Insomnia is thought to be common in clinical settings and is reported to be highly comorbid with obstructive sleep apnea （OSA）. It is important for physicians to have appropriate understanding for the treatment of insomnia. Because both insomnia and OSA are closely related to life style-related diseases, such as hyper tension and diabetes mellitus, treatment of insomnia is thought to be important for preventing these diseases.
Sleep hygiene education is the most important for the treatment of insomnia before starting hypnotic treatment. Single kind and usual doses of benzodiazepines and benzodiazepine receptor agonists, which are the most frequently used for the treatment of insomnia, were effective and safe for insomnia comorbid with mild to moderate degree of OSA. On the other hand, high-dose use of these hypnotics was reported to deteriorate symptoms of OSA. Therefore, physicians should not use high-dose or multi-kind use of these hypnotics for insomnia patient comorbid with OSA. Recently, a melatonin receptor agonist and orexin receptor antagonist have been reported to be effective and safe for insomnia patient comorbid with OSA. Similarly, cognitive behavioral therapy as non-hypnotic treatment is expected to be alternative treatment for insomnia comorbid with OSA. In the future, it will be needed to confirm these effectiveness and safety for the appropriate treatment strategy of insomnia comorbid with OSA.
