The article discusses the challenges and strategies related to adherence to continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA). Despite the high efficacy of CPAP in reversing upper airway obstruction, adherence to treatment is variable, with 46 to 83% of patients with OSA being nonadherent. The decision to use CPAP often occurs within the first few days of treatment, and various factors influence adherence, including patient perception of symptoms and improvement in sleepiness and daily functioning. Behavioral interventions, such as cognitive-behavioral therapy (CBT), have shown promise in improving CPAP adherence by enhancing patient motivation and problem-solving skills. The article also reviews the impact of different CPAP modalities, such as bilevel CPAP, auto-CPAP, and flexible CPAP, on adherence, noting that while these devices aim to improve patient comfort and compliance, their effectiveness is limited by the lack of clear evidence. Additionally, the article highlights the importance of addressing side effects, such as claustrophobia and nasal congestion, and the role of social support and partner interaction in improving adherence. Overall, the article emphasizes the need for a multifaceted approach to improve CPAP adherence, including patient education, psychological support, and innovative device designs.The article discusses the challenges and strategies related to adherence to continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA). Despite the high efficacy of CPAP in reversing upper airway obstruction, adherence to treatment is variable, with 46 to 83% of patients with OSA being nonadherent. The decision to use CPAP often occurs within the first few days of treatment, and various factors influence adherence, including patient perception of symptoms and improvement in sleepiness and daily functioning. Behavioral interventions, such as cognitive-behavioral therapy (CBT), have shown promise in improving CPAP adherence by enhancing patient motivation and problem-solving skills. The article also reviews the impact of different CPAP modalities, such as bilevel CPAP, auto-CPAP, and flexible CPAP, on adherence, noting that while these devices aim to improve patient comfort and compliance, their effectiveness is limited by the lack of clear evidence. Additionally, the article highlights the importance of addressing side effects, such as claustrophobia and nasal congestion, and the role of social support and partner interaction in improving adherence. Overall, the article emphasizes the need for a multifaceted approach to improve CPAP adherence, including patient education, psychological support, and innovative device designs.