CO-MORBID INSOMNIA AND SLEEP APNOEA: A HIDDEN EPIDEMIC IN THE UK
Quality sleep is essential for good health, yet it’s estimated that millions of adults in the UK suffer silently from sleep disorders that result in significant disruption to their lives.
A
mong the most under-recognised and under-diagnosed conditions is COMISA - the co-occurrence of Insomnia and
Obstructive sleep apnoea (OSA)[1] . The overall
impact of COMISA represents an enormous burden at an individual’s level, on healthcare services and on healthcare policy.
What is COMISA? COMISA is a condition where individuals suffer from both insomnia and sleep apnoea [2]
. While
each condition alone can severely impact health and wellbeing, in combination they create a vicious cycle of sleep disruption, fatigue and increased risk of chronic diseases [3]
. Insomnia in
this context often manifests as difficulty falling asleep, difficulty maintaining sleep, or non- restorative sleep and symptoms of insomnia may persist even when OSA is treated [4]
.
How Common is COMISA? The AWAKE Check study protocol highlights compelling statistics: • 30% to 50% of people with OSA report clinically significant insomnia symptoms [4]
.
• 30% to 40% of individuals diagnosed with insomnia also have co-morbid OSA [1, 2, 5]
.
• A recent meta-analysis estimates the global prevalence of insomnia at 12.4%, while OSA affects 24.5% of UK adults [4]
.
• The prevalence of COMISA is rising, especially among older adults, and is associated with poor sleep quality, reduced daytime functioning, and increased mortality risk [4, 6]
.
These figures suggest that COMISA may affect millions of adults in the UK, yet it remains under- diagnosed and under-treated.
Why Is COMISA Often Missed? One reason COMISA flies under the radar is that insomnia symptoms are frequently considered secondary to OSA [4, 5]
. However, research shows
that insomnia may persist even after OSA treatment, indicating a need for dual diagnosis and integrated care. Moreover, traditional screening tools often fail to capture the complexity of COMISA, especially in primary care settings [1, 4]
. COMISA is also often missed because
its symptoms overlap with both insomnia and obstructive sleep apnoea, leading to misdiagnosis or underdiagnosis. The lack of a specific diagnostic ICD10 code in the UK, fragmented care between sleep and mental health specialists, and limited access to Cognitive
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