Insomnia and sleep-disordered breathing

Approximately half of patients with sleep-disordered breathing (SDB) also experience insomnia. The relationship between these two common sleep disorders is complex and unclear but patients with both SDB and insomnia have poorer sleep quality and are more likely to have psychiatric disorders than those with SDB alone. SDB is more common in men than women; however, the incidence of comorbid insomnia is greater in women with SDB than in men. The management of comorbid SDB and insomnia involves the screening of patients with insomnia or psychiatric disorders for SDB; although interviews may be effective in diagnosing SDB in patients with insomnia, polysomnography can diagnose veiled SDB. To address comorbid SDB and insomnia therapies should be aimed at both disorders. Patients should first be encouraged to improve their sleep hygiene and make lifestyle changes to improve sleep. Treatments for SDB include continuous positive airway pressure and oral appliances, while upper airway surgery may improve sleep outcomes in some patients. The use of pharmacological drugs such as hypnotics for the treatment of insomnia in patients with SDB remains controversial. (c) 2007 Elsevier B.V. All rights reserved.