Struggling to Stay Asleep? It Might Be COMISA—and It’s Harder on Your Heart Than You Think

If you frequently wake up in the middle of the night and struggle to fall back asleep, you may assume it’s just stress or aging. But for many people, the real problem is COMISA, a condition that occurs when insomnia and sleep apnea happen at the same time. Insomnia makes it difficult to fall asleep or stay asleep, while sleep apnea causes repeated breathing interruptions during the night.

When these two conditions overlap, the result is fragmented sleep and a body that never fully recovers overnight. Researchers increasingly warn that COMISA is more than a sleep issue—it may also increase the risk of heart disease and high blood pressure. Here is what you need to know about this condition and how it could be severely impacting your heart health.

What Exactly Is COMISA?

COMISA stands for comorbid insomnia and sleep apnea, meaning both disorders occur in the same person. Insomnia involves persistent trouble falling asleep or staying asleep, while obstructive sleep apnea causes breathing to repeatedly stop and start during sleep. Each disorder alone can disrupt rest, but together they often amplify each other’s effects.

Studies suggest that 30–50% of people with sleep apnea also report insomnia symptoms, and many insomnia sufferers also meet criteria for sleep apnea. Because the symptoms overlap, the condition is often overlooked or misdiagnosed.

Why COMISA Is Tougher on the Heart

Healthy sleep is essential for the cardiovascular system to reset and recover each night. When sleep is repeatedly interrupted by breathing pauses or frequent awakenings, blood pressure may stay elevated, and stress hormones can rise.

Researchers studying nearly one million U.S. veterans found that people with both insomnia and sleep apnea had significantly higher risks of hypertension and cardiovascular disease than those with only one disorder.

In some cases, the combined condition was linked to more than triple the risk of heart disease. The overlap appears to intensify inflammation and strain on blood vessels, which may explain the higher risk.

Warning Signs That Could Point to COMISA

Many people with COMISA experience symptoms that seem unrelated at first. You might wake up multiple times per night, feel exhausted despite spending enough hours in bed, or struggle with loud snoring and gasping during sleep. Daytime symptoms can include brain fog, irritability, and excessive sleepiness.

Some individuals also experience headaches in the morning or difficulty concentrating throughout the day. If insomnia and possible apnea symptoms occur together, doctors often recommend a sleep study to confirm the diagnosis.

Why COMISA Often Goes Undiagnosed

One reason COMISA is often missed is that insomnia and sleep apnea are traditionally treated as separate problems. A patient may receive medication or therapy for insomnia without being screened for breathing disruptions during sleep.

Meanwhile, someone diagnosed with sleep apnea might receive treatment but still experience insomnia symptoms that go unaddressed. Experts increasingly say this fragmented approach can leave a major health risk untreated. Addressing both conditions together may significantly improve sleep quality and long-term health outcomes.

Treatments That Can Help Restore Healthy Sleep

The good news is that COMISA can often be managed effectively with the right combination of treatments. Continuous Positive Airway Pressure (CPAP) therapy is commonly used to treat moderate to severe sleep apnea by keeping the airway open during sleep. Cognitive behavioral therapy for insomnia (CBT-I) can help retrain the brain to fall asleep and stay asleep more easily.

Doctors may also recommend lifestyle changes such as weight management, improved sleep routines, and limiting alcohol before bedtime. In many cases, treating both conditions simultaneously produces the best results.

Why Taking Sleep Problems Seriously Could Protect Your Heart

Sleep struggles are easy to dismiss as a minor annoyance, especially if you’ve dealt with them for years. However, growing evidence suggests that COMISA may quietly increase the risk of cardiovascular problems if left untreated. The combination of insomnia and breathing disruptions prevents the body from getting the restorative sleep it needs to maintain healthy blood pressure and circulation.

The encouraging news is that sleep disorders are measurable and treatable once they’re properly identified. If you consistently wake during the night or feel exhausted despite sleeping for hours, it may be worth discussing COMISA with your doctor. Catching the condition early could improve both your sleep and your long-term heart health.

Have you ever been diagnosed with insomnia or sleep apnea—or struggled with both without realizing they could be connected? Share your experience in the comments.

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Amanda Blankenship

Amanda Blankenship is Chief Editor at District Media, Inc., leading content strategy, quality assurance, and editorial operations across high-traffic personal finance sites like SavingAdvice.com and CleverDude.com. A Wingate University graduate with a BA in Communications (Journalism focus), she brings over a decade of experience in digital publishing, writing, and team leadership in the personal finance space.