You have tried every viral sleep hygiene tip on the market. You keep your bedroom at the optimal cool temperature, you religiously put your phone away hours before bed, and you even invested in a high-end luxury mattress designed for spinal alignment. Yet, despite following all the standard advice, you still wake up feeling completely exhausted, dragging yourself through the day. If that scenario sounds painfully familiar, medical experts warn that there might be a much deeper physiological issue at play than just a temporary bout of poor rest or an endless cycle of bad sleep habits.
A major new study published in the Journal of the American Heart Association has shed new light on this widespread fatigue, revealing that having both insomnia and obstructive sleep apnea at the same time—a dangerous medical intersection known as COMISA—is associated with more than triple the risk of developing cardiovascular disease. The expansive investigation followed nearly one million United States military veterans for a period of up to 20 years, making it one of the largest and most comprehensive epidemiological studies ever conducted into how the dual presence of these two common sleep disorders profoundly impacts long-term heart health.
What is COMISA?
In clinical terms, COMISA is an acronym that stands for comorbid insomnia and obstructive sleep apnea. Put simply, it describes a patient who suffers from both conditions simultaneously. While they affect sleep in different ways, they frequently overlap and compound one another.
Insomnia is broadly defined as the persistent struggle to either fall asleep initially or stay asleep through the night, leaving individuals restless and chronically under-rested. On the other hand, obstructive sleep apnea is a serious medical disorder characterized by repeated interruptions in breathing throughout the night, where the upper airway collapses or becomes blocked. These episodes are frequently accompanied by loud snoring, choking, or gasping sounds as the body struggles to resume normal breathing.
Individually, both insomnia and obstructive sleep apnea rank as the two most prevalent sleep disorders in modern society. However, clinical data demonstrates that they occur together far more frequently than many physicians previously realized. In the landmark study of nearly one million veterans, approximately 14 percent of the total participant pool suffered from the overlapping burden of COMISA.
What the Research Found
The observational study examined health records and outcomes from a staggering 984,946 veterans who were tracked over a longitudinal period stretching up to two decades. By comparing participants who had no documented sleep disorders against those who suffered from insomnia only, sleep apnea only, and the combined COMISA profile, researchers were able to isolate the specific cardiovascular risks associated with each category.
The findings were striking. While individuals dealing with either insomnia alone or sleep apnea alone faced elevated risks for heart-related complications, those suffering from COMISA faced an exponentially higher danger. The data clearly demonstrated that the coexistence of both sleep disorders multiplies the strain on the cardiovascular system, resulting in a risk factor for heart disease that is more than three times higher than that of individuals with healthy sleep patterns.
Why Disrupted Sleep Strains the Heart
To understand why this dual diagnosis creates such a severe medical threat, researchers point to the vital restorative processes that normally occur during healthy, uninterrupted sleep. Under normal physiological conditions, a person’s heart rate and blood pressure experience a natural downward dip during deep sleep. This nocturnal dipping gives the cardiovascular system a much-needed chance to rest, recover, and repair wear and tear from daily activities.
When sleep becomes chronically fragmented or disrupted by underlying medical conditions, that essential recovery phase is entirely interrupted. Obstructive sleep apnea triggers intermittent, sharp drops in blood oxygen levels throughout the night, which immediately activates the sympathetic nervous system and places acute physiological stress on the heart and blood vessels.
Simultaneously, chronic insomnia keeps the body trapped in a state of heightened neurological and physiological alertness, even when the person desperately wants to rest. This continuous hyperarousal triggers systemic inflammation and activates chronic stress responses within the body. When these two mechanisms occur together, researchers describe the resulting physiological environment as a perfect storm of relentless cardiovascular strain.
Signs You Might Have COMISA
Medical professionals emphasize that recognizing the symptoms of overlapping sleep disorders is the first crucial step toward mitigating long-term health risks. Individuals may be dealing with COMISA if they experience a chronic inability to initiate or maintain sleep, combined with physical symptoms linked to airway collapse during the night.
A central challenge in diagnosing these overlapping conditions is that many people who suffer from sleep apnea are entirely unaware that their breathing is repeatedly stopping while they sleep, as the micro-awakenings often do not register in conscious memory. Patients frequently seek medical help strictly for insomnia symptoms like racing thoughts or broken sleep, completely missing the underlying respiratory issue. If your sleep continues to feel intensely broken and unrefreshing despite doing everything right from a lifestyle perspective, researchers note that it warrants a much deeper medical investigation.
What to Do About It
For individuals who recognize these persistent symptoms in their own lives, healthcare providers recommend scheduling a formal consultation to discuss the possibility of undergoing a comprehensive sleep study. A clinical sleep study remains the gold standard and is the only definitive way to accurately diagnose obstructive sleep apnea and evaluate the true architecture of a patient’s sleep patterns.
Addressing the problem effectively requires treating both conditions concurrently rather than focusing on just one. For the insomnia component of COMISA, cognitive behavioral therapy for insomnia, commonly referred to as CBT-I, is widely regarded by medical authorities as the gold-standard treatment, outperforming sleep medications for long-term management. For the obstructive sleep apnea component, standard interventions such as continuous positive airway pressure, or CPAP, therapy—along with alternative medical devices or positional therapies—play a critical role in keeping the airway open and stable throughout the night.
Study authors and cardiovascular specialists strongly emphasize that sleep disorders are extremely common, highly measurable, and, most importantly, entirely treatable conditions. Given the profound impact that poor sleep has on systemic health, medical experts advocate for evaluating sleep quality just as routinely as traditional cardiovascular risk factors, such as blood pressure and cholesterol levels, during standard medical checkups.
The Takeaway
Ultimately, the new research demonstrates that COMISA is far more widespread than previously recognized, presenting a hidden danger to millions of people struggling with chronic fatigue. The encouraging reality is that once patients receive an accurate diagnosis, both underlying conditions
respond well to established medical treatments.
Prioritizing sleep health goes far beyond simply seeking a boost in daily energy or productivity. It is fundamentally about protecting the long-term health and resilience of the cardiovascular system. Anyone experiencing persistent, unexplained sleep disruptions is encouraged to consult with a qualified healthcare professional to determine whether a formal sleep evaluation is appropriate for their specific situation.
