Dental Sleep Blog

Insomnia and Sleep Apnea: Two Sides of the Same Coin?

Posted by inboundMed on Feb 19, 2019 8:10:00 AM

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Do you often wake up during the night and have no idea why? Do you struggle through the day, wondering how you’re so tired all the time? Insomnia can be a nightmare, but the root causes could be even more threatening.

Once you understand what chronic insomnia can do to your life and the role sleep apnea plays in frequent sleep interruptions, you’ll know that you need to take action. These conditions are closely related and could put you at serious risk for injury due to exhaustion, or other long-term health problems.

Understanding Insomnia

Sleep disorders are shockingly common, especially insomnia. In fact, about a third of the adult population deals with insomnia on at least an occasional basis. One out of ten people have what’s known as “chronic insomnia.” This means that you have insomnia at least three days a week and the episode lasts a minimum of three months.

Getting to the bottom of your insomnia problem requires some observation and might call for testing like a sleep study. There are many different ways to experience sleeplessness, but most can be categorized into two groups:

  • Onset Insomnia: Trouble falling asleep
  • Maintenance Insomnia: Difficulty staying asleep, often resulting in an early wakeup

Some people might have a combination of the two, or trade off the one they have to deal with on a given night. Knowing which condition is the worst for you can make it easier to consider possible causes and treatments to manage it.

When you start to explore how insomnia affects you, it’s good to begin by keeping a diary to record how sleep went each night. This will help you to identify trends and other issues that may be ruining your sleep. It also provides more concrete information for a sleep expert.

Underlying Health Causes of Insomnia

For a lot of people, chronic insomnia has a health-related cause. Some are minor, and others could be life-threatening if you don’t pay attention to them:

  • Medications: Some drugs you take can make you more alert or disrupt your sleep cycles. You might have to change the time you take them, or consider an alternative.
  • Chronic Pain: If you can’t get comfortable or find yourself getting painfully restless in one position, chronic pain can keep you awake.
  • Heart Conditions: High blood pressure, heart disease and heart failure are closely related to insomnia.
  • Mental Illness: Anxiety and depression are common causes of insomnia, but other mental health disorders can create this problem, too.
  • Other Sleep Disorders: Undiagnosed and untreated insomnia could be caused by other sleep disorders like Obstructive Sleep Apnea.

Distinguishing insomnia caused by health problems from sleeplessness activated by behavior can be really difficult. Since insomnia can aggravate other health conditions, it’s hard to discover which came first.

The things you do subconsciously to deal with them can make the waters even muddier. Are you struggling to settle because you drank too much coffee, or do you need the afternoon hit of caffeine because you have a health problem destroying your sleep? Is your alcohol consumption triggering frequent sleep disturbances, or are you using alcohol to self-medicate a more serious condition? A sleep medicine expert can often help you find the root causes and an effective treatment.

Obstructive Sleep Apnea’s Effect on Sleep

OSA is fairly easy to understand and its also easy to diagnose. Sleep apnea refers to periods at night when you aren’t breathing. They typically last at least 10 seconds at a time. It typically starts because the muscles of your mouth, nose and throat are not holding your airway open enough.

Once your brain realizes it is no longer getting oxygen, it wakes you up so you start breathing. It can happen multiple times each minute. Since you’re asleep, you might not notice the frequency. It may only feel like you’re waking up frequently during the night and struggling to settle again, which is the primary symptom of maintenance insomnia.

Chronic Insomnia vs Sleep Apnea

If you’re dealing with insomnia on a regular basis, you might be in a big hurry to get it all organized so you can put it to bed forever. The reality is much more nuanced. It’s common for chronic insomniacs to have another sleep disorder. When you have two conditions that relate to each other, trigger one another or make each one worse, it’s called a “co-morbidity.”

A few decades back, sleep experts started to look at how insomnia and Obstructive Sleep Apnea relate in particular. OSA usually presents with a few common symptoms, like snoring or excessive daytime sleepiness. Sleep experts know how important it is to get OSA under control, since untreated OSA can cause:

  • daytime sluggishness
  • poor decision-making related to exhaustion
  • health problems like stroke or cardiovascular disease

Researchers started to revisit their assumptions about comorbid sleep apnea and insomnia. Some studies revealed a surprising conclusion: About 40% of people suffering from chronic insomnia have OSA. Around half of people with OSA report problems with insomnia. It indicates a plain relation that needs more study.

Can Sleep Apnea Cause Insomnia?

The tie between OSA and insomnia now seems pretty clear, but experts are just scratching the surface. Part of the trickiness of this discussion is the difficulty in assessing and treating insomnia that occurs after you fall asleep. People who present with maintenance insomnia, instead of the typical snoring that alerts doctors to OSA, are raising a number of interesting questions that researchers want to explore.

Knowing why you wake up a lot isn’t always obvious. Unless you need to get up because your legs hurt or you need to use the bathroom, you might have no idea what’s disrupting you. That’s what researchers wanted to figure out. In 2012, a group of experts identified 20 patients who had maintenance insomnia but did not show any obvious signs of OSA. They had each person go through a diagnostic sleep study and other screenings.

The results were striking. Ninety percent of the awakenings recorded in the sleep study resulted from disruption due to poor sleep breathing behavior. Out of the original 20 participants, 11 were eventually diagnosed with OSA. As such, even if you don’t think you have sleep apnea, it might be causing your insomnia anyway.

Treating the Root Causes of Sleep Apnea and Insomnia

Experts delving into this issue have encouraged other researchers to investigate diagnosis and treatment for OSA as a way to manage maintenance insomnia. Although existing research on it is limited, there’s reason to believe that improving a person’s airway might improve their sleep. Since evidence suggests that the vast majority of night waking comes from disordered sleep breathing, operating under the assumption that it could be a problem may be a wise course of action.

People have a few ways to better open their airways. The most common is a continuous passive airway pressure (CPAP) machine, which keeps the air flowing to your throat so it can’t close. If you have been diagnosed with OSA, or you haven’t but struggle with maintenance insomnia or snoring, a sleep apnea mouthpiece might also be a very helpful tool. This is a device that you put into your mouth that keeps your tongue out of the way of your throat while you sleep.

Insomnia is bad enough without worrying that it’s going to cause high blood pressure or a stroke. That’s why it’s crucial to think about the causes of insomnia, including sleep apnea. The dental sleep medicine experts of Premier Sleep Associates have years of experience helping people improve their sleep and snoring problems. Schedule an appointment online or call us today at (425) 698-1732.

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Topics: insomnia

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Sleep Apnea and Sleep Disordered Breathing Signs, Symptoms, and Consequences