CBT-I Improves Sleep and CPAP Compliance in Sleep Apnea Patients

Insomnia and sleep apnea commonly co-occur, which makes sleep apnea difficult to treat with continuous positive airway pressure (CPAP). In some cases, sleep apnea patients develop insomnia from the discomfort of trying to sleep with a CPAP mask.

A study involving patients with sleep apnea and co-occurring insomnia tested whether treatment with CBT-I before starting CPAP would improve insomnia symptoms and increase use of CPAP. One hundred and forty-five patients with sleep apnea and comorbid insomnia were randomized to either four sessions of CBT-I or treatment as usual before beginning CPAP therapy. Measures included objective average CPAP adherence and insomnia severity after six months of CPAP use.

The results indicated that patients who received CBT-I before starting CPAP had 60 minutes greater average nightly adherence to CPAP. The CBT-I group also showed greater improvement in insomnia severity. These findings suggest that, in sleep apnea patients with comorbid insomnia, CBT-I prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-I. Since many insurers require a minimum amount of nightly compliance with CPAP to be eligible for insurance coverage of their CPAP machine, sleep apnea patients should be evaluated for co-occurring insomnia and consider CBT-I before starting CPAP therapy.