Why Having Insomnia & Sleep Apnea Puts Your Heart At High Risk
You've tried all the viral sleep hygiene tips. You keep your room cool, you put your phone away, and you even invested in a fancy mattress. And yet, you're still waking up exhausted. If that sounds familiar, there might be more going on than just an endless cycle of "bad sleep."
New research published in the Journal of the American Heart Association found that having both insomnia and obstructive sleep apnea (a combination called COMISA) is associated with more than triple the risk of developing cardiovascular disease. The study followed nearly 1 million U.S. Veterans for up to 20 years, making it one of the largest investigations into how these two common sleep disorders affect heart health.
What is COMISA?
COMISA stands for comorbid insomnia and obstructive sleep apnea. In simpler terms, it means having both conditions at the same time.
Insomnia is the struggle to fall asleep or stay asleep. Sleep apnea is when your breathing repeatedly stops and starts during the night (often accompanied by loud snoring or gasping). These are the two most common sleep disorders, and they occur together more often than you might think. In this study, about 14% of participants had both.
What the research found
The study included 984,946 Veterans who were followed for up to 20 years. Researchers compared those with no sleep disorders, insomnia only, sleep apnea only, and COMISA.
Here's what they found:
- COMISA was linked to a more than 2-times increase in hypertension risk
- COMISA was linked to a more than 3-times increase in cardiovascular disease risk
- Having just insomnia or just sleep apnea also raised risk, but the combination was significantly worse
- These associations held true for both men and women
Why disrupted sleep strains the heart
During healthy sleep, your heart rate and blood pressure naturally dip, giving your cardiovascular system a chance to rest and repair. When sleep is fragmented or disrupted, that recovery doesn't happen the way it should.
Sleep apnea causes intermittent drops in oxygen levels, which stresses the heart and blood vessels. Insomnia keeps the body in a state of heightened alertness, triggering inflammation and chronic stress responses. Together, they create what researchers describe as a "perfect storm" of cardiovascular strain.
Signs you might have COMISA
You might have COMISA if you experience:
- Trouble falling asleep or staying asleep and waking up feeling unrefreshed
- Loud snoring or your partner noticing you stop breathing during sleep
- Waking up gasping or with a dry mouth
- Daytime fatigue despite spending enough time in bed
One important note: Many people with sleep apnea don't know they have it. If your sleep feels broken despite doing everything "right," it's worth looking into.
What to do about it
If any of this sounds familiar, talk to your doctor about a sleep study. It's the only way to definitively diagnose sleep apnea.
Treating both conditions matters. For insomnia, cognitive behavioral therapy for insomnia is considered the gold standard. For sleep apnea, treatments like CPAP (continuous positive airway pressure) or other therapies can help keep your airway open during sleep.
The researchers emphasize that sleep problems are common, measurable, and treatable. They recommend evaluating sleep as routinely as other major cardiovascular risk factors like blood pressure and cholesterol.
The takeaway
COMISA is more common than you might think, and the good news is that both conditions are treatable once you have a diagnosis.
Prioritizing sleep isn't just about having more energy. It's about protecting your heart for the long haul. If you're experiencing symptoms, ask your doctor if a sleep study makes sense for you.