sleep

Insomnia vs. Sleep Apnea: Which Problem Do You Have?

Insomnia and sleep apnoea both wreck your sleep but in opposite ways. Learn the tell-tale signs of each, the validated tests for both, and how to tell them apart.

Maya Lindqvist · Senior Health WriterMedically reviewed by Dr. James Okonkwo, MDPublished June 7, 2026 · 8 min read

Insomnia and obstructive sleep apnoea are the two most common reasons people sleep badly — but they're almost opposites. Insomnia is trouble getting sleep; apnoea is trouble keeping sleep, often without you ever knowing. Telling them apart matters, because the help for each is completely different.

The quickest way to tell them apart

Sign	Insomnia	Sleep apnoea
Main problem	Can't fall or stay asleep	Breathing pauses during sleep
In bed you feel…	Wired, frustrated, awake	Asleep — often unaware of waking
Snoring	Not typical	Loud, often with gasping or choking
Mornings	Unrefreshed after little sleep	Unrefreshed despite enough hours; headaches
Daytime	Tired but often can't nap	Sleepy enough to doze off easily
Bed partner notices	Restlessness, light sleep	Snoring and pauses in breathing

A useful rule of thumb: insomnia is loud in your head and quiet in the room; apnoea is quiet in your head and loud in the room.

Screen for each

Insomnia — the ISI

The Insomnia Severity Index is seven questions about how hard it is to fall and stay asleep, and how much it affects your day.

Try it nowFree · runs right here · ~3 min

Before you start

How it works

1Rate seven sleep aspects — Each question covers a different dimension of insomnia — from getting to sleep to its effect on your daily life.
2Get your ISI score — Your answers are totalled into a score out of 28, placed in a clinically recognised band.
3Read your personalised guidance — You will receive a plain-language interpretation with practical next steps tailored to your result.

1Think about the past two weeks — Answer based on how your sleep has generally been over the last fortnight, not just last night.
2Be honest, not aspirational — Rate how things actually are, not how you wish they were or how you think they should be.
3Consider the full picture — Take into account how your sleep affects your mood, energy, concentration, and relationships — not only how long you sleep.
4Find a quiet moment — A couple of undistracted minutes will help you reflect accurately rather than rushing through.

7 questions

3′

Insomnia Severity Index (ISI), 7 items

Sleep apnoea — STOP-BANG

STOP-BANG asks eight yes/no questions about snoring, tiredness, observed pauses, blood pressure, and body measures. Three or more "yes" answers raises the risk.

Try it nowFree · runs right here · ~3 min

Before you start

How it works

1Eight yes/no questions — Each question covers one recognised OSA risk factor — snoring, tiredness, observed apnoeas, blood pressure, BMI, age, neck size, and sex.
2Instant risk score — Your 'Yes' answers are counted and matched to a validated low, intermediate, or high-risk band.
3Personalised next steps — You receive plain-language guidance on whether and how urgently to discuss your result with a clinician.

1Answer for yourself as you are now — Reflect your current health, weight, and sleep habits rather than how you were a few years ago.
2Ask a bed partner if you can — Questions about snoring and observed pauses in breathing are most accurately answered by someone who has watched you sleep. If you sleep alone, answer as honestly as you can.
3Have your measurements handy — BMI and neck circumference questions are most accurate when you have recent figures. BMI calculators are freely available online.
4Answer truthfully, not hopefully — The screener only works if you answer what is genuinely true, even if the honest answer is uncomfortable.

8 questions

3′

STOP-BANG sleep-apnoea screener (Chung 2008)

Key takeaways

Insomnia is trouble getting or staying asleep; apnoea is fragmented sleep from breathing pauses.
Loud snoring with gasping, plus daytime sleepiness, points toward sleep apnoea.
Lying awake frustrated, with a racing mind, points toward insomnia.
The ISI and STOP-BANG are validated screens — and you can have both conditions at once.

Why daytime sleepiness is the clue

Both conditions leave you tired, but the flavour differs. Apnoea tends to cause true sleepiness — actually dozing off in passive moments — because your sleep is constantly interrupted. Insomnia more often causes fatigue with a "tired but wired" quality, where napping is hard even when you're exhausted.

The Epworth Sleepiness Scale is the tie-breaker: high Epworth scores lean toward apnoea, while insomnia can leave Epworth scores surprisingly normal.

Free test · ~2 min

Measure your daytime sleepiness

The Epworth Sleepiness Scale helps separate apnoea-style sleepiness from insomnia-style fatigue.

Take the Epworth test

Myth

If I sleep through the night, I can't have sleep apnoea.

Which way should you go?

Insomnia, apnoea, or both?

Do you snore loudly, or has anyone noticed you gasp or stop breathing in your sleep?

Frequently asked questions

How do I know if I have insomnia or sleep apnoea?

Insomnia means lying awake, struggling to fall or stay asleep, and feeling under-rested. Sleep apnoea means your sleep is broken by breathing pauses you may not notice — the clues are loud snoring, gasping, morning headaches, and dozing off easily by day. The ISI and STOP-BANG screens help point you in the right direction.

Can you have both insomnia and sleep apnoea?

Yes — and it's common. The combination is sometimes called COMISA (co-morbid insomnia and sleep apnoea). If treating one condition doesn't fully fix your sleep, it's worth screening for the other.

Does snoring always mean sleep apnoea?

No. Plenty of people snore without having apnoea. But loud snoring combined with gasping or choking, witnessed breathing pauses, and daytime sleepiness raises the likelihood — which is what the STOP-BANG screen is designed to flag.

What's the treatment for each?

Insomnia responds best to CBT for insomnia (CBT-I) plus good sleep habits, with medication used cautiously and short-term. Sleep apnoea is treated by addressing risk factors and, for many people, a CPAP machine or oral device. Both should be guided by a clinician.

Keep reading

sleep

Epworth Sleepiness Scale: Score Yourself & What It Means

How the Epworth Sleepiness Scale (ESS) works: rate 8 everyday situations, score 0–24, and find out whether your daytime sleepiness is normal, mild, moderate, or severe.

sleep

Sleep Hygiene That Actually Works

Most sleep advice is either obvious or wrong. Here's the evidence-based core of sleep hygiene — light, caffeine, and a consistent schedule — plus the signs that point to a sleep disorder rather than a bad habit.

sleep

Morning Lark or Night Owl? Understanding Your Chronotype

Your chronotype is your body's built-in timing preference — set by genetics and your circadian clock. Learn the science of larks vs owls, social jetlag, and how to work with your natural rhythm.

References

This guide is educational and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified clinician about your individual circumstances.