CPAP Therapy Support in Austin
When the Treatment Becomes the Enemy
Before we talk about using CPAP, let's identify what's making it difficult for you to use it.
Jessica Fink LCSW-S provides CPAP adherence support in Austin and across Texas via online therapy
You were diagnosed with sleep apnea, prescribed CPAP, and are repeatedly told:
"You just need to use it."
But people aren't "just using it." In fact, the data show that CPAP adherence rates are fairly low, especially the further out people get from diagnosis.
Maybe you're still not convinced you actually need it. Maybe no one really explained what your sleep study results meant. Maybe you never got the time and space to process the fact that you've been given a serious, potentially lifelong medical diagnosis. Maybe the mask makes you feel trapped. Or maybe you're lying awake for hours because you also have insomnia, wondering why this clunky, expensive thing isn't fixing your sleep. Wasn't that the point?
Those are all very different problems. And they deserve different solutions.
I am a Texas-licensed therapist who has practiced since 2007 and now specializes in behavioral sleep medicine. My training includes advanced Cognitive Behavioral Therapy for Insomnia through the University of Pennsylvania and ongoing behavioral sleep medicine consultation with Dr. Donn Posner. I am a member of the Society of Behavioral Sleep Medicine and the American Academy of Sleep Medicine.
I help adults address behavioral and psychological barriers to CPAP use, including anxiety, claustrophobia, ambivalence, and co-occurring insomnia.
There Isn't Just One Reason People Struggle With CPAP
When someone tells me they are not using their CPAP, I operate on the assumption that they have a valid reason. In my experience, the problem is rarely a simple lack of motivation or willpower.
My job is to uncover what’s actually getting in the way. I come in after you’ve problem-solved all the mechanical barriers, working alongside your physician, not in place of them.
If you haven’t had a sleep study or you’re still adjusting pressure with your sleep doc, I recommend exhausting those steps before reaching out to me.
There is no single therapy technique for CPAP adherence because different barriers require different approaches. I may use Motivational Enhancement Therapy when you feel ambivalent about CPAP, exposure therapy when the mask or airflow triggers claustrophobia or panic, and Cognitive Behavioral Therapy for Insomnia (CBT-I) when insomnia is making CPAP harder to use.
For a more in-depth look at the kind of issues I work with, I wrote a Beginner’s Guide to Starting CPAP that explores the most common non-equipment-related barriers to using the device.
In my experience, these barriers usually fall into one of a few categories.
Part of you wants to use it—and part of you doesn't.
This is called ambivalence. Ambivalence means wanting two things at the same time and it shows up any time someone is making a significant behavior change.
Using CPAP is ultimately a behavior change, and like every behavior change, it comes with tradeoffs. You may recognize the benefits of treatment while also disliking the inconvenience, the equipment, or what CPAP represents. You don't have to pretend those mixed feelings don't exist.
We'll explore all of them together instead of treating them like something you simply need to "get over."
The mask or pressure makes you anxious.
Some people experience claustrophobia. Others feel like they're suffocating. Some panic as soon as the mask goes on.
Our brains can interpret restricted facial movement and forced airflow as a threat, so naturally your brain says:
"Get this thing off of me."
Then you feel immediate relief when you remove the mask. That relief teaches your brain to remove it even faster the next time.
Fortunately, there is a research-backed protocol for overcoming this reaction. We can ease you into using CPAP instead of throwing you into the deep end.
You also have insomnia.
One of the most common barriers I see is something called COMISA—having insomnia and obstructive sleep apnea at the same time.
CPAP is a breathing treatment. It is not a sleep treatment.
And honestly, I can't think of a worse treatment for insomnia than:
"Here, put this weird thing on your face and try to sleep."
If untreated insomnia is also part of the picture, wearing CPAP often becomes much harder than it needs to be. Sometimes treating the insomnia changes the entire CPAP experience.
My Job Isn’t To Convince You
I want you to feel like you're making an informed decision.
I won't pressure you into using CPAP.
Instead, I'll help you understand:
what the data from your sleep study actually mean
the potential benefits of CPAP
what barriers are getting in the way
what options exist for addressing those barriers
Once you have that information, you can make decisions that fit your health, your values, and your goals.
Some people ultimately decide CPAP is the right treatment for them. Others explore alternative treatments with their sleep physician.
My role is to help you feel confident in the decision you're making.
What Treatment Looks Like
Treatment depends on what's actually making CPAP difficult.
If you're unsure why you need it, we'll review your sleep study together and make sense of the findings.
If you're feeling conflicted about using CPAP, we'll explore that ambivalence without judgment.
If anxiety or claustrophobia is the barrier, we'll use gradual exposure techniques to help your brain learn that the mask isn't dangerous.
If insomnia is part of the picture, we'll address that too.
Every recommendation has a reason.
I'll explain why we're doing what we're doing before asking you to try it.
Is this service right for you?
This service may be a good fit if:
you've been prescribed CPAP but rarely use it
you're unsure whether CPAP is right for you
the mask makes you feel claustrophobic or panicked
you have insomnia along with sleep apnea
you feel like nobody has taken the time to answer your questions
you want to make an informed decision rather than feeling pressured
Benefits of Successful CPAP Treatment
When PAP treatment becomes more manageable and consistent, people often notice improvements in both daily functioning and long-term health.
I have honestly heard people call their CPAP “my best friend.”
Clients often report:
more energy during the day
clearer thinking and better concentration
improved sustained attention and memory
fewer unintentional naps or daytime sleep episodes
feeling more alert while driving, working, or traveling
improved mood and patience
sleeping through the night more consistently
Consistent treatment can also reduce strain on the body and support broader health goals, including:
cardiovascular health
blood pressure management
diabetes management
Frequently Asked Questions about CPAP Adherence Therapy
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This is extremely common, and it does not mean you’re lazy, unmotivated, or “noncompliant.”
There are many different reasons people struggle with PAP therapy, including claustrophobia, untreated insomnia, discomfort with the mask, anxiety about sleep, low motivation, or simply not understanding why treatment matters.
The first step is identifying the actual barrier. Once we understand what’s getting in the way, we can use targeted, evidence-based strategies to address it.
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Untreated obstructive sleep apnea can affect both daily functioning and long-term health. Common effects include excessive daytime sleepiness, unrefreshing sleep, difficulty concentrating, memory problems, irritability, and fatigue that can interfere with work, driving, and relationships.
The American Academy of Sleep Medicine notes that untreated obstructive sleep apnea is associated with high blood pressure, heart disease, stroke, and type 2 diabetes. The level of risk depends on factors such as the severity of the sleep apnea and a person’s overall health, so questions about individual medical risk should be discussed with a sleep physician or other medical provider.
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Yes. Research shows that behavioral interventions can improve PAP use. In a systematic review, behavioral approaches increased average nightly PAP use by approximately 1.3 hours compared with usual care among adults newly starting treatment.
Treatment is not about forcing yourself to “just deal with it.” It begins by identifying the specific barrier interfering with use and selecting an intervention that fits it. Depending on your needs, treatment may include:
education about sleep apnea and PAP therapy
Motivational Enhancement Therapy for ambivalence or difficulty committing to treatment
gradual exposure and desensitization for claustrophobia, panic, or mask anxiety
Cognitive Behavioral Therapy for Insomnia (CBT-I) when insomnia is making PAP use more difficult
changes to routines and habits that interfere with consistent use
referral back to your sleep physician or equipment provider when the barrier involves mask fit, air pressure, leaks, or another technical issue
These approaches do not replace medical management of sleep apnea. They address the behavioral and psychological barriers that can prevent someone from using the treatment already prescribed.
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Absolutely.
Many people have both obstructive sleep apnea and insomnia, and the insomnia often goes untreated.
Trying to sleep with a mask on while you are already struggling to fall asleep can make the experience significantly more frustrating and stressful. Sleep apnea and insomnia are separate conditions, and treating one does not automatically resolve the other.
If insomnia is part of the picture, it’s important to address it directly rather than assuming PAP therapy alone will fix the problem.
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Claustrophobic or suffocation reactions to PAP masks are more common than many people realize. Treatment uses graduated exposure: together, we create a personalized hierarchy and begin practicing with the mask and airflow while you are awake, starting with short periods and gradually increasing the time as your anxiety decreases. You may progress from holding the mask in place, to wearing it with the straps and airflow on, to resting with it in bed, and eventually to wearing it while sleeping. During follow-up sessions, we review how each step is going, examine your PAP-use data when available, troubleshoot obstacles, and adjust the hierarchy rather than forcing you to advance before you are ready.
You Deserve More Than "Just Use Your CPAP"
Using CPAP isn't simply a matter of willpower.
For many people, there are logical barriers standing in the way.
Once we are aware of the barriers, we can decide together how to address them.
Whether that means education, problem-solving, exposure therapy, insomnia treatment, or simply having someone take the time to answer your questions, we'll start with understanding—not assumptions.