HEALTH: Sleep

Sleep Apnea vs. Insomnia

Although everyone has an occasional bad night’s sleep, people with sleep disorders have more persistent or severe sleeping problems. Among all sleep disorders, sleep apnea and insomnia are two of the most common, affecting millions of people.

Sleep apnea and insomnia are common sleep disorders that can significantly impact a person’s well-being, and it’s possible to experience both simultaneously.

Sleep Apnea

• Definition: Sleep apnea involves repeated interruptions in breathing during sleep, leading to fragmented and poor-quality sleep.
• Types:
  • Obstructive Sleep Apnea (OSA): The most common type, occurring when the airway becomes blocked, causing breathing to slow or stop. Brief awakenings occur to restore breathing, often without the person’s awareness.
  • Central Sleep Apnea (CSA): Less common, caused by the brain’s inability to properly regulate breathing during sleep.
• Symptoms of OSA:
  • Excessive daytime sleepiness (often includes involuntarily dozing off)
  • Loud snoring, gasping, or choking sounds during sleep
  • Restless sleep
  • Morning headaches or dry mouth
  • Impaired concentration or memory
• Diagnosis: Requires specific testing to quantify breathing disruptions, such as an overnight sleep study or an in-home sleep apnea test.
• Treatment: Focuses on preventing breathing disruptions.
  • Positive Airway Pressure (PAP) devices: Such as CPAP machines, which deliver pressurized air to keep the airway open.
  • Lifestyle changes: Weight loss, side-sleeping, avoiding evening alcohol.
  • Oral appliances: Custom-fitted mouthpieces.
  • Nerve stimulation or surgery: In some cases, to address anatomical issues.

Insomnia

• Definition: Difficulty falling asleep or staying asleep, leading to negative effects during waking hours.
• Symptoms: Irritability, fatigue, forgetfulness, and anxiety about sleep.
• Types:
  • Short-term insomnia: Lasts less than three months, often triggered by stress.
  • Chronic insomnia: Persists for more than three months, often associated with underlying physical or mental health issues.
• Diagnosis: Typically based on a person’s symptoms without specific testing.
• Treatment: Aims to help individuals fall asleep and stay asleep.
  • Cognitive-Behavioral Therapy for Insomnia (CBT-I): A highly effective treatment that addresses sleep-related habits and negative thoughts about sleep. It often emphasizes improving sleep hygiene (consistent sleep schedule, dark/quiet bedroom, limiting screen time before bed).
  • Relaxation techniques: Can be part of CBT-I to aid in falling asleep.
  • Medications: May be prescribed sometimes, often in conjunction with CBT-I, but can have side effects.

Key Differences Between Sleep Apnea and Insomnia

• Underlying Cause:
  • Sleep Apnea: Primarily a problem of disrupted breathing during sleep.
  • Insomnia: Occurs because the mind and body remain excessively activated when trying to sleep.
• Typical Symptoms:
  • Snoring: Common and often loud in OSA; not a symptom of insomnia.
  • Daytime Drowsiness: Extreme sleepiness and involuntary dozing are characteristic of OSA; while people with insomnia feel fatigued, involuntary napping is rare.
  • Awareness of Problems: People with insomnia are usually aware of their sleep difficulties; many with OSA are unaware of their nighttime breathing issues.
• Diagnosis:
  • Sleep Apnea: Requires objective testing like a sleep study.
  • Insomnia: Typically diagnosed based on reported symptoms.

Connection Between Sleep Apnea and Insomnia

• Overlap: The two conditions frequently overlap and can exacerbate each other.
  • Up to 50% of people with OSA report experiencing insomnia because of restless sleep and frequent awakenings.
  • Conversely, up to 40% of those with insomnia also have OSA, which can lead to more unwanted awakenings.
• Shared Risk Factors: Both conditions are more common in older adults, individuals with obesity, and those with certain coexisting health issues (e.g., lung and kidney conditions).

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