#43 - Insomnia + Sleep Apnea: A Marriage, Not a Divorce

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“Hi Michael. I just wanted to let you know I had a car accident.”

This is not the sort of email you want to read when you’re in your first year as a sleep practitioner…

And it came from one of my insomnia patients.

When they came to their first session with me, they were:

  • Female

  • In her 40s

  • Thin

She had the phenotype (ie, the look) of a classic insomnia patient.

A few weeks after her car accident …

… which was caused by the treatment I had prescribed her - she came to see me. This time I was holding a report in my hot little hands.

She had sleep apnea. And it was a severe case!

Back then - in 2002 - the typical sleep apnea patient was:

  • Older

  • Male

  • With a large neck circumference

But everything now made sense. You see, when I first assessed this insomnia patient, she:

  • had the look,

  • her sleep diary showed a lot of broken sleep, and

  • she reported that she was tired - but not sleepy.

The evidence was mounting. She was a classic case for receiving Sleep Restriction Therapy (a therapy embedded within CBT for insomnia).

But whilst this therapy helped her spend less time awake in bed, it meant she was at higher risk of having a car accident. Thankfully, it was a minor car accident. But even a minor car accident is a pain in the ass (or is it arse?).

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Worthy of a Case Study

My mentor at the time - Prof Leon Lack - saw this as a new discovery. Insomnia and Sleep Apnea were not bedfellows. But this insomnia patient broke that mould.

So with her permission, we presented her case at the Australasian Sleep Association conference way back in 2003.

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But Leon did not stop there.

He managed to convince doctors to perform sleep studies on all insomnia patients - which is unheard of. But this provided us with a deeper window into the sleep of people with insomnia. Not only whether they had sleep apnea, but:

  • whether they misperceived their sleep,

  • whether high doses of caffeine fragmented their sleep,

  • and how much deep sleep they were getting (to name a few).

Fast forward to 2017 - and we now know that:

  • 1 in every 3 people seeking treatment for insomnia have Sleep Apnea

  • CBT for insomnia is still effective for people who have both Insomnia and Sleep Apnea

  • CBT for insomnia may help such people with their Sleep Apnea therapy (known as CPAP: continuous positive airway pressure) …

… Or in other words - a vacuum on their face set to ‘blow’ - which some people have said looks like Darth Vader’s mask.

Any excuse to insert a Star Wars image …

Any excuse to insert a Star Wars image …

So How Does One Modify Their Insomnia Therapy to Account for Possible Sleep Apnea?

Well the answer is pretty simple.

You learn from those more experienced than yourself.

And in this case it’s free. All you have to do is subscribe to our free weekly newsletter by this Sunday and we’ll not only email this blog to you, but we’ll add on things you should do to safeguard you and your insomnia patients.

This has meant that since I saw this Insomnia/Sleep Apnea patient in 2002, I’ve only had one out of hundreds of patients have a car accident.

And this accident occurred because the client did not heed our advice!

Sleep well + Drive defensively!

  • Prof Mike Gradisar

BlogMike Gradisarsleep apnea, osa, insomnia, andrew huberman, huberman, sleeping, sleep, matthew walker, matt walker, six, lightComment