Comfort and side effects
Can't Sleep Since Starting CPAP? Insomnia Fixes
Trouble falling or staying asleep after starting CPAP is common in the early weeks and usually improves as you adjust. Good sleep habits, the ramp, a comfortable mask, and sometimes a referral for cognitive behavioral therapy for insomnia (CBT-I) can help.
Signs
- Lying awake with the mask on
- Waking in the night and not falling back asleep
- Feeling more tired than before starting
- Dreading bedtime
Common causes
- Getting used to the equipment
- F&P notes that struggling to sleep with the mask is normal when you are new and adjusting.
- Mask discomfort or leaks
- Leaks, noise and pressure marks can keep you awake.
- Insomnia separate from CPAP
- If you had trouble sleeping before CPAP, or it continues for weeks, you may have insomnia as well as sleep apnea. The AASM recommends CBT-I for chronic insomnia in adults.
- Daytime naps
- ResMed notes naps reduce sleep debt, which can make falling asleep with CPAP harder for beginners.
Fixes to try, easiest first
Keep a steady sleep schedule
Go to bed and get up at the same time each day, including weekends. The AASM's healthy sleep habits page recommends a consistent schedule.
Avoid long daytime naps
ResMed suggests CPAP beginners avoid naps, because being tired at bedtime makes it easier to fall asleep with the equipment. If you do nap, use CPAP.
Use the ramp
Ramp starts with gentle pressure while you drift off. Auto ramp on some machines raises pressure only after it senses sleep.
Fix mask comfort issues
Refit the mask, treat dryness with humidity, and use a CPAP pillow if your mask shifts when you turn.
Practice with the mask during the day
NHLBI suggests wearing the mask for part of the day, such as while watching TV, to get used to it.
Ask about CBT-I with your clinician
CBT-I is recommended by the AASM for chronic insomnia in adults. It teaches strategies such as sleep schedule management and relaxation, and is available in person, by video or through online programs. Ask your sleep doctor for a referral.
NHLBI advises talking to your provider if you have difficulty falling or staying asleep with your PAP. Call sooner if insomnia lasts more than a few weeks, you are very sleepy during the day, or you feel low or anxious. Do not drive if you feel drowsy.
Supplies that can help
A pillow with cutouts or a contoured edge so a mask and hose are not pushed out of place when you sleep on your side.
Moldable ear plugs that block noise from the CPAP, mask vent air or a bed partner.
A stand or arm that lifts the tubing above the bed so it does not drag on the mask when you turn over.
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Mask types this applies to
Frequently asked questions
Is it normal to have insomnia after starting CPAP?
Yes, many people sleep worse for the first few nights or weeks while they get used to it. If it lasts beyond a few weeks, tell your sleep doctor.
Can I take a sleeping pill with CPAP?
Ask your doctor. Some sleep medicines and sedatives can affect breathing during sleep and the pressure you need.
What is CBT-I?
Cognitive behavioral therapy for insomnia is a structured, non drug treatment. The AASM recommends it for chronic insomnia in adults.
Sources
Last reviewed October 11, 2026. How we research · Report an error