Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series

Emerson M. Wickwire, Michael T. Smith, Sandra Birnbaum, Nancy A. Collop

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background: Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up. Methods: This was a retrospective chart review of 232 patients (56.5% men, mean age = 53.6 ± 12.4 years) newly diagnosed with OSA (mean AHI = 41.8 ± 27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards. Results: Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<02). Conclusions: To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.

Original languageEnglish (US)
Pages (from-to)772-776
Number of pages5
JournalSleep Medicine
Issue number8
StatePublished - Sep 2010


  • Adherence
  • Apnea
  • CPAP
  • Comprehensive sleep medicine
  • Insomnia
  • Interdisciplinary
  • Sleep

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series'. Together they form a unique fingerprint.

Cite this