In addition to the role of insomnia in prevalence and diagnosis of sleep apnea, it must also be appreciated that it can have profound effect on treatment outcomes as well. For those practicing clinical sleep medicine, it is not difficult to understand that associated complaints of insomnia or depression, which are common in patients with SDB may contribute significantly not only to initial difficulty with acceptance and adjustment to CPAP therapy, but also contribute to suboptimal adherence for continued long-term use. This has been addressed to some extent by Engleman and Wild (44). Krakow et al. (45) demonstrated clinical cures or near-cures with combined cognitive behavioral therapy and CPAP treatment for SDB in 15 out of 17 subjects with SDB and chronic insomnia. It must also be noted that sedatives and hypnotics used for insomnia may have adverse effects on sleep apnea (46).
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