somnio and the occurrence of symptoms of OSA and insomnia (COMISA)

In this article, you will learn what COMISA means, how sleep apnea and insomnia affect each other, and what role somnio can play in this situation.

What does COMISA mean?
In many people, sleep problems do not occur in isolation. In addition to obstructive sleep apnea (OSA), persistent sleep onset insomnia or sleep maintenance insomnia may also be present at the same time. When both conditions occur together, this is called COMISA – the simultaneous presence of sleep apnea and chronic insomnia.

How do sleep apnea and insomnia affect each other?
Both obstructive sleep apnea and insomnia are widespread sleep disorders, and they affect each other. Studies show that about 30–40 % of patients with insomnia also meet the diagnostic criteria for sleep apnea, while conversely around 50 % of all people with obstructive sleep apnea also meet the criteria for insomnia [Reference]. Pauses in breathing and nighttime waking reactions in untreated sleep apnea can fragment sleep, and in the long term lead to sleep problems that can become established as insomnia. Conversely, insomnia, through sleep fragmentation, persistent hyperarousal, and altered sleep architecture, can in turn worsen obstructive sleep apnea. When both conditions occur together, sleep quality, well-being (by day), and performance are often significantly more impaired than with only one of the two conditions. In addition, the risk of cardiovascular disease is significantly increased.

Does somnio treat sleep apnea?
What is important here is the clear distinction: somnio does not treat obstructive sleep apnea. Treatment of sleep apnea is provided medically, for example through positive airway pressure therapy (PAP), mandibular advancement splints, lifestyle changes, or, in selected cases, surgical procedures. This medical treatment is central and indispensable in OSA.

What role can somnio play in COMISA?
In In COMISA, somnio specifically targets chronic insomnia as a comorbid sleep disorder. The app digitally implements cognitive behavioral therapy for insomnia (CBT-I) and can help to sustainably change sleep-related thoughts, behavior patterns, and sleep habits – even when sleep apnea is being medically treated at the same time.

Improving the ability to fall asleep and sleep through the night can also make PAP therapy easier to manage, for example by reducing difficulty falling asleep, nighttime awakenings, or sleep-related worries, and by supporting acceptance of PAP therapy in daily life.

How does somnio take existing sleep apnea into account in the training?
At the beginning of the somnio training, you are therefore actively asked whether you have been diagnosed with obstructive sleep apnea in addition to existing insomnia. This information is used to classify and adjust the content in the program according to the situation. If sleep apnea is present, certain recommendations are taken into account accordingly so that your individual starting point is appropriately considered in the training. As a result, somnio does not replace medical treatment of sleep apnea, but only complements it with regard to additionally existing insomnia.

PAP therapy: What should you do if you have mask problems or persistent tiredness?
If you use a PAP device and have problems with the mask, this is not unusual. A mask that fits poorly or feels uncomfortable can impair both the effectiveness of PAP therapy and overall sleep. In such cases, it makes sense to seek professional advice, as there are many different mask models and individual adjustment is often helpful.

If you are still very tired or sleepy despite PAP therapy, this may indicate that the sleep apnea is not yet being treated optimally. Here, too, it is recommended to consult a health care professional again.

In the daily somnio morning log, you enter your sleeping Hours and nighttime periods of wakefulness. A separate evaluation of nights with or without PAP mask is currently not provided in somnio. If you would like to record differences between nights with and without a mask, you can note this – similar to taking medication or special events – in the personal notes. A direct technical connection between somnio and PAP devices is currently not possible.

Is somnio suitable for me?
somnio can be used meaningfully both before the start of PAP therapy and alongside it if insomnia is present in addition to sleep apnea. In these cases, somnio is specifically aimed at the treatment of insomnia and complements the medical care of sleep apnea.

Whether and at what point somnio is useful in an individual case should ideally be decided together with a health care professional. A holistic view of both conditions can help stabilize sleep overall and improve treatment success in the long term.

If you sleep poorly for several weeks, feel very tired or exhausted during the day, or additionally have symptoms such as loud snoring, pauses in breathing, or morning headaches, you should have your sleep problems medically evaluated. Early diagnosis and individually tailored treatment can help significantly improve sleep quality, well-being (by day), and long-term health.

Any questions?
If you have questions about the somnio app – both regarding content and technical issues – you can contact our support team at any time. You can reach us by email at support@somn.io or directly via the support feature in the app. We respond within 24 hours, seven days a week. You can reach us by phone Monday to Friday between 10:00 and 14:00 on 0341 978 528 48, excluding public holidays.