Table of ContentsView AllTable of ContentsYour Condition Is MildYour Sleep Apnea Is MildYou’re Using It WrongCPAP Keeps You AwakeYou Have Congestion or DrynessYou Have InsomniaCPAP Pressure Is WrongYou’re Gaining WeightYou Have Central ApneaWhen to See a Specialist
Table of ContentsView All
View All
Table of Contents
Your Condition Is Mild
Your Sleep Apnea Is Mild
You’re Using It Wrong
CPAP Keeps You Awake
You Have Congestion or Dryness
You Have Insomnia
CPAP Pressure Is Wrong
You’re Gaining Weight
You Have Central Apnea
When to See a Specialist
Continuous positive airway pressure (CPAP) therapy can be effective in treating sleep apnea, but some people may not feel better when first starting treatment. There are many reasons for this, some of which are transient and will ease over time. Others may require an adjustment of treatment to help you feel better.
CPAP, a machine that uses mild air pressure to keep your airways open while you sleep, is sometimes known to cause insomnia, discomfort, and even weight gain (referred to as “CPAP belly”). Fortunately, most of these will resolve as treatment is fine-tuned and your body adapts to therapy.
Brandon Peters, MD
You Just Started Treatment
The amount of time it takes for CPAP therapy to work differs from one person to the next. Ifsleep apneais severe prior to treatment, the improvement may be more obvious. On the other hand, when the symptoms are mild, it may take longer to notice any changes.
Keep in mind that it can take several weeks before you feel the impact of CPAP therapy. Perseverance, support, and regular contact with your healthcare provider will help you cope with the transition. In time, you may not only feel the benefits of CPAP but see the benefits on your AHI report and with improved blood pressure readings.
If you are not noticing any improvement, speak with your sleep specialist about ways to adjust your therapy to work better for you.
Even when using a CPAP correctly, it’s possible to experience residual excessive daytime sleepiness (REDS). This may be due to issues that can’t be resolved with adjustments in CPAP use, including genetic causes. In these cases, healthcare providers may prescribe stimulants or suggest other treatments based on the severity of symptoms.
How long does it take for a CPAP to reduce fatigue?It typically takes about three weeks of using a CPAP machine to feel less fatigue and more energy.However, the amount of time can vary depending on the person.
How long does it take for a CPAP to reduce fatigue?
It typically takes about three weeks of using a CPAP machine to feel less fatigue and more energy.However, the amount of time can vary depending on the person.
Excessive daytimesleepinessis a common symptom of untreated sleep apnea.However, not everyone has this symptom and many wonder why they should go through the hassle of CPAP if they don’t feel any difference.
This is especially true for people with mild sleep apnea (defined as having between five and 14 breathing interruptions per night).At this level, many people have little, if any, daytime sleepiness and score low on theEpworth sleepiness scale—meaning they don’t need treatment for daytime sleepiness.
But that doesn’t mean that they don’t need treatment for sleep apnea. If left untreated, mild sleep apnea is likely to progress over time and become worse. This, in turn, can increase your risk of long-term complications, such as diabetes, heart disease, or stroke.
Even over the short term, CPAP can benefit people with mild sleep apnea, in part because they may not realize how much the condition affects them and consider their current state as being “normal.” It is only after treatment that they may realize that their “normal” was not, in fact, so.
According to a 2020 study inLancet Respiratory Medicine,people treated with CPAP had better vitality scores—a subjective measurement of one’s health, wellness, and energy—than those who were not. At the end of the three-month trial period, those treated with CPAP had a vitality score of 7.5 out of a possible 10 compared to 1.5 for those who were not treated.
You Are Not Using It Long Enough Each Night
It can be hard to adjust to CPAP therapy. You may want to remove your mask, especially as it gets closer to the morning. The problem with this is that sleep apnea often gets worse as morning approaches.
Rapid eye movement (REM) sleepmostly occurs in the last third of the nightly sleep cycle. During this stage, the soft tissues in your throat, such as the tongue and soft palate, will temporarily relax. When this happens, your airways will narrow or collapse, cutting your breathing off momentarily.
In order to reap the benefits of CPAP, you need to commit to wearing the mask from bedtime right up until the time when you awaken in the morning.
Your CPAP Mask Doesn’t Fit Properly
Using a CPAP machine is not without its challenges. Some people may struggle with the fit of theCPAP maskwhich, if not properly sized, can leak or cause marks, pain, sores, or ulcers on the face.
To better overcome this, work with your healthcare provider to find the mask best suited for your face. You can try other options, including nasal pillows, nasal masks, and full-face masks.
You Have Congestion or a Dry Nose
You Have Insomnia for Other Reasons
Insomnia, a condition in which you have trouble falling or staying asleep, is a common symptom of sleep apnea.
If you have insomnia prior to undergoing CPAP therapy, the very notion of putting on a mask for a machine that blows air in your face may not sound like a remedy that would help.
However, it is important to remember that the main reason for insomnia in people with sleep apnea is that the stoppage of breathing often awakens them, sometimes multiple times a night.With perseverance, CPAP can help reduce this and allow you to get a full night’s rest.
If your insomnia seems to be getting worse with CPAP, ask your healthcare provider about sleep aids or ways to improve yoursleep hygiene. There are also therapists trained incognitive behavioral therapy for insomnia (CBTI)who can help.
Your CPAP Pressure Needs Adjusting
You may not get the full benefit of treatment if yourCPAP settingsare incorrect. These settings regulate the pressure of air delivered to your mask.
If the setting is too high, you may struggle to exhale and find yourself waking in the middle of the night. If the setting is too low, you might continue to have frequent breathing gaps and wake up in the morning feeling tired.
Finding the right setting can take trial and error. One way to get there faster is to check the nightlyapnea-hypopnea index (AHI)report on your machine. The AHI report will tell you how many breathing interruptions you had per night.
Ideally, you would aim for less than five per hour. If it is more than this, the CPAP setting may need to be increased. If you find yourself struggling against the air pressure, the setting may need to be decreased.
Do this with your healthcare provider, however, who will want to adjust the setting based on other factors, such as changes in yourblood oxygen.
If you still find that breathing against the air pressure is difficult, ask about CPAP machines with a “ramp” feature. This allows you to start at low air pressure and gradually increase as you fall asleep.
In the past, CPAP was thought to lead to weight loss. Recent studies suggest that may not be the case and that people often gain weight, particularly around this midsection.Many people call this “CPAP belly.”
In such cases, an improved diet and routine exercise can mitigate the risk. Exercise is especially beneficial for people with sleep apnea, increasing the tone of the upper airways and reducing the accumulation of fluid in the neck that can contribute to airway collapse.
At the same time, CPAP can cause you to swallow air if the setting is too high, leading to bloating and abdominal distention.Adjusting the machine to a lower setting may prevent this and reduce the appearance of a bulging belly.
How much weight do I need to lose to cure sleep apnea?
You Have Central Sleep Apnea
In some people, CPAP therapy can lead to a condition known ascomplex sleep apnea (CSA). This occurs when the brain “forgets” to tell the respiratory muscles to make you breathe. CSA is a type ofcentral sleep apneain which the brain is the cause of the breathing gaps as opposed toobstructive sleep apneain which the airways physically collapse.
The exact cause of CSA is unknown. With that said, central apnea is more common in people who live in high altitudes.It is possible, therefore, that a high air pressure setting on your CPAP machine may contribute to CSA symptoms. In such cases, lowering the CPAP settings can help.
Fortunately, CSA resolves in 98% of people with continued treatment, although this can take several months.
When to See Your Sleep Specialist
If you continue to feel tired when using a CPAP machine, see your healthcare provider or sleep specialist. Your machine may need an adjustment, or you may have an unrelated condition. Other health conditions can occur alongside sleep apnea and cause insomnia, including restless leg syndrome, anxiety, or depression.
It’s important to find the source of your sleep issues since it can impact your health. In the short term, sleep deprivation can affect your ability to fight off germs that cause illnesses like the cold or flu. In the long term, it can increase your risk for chronic diseases, including heart disease, high blood pressure, and stroke.
Alternatives to CPAPOther ways to manage sleep apnea may include:Weight lossAn oral appliance or other type of device to help with breathingExperimenting with differentsleep positionsMedicationSurgery to remove enlarged tonsils (tonsillectomy), to fix an elongated palate or enlarged uvula (uvulopalatopharyngoplasty)Outpatient surgery to placeInspire, an upper airway stimulation system that detects breathing patterns and stimulates nerves to maintain an open airway
Alternatives to CPAP
Other ways to manage sleep apnea may include:Weight lossAn oral appliance or other type of device to help with breathingExperimenting with differentsleep positionsMedicationSurgery to remove enlarged tonsils (tonsillectomy), to fix an elongated palate or enlarged uvula (uvulopalatopharyngoplasty)Outpatient surgery to placeInspire, an upper airway stimulation system that detects breathing patterns and stimulates nerves to maintain an open airway
Other ways to manage sleep apnea may include:
Summary
If you are using CPAP therapy but still feel tired, there could be several reasons why. It’s possible that you haven’t been doing the therapy for long enough, you are removing your mask during the night, your pressure needs to be adjusted, or your symptoms are mild.
It may take several weeks of proper and continuous usage before you feel the results of CPAP therapy. If you haven’t noticed any changes, be sure to speak with your healthcare provider. There is a chance they may diagnose you with another underlying medical condition or complex sleep apnea. In these cases, other treatment methods may be used.
26 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et l.Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial.JAMA.2013;310(22):2407-2415. doi:10.1001/jama.2013.281250Mehra R, Heinzer R, Castillo P.Current management of residual excessive daytime sleepiness due to obstructive sleep apnea: insights for optimizing patient outcomes.Neurol Ther. 2021;10(2):651-672. doi:10.1007/s40120-021-00289-6Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE.Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.Sleep. 2011;34(1):121-126. Published 2011 Jan 1. doi:10.1093/sleep/34.1.121Lal C, Weaver TE, Bae CJ, Strohl KP.Excessive daytime sleepiness in obstructive sleep apnea. mechanisms and clinical management.Ann Am Thorac Soc. 2021;18(5):757-768. doi:10.1513/AnnalsATS.202006-696FRMalhotra A, Ayappa I, Ayas N, et al.Metrics of sleep apnea severity: beyond the apnea-hypopnea index.Sleep. 2021 Jul 9;44(7):zsab030. doi: 10.1093/sleep/zsab030Abbasi A, Gupta SS, Sabharwal N, et al.A comprehensive review of obstructive sleep apnea.Sleep Sci.2021 Apr-Jun;14(2):142–154. doi:10.5935/1984-0063.20200056Wimms AJ, Kelly JL, Turnbull CD, et al.Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial.Lancet Respir Med.2020;8(4):349-358 . doi:10.1016/S2213-2600(19)30402-3Virk JS, Kotecha B.When continuous positive airway pressure (CPAP) fails.J Thorac Dis. 2016;8(10):E1112-E1121. doi:10.21037/jtd.2016.09.67Gomase VG, Deshmukh P, Lekurwale VY.Obstructive sleep apnea and its management: a narrative review.Cureus.2023 Apr;15(4):e37359. doi:10.7759/cureus.37359Rathore FA, Ahmad F, Zahoor MU.Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask.Cureus. 2016;8(10):e813. doi:10.7759/cureus.813UNC School of Medicine, Neurology.Helpful hints for your CPAP unit.Ong JC, Crawford MR, Wallace DM. Sleep apnea and insomnia:Emerging evidence for effective clinical management.Chest. 2021;159(5):2020-2028. doi:10.1016/j.chest.2020.12.002Koffel EA, Koffel JB, Gehrman PR.A meta-analysis of group cognitive behavioral therapy for insomnia.Sleep Med Rev.2015;19:6-16. doi:10.1016/j.smrv.2014.05.001Wahab NA, Ahmed YN.Optimal level of continuous positive airway pressure: auto-CPAP titration versus predictive formulas.Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66(2):353-361. doi:10.1016/j.ejcdt.2016.11.004Quan SF, Budhiraja R, Clarke DP.Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.J Clin Sleep Med.2013 Oct 15;9(10):989–993. doi:10.5664/jcsm.3064Dias de Andrade FM, Pedrosa RP.The role of physical exercise in obstructive sleep apnea.J Bras Pneumol.2016 Nov-Dec;42(6):457–464. doi:10.1590/S1806-37562016000000156Shepherd K, Hillman D, Eastwood P.Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux.J Clin Sleep Med. 2013;9(1):13–17. doi:10.5664/jcsm.2328Harvard Health.Weight loss, breathing devices still best for treating obstructive sleep apnea.Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence. 2013;7:633-641. doi:10.2147/PPA.S46626Muza RT.Central sleep apnoea—a clinical review.J Thorac Dis. 2015;7(5):930-937. doi:10.3978/j.issn.2072-1439.2015.04.45Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence.2013;7:633-641. doi:10.2147/PPA.S46626Stanford Medicine.Causes of insomnia.National Heart, Lung, and Blood Institute.How sleep affects your health.Harvard Health.I can’t tolerate CPAP, what can I do?July 29, 2020.Penn Medicine, Becker ENT & Allergy.5 Alternatives to CPAP for sleep apnea.U.S. Food and Drug Administration.Inspire upper airway stimulation—P130008/S090.
26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et l.Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial.JAMA.2013;310(22):2407-2415. doi:10.1001/jama.2013.281250Mehra R, Heinzer R, Castillo P.Current management of residual excessive daytime sleepiness due to obstructive sleep apnea: insights for optimizing patient outcomes.Neurol Ther. 2021;10(2):651-672. doi:10.1007/s40120-021-00289-6Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE.Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.Sleep. 2011;34(1):121-126. Published 2011 Jan 1. doi:10.1093/sleep/34.1.121Lal C, Weaver TE, Bae CJ, Strohl KP.Excessive daytime sleepiness in obstructive sleep apnea. mechanisms and clinical management.Ann Am Thorac Soc. 2021;18(5):757-768. doi:10.1513/AnnalsATS.202006-696FRMalhotra A, Ayappa I, Ayas N, et al.Metrics of sleep apnea severity: beyond the apnea-hypopnea index.Sleep. 2021 Jul 9;44(7):zsab030. doi: 10.1093/sleep/zsab030Abbasi A, Gupta SS, Sabharwal N, et al.A comprehensive review of obstructive sleep apnea.Sleep Sci.2021 Apr-Jun;14(2):142–154. doi:10.5935/1984-0063.20200056Wimms AJ, Kelly JL, Turnbull CD, et al.Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial.Lancet Respir Med.2020;8(4):349-358 . doi:10.1016/S2213-2600(19)30402-3Virk JS, Kotecha B.When continuous positive airway pressure (CPAP) fails.J Thorac Dis. 2016;8(10):E1112-E1121. doi:10.21037/jtd.2016.09.67Gomase VG, Deshmukh P, Lekurwale VY.Obstructive sleep apnea and its management: a narrative review.Cureus.2023 Apr;15(4):e37359. doi:10.7759/cureus.37359Rathore FA, Ahmad F, Zahoor MU.Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask.Cureus. 2016;8(10):e813. doi:10.7759/cureus.813UNC School of Medicine, Neurology.Helpful hints for your CPAP unit.Ong JC, Crawford MR, Wallace DM. Sleep apnea and insomnia:Emerging evidence for effective clinical management.Chest. 2021;159(5):2020-2028. doi:10.1016/j.chest.2020.12.002Koffel EA, Koffel JB, Gehrman PR.A meta-analysis of group cognitive behavioral therapy for insomnia.Sleep Med Rev.2015;19:6-16. doi:10.1016/j.smrv.2014.05.001Wahab NA, Ahmed YN.Optimal level of continuous positive airway pressure: auto-CPAP titration versus predictive formulas.Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66(2):353-361. doi:10.1016/j.ejcdt.2016.11.004Quan SF, Budhiraja R, Clarke DP.Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.J Clin Sleep Med.2013 Oct 15;9(10):989–993. doi:10.5664/jcsm.3064Dias de Andrade FM, Pedrosa RP.The role of physical exercise in obstructive sleep apnea.J Bras Pneumol.2016 Nov-Dec;42(6):457–464. doi:10.1590/S1806-37562016000000156Shepherd K, Hillman D, Eastwood P.Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux.J Clin Sleep Med. 2013;9(1):13–17. doi:10.5664/jcsm.2328Harvard Health.Weight loss, breathing devices still best for treating obstructive sleep apnea.Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence. 2013;7:633-641. doi:10.2147/PPA.S46626Muza RT.Central sleep apnoea—a clinical review.J Thorac Dis. 2015;7(5):930-937. doi:10.3978/j.issn.2072-1439.2015.04.45Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence.2013;7:633-641. doi:10.2147/PPA.S46626Stanford Medicine.Causes of insomnia.National Heart, Lung, and Blood Institute.How sleep affects your health.Harvard Health.I can’t tolerate CPAP, what can I do?July 29, 2020.Penn Medicine, Becker ENT & Allergy.5 Alternatives to CPAP for sleep apnea.U.S. Food and Drug Administration.Inspire upper airway stimulation—P130008/S090.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et l.Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial.JAMA.2013;310(22):2407-2415. doi:10.1001/jama.2013.281250Mehra R, Heinzer R, Castillo P.Current management of residual excessive daytime sleepiness due to obstructive sleep apnea: insights for optimizing patient outcomes.Neurol Ther. 2021;10(2):651-672. doi:10.1007/s40120-021-00289-6Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE.Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.Sleep. 2011;34(1):121-126. Published 2011 Jan 1. doi:10.1093/sleep/34.1.121Lal C, Weaver TE, Bae CJ, Strohl KP.Excessive daytime sleepiness in obstructive sleep apnea. mechanisms and clinical management.Ann Am Thorac Soc. 2021;18(5):757-768. doi:10.1513/AnnalsATS.202006-696FRMalhotra A, Ayappa I, Ayas N, et al.Metrics of sleep apnea severity: beyond the apnea-hypopnea index.Sleep. 2021 Jul 9;44(7):zsab030. doi: 10.1093/sleep/zsab030Abbasi A, Gupta SS, Sabharwal N, et al.A comprehensive review of obstructive sleep apnea.Sleep Sci.2021 Apr-Jun;14(2):142–154. doi:10.5935/1984-0063.20200056Wimms AJ, Kelly JL, Turnbull CD, et al.Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial.Lancet Respir Med.2020;8(4):349-358 . doi:10.1016/S2213-2600(19)30402-3Virk JS, Kotecha B.When continuous positive airway pressure (CPAP) fails.J Thorac Dis. 2016;8(10):E1112-E1121. doi:10.21037/jtd.2016.09.67Gomase VG, Deshmukh P, Lekurwale VY.Obstructive sleep apnea and its management: a narrative review.Cureus.2023 Apr;15(4):e37359. doi:10.7759/cureus.37359Rathore FA, Ahmad F, Zahoor MU.Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask.Cureus. 2016;8(10):e813. doi:10.7759/cureus.813UNC School of Medicine, Neurology.Helpful hints for your CPAP unit.Ong JC, Crawford MR, Wallace DM. Sleep apnea and insomnia:Emerging evidence for effective clinical management.Chest. 2021;159(5):2020-2028. doi:10.1016/j.chest.2020.12.002Koffel EA, Koffel JB, Gehrman PR.A meta-analysis of group cognitive behavioral therapy for insomnia.Sleep Med Rev.2015;19:6-16. doi:10.1016/j.smrv.2014.05.001Wahab NA, Ahmed YN.Optimal level of continuous positive airway pressure: auto-CPAP titration versus predictive formulas.Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66(2):353-361. doi:10.1016/j.ejcdt.2016.11.004Quan SF, Budhiraja R, Clarke DP.Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.J Clin Sleep Med.2013 Oct 15;9(10):989–993. doi:10.5664/jcsm.3064Dias de Andrade FM, Pedrosa RP.The role of physical exercise in obstructive sleep apnea.J Bras Pneumol.2016 Nov-Dec;42(6):457–464. doi:10.1590/S1806-37562016000000156Shepherd K, Hillman D, Eastwood P.Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux.J Clin Sleep Med. 2013;9(1):13–17. doi:10.5664/jcsm.2328Harvard Health.Weight loss, breathing devices still best for treating obstructive sleep apnea.Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence. 2013;7:633-641. doi:10.2147/PPA.S46626Muza RT.Central sleep apnoea—a clinical review.J Thorac Dis. 2015;7(5):930-937. doi:10.3978/j.issn.2072-1439.2015.04.45Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence.2013;7:633-641. doi:10.2147/PPA.S46626Stanford Medicine.Causes of insomnia.National Heart, Lung, and Blood Institute.How sleep affects your health.Harvard Health.I can’t tolerate CPAP, what can I do?July 29, 2020.Penn Medicine, Becker ENT & Allergy.5 Alternatives to CPAP for sleep apnea.U.S. Food and Drug Administration.Inspire upper airway stimulation—P130008/S090.
Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et l.Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial.JAMA.2013;310(22):2407-2415. doi:10.1001/jama.2013.281250
Mehra R, Heinzer R, Castillo P.Current management of residual excessive daytime sleepiness due to obstructive sleep apnea: insights for optimizing patient outcomes.Neurol Ther. 2021;10(2):651-672. doi:10.1007/s40120-021-00289-6
Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE.Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.Sleep. 2011;34(1):121-126. Published 2011 Jan 1. doi:10.1093/sleep/34.1.121
Lal C, Weaver TE, Bae CJ, Strohl KP.Excessive daytime sleepiness in obstructive sleep apnea. mechanisms and clinical management.Ann Am Thorac Soc. 2021;18(5):757-768. doi:10.1513/AnnalsATS.202006-696FR
Malhotra A, Ayappa I, Ayas N, et al.Metrics of sleep apnea severity: beyond the apnea-hypopnea index.Sleep. 2021 Jul 9;44(7):zsab030. doi: 10.1093/sleep/zsab030
Abbasi A, Gupta SS, Sabharwal N, et al.A comprehensive review of obstructive sleep apnea.Sleep Sci.2021 Apr-Jun;14(2):142–154. doi:10.5935/1984-0063.20200056
Wimms AJ, Kelly JL, Turnbull CD, et al.Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial.Lancet Respir Med.2020;8(4):349-358 . doi:10.1016/S2213-2600(19)30402-3
Virk JS, Kotecha B.When continuous positive airway pressure (CPAP) fails.J Thorac Dis. 2016;8(10):E1112-E1121. doi:10.21037/jtd.2016.09.67
Gomase VG, Deshmukh P, Lekurwale VY.Obstructive sleep apnea and its management: a narrative review.Cureus.2023 Apr;15(4):e37359. doi:10.7759/cureus.37359
Rathore FA, Ahmad F, Zahoor MU.Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask.Cureus. 2016;8(10):e813. doi:10.7759/cureus.813
UNC School of Medicine, Neurology.Helpful hints for your CPAP unit.
Ong JC, Crawford MR, Wallace DM. Sleep apnea and insomnia:Emerging evidence for effective clinical management.Chest. 2021;159(5):2020-2028. doi:10.1016/j.chest.2020.12.002
Koffel EA, Koffel JB, Gehrman PR.A meta-analysis of group cognitive behavioral therapy for insomnia.Sleep Med Rev.2015;19:6-16. doi:10.1016/j.smrv.2014.05.001
Wahab NA, Ahmed YN.Optimal level of continuous positive airway pressure: auto-CPAP titration versus predictive formulas.Egyptian Journal of Chest Diseases and Tuberculosis. 2017;66(2):353-361. doi:10.1016/j.ejcdt.2016.11.004
Quan SF, Budhiraja R, Clarke DP.Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.J Clin Sleep Med.2013 Oct 15;9(10):989–993. doi:10.5664/jcsm.3064
Dias de Andrade FM, Pedrosa RP.The role of physical exercise in obstructive sleep apnea.J Bras Pneumol.2016 Nov-Dec;42(6):457–464. doi:10.1590/S1806-37562016000000156
Shepherd K, Hillman D, Eastwood P.Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux.J Clin Sleep Med. 2013;9(1):13–17. doi:10.5664/jcsm.2328
Harvard Health.Weight loss, breathing devices still best for treating obstructive sleep apnea.
Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence. 2013;7:633-641. doi:10.2147/PPA.S46626
Muza RT.Central sleep apnoea—a clinical review.J Thorac Dis. 2015;7(5):930-937. doi:10.3978/j.issn.2072-1439.2015.04.45
Wang J, Wang Y, Feng J, Chen BY, Cao J.Complex sleep apnea syndrome.Patient Prefer Adherence.2013;7:633-641. doi:10.2147/PPA.S46626
Stanford Medicine.Causes of insomnia.
National Heart, Lung, and Blood Institute.How sleep affects your health.
Harvard Health.I can’t tolerate CPAP, what can I do?July 29, 2020.
Penn Medicine, Becker ENT & Allergy.5 Alternatives to CPAP for sleep apnea.
U.S. Food and Drug Administration.Inspire upper airway stimulation—P130008/S090.
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