How Insomnia and Sleep Apnea Can Raise Your Heart Risk

You may have already tried the usual sleep advice: keep the bedroom cool, put the phone away, and upgrade the mattress. If you still wake up drained, the problem may be more than simply poor sleep habits.

Research published in the Journal of the American Heart Association found that people who have both insomnia and obstructive sleep apnea, a combination known as COMISA, face more than triple the risk of developing cardiovascular disease. The study tracked nearly 1 million U.S. Veterans for as long as 20 years, making it one of the largest looks at how these two sleep disorders affect the heart.

What COMISA means

COMISA is short for comorbid insomnia and obstructive sleep apnea, which means a person has both conditions at the same time.

Insomnia involves difficulty falling asleep or staying asleep. Sleep apnea causes breathing to repeatedly stop and start during sleep, often with loud snoring or gasping. These are two of the most common sleep disorders, and they can occur together more often than many people realize. In this study, about 14% of participants had both.

What the study showed

Researchers examined 984,946 Veterans and compared four groups: those with no sleep disorder, insomnia alone, sleep apnea alone, and COMISA.

The main findings were:

• COMISA was associated with more than double the risk of hypertension
• COMISA was associated with more than triple the risk of cardiovascular disease
• Insomnia alone and sleep apnea alone also increased risk, but the combined condition was much worse
• These results were seen in both men and women

How poor sleep affects the heart

During normal sleep, heart rate and blood pressure naturally drop, allowing the cardiovascular system time to recover. When sleep is interrupted or fragmented, that restorative process is weakened.

Sleep apnea leads to repeated drops in oxygen, putting stress on the heart and blood vessels. Insomnia can keep the body in a state of alertness, fueling inflammation and chronic stress responses. Together, researchers say, these conditions can create a powerful strain on cardiovascular health.

Possible signs of COMISA

COMISA may be a possibility if you have:

• Difficulty falling asleep or staying asleep, along with waking up unrefreshed
• Loud snoring or reports from a partner that you stop breathing in sleep
• Waking up gasping or with a dry mouth
• Daytime tiredness even after enough time in bed

It is also worth noting that many people with sleep apnea are unaware they have it. If your sleep feels broken even though you are doing everything right, it may be time to look deeper.

What to do next

If this sounds familiar, ask a doctor about a sleep study. That is the only reliable way to diagnose sleep apnea.

Treating both conditions is important. For insomnia, cognitive behavioral therapy for insomnia is considered the gold standard. For sleep apnea, treatments such as CPAP, or other therapies, can help keep the airway open during sleep.

The researchers stress that sleep disorders are common, measurable, and treatable. They suggest that sleep should be checked as routinely as other major cardiovascular risk factors, including blood pressure and cholesterol.

Bottom line

COMISA may be more common than many people think, and both conditions can be treated once they are identified.

Sleep matters for more than energy levels. Protecting your sleep may also help protect your heart over time. If you have symptoms, ask your doctor whether a sleep study could be appropriate.