Why Sleep Hygiene Still Matters When You’re Being Treated for Sleep Apnea

Sleep apnea treatment, whether it's with a CPAP, a BiPAP, or an oral appliance, is an important part of achieving better, more refreshing sleep when you have obstructive sleep apnea (OSA). But even with treatment, some people still have trouble falling asleep or staying asleep.

Many people with sleep apnea think that lifestyle habits aren’t important once they’ve started treatment, but that’s not the case, says Neal Walia, MD, a sleep medicine specialist at UCLA Health in Los Angeles.

Here’s how sleep apnea treatment and everyday sleep habits work together, and what to adjust if your sleep still isn’t where you want it to be.

How Sleep Apnea Treatments Improve Your Sleep

In obstructive sleep apnea, the muscles in your throat relax too much during sleep, causing your airway to narrow or collapse and briefly cut off your breathing, sometimes hundreds of times a night.

CPAP, BiPAP, and oral appliances all work by keeping your airway open while you sleep, though they do it in different ways.

• CPAP delivers a steady stream of air through a mask to prevent your throat muscles from collapsing.
• BiPAP alternates between two pressure levels for people who need more support breathing out.
• An oral appliance repositions your jaw to hold the airway open without a mask at all.

How Sleep Hygiene Practices Can Improve Your Sleep

Good sleep means cycling through all four sleep stages, including REM (rapid eye movement), in the right amounts, says Dr. Walia.

“Sleep apnea is one of the biggest things that gets in the way of that, since it’s especially likely to disrupt REM sleep, but everyday habits can help or hinder good sleep, too, even if your OSA is being treated,” he says.

Sleep hygiene can support the circadian rhythm, which is the rhythm of the brain between wakefulness and sleep.

How Good Sleep Hygiene Supports Sleep Apnea Treatment

The following habits can support treatment goals and make it easier to use your CPAP machine.

“Patients should work with a respiratory therapist to learn what they can adjust themselves, like humidity settings or pressure relief,” he says.

Support your circadian rhythm. Consistent bedtimes and wake times help more than just your circadian rhythm, says Walia. Falling and staying asleep both depend on your body’s internal clock and on sleep pressure (the drive to sleep that builds the longer you’re awake) staying in sync with each other.

When your schedule moves around, those factors become more discordant over time, which makes it harder to fall and stay asleep, he says.

Consistency also helps with CPAP consistency. “You’re introducing something that’s different to sleep with, and you want to make sure the rest of the factors that play a role in sleep are not disrupted, to give it the best chance to work,” says Walia.

Pay attention to temperature and light exposure. “A too-warm bedroom is one example [of an environmental trigger]: Rooms above 73 degrees F are linked to more fragmented deep sleep, known as stage three or slow-wave sleep, and a cooler room supports that stage,” says Walia.

Bright light, especially blue light, suppresses the melatonin your body needs to fall asleep, and so a lot of light exposure before bed can make that harder, too, even once sleep apnea is being treated, he says.

Sleep Hygiene Tweaks for People With Sleep Apnea

A few small changes can make sleep apnea treatment easier to stick with and improve sleep.

Don’t sweat the small stuff. Walia also tells patients not to fixate on small issues that aren’t actually affecting their results.

“A lot of patients want to do really well with their CPAP machine, and that becomes stressful,” he says.

For example, if your CPAP app flags a leak, but it’s not bothering you and your numbers look good, don’t worry about it, says Walia.

“I have some patients who get stressed about their sleep and small issues with their treatment, and unfortunately, being stressed out is a big inhibitor to sleep,” he says.

“Sleep is kind of like playing with a cat,” says Walia. “If you try really hard, it’s hard to do — you’ve got to let it come to you a little bit.”

Keep your schedule consistent. A steady bedtime and wake time make it easier to fall asleep and easier to use a CPAP night after night, says Walia.

Limit caffeine, especially later in the day. Caffeine takes six to eight hours to fully clear your system, says Safia S. Khan, MD, an associate professor of neurology at UT Southwestern Medical Center and sleep disorder specialist in Dallas.

A caffeinated drink with dinner can disrupt sleep whether or not you’re being treated for sleep apnea, she says. She generally recommends limiting caffeine to two or three drinks in the morning, ideally before lunch, and avoiding it afterward.

“If you need a lot of caffeine to stay alert during the day, that can also be a clue that your sleep quality isn’t where it should be,” says Dr. Khan.

Limit alcohol, and time it carefully. Alcohol’s muscle-relaxing effect on the throat doesn’t go away just because you’re being treated, says Walia; it can still make a CPAP work harder.

Khan generally doesn’t recommend alcohol for her patients; if you choose to drink, she suggests moderation: one to two drinks a day for men and one for women, and finish drinking three to four hours before bed.