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94: The First Month with CPAP: What No One Tells You

cpap Jan 20, 2024

Getting great sleep after you’ve been sleeping poorly is a glorious experience.  I would rate the satisfaction right up there with spending time with the person you love the most.  Or wrapping up a major project with a job well done.  Or sitting down to your favorite meal ready to savor every bite. 

The promise of good sleep, night after night, is often held out as a reward for getting your sleep apnea treated.  And for those who are symptomatic every day with the effects of poor sleep, this sounds like a wonderful accomplishment.  So how long will it take to get there?  

First off, the majority of people who start using CPAP feel worse before they feel better.  

Uhhhh, what?

Yep, I said it.  This is a dirty little secret that gets revealed pretty quickly once you start using your machine at home.  Most people need time to acclimate to the therapy, and it’s probably longer than you think.  The truth is, you are learning a new sleep skill.  So there is a period of time when you are a beginner– awkward, fumbling, and frustrated.  This means your sleep is interrupted and you’re probably sleeping less than before.  

This is relevant because when you feel frustrated with using CPAP, there exists the real possibility that your use of the therapy will start to get spotty if you’re not seeing the reward.  This makes sense- why torture yourself night after night?  I find the problem to be directly related to not having enough support in the early days.  Your questions need to be answered.  You need guidance and help troubleshooting.  You need encouragement and reassurance that it won’t always be this way.  

Research has shown that the first month of CPAP use is critical to predicting long-term success with the therapy.  If you can get past the first month with CPAP then chances are very good that you’ll be able to stick with it. 

Studies looking at sleepiness among new CPAP users have indicated that sleepiness starts to get better with 4 hours of nightly treatment.  This has a lot to do with why four hours was chosen as a mark of minimum compliance.  What you need to know is that the feel-good benefits (and the long-term health benefits!) increase with every additional hour of CPAP use.  To get maximum benefit, you need to work up to using CPAP nightly and throughout the night!  Ideally, that would be 7-8 hours of total sleep time.

Research has also demonstrated that feeling at least a bit better takes two to four weeks for the majority of people who use CPAP nightly.  In my clinical experience, I have seen a wide spectrum.   For some people, it can take up to six months or so.  But almost invariably, when people get to the point that their sleep feels good again, they have no regrets.  

There are two ways to shorten the time it takes to acclimate to CPAP:

  • First, be consistent in using your CPAP every time you sleep.  It’s more important to use the treatment nightly than to use it for a long time.  Expect to work up to using it longer and longer if you’re putting on the mask every night.  If the treatment makes you agitated, practicing for at least 15 minutes during the day can really help. 
  • Second, be proactive about your care.  Get your pain points fixed.  If your sleep doctor or sleep clinic has quick and comprehensive resources to support you in the first month, that is the place to go.  You can also join the Super Sleep MD Facebook group and the free membership at  Here you can be part of a supportive community and get knowledge and guidance to overcome whatever obstacles you’re experiencing.  

Whether you’re new to CPAP or coming back to try the therapy again, know that you can have healthy sleep again.  Stick with it, it’s only a matter of time. 




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