Advanced Positive Airway Pressure Linked with Marked Decrease in Insomnia

Emerging research and clinical experience strongly indicate sleep apnea and insomnia are more tightly linked than previously imagined. A new study reveals that an innovative treatment for sleep apnea is strongly associated with marked reductions in insomnia severity.

In a study published in Nature and Science of Sleep, 302 chronic insomnia patients with obstructive sleep apnea (OSA) were treated with advanced positive airway pressure (PAP) in the form of auto-bilevel (ABPAP) or adaptive servo-ventilation (ASV). These advanced PAP technologies markedly improve the comfort and ease of use compared to basic CPAP (continuous positive airway pressure), which presents greater challenges in adaptation to insomnia patients with OSA.

At seven months follow-up, regular users of ABPAP or ASV cut their insomnia scores nearly in half. The changes were significant and diminished baseline insomnia severity from moderately severe to mild. Both ABPAP and ASV devices yielded these insomnia-diminishing results.

This study shows advanced PAP is systematically linked with improvements in all three types of standard insomnia categories: sleep onset, sleep maintenance, and early morning awakenings. In past PAP treatment research for insomnia, benefits to sleep maintenance insomnia (that is, middle of the night awakenings) are the usual outcome. In this study, changes were also observed for sleep-onset insomnia and late insomnia/early morning awakenings with medium to large decreases in symptoms.

Finally, these insomniacs were pleasantly surprised by the very large improvements in their symptoms, despite beliefs that their unwanted episodes of sleepiness had been caused by psychological factors, including poor sleep hygiene, maladaptive beliefs about sleep, and psychiatric symptoms and disorders. The study then provides evidence in support of the emerging theory that breathing-related physiological disruption to sleep is a major cause of or contributor to insomnia.

The study is from researchers at the Sleep & Human Health Institute, a non-profit research facility currently conducting a randomized controlled trial to compare CPAP versus ASV in the treatment of chronic insomnia.