Insomnia and sleep apnea

John is a 39 year old gentleman who presented with a history of difficulty maintaining sleep present over the previous 3 years. He has a background of high blood pressure for which he is on medication. He consumes 7-8 standard drinks a week and no caffeinated beverages.

He normally goes to bed between 8.30pm-midnight and would fall asleep quickly within 10 minutes but he wakes up recurrently through the night. He is a heavy snorer with a history of stopping breathing reported by his wife. The history and examination are strongly suggestive of sleep apnoea as the probable reason for his difficulty to stay asleep. A formal sleep study showed that Paul had 88 episodes of stopping breathing/hour (normal less than 5/hour) with marked lack of oxygen through the period of sleep.

The importance of weight reduction was discussed but there was the need for immediate treatment. He was started on nasal CPAP (nasal continuous positive airway pressure), which consists of a small nasal mask, or prongs, which create a pressure gradient across the airway, and keeps the airways open promoting regular breathing. The treatment had a remarkable effect on the quality of sleep. Paul was able to sleep through the night with no awakening and feeling much refreshed in the morning. The degree of daytime tiredness and sleepiness improved. Given his young age the importance of weight reduction and undertaking regular physical activity every day as well as dietary manipulation was explained as long term management.

This is an example of how sleep disorders such as sleep apnoea can be associated with symptoms of insomnia. In a case like Paul’s the history and examination are usually sufficient to suspect sleep apnoea. In other cases only after a full sleep study investigation it is possible to recognize the problem.