I’ve been holding off saying this until now, but, "I told you so." In my recently published, book, Sleep, Interrupted, I proposed that many people with insomnia may actually have a mild sleep-breathing disorder due to very narrow breathing passageways which worsen in deep sleep. Inefficient sleep sets off a low-grade stress response which stimulates the nervous system, preventing the insomniac’s mind from calming down before going to bed. In this month’s issue of Sleep, Dr. Guilleminault and colleagues reported on a study where they took patients who have both insomnia and mild sleep breathing problems, and randomized them into either a surgical arm (to treat the sleep-breathing problem) or to cognitive behavioral therapy (CBT). Based on subjective questionnaires, people who underwent surgical management rated much better in their insomnia scores than people who underwent CBT, although the CBP scores did improve to what was considered "normal.". The researchers went further and crossed over each group into the other, and the effects were additive.
I realize that they didn’t choose purely insomniacs, but their premise in designing the study was to determine how to approach someone with both insomnia and a mild sleep-breathing disorder. They also noted that most patients who have mild sleep-breathing problems also have insomnia, are women, and are thin and don’t fit the typical sleep apnea profile.
This study is one more in the daily to weekly studies that are published that only serves to strengthen the sleep-breathing paradigm that I describe in my book. I realize it’s controversial to say that most of insomnia is actually a breathing issue, but take a look at all the studies that show that having insomnia places you at a higher risk for developing depression, diabetes, and heart disease later in life—all complications of obstructive sleep apnea. Of course CBT is still very useful and should be recommended much more often than offered currently. In addition, good sleep hygiene is still the gold standard and must be tried first. Unfortunately, our medical establishment’s obsession to search for the magic bullet to insomniacs to sleep better without all the side effects will dominate treatment recommendations for years to come.