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For the 22 million Americans with sleep apnea, getting a good night’s sleep is hard enough. For the roughly 30 percent of people who have both sleep apnea and the co-morbid condition insomnia, getting a good night’s sleep is nearly impossible. Known as COMISA (co-morbid insomnia and sleep apnea), the condition is marked by the inability to sleep combined with apnea when sleep finally is achieved. Though not much data exist on COMISA, a recent study by a team at Flinders University’s Adelaide Institute for Sleep Health in Bedford Park, South Australia, is taking a closer look at the condition – and how to treat it.

The study followed 145 subjects who have COMISA. It found that when treating the insomnia first, patients with COMISA were able to not only sleep longer, but were also more apt to use their sleep apnea therapy.

“To treat the insomnia, researchers treated patients with drug-free cognitive and behavioral (CBTi) therapy,” says Dr. Kelley Mingus, a dentist and sleep apnea specialist in Bend, Oregon.

The CBTi worked, and results improved even more with the addition of continuous positive airway pressure, or CPAP, therapy. In fact, those patients who underwent CBTi were found to use their CPAP machine for one hour longer than they did before the CBTi. But Mingus says that may not be good enough.

“It’s promising to hear that the patients in this study were able to lessen symptoms of both insomnia and CPAP, but when you hear that they were able to use their CPAP for an additional hour, that is a red flag,” Mingus says.

That’s because, according to Mingus, most people who are prescribed CPAP therapy don’t actually use it as prescribed.

“An increase of an hour means they weren’t using the CPAP the whole night to begin with, and they still may not be using it now,” says Mingus.

Mingus says that for patients who cannot tolerate their CPAP machine there are options that don’t involve the awkward mask and complicated machinery. Custom dental devices that fit in the mouth and prop open the airway are often a better choice for those patients.

“Sleep orthotics are less bulky and more comfortable,” he says. “They fit easily into the mouth and don’t require any complicated adjustments like CPAP does. And studies have shown that patients with more severe apnea may respond better to dental device therapy than they do to CPAP.”

As for the COMISA study, Mingus says even if you suffer from insomnia and aren’t sure if you have sleep apnea, it’s worth it to visit a sleep specialist to be evaluated. Sleep apnea can take its toll on your overall health, and the two conditions combined can make a bad situation worse.