Insomnia and sleep apnea: the hidden second problem

Can you have insomnia and sleep apnea at the same time?

Yes, you can have insomnia and sleep apnea at the same time, and it is common. Researchers call it comorbid insomnia and sleep apnea, or COMISA. Sleep apnea is a breathing problem. Insomnia is a sleep problem your nervous system learns over time. They need different kinds of help, and feeling rested usually means addressing both.

Your snoring stopped, but you still wake up tired

Maybe your partner says the snoring is gone. Your mouth guard fits, or you made peace with your CPAP. Yet you still wake up drained and wonder if the device failed.

It probably did not. A large review of studies from around the world found that about 38% of people with obstructive sleep apnea also have insomnia (Zhang et al., 2019). The overlap runs the other way too: about a third of people with insomnia also have sleep apnea.

So if you lie awake with a quiet airway, nothing is wrong with you. You may have two problems that share the same bed. One is mechanical. The other is learned. Care for insomnia and sleep apnea works best when each problem gets the right tool.

Insomnia and sleep apnea are two problems that feed each other

1. 01

   Sleep apnea

   What it is: your airway narrows or closes during sleep, so breathing pauses and restarts. What it feels like: loud snoring, gasping, morning headaches, heavy daytime sleepiness. Who diagnoses it: a physician, usually with a sleep study. What helps: CPAP, a dentist-fitted mouth guard, or other medical care.

2. 02

   Insomnia

   What it is: trouble falling asleep, staying asleep, or getting back to sleep, most nights, for months. What it feels like: lying awake alert, clock-watching, a busy mind, dread as bedtime nears. Who diagnoses it: a physician or sleep specialist. What helps: cognitive behavioral therapy for insomnia (CBT-I) is the recommended first step (Edinger et al., 2021).

How broken nights teach your body to stay alert

Sleep apnea causes many small wake-ups as your body restarts breathing. Over months, your brain starts to link the bed with being awake, effortful, and frustrated.

That link is a form of hyperarousal (a body and mind stuck on alert when they should be winding down). Your thoughts speed up and you start to worry about sleep itself. Once set, that pattern can keep going on its own, even after your breathing is treated.

An open airway does not teach your body to settle

The common belief is simple: treat the apnea and the sleep problems will clear up. For many people, that is only half true.

A CPAP or a mouth guard keeps the airway open. It cannot retrain a nervous system that spent years learning to stay alert in bed. Devices do not teach skills. For how the device works, see our guide to whether a sleep apnea mouth guard is right for you.

A 2026 study of 283 people in Japan looked at what sets people with both conditions apart (Utsumi et al., 2026). Those who held strong unhelpful beliefs about sleep and also felt very sleepy during the day had about three times the odds of having both conditions rather than sleep apnea alone, and about nine times the odds compared with insomnia alone.

These beliefs sound like: "If I don't get eight hours, tomorrow is ruined." The study does not prove these beliefs cause the overlap, and its insomnia-only group was small. Still, the beliefs and habits people build around sleep are a hallmark of this pattern, and they are what CBT-I-informed coaching works on.

If your mind starts racing the moment you lie down, the same pattern shows up in our guide on how to stop overthinking at night.

Is it sleep apnea or insomnia keeping you awake?

You cannot diagnose yourself, but you can notice patterns to share with your doctor.

Signs that point more toward breathing: your partner hears snoring, choking, or pauses in your breathing; you wake up gasping or with a dry mouth or headache; you fall asleep easily, even at the wrong times, like in meetings or while driving.

Signs that point more toward insomnia: you feel tired but wired at bedtime; you lie awake for 30 minutes or more, most nights; your mind gets busy the moment the lights go off.

Many people have signs from both lists. If you see yourself in the breathing list and have never had a sleep study, talk to your physician. Our guide on whether you need a sleep doctor walks through the red flags.

Working on insomnia can help you stick with your device

Insomnia can make apnea care harder to live with. If you already lie awake for long stretches, a mask or mouth guard is one more thing to notice in the dark.

In a randomized trial, people with both sleep apnea and insomnia got either four sessions of CBT-I or usual care before starting CPAP (Sweetman et al., 2019). The CBT-I group used their CPAP about an hour more per night on average. They also had larger improvements in insomnia severity and in unhelpful beliefs about sleep.

That trial used CPAP, not a mouth guard, so the same result is not proven for oral appliances. But a calmer nervous system makes any nightly device easier to live with.

Your device opens your airway. Coaching teaches you to sleep. Working on both, and often building sleep skills early, is how many people finally feel rested. For how coaching relates to formal therapy, read whether sleep coaching is the same as CBT-I.

The uncomfortable habit that works: get out of bed

This is the habit most people resist. When you have been lying awake for what feels like 20 minutes, and you feel alert or frustrated, get up.

Go to another room with dim light and do something calm, like reading a paper book. Return to bed when you feel sleepy, and put your device back in.

It feels backwards. But every hour spent awake and tense in bed strengthens the link between bed and alertness. Getting up starts to break it. Pair this with the same wake time every morning, even after a rough night.

What not to do

1. 01

   Do not give up on your device

   Do not give up on your device. Keep using it as prescribed.

2. 02

   Do not try harder to sleep

   Do not try harder to sleep. Effort raises alertness. Sleep comes when you stop chasing it.

3. 03

   Do not stay in bed to catch up

   Do not stay in bed to catch up. Long lie-ins weaken your drive to sleep the next night.

4. 04

   Do not start sleeping pills on your own

   Do not start sleeping pills on your own. Talk to your physician first so any medicine fits with your breathing care.

5. 05

   Do not read your tracker as a diagnosis

   Do not read your tracker as a diagnosis. An Oura Ring or Apple Watch can show restless nights, but not whether apnea or insomnia caused them. Bring patterns to your doctor instead of grading yourself.

A simple checklist for tonight

1. 01

   Wear your device

   Wear your CPAP or mouth guard as your physician and dentist prescribed.

2. 02

   Wind down

   Start a 30 to 60 minute wind-down with dim lights and no work.

3. 03

   Go to bed sleepy

   Go to bed only when you feel sleepy.

4. 04

   Get up if wide awake

   If you are awake and alert in bed, get up and come back when sleepy.

5. 05

   Keep your wake time

   Get up at the same time tomorrow, no matter how the night went.

Progress over perfection

You do not need a perfect night to feel better tomorrow. You need a body that trusts the bed again, and that trust is learnable. Skills before pills. If you are weighing medication, our comparison of CBT-I vs sleeping pills lays out the tradeoffs.

At Clementine, the Clementine Protocol we build with clients is a 90-day coaching approach grounded in CBT-I principles. It runs alongside the apnea care your physician and dentist manage, and never replaces it.

A note on safety: Coaching never diagnoses or treats sleep apnea. Breathing care is prescribed and managed by your physician and dentist. If you suspect sleep apnea and have not been tested, please talk to your doctor about a sleep study.

When you are ready to work on the half of the plan your device cannot do, a complimentary assessment can help you build the Clementine Protocol around your nights and your breathing care.