longer a barrier.
Struggling to Sleep with CPAP?
CPAP helps with breathing, but many still can't fall asleep. You're not alone — insomnia and CPAP resistance are common. Learn tools that actually help
Make CPAP feel more uncomfortable
Make it harder to fall asleep with the mask on
Cause you to stop using your CPAP altogether
Diagnosed with Both Sleep Apnea and Insomnia?
Treating just one doesn’t solve the other. If you have both apnea and insomnia, you need a tailored plan that treats both simultaneously. Learn how with our Breathe + Rest™ protocol
Insomnia... But Something Feels Off?
Do you or your partner notice loud snoring, choking, or gasping while you sleep? You may have undiagnosed sleep apnea. Let’s figure it out.
Using a Dental or Mandibular Advance Device but Still Can't Sleep ?
Mandibular Advancement and Dental Devices improve airflow — but don’t solve sleeplessness or insomnia. Learn simple, effective strategies that actually help.
Claustrophobic or Anxious with CPAP?
If you feel trapped, claustrophobic or anxious about your CPAP therapy, you're not alone. CPAP intolerance can trigger or worsen insomnia. We help you adjust and offer gentle approaches to ease your therapy fears.
Our nurse-led clinic provides specialist care for Insomnia, Sleep Apnea, and CPAP-related challenges
BREATHE + REST™ PROTOCOL
Introducing the Breathe + Rest™ Protocol
Our on-demand course combines natural sleep aids, behavioral strategies, and therapy adjustments to tackle COMISA effectively — so you can finally breathe and rest well, every night.