To fall asleep with a CPAP on, put the mask on 30 to 45 minutes before bed while you relax in a chair near your machine. Get into bed only when you feel sleepy, and use the ramp so the air starts gently. If you're still awake after about 20 minutes, get up and do something quiet in low light. [1] [2]
Lying awake with a mask on is a common problem for new CPAP users, and it usually gets easier with practice. The steps below come from Sleeplay's respiratory therapists and CPAP team in our video lessons, plus guidance from the American Academy of Sleep Medicine and the NIH. This guide was reviewed by our expert, Aliria Perez, CRT.
Tonight Plan
- Afternoon: No caffeine after early afternoon. Its effects can last up to 8 hours. [3]
- 1 hour before bed: Set up the machine, fill the heated humidifier, and put the mask on the nightstand. Screens go off 30 minutes before bed. [4]
- 30 to 45 minutes before bed: Put the mask on with the machine running, and read or journal in a chair near the bed.
- Lights-out: Lie down when you feel sleepy. Turn the ramp on. Breathe slowly through your nose.
- Still awake after 20 minutes: Get up, do something quiet in low light, and come back when you're sleepy. [1]
- You wake up and want it off: Take it off, catch your breath, put it back on, and restart the ramp.
Why is it so hard to fall asleep with a CPAP on?
It's hard because your brain treats the mask and the pressurized airflow as something new and slightly threatening, so it stays alert. Many people feel claustrophobic at first, and that feeling is linked to using CPAP less. It's common; it doesn't mean CPAP is failing, and it usually eases with practice.
Cleveland Clinic is blunt about it: "Many people at first find the mask uncomfortable, claustrophobic and/or embarrassing. It may be difficult to fall asleep at first." [5]
In one study of 97 adults, 63% had claustrophobic tendencies after their first night on CPAP in a sleep lab. Those tendencies were linked to lower CPAP use at one week and one month. [6] A separate study of 153 people found that poor CPAP use (under 2 hours a night) was more than twice as common in people with high claustrophobia scores. [7]
If you've caught yourself listening to every "in and out" breath, feeling like the air is suffocating when you lie down, or trying to "keep up" with the machine, you're in good company. Our team hears it all the time. For a mostly claustrophobic feeling, claustrophobia-friendly masks are worth a look, and our guide to anxiety and sleep apnea covers the worry that can build at bedtime.
"Discomfort, frustration, trouble falling asleep, these are not signs that CPAP is failing. They are rather signs that your body and mind are adjusting."
Aliria Perez, CRT, Respiratory Therapist at Sleeplay
"when you put on the mask you put you put all your concentration into the mask and it it creates a sensation that you start hyperventilating"
Ozzy, Respiratory Therapist at Sleeplay
What should you do in the hour before bed?
Set up the machine before you're tired, keep your evening bedroom routine the same every night, and put the mask on 30 to 45 minutes before bed while you read or journal in a chair. Cut caffeine after early afternoon, skip alcohol and heavy meals late, and turn screens off 30 minutes before bed.
"Prepare your machine before you go to bed. Connect the tubing, fill the humidifier if your device uses one, and have your mask ready on your nightstand."
Aliria Perez, CRT, Respiratory Therapist at Sleeplay
"One of the biggest mistakes new CPAP users make is putting on the mask when they are already exhausted."
Aliria Perez, CRT, Respiratory Therapist at Sleeplay
Put the mask on before you're sleepy
Aliria Perez, CRT, puts it in one line: "Put your CPAP on 30 to 45 minutes before bed." Sit somewhere comfortable near your machine, like a chair beside the bed if the hose reaches. Read or journal with the mask on, and get into bed only when you feel sleepy. The AASM gives the same rule for any bedtime: "Don't go to bed unless you are sleepy." It adds: "Use your bed only for sleep and sex." [1]
Order matters too. Aliria suggests this routine: "Try putting the mask on after brushing your teeth. Then, turn on the machine before you lie down and always do it in the same order every night."
Keep the evening habits simple
- Same schedule: NHLBI advises you to "Go to bed and wake up at the same time every day." [3]
- Caffeine: NHLBI warns that "The effects of caffeine can last up to 8 hours. So, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night."
- Meals and alcohol: "Avoid heavy or large meals within a few hours of bedtime. (Having a light snack is okay.) Also, avoid alcoholic drinks before bed."
- Screens: The CDC recommends "Turning off electronic devices at least 30 minutes before bedtime." [4]
Practice by day if the mask still feels strange
If the mask still feels strange, wear it for short periods during the day. The AASM suggests you "Begin using your CPAP for short periods of time during the day while you watch TV or read." [2] If you want more beginner tips, start with our beginner tips guide. Curious whether wearing CPAP while awake counts as practice? We cover that too.
How do you set up the mask and machine for lights-out?
Adjust the mask while lying down with the machine running, and turn on the ramp so the air starts low. Ask your provider about exhale relief if it isn't on. Adjust your humidity settings so your nose and mouth don't dry out. Your doctor sets your prescribed pressure, so ask your provider before changing it.
Fit the mask lying down
NHLBI says to "Adjust the mask every night while lying down with the machine on to ensure it fits properly." [8] That matters because, per the AASM, "The most common problems with CPAP occur when the mask does not fit properly." [2] If you hear hissing or feel air on your face, adjusting your headgear to secure the mask seal and reading our guide to stopping air leaks will walk you through the fixes.
Turn on the ramp
The AASM tells new users: "If the pressure feels too high as you are trying to fall asleep, use the 'ramp' mode on your CPAP unit." It continues: "You should be able to fall asleep before the air pressure reaches its set level," as it gradually rises to your prescribed level. [2] On the AirSense 11, ResMed's user guide says "Ramp Time can be set to Off, 5 to 45 minutes (in 5-minute increments), or Auto." [9] Here's how ramp works in more detail: our CPAP ramp function guide breaks it down.
"You want to set it for longer than it typically would take you to fall asleep. So, let's say it typically takes you 10 to 15 minutes to fall asleep. You want to set your ramp time to 20 minutes or more."
Kristen Cascio, a CPAP user since 2020 who collaborates with Sleeplay on its YouTube channel
Ask about exhale relief
If breathing out against the air feels like work, ask your provider about exhale relief. ResMed explains: "When EPR (Expiratory Pressure Relief) is enabled, you may find it easier to breathe out. This setting can help you get used to therapy." The levels are 1, 2 or 3 cm H2O, and "the pressure delivered will not drop below 4.0 cm H2O" [9].
"If you've ever felt like the airflow is too much when trying to fall asleep, the ramp feature is your best friend."
Nicole Haut, RRT, Respiratory Therapist at Sleeplay
What ramp and exhale relief can and can't do
Ramp and exhale relief are comfort features. Research hasn't shown that they raise how many hours people use CPAP on average, but they can make the first minutes easier for some people. A meta-analysis found flexible pressure "neither significantly improves compliance" [10], and a Cochrane review found too little evidence on pressure relief, and that auto-CPAP (APAP) adds about 13 minutes a night. [11]
Set the humidity
ResMed's guidance is direct: "If you are getting a dry nose or mouth, turn up the humidity" and "If you are getting any moisture in your mask, turn down the humidity." [9] A heated tube helps keep moisture steady, and AirSense 11 users can add a heated tube. For lingering dry mouth, our dry mouth guide has more fixes. The AASM adds that "Using a saline nasal spray can ease mild nasal congestion. Increasing the humidity in your device may help." [2]
Match the mask to how you breathe
Nasal masks are linked to more nightly use than full face masks. In a meta-analysis of 4,563 patients, full face masks were associated with about 48 fewer minutes of use per night. [12] A 2022 network meta-analysis of 6,378 people found nasal masks and nasal pillows were both linked to higher adherence than oronasal masks. [13] If you breathe through your mouth, a full face mask, or a chin strap paired with a nasal mask may still be the right choice, so ask your provider. Some people do better with masks that cover less of your face, and our guide to breathing with nasal pillows helps if you go that route.
What to do in the first 20 minutes with the mask on
Breathe slowly through your nose and let the machine do the work, without trying to match its rhythm. Use a slow belly breath, then give your mind something dull to hold, like picturing objects from a random word. If your mind keeps going back to the mask, that's normal in the first nights.
"I want you to inhale deeply through your nose, focusing on expanding your diaphragm"
Teresa, a sleep coach on the Sleeplay team
Teresa continues: "Then you're going to exhale very slowly and completely." Then she introduces a mind game: "While you're lying in bed with your CPAP machine, I want you to pick a random, neutral word that has at least five letters, like apple or blanket or tacos." The point, in her words: "It's just to keep your mind occupied with something mundane so that you can't at the same time be worrying about your to-do list or how the mask feels on your face, for example."
To play it, take the first letter of the word and picture as many things as you can that start with it, then move to the next letter. Want more ideas to improve your sleep quality? Try these breathing exercises for better sleep.
Aliria Perez, CRT, keeps the rest of the routine simple: "At night, keep your routine simple and consistent. Dim the lights, slow your breathing, and give yourself permission to rest, even if sleep takes time. If your machine has a ramp feature, use it."
What if you are still awake after 20 minutes?
Get out of bed and do something quiet in low light, without your phone. Go back to bed when you feel sleepy and put the mask back on. If you lie awake most nights for weeks, ask your doctor about insomnia. It often comes with sleep apnea, and insomnia therapy can help you use CPAP more.
"Don't stay in bed awake if you can't fall asleep after 20 minutes. Get up, do something relaxing in low light, and try again."
Aliria Perez, CRT, Respiratory Therapist at Sleeplay
The AASM agrees: "If you don't fall asleep after 20 minutes, get out of bed. Do a quiet activity without much light exposure. It is especially important to not get on electronics." [1]
When insomnia and sleep apnea show up together
Insomnia and sleep apnea often show up together. Early studies reported that 30% to 50% of people with one also had the other. [14] In a randomized trial of 145 people with both, those who had four sessions of cognitive behavioral therapy for insomnia (CBT-I) before starting CPAP used it 61 minutes more per night and were more likely to accept it (99% vs 89%). [15] The AASM recommends multicomponent CBT-I for chronic insomnia in adults (a strong recommendation). [16]
Sleeplay also sells Sleep Reset, a sleep coaching program made by Sleep Reset that works through a mobile app with a sleep coach. Ask your doctor whether a program like this fits you. It isn't a treatment for sleep apnea, and it isn't the program tested in the trial above.
Sleep medicine
One trial in people with severe sleep apnea treated at a specialized sleep center found that those who took the prescription sleep medicine eszopiclone for their first 14 nights used CPAP 20.8% more nights and 1.3 more hours per night than people on placebo. [17] Eszopiclone, zolpidem, and zaleplon carry an FDA boxed warning for complex sleep behaviors like sleepwalking and sleep driving. [18] Whether any sleep medicine is right for you is your doctor's decision.
If worry keeps you up, our guide to worrying about not sleeping can help. And if you're up in the middle of the night, see how to get better at falling back asleep.
What if you wake up and pull the mask off?
Take the mask off for a moment and catch your breath. Then put it back on and restart the machine, and the ramp starts again at low pressure. Waking up a few times in the first weeks is common. If you keep finding the mask on the floor, check the mask fit and leaks, and tell your provider.
"what you can do in this case is take the mask off catch your breath relax then put your mask back on and start therapy all over again the machine will go back to that low pressure"
Ozzy, Respiratory Therapist at Sleeplay
"you need to expect that you are going to wake up multiple times throughout the night"
James Curles, Sleep Coach at Sleeplay
"If you wake up with your mask on the floor, you're not alone. This usually happens because of leaks or discomfort during sleep."
Gabriel, Product Specialist at Sleeplay
Keep the mask within reach in the dark. A hose holder can keep the tube from pulling on the mask when you turn.
What if you can't get comfortable in bed with the mask on?
CPAP tubing is long enough to let you turn over, so you don't have to lie still. If the mask shifts when you turn, a CPAP pillow shaped for the mask and tubing can help. Providers often recommend a nasal mask for people who move a lot in their sleep.
Here's what the AASM says: "The tubing is long enough to allow you to move around or turn over in your bed." It adds: "You also can try using a special bed pillow that is shaped for a CPAP mask and tubing." [2] Cleveland Clinic notes that "Healthcare providers often recommend a nasal mask if you move around a lot when you sleep." [5]
Sleeplay offers CPAP pillows, like the Best In Rest Memory Foam CPAP Pillow. For more on finding the right sleeping position, our guides to the best position to sleep with sleep apnea, CPAP masks for side sleepers, and the best CPAP pillows go deeper.
Can you skip CPAP on a hard night?
Try not to. Early nights signal how you'll do later. In one study of 100 people, using CPAP more than 4 hours a night on day 3 predicted use a month later. If a night goes badly, use it for whatever part of the night you can, then start the next evening again.
The researchers put it this way: "An empiric threshold value of objective CPAP use of greater than 4 hours per night measured 3 days following CPAP initiation was predictive of level of CPAP adherence measured 30 days later." [19]
Aliria Perez, CRT, explains why consistency helps: "Using CPAP every time you sleep helps your brain stop treating it like a threat. Instead, it becomes background noise and normal. Skipping nights resets that adjustment clock."
The 4-hour rule
Medicare defines adherence as using CPAP 4 or more hours a night on 70% of nights in any 30 days in a row during your first 3 months. Your doctor must also see you between day 31 and day 91. Private insurers may have their own rules. The official wording reads: "Adherence to therapy is defined as use of PAP ≥4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage." [20]
That's a coverage rule, not a medical target, so don't treat 4 hours as "enough." To see what's at stake, read what happens if you stop using your CPAP.
When should you call your doctor or sleep provider?
Call your provider if you still can't fall asleep or stay asleep with CPAP after you've tried these steps, if the mask won't stay on or leaks, or if claustrophobia keeps you from using it. Stop CPAP and call right away if you have stomach discomfort or bloating.
NHLBI lists the signs to watch for: "You feel claustrophobic or are bothered by the noise. Your provider can suggest a different type of mask or PAP machine." Also: "Your mask does not stay on or fit well, or it leaks air." And: "You have difficulty falling or staying asleep." [8]
For stomach symptoms, NHLBI is clear: "If you experience stomach discomfort or bloating, you should stop using your CPAP machine and call your healthcare provider right away." [21] Our guide to CPAP-related aerophagia explains the bloating side in plain language.
Asking for help works. In a Cochrane review, behavioral programs added about 1.3 hours of CPAP use per night compared with usual care (high-certainty evidence). [22] The AASM recommends education at the start of PAP therapy (STRONG) and suggests behavioral or troubleshooting help early on (CONDITIONAL). [23]
Your situation tonight: what to try
Match your problem to one first step. If the mask makes you panic, wear it in a chair before bed; use the ramp if the air feels strong; raise humidity for dryness; get up after 20 minutes awake; and restart the ramp if you wake up. If a fix doesn't help after a few nights, tell your provider.
| If tonight you... | Try this first | Read more |
|---|---|---|
| Feel trapped or panicky when the mask goes on | Wear it in a chair 30 to 45 minutes before bed; slow belly breathing | Best CPAP masks for claustrophobia |
| Feel the air is too strong when you lie down | Turn on ramp, set longer than it takes you to fall asleep | CPAP ramp function |
| Struggle to breathe out | Ask about exhale relief (EPR) if your machine has it | What is EPR on CPAP? |
| Have a dry mouth or stuffy nose | Raise humidity; saline spray for mild congestion | CPAP dry mouth |
| Lie awake more than 20 minutes | Get up, quiet activity in low light, back when sleepy | Sleep anxiety |
| Wake up and rip the mask off | Take it off, catch your breath, put it back, restart the ramp | How to reduce CPAP mask leaks |
| Can't get comfortable in bed | A CPAP pillow; ask your provider about a nasal mask | CPAP masks for side sleepers |
Frequently Asked Questions
How do you fall asleep fast with a CPAP?
Put the mask on 30 to 45 minutes before bed while you relax in a chair, get into bed only when sleepy, and use the ramp so the air starts low. Slow belly breathing through your nose helps your body settle.
Is it normal not to sleep the first night with CPAP?
Yes. Cleveland Clinic notes it may be difficult to fall asleep at first, and sleep coaches tell new users to expect to wake up several times in the first nights. Tell your provider if it does not ease.
What is the 4-hour rule for CPAP?
Medicare defines adherence as using CPAP 4 or more hours a night on 70% of nights in any 30 days in a row during your first 3 months. It is a coverage rule; private insurers may differ.
Can I skip CPAP for one night?
Try not to, especially early on. Use it for as much of the night as you can. One study found that early use predicted how much people used CPAP a month later.
What happens if I can't get used to my CPAP machine?
Tell your doctor or sleep specialist. They can suggest a different mask or PAP machine, and a Cochrane review found that support programs added about 1.3 hours of nightly use. Don't stop on your own.
Can I take a sleeping pill to get used to CPAP?
Only if your doctor prescribes it. One trial found a short course of eszopiclone helped early CPAP use. Eszopiclone, zolpidem, and zaleplon carry an FDA boxed warning for complex sleep behaviors.
What should I do if I keep taking my CPAP mask off in my sleep?
Check the fit and leaks, make sure humidity is comfortable, and keep the hose from pulling on the mask. If it keeps happening, tell your doctor or sleep provider.
The bottom line
Falling asleep with a CPAP on is a skill, and most of it happens before lights-out: a set routine, the mask on while you relax, the ramp on, and getting up if sleep doesn't come in 20 minutes. Take it one night at a time. If you're still struggling after trying these steps, talk to your doctor or sleep provider.
If you want more support, our CPAP Masterclass is a 30-video course with lessons from our respiratory therapists and real CPAP users.
Aliria Perez, CRT, closes with this reminder: "Instead, try thinking about CPAP one night at a time. You do not have to solve the rest of your life tonight."
References
[1] American Academy of Sleep Medicine. "Healthy Sleep Habits". sleepeducation.org, updated August 2020. https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/
[2] American Academy of Sleep Medicine. "Continuous Positive Airway Pressure (CPAP)". sleepeducation.org, 2020. https://sleepeducation.org/patients/cpap/
[3] National Heart, Lung, and Blood Institute. "Sleep Deprivation and Deficiency: Healthy Sleep Habits". Updated March 24, 2022. https://www.nhlbi.nih.gov/health/sleep-deprivation/healthy-sleep-habits
[4] Centers for Disease Control and Prevention. "About Sleep". May 15, 2024. https://www.cdc.gov/sleep/about/index.html
[5] Cleveland Clinic. "CPAP Machine: What It Is, How It Works & Side Effects". Updated July 11, 2024. https://my.clevelandclinic.org/health/treatments/22043-cpap-machine
[6] Edmonds JC, Yang H, King TS, et al. "Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea." Heart Lung 2015;44(2):100-106. https://pubmed.ncbi.nlm.nih.gov/25744632/
[7] Chasens ER, Pack AI, Maislin G, Dinges DF, Weaver TE. "Claustrophobia and adherence to CPAP treatment." West J Nurs Res 2005;27(3):307-321. https://pubmed.ncbi.nlm.nih.gov/15781905/
[8] National Heart, Lung, and Blood Institute. "Sleep Apnea: Living With". Updated January 9, 2025. https://www.nhlbi.nih.gov/health/sleep-apnea/living-with
[9] ResMed. AirSense 11 User Guide (Americas), 2021. https://document.resmed.com/documents/products/machine/airsense-11/user-guide/airsense11_user-guide_amer_mul.pdf
[10] Bakker JP, Marshall NS. "Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis." Chest 2011;139(6):1322-1330. https://pubmed.ncbi.nlm.nih.gov/21193533/
[11] Kennedy B, Lasserson TJ, Wozniak DR, Smith I. "Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea." Cochrane Database Syst Rev 2019;12:CD003531. https://pubmed.ncbi.nlm.nih.gov/31792939/
[12] Andrade RGS, Viana FM, Nascimento JA, et al. "Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis." Chest 2018;153(3):665-674. https://pubmed.ncbi.nlm.nih.gov/29273515/
[13] Chen LY, Chen YH, Hu SW, et al. "In search of a better CPAP interface: A network meta-analysis comparing nasal masks, nasal pillows and oronasal masks." J Sleep Res 2022;31(6):e13686. https://pubmed.ncbi.nlm.nih.gov/35821391/
[14] Sweetman A, Lack L, Bastien C. "Co-Morbid Insomnia and Sleep Apnea (COMISA)." Brain Sci 2019;9(12):371. https://pubmed.ncbi.nlm.nih.gov/31842520/
[15] Sweetman A, Lack L, Catcheside PG, et al. "Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial." Sleep 2019;42(12):zsz178. https://pubmed.ncbi.nlm.nih.gov/31403168/
[16] Edinger JD, et al. "Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline." J Clin Sleep Med 2021;17(2):255-262. https://pubmed.ncbi.nlm.nih.gov/33164742/
[17] Lettieri CJ, Shah AA, Holley AB, et al. "Effects of a short course of eszopiclone on continuous positive airway pressure adherence: a randomized trial." Ann Intern Med 2009;151(10):696-702. https://pubmed.ncbi.nlm.nih.gov/19920270/
[18] U.S. Food and Drug Administration. "Certain Prescription Insomnia Medicines: New Boxed Warning". April 30, 2019. https://www.fda.gov/safety/medical-product-safety-information/certain-prescription-insomnia-medicines-new-boxed-warning-due-risk-serious-injuries-caused
[19] Budhiraja R, Parthasarathy S, Drake CL, et al. "Early CPAP use identifies subsequent adherence to CPAP therapy." Sleep 2007;30(3):320-324. https://pubmed.ncbi.nlm.nih.gov/17425228/
[20] Centers for Medicare & Medicaid Services. Local Coverage Determination L33718, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33718
[21] National Heart, Lung, and Blood Institute. "CPAP". Updated March 24, 2022. https://www.nhlbi.nih.gov/health/cpap
[22] Askland K, et al. "Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea." Cochrane Database Syst Rev 2020;4:CD007736. https://pubmed.ncbi.nlm.nih.gov/32255210/
[23] Patil SP, Ayappa IA, Caples SM, et al. "Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline." J Clin Sleep Med 2019;15(2):335-343. https://pubmed.ncbi.nlm.nih.gov/30736887/
Get useful articles straight to your inbox
