What Women Veterans Care About Most When Starting Sleep Apnea Treatment

Obstructive sleep apnea is one of the most common chronic sleep disorders treated in the Department of Veterans Affairs health care system, and its management depends heavily on whether patients accept and sustain the therapies that clinicians prescribe. A new research letter published in the Journal of Clinical Sleep Medicine by Gwendolyn C. Carlson of the VA Greater Los Angeles Healthcare System and colleagues, including senior author Jennifer L. Martin, takes an unusual angle on this problem. Rather than measuring symptom severity, adherence rates, or physiological outcomes, the study asks a more fundamental question: what do women veterans themselves say they value in their lives at the moment they are starting treatment for sleep apnea? The work, published on 7 October 2026, is part of a growing effort to place patient priorities at the center of sleep medicine.

The clinical backdrop is sobering. Obstructive sleep apnea involves repeated collapse of the upper airway during sleep, producing intermittent oxygen desaturation, fragmented sleep, daytime sleepiness, and elevated long-term risks for cardiovascular and metabolic disease. The gold-standard treatment, continuous positive airway pressure, or CPAP, delivers pressurized air through a mask worn during sleep and is highly effective when used consistently. Yet registry-based cohort research, including a national Swedish study cited by the authors, has shown that a substantial fraction of patients fail to adhere to CPAP, and that treatment failure is associated with increased mortality. Educational, supportive, and behavioral interventions designed to boost CPAP usage have produced only modest and inconsistent benefits in Cochrane systematic reviews, suggesting that the field has not yet identified the levers that genuinely change patient behavior.

Carlson and her colleagues argue that one neglected lever is personal values. Their approach draws on acceptance and commitment therapy, a behavioral framework developed by Steven Hayes and colleagues and validated in a 2015 meta-analysis across a wide range of mental and physical health conditions. In this framework, values are not abstract moral positions but chosen life directions, such as being an engaged parent, maintaining physical health, or contributing to a community, that give meaning to daily actions. The idea is that health behaviors are more likely to be sustained when patients can connect them to what they personally care about. A CPAP mask is easier to tolerate, in this view, when wearing it is framed not as compliance with a prescription but as a step toward the energy and alertness needed to live according to one’s values.

To capture those values systematically, the research team turned to established psychometric instruments from the acceptance and commitment therapy literature, including the Bull’s-Eye Values Survey developed by Tobias Lundgren and colleagues and the Valued Living Questionnaire described by Kirkman Strobs Wilson and collaborators. These tools ask respondents to identify the domains of life that matter most to them, to rate how consistently their recent behavior aligns with those domains, and to indicate where they would like to direct more effort. Applying such instruments at the point of treatment initiation is methodologically significant: it captures patients’ priorities before the experience of therapy, success or failure, and clinical interaction can reshape their outlook, providing a baseline against which later adherence and quality-of-life outcomes can be interpreted.

The focus on women veterans is itself a deliberate scientific choice. Women are the fastest-growing segment of the veteran population, and the VA has invested substantially in women’s health research and care delivery, yet sleep disorders in women have historically been understudied relative to men. Sleep apnea in women can present differently, with symptoms such as insomnia, fatigue, and mood disturbance sometimes overshadowing the classic loud snoring and witnessed apneas that trigger referral in men. Women veterans also frequently navigate caregiving responsibilities, employment, and the physical and psychological sequelae of military service, all of which shape how a nightly medical device fits into a life. Understanding what this population values, the authors contend, is a prerequisite for designing sleep apnea care that they will actually want to use.

The new study builds directly on the group’s earlier work with chronic insomnia. In a 2024 paper in Behavioral Sleep Medicine, Kathryn Saldaña, Gwendolyn Carlson, and the same Los Angeles-based team examined the values expressed by women veterans receiving cognitive behavioral treatment for chronic insomnia disorder, the first-line therapy for that condition. That line of inquiry emerged from the VA’s broader transformation toward a Whole Health system of care, described by Bokhour and colleagues in Medical Care in 2020, which explicitly reorients clinical practice around what matters most to each patient rather than around diseases alone. Extending the values assessment from insomnia to sleep apnea is a logical next step, because the two disorders co-occur frequently and demand different kinds of daily commitment: insomnia treatment requires behavioral change during waking hours, while apnea treatment requires wearing equipment through the night.

The study was conducted within a registered clinical trial, NCT03377452, approved by the VA Greater Los Angeles Institutional Review Board, with written informed consent obtained from all participants. The research team spans an unusually broad set of disciplines, including health services research, geriatrics, pulmonary medicine, nursing, psychiatry, and psychology, reflecting the recognition that sleep apnea care is not delivered by a single specialty. Funding came from a VA Health Services Research and Development Merit Award, with additional support from the National Institutes of Health and the VA Office of Academic Affiliations. The authors note that participants did not consent to public sharing of their raw data, a constraint that shapes how the findings can be reanalyzed but does not diminish the value of the published summary.

Why should a values-based approach matter for the hardest problem in sleep apnea care, namely long-term adherence? Research on CPAP use has shown that social context plays a role: a dyadic perspective study by Lu and colleagues in Sleep Medicine Reviews highlighted how spousal involvement influences whether patients keep using their machines. Values assessment adds a complementary, intrapersonal dimension, giving clinicians a structured way to discuss why treatment is worth the inconvenience. It also aligns with parallel work by Fung, Martin, and colleagues, who developed and tested a patient decision aid for older adults with obstructive sleep apnea, published in the Journal of Clinical Sleep Medicine in 2021, designed to improve person-centered decision-making. Together, these efforts sketch a model in which the clinical encounter begins not with a prescription but with a conversation about the patient’s goals.

The implications extend beyond the VA. If values expressed at treatment initiation predict subsequent engagement with CPAP or other apnea therapies, a brief values inventory could become a low-cost screening tool embedded in sleep clinics everywhere, flagging patients whose priorities are in tension with the demands of therapy and who might benefit from tailored counseling. More broadly, the study contributes to a quiet revolution in behavioral medicine: the recognition that adherence is not simply a matter of education or motivation, but of meaning. For women veterans, a population that has served and often struggled in silence, being asked what they value, rather than merely what symptoms they have, may itself be a therapeutic act. As the VA and health systems worldwide push toward whole-person care, this research letter offers a concrete, testable method for making that aspiration measurable, one patient and one night of better sleep at a time.

Subject of Research: Personal values reported by women veterans at the start of obstructive sleep apnea treatment

Article Title: Values expressed by women veterans initiating treatment for sleep apnea

Article References: Carlson, G. C., Gomez, G., Carlson, K. J., MacCabe, C. H. G., Gold, A. I., Erickson, A. J., Saldaña, K., Kelly, M. R., Song, Y., Zeidler, M. R., Fung, C. H., Alessi, C. A., Washington, D. L., Yano, E. M., & Martin, J. L. (2026). Values expressed by women veterans initiating treatment for sleep apnea. Journal of Clinical Sleep Medicine, 22(1), Article 189. https://doi.org/10.1007/s44470-026-00179-4

Image Credits: AI Generated

DOI: 10.1007/s44470-026-00179-4

Keywords: sleep apnea, women veterans, CPAP adherence, patient-centered care, acceptance and commitment therapy, values assessment, VA health care, behavioral sleep medicine, whole health, treatment initiation, quality of life, sleep disorders