You’re too tired to fall asleep when you get in bed, then you wake up multiple times throughout the night, and end up extremely fatigued the next day. Is it insomnia? Sleep apnea? What could it be?
Insomnia and sleep apnea are two sleep disorders that are relatively common in adults, but affect sleep in different ways. Insomnia symptoms include taking a long time to fall asleep, waking up frequently, or waking up too early. Sleep apnea is caused by an obstruction in the upper airway that causes a person to stop breathing for short periods multiple times throughout the night.
These disorders can occur simultaneously, making diagnosis difficult based on symptoms alone. However, key differences can help diagnose each condition.
Insomnia vs. Sleep Apnea: Key Differences
Insomnia | Sleep Apnoea | |
Main problem | Difficulty falling asleep, staying asleep or waking too early | Breathing repeatedly stops or becomes restricted during sleep |
Typical night-time signs | Lying awake, frequent waking or waking too early | Snoring, gasping, choking or pauses in breathing |
Daytime effects | Fatigue, poor concentration and irritability | Daytime sleepiness, fatigue and difficulty concentrating |
Common types | Acute and chronic insomnia | Obstructive sleep apnoea (OSA) and central sleep apnoea (CSA) |
How it may be assessed | Sleep history and clinical assessment | Sleep study or an appropriate home sleep apnoea test |
Treatment examples | CBT-I and addressing contributing factors | CPAP therapy and other treatments, depending on the individual |
Similar symptoms can occur with other sleep and health conditions, so this comparison alone cannot diagnose either condition.
What Is Insomnia?
Insomnia is more than just a few restless nights. It is a condition in which a person cannot fall asleep or stay asleep, despite having the opportunity to do so. Some people wake up much earlier than they should and can’t fall back asleep. Others may find themselves awake for long periods at night, despite feeling tired.
Insomnia can occur on a short-term basis (acute insomnia) or a long-term basis (chronic insomnia), with the latter affecting a person’s day-to-day activities.
What Causes Insomnia?
There can be multiple and unrelated causes of insomnia. These can include, but are not limited to:
- Psychological stress
- Anxiety and other mental health conditions
- Disruption in routine
- Physical health conditions
- Certain medications or substances
- An uncomfortable or disruptive sleep environment
- Preoccupation with falling asleep
Common Signs of Insomnia
Someone with insomnia may experience one or more of the following:
- Take a long time to fall asleep
- Wake up repeatedly throughout the night
- Have trouble returning to sleep after waking
- Wake up too early in the morning
- Have unrefreshing or non-restorative sleep
- Experience tiredness or a lack of energy during the day
- Have trouble concentrating
- Mood swings
What Is Sleep Apnoea?
Sleep apnoea is a condition in which breathing repeatedly stops or becomes restricted during sleep. When a person’s breathing is disrupted, it can cause brief awakenings they might not remember the next day.
Common Signs of Sleep Apnoea
Sleep apnoea can cause various symptoms, including
- Loud snoring
- Gasping or choking while sleeping
- Being observed to have periods of no breathing while sleeping
- Frequent or restless sleep
- Dry mouth on waking
- Morning headaches
- Waking without feeling rested
- Low energy during the day
- Difficulty concentrating
- Persistent tiredness
Sleep Apnoea Symptoms in Women
Women may report symptoms such as:
- Persistent fatigue
- Restless or disrupted sleep
- Difficulty falling or staying asleep
- Morning headaches
- Reduced concentration
- Mood changes
- Feeling drained
Types of Sleep Apnoea
Sleep apnoea has several types. The two most commonly discussed are obstructive sleep apnoea (OSA) and central sleep apnoea (CSA).
Obstructive Sleep Apnoea (OSA)
Obstructive sleep apnoea occurs when the upper airway narrows or completely blocks during sleep. Not everyone with OSA will show signs. A family member or loved one often first notices OSA through unusual breathing during sleep.
Central Sleep Apnoea (CSA)
Central sleep apnoea is different from OSA. Instead of the airway becoming physically blocked, the brain temporarily fails to send the appropriate signals that control breathing.
CSA can have other causes aside from obstructive sleep apnoea; therefore, a full medical evaluation is necessary if CSA is suspected.
Insomnia vs Sleep Apnoea: What's the Difference?
The simplest way to distinguish insomnia from sleep apnoea is to consider what is disrupting sleep.
- With insomnia, the main problem is difficulty falling asleep, staying asleep, or falling back asleep after waking.
- With sleep apnoea, the person may fall asleep normally but experience repeated interruptions to breathing during the night. As a result, they might have a restless night without realising they woke up several times.
Can You Have Sleep Apnoea and Insomnia at the Same Time?
Yes, it is possible to have sleep apnoea and insomnia at the same time. When insomnia occurs alongside obstructive sleep apnoea, it is often described as comorbid insomnia and obstructive sleep apnoea (COMISA).
For instance, someone may struggle to fall asleep at night, wake frequently in the middle of the night, and then have trouble falling back asleep. By morning, they may know they had a terrible night’s sleep without knowing why.
Because the two conditions can overlap, treating one problem does not necessarily resolve every sleep difficulty.
. When insomnia occurs alongside obstructive sleep apnoea, it is often described as comorbid insomnia and obstructive sleep apnoea (COMISA).
For instance, someone may struggle to fall asleep at night, wake frequently in the middle of the night, and then have trouble falling back asleep. By morning, they may know they had a terrible night’s sleep without knowing why.
Because the two conditions can overlap, treating one problem does not necessarily resolve every sleep difficulty.
Why Do Insomnia and Sleep Apnoea Get Confused?
There are similarities between the two conditions, such as:
- Poor-quality sleep
- Tiredness during the day
- Difficulty concentrating
- Irritability or mood changes
- Reduced energy
- Feeling unrefreshed in the morning
But there is also an important difference in what a person notices.
Someone with insomnia is often aware that they are awake. They may remember lying in bed, watching the clock, or struggling to fall asleep.
A person with sleep apnea may have numerous brief awakenings throughout the night, but they may not recall any of them.
How Are Insomnia and Sleep Apnoea Diagnosed?
Although insomnia and sleep apnoea can share some symptoms, they are assessed differently.
Assessing Insomnia
Your GP may ask about what your sleep has been like, including:
- When the sleep difficulties started
- How often they occur
- Your usual sleep and wake times
- How you feel during the day
- Any medicines, substances or health factors that may affect your sleep
- A sleep diary can also help you track your sleep patterns over time.
Testing for Sleep Apnoea
Polysomnography is a type of sleep study used to assess sleep and breathing during the night. It may be carried out in a sleep laboratory or, in some circumstances, at home. A home sleep apnoea test may be recommended in some circumstances, depending on the person’s symptoms and clinical assessment.
These assessments can identify breathing problems that may not be obvious from how a person describes their sleep.
What Is AHI?
AHI stands for apnoea-hypopnoea index. It measures the average number of times your breathing stops or becomes reduced during each hour of sleep. It is one measure used to assess sleep apnoea.
A healthcare professional looks at the result along with your symptoms and medical history to get a clearer picture of your sleep.
Insomnia Treatment vs Sleep Apnoea Treatment
Treatment depends on the patient’s condition and other patient-specific factors.
Insomnia Treatment
- CBT-I (cognitive behavioural therapy for insomnia) is an important treatment approach for persistent insomnia. It helps people reorient their thoughts and habits that may affect sleep, such as worrying about not being able to sleep or spending too much time awake in bed.
- Good sleep hygiene strategies, such as maintaining a regular sleep schedule, making your sleep environment comfortable, and relaxing before bed, also support sound sleep.
Sleep Apnoea Treatment
Many sleep apnoea therapies depend on the type, severity, and cause of the condition.
For some people with obstructive sleep apnoea, CPAP therapy may be recommended. A CPAP machine pressurises a stream of air to keep the airways open during sleep. Consistently using this machine helps improve breathing and sleep quality
Other treatments include:
- Lifestyle changes: Maintaining a healthy weight, sleeping on your side, and avoiding alcohol before bed may help improve breathing during sleep.
- Oral appliances: A dentist can provide a custom-made mouthpiece that gently moves the jaw forward, helping to keep the airway open while you sleep.
- Nerve stimulation: This involves placing a small device under the skin that sends signals to the nerves that control the airway muscles, helping to keep the airway open.
- Surgery: For some people, surgery may improve airflow by correcting physical problems in the mouth or throat that affect breathing during sleep.
Not Sure Which One You Have?
If you are struggling with sleep and do not know whether it’s insomnia or sleep apnoea, you don’t have to diagnose it yourself.
At first, focus on the pattern.
- How long does it take you to fall asleep?
- How often do you wake during the night?
- Do you wake earlier than planned?
- How rested do you feel in the morning?
- Are you feeling sleepy during the day?
- Has a partner or family member noticed snoring, gasping, or pauses in breathing
If sleep problems are persistent or affecting your mood, concentration, work or everyday life, speak with a GP or qualified healthcare professional.
At ExpertMinds, our qualified mental health professionals can help you understand the factors affecting your sleep and provide appropriate support for concerns such as stress, anxiety and other mental health difficulties that may be contributing to poor sleep.
And if the symptoms suggest both, it is important to discuss this with your GP, as you may need further assessment for a sleep-related breathing disorder.
Insomnia vs Sleep Apnoea FAQs
Can Sleep Apnoea cause exhaustion after a full night of sleep?
Yes. Sleep Apnoea can repeatedly interrupt your sleep, sometimes without you fully waking or remembering it. This can leave you feeling tired or exhausted even after spending a full night in bed.
Can Sleep Apnoea feel similar to Insomnia?
It can. Both conditions can leave you feeling as though you haven’t slept well, particularly when you wake frequently during the night. The difference is that Sleep Apnoea involves interruptions to breathing, while Insomnia centres on difficulty sleeping.
Can someone have Sleep Apnoea without knowing?
Yes. Some breathing interruptions are brief enough that you may not remember them the next morning. A partner or family member may notice loud snoring, gasping or pauses in breathing before you become aware of them yourself.
What should I tell my GP about my sleep problems?
Tell your GP what happens before bed, during the night and when you wake up. It can help to mention how often the problem occurs, how you feel during the day, and whether someone has noticed snoring, gasping or pauses in your breathing while you sleep.
When should I seek help for ongoing sleep problems?
If poor sleep continues or starts to affect your mood, concentration, work, or everyday life, speak with a GP or qualified healthcare professional. Seek advice if you also experience loud snoring, gasping, choking, or pauses in your breathing during sleep.
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