OSA PAP Treatment for Veterans With SUD and PTSD on Residential Treatment Unit

Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur and having both disorders is associated with greater psychological and functional impairment than having either disorder alone. This is especially true in residential settings where both disorders are more severe than outpatient settings. Obstructive sleep apnea (OSA) is highly comorbid with both disorders and untreated OSA is associated with worse functional impairment across multiple domains, worse quality of life, worse PTSD, higher suicidal ideation, and higher substance use and relapse rates. Treating OSA with evidence-based positive airway pressure (PAP) in Veterans with SUD/PTSD on a residential unit is a logical way to maximize treatment adherence and treatment outcomes. This study compares OSA treatment while on a SUD/PTSD residential unit to a waitlist control group. The investigators hypothesize that treating OSA on the residential unit, compared to the waitlist control, will have better functional, SUD, and PTSD outcomes.

Inclusion Criteria: * a Veteran of the U.S. military or Reserve/National Guard member * have an Apnea Hypopnea Index (AHI) 5 per hour * experienced trauma that occurred in childhood or adulthood; at least one month post-trauma * have current DSM-5 diagnoses of substance use disorder (SUD) via Structured Clinical Interview for DSM-Substance Use Disorders (SCID-SUD) module with a minimum 20 days of substance use in the last 90 days (Timeline Follow-back) * Full post-traumatic stress disorder (PTSD) diagnosis via clinician administered post-traumatic stress disorder (PTSD) scale * are literate in English * are on the post-traumatic stress disorder (PTSD) track of the Substance Abuse Residential Rehabilitation Treatment Program (SARRPT) unit * are capable of giving informed consent Exclusion Criteria: * have central sleep apnea (Apnea Hypopnea Index (AHI)\>=5 and \> 50% central apneas) * arrives on the Substance Abuse Residential Rehabilitation Treatment Program (SARRPT) unit already using a positive airway pressure (PAP) device (Veteran's previously diagnosed with OSA, but not using positive airway pressure (PAP) therapy will be eligible) * the Substance Abuse Residential Rehabilitation Treatment Program (SARRPT) medical staff advises against the study based on medical history and physical examination; d) history of severe cognitive impairment (via Montreal Cognitive Assessment (MOCA) \< 26) * history of psychosis or mania independent of substance use will be excluded because the presence of these disorders can impede therapy progress