Monday, August 16, 2010

CPAP for Sleep Apnea Obstructed by Insomnia

A double dose of sleep disorders can disrupt the first option of treatment. Patients who complain of insomnia more often give up on Continuous Positive Airway Treatment (CPAP), researchers at Johns Hopkins University report.

CPAP involves wearing a sealed mask while you sleep. A tube connected to the mask gently blows air into the back of your throat. The sensation may feel unnatural at first. Some patients give up on treatment before they become comfortable with CPAP.

This phenomenon appears to be worse among insomnia patients. People with insomnia may fixate on environmental distractions or sensations like muscle soreness or the urge to urinate while lying awake restlessly. The foreign-feeling CPAP machine might be a big hang-up for this type of insomnia patient.

The study looked at 232 patients’ medical charts at Johns Hopkins Hospital Sleep Disorders Center. Each subject was newly diagnosed with obstructive sleep apnea and prescribed CPAP. Questionnaire data shows 37 percent of participants had at least one form of primary insomnia.

Electronic monitoring data from CPAP shows patients who complained of sleep maintenance insomnia used their device for the fewest overall minutes.

The authors of the study believe more patients may stick with CPAP if their insomnia is first addressed. Cognitive-behavioral therapy is an effective long-term solution to insomnia and may also help CPAP adherence.

The two sleep disorders often coexist and have similar symptoms. A previous study shows 39 to 58 percent of OSA patients have insomnia. Insomnia and sleep apnea can reduce your quality of life, destroy your work productivity and increase your risk of getting in an auto accident.


dharmesh said...

That was a really good post. It helped me to make sense of some of the issues with the subject.

robysue said...

I really wish my first sleep doctor had treated my suggestion that my long history of off and on insomnia for my entire adult life seriously. Every major stressful change in my life has triggered a round of significant insomnia. But alas, he completely ignored me and simply said, "You'll feel better in two weeks."

After nine months, four sleep studies, going from CPAP to APAP to BiPAP to Auto BiPAP, and a change in sleep doctors, I still have insomnia most nights. But I've continued to stick with using my BiPAP every night, all night long. The CBT I've been doing to tame the insomnia is slowly working. But I think it would have worked much more quickly had my insomnia not been ignored right at the start of my therapy. Or if my desire to stay away from sleeping medicine had been taken more seriously during the first three months of treatment when all the PA kept suggesting was, "Why don't you try some Ambien?"

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