Stuck Awake with a New CPAP? Try These Sleep Habits

At‑a‑glance

• 🌟 Who this helps: people starting CPAP who still lie awake or wake often.

• 🧰 What to try first: simple bedtime steps, mask‑comfort practice, and a plan for middle‑of‑the‑night wake‑ups.

• 🆘 When to get extra help: clear signs it’s time for brief CBT‑I with ScienceWorks (we coordinate with your sleep clinic).

If you can’t sleep with CPAP or PAP keeps you wide‑awake, you’re not alone. Early nights can feel strange: new sensations, airflow, and a mask your brain hasn’t learned to trust yet. The good news: a few targeted habits—plus short, evidence‑based sleep therapy when needed—help most people settle in. Multicomponent CBT‑I is the first‑line treatment for chronic insomnia and blends smoothly with PAP care (1).

🌙 Key takeaway: You don’t have to choose between CPAP and sleep—pair the device with smart sleep steps, and add CBT‑I if insomnia signs persist.

1) Can’t sleep with CPAP? Who this helps

• New CPAP/APAP/BiPAP users adjusting to the mask or airflow

• People who can’t fall asleep, wake a lot, or dread bedtime

• Anyone whose sleep schedule slid later after starting treatment

Helpful next reads on our site: Specialized Therapy, Meet the ScienceWorks Behavioral Healthcare Team, and Why You Can’t Sleep: How CBT‑I Helps Reset a Stuck Sleep Cycle.

2) Quick signs it’s not just the mask (and when to refer)

If any of these are true, think insomnia + PAP, not just equipment:

• ~30 minutes to fall asleep on most nights

• Awake >30–45 minutes after middle‑of‑the‑night wake‑ups

• “Trying hard” to sleep or worrying about sleep

• Bedtime keeps drifting later; weekends run much later than weekdays

These are good times to add brief, structured CBT‑I alongside CPAP. CBT‑I’s core tools—stimulus control and sleep scheduling—are guideline‑recommended (1) and can be sequenced with PAP without hurting adherence (2–4).

🧭 Key takeaway: If worry and wide‑awake time are piling up, it’s likely insomnia—add CBT‑I to speed stabilization.

3) The first 14 days: a simple plan

Days 1–3: Get set

• Pick one steady wake‑up time (even on weekends)

• Build a 20–30 minute wind‑down (same steps each night)

• Daytime mask practice: wear the mask while reading/TV for 15–20 minutes to build comfort (machine on, relaxing setting); structured desensitization is recommended by sleep‑medicine orgs (5)

• Morning light: 15–30 minutes outdoors or near a bright window to nudge circadian timing earlier (6–8)

• Caffeine cut‑off: aim for ~8 hours before bedtime; even 6 hours can measurably disrupt sleep for many (9)

Days 4–7: Make nights smoother

• If you’re not asleep after ~20 minutes, get up briefly: low light, quiet activity; return when sleepy (stimulus control) (1)

• Keep the mask on during brief wake‑ups if comfortable

• Log three numbers nightly: time to fall asleep, total time awake overnight, total sleep time

Days 8–14: Fine‑tune

• Set bedtime by sleepiness, not the clock (get in bed only when drowsy)

• Keep wake‑up time fixed; avoid long morning “catch‑up” sleep

• Review your 3‑number log; look for small wins and repeat what helped

🧠 Key takeaway: In two weeks, you’re teaching your brain: Bed = sleep, mornings = light and movement.

4) A no‑stress bedtime routine (20–30 minutes)

• Dim lights → light stretch/shower → soothing activity (paper book, gentle music)

• Screens off or on “night mode,” phone outside the bedroom if possible

• Bedroom basics: cool, dark, quiet; mask and machine set up before you’re sleepy

5) Mask comfort tips (with your sleep clinic)

• Practice when calm; notice and name small wins

• If leaks, soreness, or dry mouth show up: note it and call your clinic about fit, humidity, or liners; desensitization and humidification are common fixes (5)

• Pair mask‑on time with something pleasant (podcast, audiobook)

🛠️ Key takeaway: Mask “trust” grows from daytime practice + tiny successes—and your clinic can tune the gear.

6) The middle‑of‑the‑night playbook

1. Pause and breathe slowly for one minute

2. If still alert after ~20 minutes, get up for a short, boring activity in low light

3. Return to bed when sleepy; repeat as needed (no clock‑watching)

This is classic stimulus control—a core CBT‑I tool with strong support (1).

7) Common roadblocks—and simple fixes

• Racing mind: write a quick worry list earlier in the evening; keep a bedside “parking lot” sticky note

• Early morning awakening: keep wake time steady; add morning light; avoid “going to bed earlier” the next night (6–8)

• Shifted schedule: keep wake time fixed for 7–10 days before adjusting bedtime

• Mask anxiety: more daytime practice + one calming cue (same sound or scent each night)

8) When to loop in extra help

• Two weeks of steady effort with little change

• Strong anxiety, trauma memories, OCD worries, or ADHD patterns that derail routines

That’s when brief, structured sleep therapy (CBT‑I) adds speed and staying power (1–4). We also coordinate with your sleep clinic so PAP progress continues while sleep improves.

Find your next step: Ryan Robertson, TLPC‑MHSP, NCC offers gentle, practical help for insomnia and co‑occurring conditions, and can coordinate care with our team.

9) How ScienceWorks supports you (and your sleep clinic)

• Fast start: two early visits, then short follow‑ups

• Practical steps: bedtime plan, middle‑of‑the‑night plan, and simple tracking

• Teamwork: we coordinate with your sleep clinic; you keep CPAP progress while sleep improves

• Updates: we share short progress summaries with referrers on a predictable schedule

Related links: Specialized Therapy · Psychological Assessments · Groups

10) How to get help or refer

• Patients: Request an appointment via Specialized Therapy (telehealth available)

• Clinicians: Refer directly to our sleep team via Ryan Robertson, TLPC‑MHSP, NCC

• Stuck cases: Consider Psychological Assessments when attention, learning, or mood questions are in the mix

• Learn more: Explore our insomnia articles in News and Research

📈 Key takeaway: A short, structured plan + the right coach can turn CPAP nights from stressful to steady.

Why these steps work (the science, briefly)

• CBT‑I is first‑line for chronic insomnia; stimulus control and sleep scheduling are key drivers (1)

• In comorbid insomnia + OSA (COMISA), CBT‑I improves insomnia outcomes and, in some studies, increases CPAP acceptance/use, especially when delivered before PAP starts (2–4)

• Morning light helps advance circadian timing so sleepiness arrives earlier (6–8)

• Caffeine can disrupt sleep even 6 hours before bed; earlier cut‑offs help (9)

FAQ for new CPAP users (quick answers)

Does getting out of bed at night “reward” sleeplessness?

✅ No—leaving bed briefly reduces the brain’s “bed = awake” link. It’s a cornerstone of CBT‑I called stimulus control (1).

Won’t delaying bedtime make me sleep‑deprived?

⏳ Temporarily, you might feel sleepier in week one. That higher sleep drive helps consolidate sleep—and the window widens as nights improve (1,3).

Should I force myself to keep the mask on all night no matter what?

🎧 Not if it fuels panic. Do short daytime practice sessions and coordinate fit/humidity with your clinic (5). Keep the long‑view: comfort first, then duration.

Is melatonin necessary?

🌅 Not typically for classic insomnia. For circadian issues (e.g., very late schedule), timing light and, in some cases, low‑dose melatonin may be considered with a clinician (6–8).

Disclaimer

This article is for informational purposes only and does not substitute for professional diagnosis or treatment. Always consult your healthcare providers for personalized guidance.

References and Citations

(1) Edinger, J. D., Arnedt, J. T., Bertisch, S. M., et al. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986

(2) Ong, J. C., Crawford, M. R., Dawson, S. C., et al. (2020). A randomized controlled trial of CBT‑I and PAP for obstructive sleep apnea and comorbid insomnia: Main outcomes from the MATRICS study. Sleep, 43(9), zsaa041. https://doi.org/10.1093/sleep/zsaa041

(3) Tu, A. Y., Crawford, M. R., Dawson, S. C., et al. (2022). A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and comorbid insomnia: Effects on nocturnal sleep and daytime performance. Journal of Clinical Sleep Medicine, 18(3), 789–800. https://doi.org/10.5664/jcsm.9696

(4) Sweetman, A., Lack, L., Catcheside, P. G., et al. (2019). Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in OSA participants with comorbid insomnia: A randomized clinical trial. Sleep, 42(12), zsz178. https://doi.org/10.1093/sleep/zsz178

(5) American Association of Sleep Technologists (AAST). (2022). Positive Airway Pressure Acclimation and Desensitization: Technical Guideline (Updated May 2022). https://aastweb.org/wp-content/uploads/2025/03/Positive-Airway-Pressure-Acclimation-and-Desensitization-Guideline-2022.pdf

(6) Khalsa, S. B. S., Jewett, M. E., Cajochen, C., & Czeisler, C. A. (2003). A phase response curve to single bright light pulses in human subjects. Journal of Physiology, 549(3), 945–952. https://doi.org/10.1113/jphysiol.2003.040477

(7) St. Hilaire, M. A., et al. (2012). Human phase response curve to a 1‑h pulse of bright white light. Journal of Physiology, 590(13), 3035–3045. https://doi.org/10.1113/jphysiol.2012.227892

(8) Auger, R. R., Burgess, H. J., Emens, J. S., et al. (2015). Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep‑Wake Disorders. Journal of Clinical Sleep Medicine, 11(10), 1199–1236. (Bright light recommendations). https://aasm.org/resources/clinicalguidelines/crswd-intrinsic.pdf

(9) Drake, C., Roehrs, T., Shambroom, J., & Roth, T. (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine, 9(11), 1195–1200. https://doi.org/10.5664/jcsm.3170