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Pacifying Proposals Prevent Appropriate Care for this Woman with Comorbid Insomnia and Sleep Apnea (COMISA)

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Marcia, a 36-year-old administrative assistant in a medical setting, has had lifelong sleep issues. She says that these problems worsened significantly in adulthood while she was going through a stressful time in her life. When she started having significant difficulty functioning during the day, she scheduled a visit with her Primary Care Physician (PCP) and shared about the full extent of her sleep issues. Her PCP attributed Marcia’s sleep problem primarily to stress and recommended that she try to relax and shut her brain off at night in order to sleep better.

After failed attempts to improve sleep using these suggestions, Marcia underwent overnight polysomnography. Marcia recalls that this sleep study identified Obstructive Sleep Apnea but had difficulty recalling the severity. She had her tonsils surgically removed shortly after that, but she continued to sleep poorly. Another sleep study identified that Marcia still had Obstructive Sleep Apnea, and she was recommended to use a Continuous Positive Airway Pressure (CPAP) therapy machine. She had great difficulty adjusting to using CPAP at night and felt claustrophobic with the full face mask she was provided. When she attempted to switch to a less intrusive mask that would primarily cover her nose, she was told by the Respiratory Therapist (RT) that it had previously been determined that Marcia was a “mouth-breather.” Although Marcia could not recall any test or medical examination that had been done by her medical provider to make this determination, she was not permitted to try any other mask.

She used CPAP consistently for years but continued to experience poor sleep. Each time she brought this up with her RT, the response involved adjusting the settings on her CPAP machine. Her doctor offered to prescribe a medication to help her sleep, but Marcia preferred not to take prescription sleep aids. Marcia eventually stopped mentioning her sleep problem at her medical check-ups due to her belief that medication and CPAP were the only available treatments to improve her sleep.

Since being referred to The Insomnia Clinic and learning about Comorbid Insomnia and Sleep Apnea (COMISA), she has been able to develop a consistent sleep schedule and significantly reduce the amount of time she spends awake at night. In fact, since taking part in Cognitive-Behavioral Therapy for Insomnia (CBT-I), her insomnia is now in remission and fatigue is no longer a problem for her. Although she continues to struggle with using her CPAP machine, she does experience fewer headaches with regular use and is striving to overcome the discomfort associated with its use. Now that both insomnia and OSA are treated, Marcia finds that she has more motivation and is ready to tackle other goals in her life.

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