Treatment Options for Comorbid Insomnia and Sleep Apnea (COMISA)

Treatment Options for Comorbid Insomnia and Sleep Apnea (COMISA)

When insomnia and obstructive sleep apnea (OSA) occur together, it is known as comorbid insomnia and sleep apnea, or COMISA, and managing it often means looking at the bigger picture. Rather than focusing on a single treatment, most people benefit from addressing both conditions through a combination of healthy sleep habits, lifestyle changes and targeted therapies.

Building healthier sleep habits

Simple changes to your daily routine can provide an important foundation for better sleep. Maintaining a regular bedtime routine, getting natural light early in the day, limiting caffeine after midday and reducing alcohol in the evening can all support healthier sleep patterns.¹

Lifestyle changes can also form part of OSA management. For people who are overweight or obese, weight loss and lifestyle interventions may help improve sleep apnea.¹ Reducing alcohol is particularly important because alcohol can worsen breathing problems during sleep.²

These changes may not be enough to treat COMISA on their own, but they can complement other treatments and support better sleep overall.

Addressing ongoing insomnia

When insomnia persists, cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment.¹ CBT-I addresses the behaviours and thought patterns that can contribute to difficulty falling or staying asleep.

Research suggests that treating insomnia can also make OSA treatment easier.¹ People with COMISA can sometimes find it difficult to fall asleep while wearing a CPAP mask,² so CBT-I may help people fall asleep more quickly and spend less time awake while using CPAP, potentially improving their ability to use the treatment consistently.²

Managing breathing during sleep

For moderate and severe OSA, continuous positive airway pressure (CPAP) is the recommended treatment.¹ CPAP provides pressurised air through a mask to help keep the airway open during sleep.

If CPAP is not well tolerated, other options may be considered depending on the individual. These can include mandibular advancement splints for those with mild to moderate OSA or for those who do not tolerate CPAP devices.¹

Finding an approach that works for you

There is no single treatment plan or order that is right for everyone with COMISA. Treatment can be tailored according to which symptoms are most troublesome, how severe each condition is and what works best for the individual. Current evidence suggests that both conditions should be addressed rather than assuming that treating one will automatically resolve the other.

If you regularly struggle to fall or stay asleep and also experience loud snoring, gasping, breathing pauses, unrefreshing sleep or persistent daytime tiredness, speak with your doctor. A thorough assessment can help identify both conditions and create a treatment plan that supports better sleep and better health.

How Sove CPAP Clinic Can Help

With COMISA, finding the right treatment is not always about choosing between treating insomnia or sleep apnea – it may mean addressing both.

At Sove CPAP Clinic, our Sleep and Respiratory Physicians and experienced Treatment Consultants can help assess your symptoms and develop a personalised treatment pathway based on what is contributing to your sleep difficulties. We offer bulk-billed home sleep studies for eligible patients to investigate obstructive sleep apnea, alongside support for patients experiencing insomnia symptoms.

Depending on your assessment and individual needs, treatment may include insomnia support, CPAP therapy, a mandibular advancement splint (MAS), or ongoing care with our clinical team. If you are already using CPAP but continue to struggle with falling asleep, staying asleep or using your therapy consistently, our team can also help explore whether another sleep issue may be contributing.

With face-to-face and telehealth consultations available, Sove can support you from assessment through to treatment and ongoing care. If you’re experiencing insomnia alongside snoring, breathing pauses, waking unrefreshed or persistent daytime tiredness, call our friendly team on 1300 76 29 39 or email info@thecpapclinic.com.au to find out how Sove can help.

ALWAYS FOLLOW THE DIRECTIONS FOR USE. CPAP is used for Obstructive Sleep Apnea treatment. MAS is intended to assist in and or prevent snoring and/or obstructive sleep apnea. When considering whether a sleep study, MAS or CPAP is right for you, speak to your doctor. Medicare criteria and T&Cs apply.

References

1. “General Practitioner Management of Comorbid Insomnia and Sleep Apnoea.” Australian Journal of General Practice, 2024, https://www1.racgp.org.au/ajgp/2023/september/general-practitioner-management-of-comorbid-insomn. Accessed 18 Aug. 2026.

2) Sleep Health Foundation. “Co-Morbid Insomnia and Sleep Apnoea.” Sleephealthfoundation.Org.Au, Sleep Health Foundation, 19 Feb. 2025, https://www.sleephealthfoundation.org.au/sleep-disorders/co-morbid-insomnia-and-sleep-apnoea. Accessed 18 Aug. 2026.