What Is COMISA?

COMISA stands for Co-Morbid Insomnia and Sleep Apnea, a condition where insomnia and sleep apnea occur together. Insomnia makes it difficult to fall asleep or stay asleep, while sleep apnea disrupts breathing repeatedly throughout the night. When these two disorders overlap, they fuel each other — insomnia makes it harder to tolerate treatments like CPAP, and untreated sleep apnea triggers frequent awakenings that worsen insomnia.

This cycle can quickly take a toll on both physical and mental health. People with COMISA often experience severe daytime fatigue, mood changes, memory problems, and reduced productivity. Beyond the day-to-day struggles, COMISA also raises the risk of serious medical issues, including high blood pressure, heart disease, diabetes, and even stroke.

Why COMISA Is Often Missed

One of the biggest challenges with COMISA is that many people are diagnosed with only one condition. A person may be told they have sleep apnea because of loud snoring or breathing interruptions, but their difficulty falling asleep is overlooked. Others may be treated for insomnia with medications or therapy while the underlying apnea goes undetected.

This one-sided approach leaves patients frustrated, since treating only half of the problem rarely leads to meaningful improvements. At The Sleep Institute, our physicians are trained to look for both insomnia and sleep apnea, ensuring that your diagnosis reflects the full picture of your sleep health.

Common Symptoms of COMISA

You may be dealing with COMISA if you recognize a combination of these signs:

  • Difficulty falling asleep or staying asleep
  • Waking up multiple times per night
  • Loud or frequent snoring
  • Gasping, choking, or pauses in breathing during sleep
  • Non-refreshing sleep despite spending enough time in bed
  • Daytime fatigue, brain fog, or reduced concentration
  • Morning headaches, dry mouth, or sore throat
  • Irritability, depression, or anxiety linked to poor sleep.

Get assessed for COMISA free of charge — fully covered by Alberta Health.

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Diagnosis and Treatment

Complete a Self-Referral for a Sleep Test

  • Diagnosis

    At The Sleep Institute, our board-certified Sleep Physicians provide a thorough evaluation that considers both conditions together. We use a combination of screening questionnaires, sleep diaries, and medical-grade sleep testing to identify the presence of sleep apnea and insomnia. Depending on the complexity of your symptoms, we may recommend an at-home sleep test or a full in-clinic sleep study to gather the most accurate information.

  • Treatment

    Treatment for COMISA is never one-size-fits-all. Instead, we create a personalized care plan that addresses both the insomnia and the sleep apnea. For many patients, this means combining CPAP therapy or oral appliances to manage breathing issues with Cognitive Behavioral Therapy for Insomnia (CBTi) to retrain the brain for healthier sleep patterns. Lifestyle strategies such as weight management, reduced alcohol use, and improved sleep hygiene may also play a role. By approaching COMISA from both sides, patients are more likely to find long-term relief and improved quality of life.

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Complete a Self-Referral for a Sleep Test

The Risks of Leaving COMISA Untreated

Without treatment, COMISA can be more harmful than insomnia or sleep apnea alone. Risks include:

  • Increased likelihood of heart disease, stroke, and diabetes
  • Higher chance of workplace accidents and motor vehicle crashes
  • Long-term disability and reduced quality of life
  • Reduced effectiveness of medications for blood pressure, mood, or anxiety

Why Choose The Sleep Institute?

  • Direct access to Sleep Physicians — not technician-run clinics

  • Integrated treatment approach: CPAP, CBTi, oral appliances, weight support

  • Full access to Level 1, 2, and 3 sleep testing

  • Self-referrals welcome

  • Covered by Alberta and NWT Health

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