• World Health Organization Quality of Life (WHOQOL-BREF) [ Time Frame: Change from baseline to 1 week post-treatment (after 6 weeks) ]
  This 26-item self-report questionnaire measures the following four broad domains: physical health, psychological health, social relationships, and environment. Each item has five response options, with higher scores indicating greater health. Mean scores are calculated for each domain and then multiplied by four (range of 4-20 for each domain) to enable comparisons with the WHOQOL-100. The primary outcome is the psychological domain.
• World Health Organization Quality of Life (WHOQOL-BREF) [ Time Frame: Change from baseline to 3 months after treatment ends ]
  This 26-item self-report questionnaire measures the following four broad domains: physical health, psychological health, social relationships, and environment. Each item has five response options, with higher scores indicating greater health. Mean scores are calculated for each domain and then multiplied by four (range of 4-20 for each domain) to enable comparisons with the WHOQOL-100. The primary outcome is the psychological domain.

• Functional Outcomes of Sleep Questionnaire (FOSQ-10) [ Time Frame: Change from baseline to 1 week post-treatment (after 6 weeks) ]
  This 10-item self-report measure evaluates functional status. In particular, items prompt participants to rate the extent to which they experience difficulty completing various tasks due to sleepiness or fatigue. Responses to items range from 0 to 4. Total scores range from 5-20. Higher scores indicate better functioning.
• Functional Outcomes of Sleep Questionnaire (FOSQ-10) [ Time Frame: Change from baseline to 3 months after treatment ends ]
  This 10-item self-report measure evaluates functional status. In particular, items prompt participants to rate the extent to which they experience difficulty completing various tasks due to sleepiness or fatigue. Responses to items range from 0 to 4. Total scores range from 5-20. Higher scores indicate better functioning.
• Insomnia Severity Index (ISI) [ Time Frame: Change from baseline to 1 week post-treatment (after 6 weeks) ]
  This seven-item self-report scale assesses severity of insomnia. Responses to items range from 0 to 4. Total scores range from 0 to 28. Higher scores indicate greater symptom severity.
• Insomnia Severity Index (ISI) [ Time Frame: Change from baseline to 3 months after treatment ends ]
  This seven-item self-report scale assesses severity of insomnia. Responses to items range from 0 to 4. Total scores range from 0 to 28. Higher scores indicate greater symptom severity.
• Total sleep time (actigraphy-based) [ Time Frame: Change from baseline to 1 week post-treatment (after 6 weeks) ]
  An actigraph will be used to determine total sleep time. An actigraph is a validated objective sleep measurement device commonly used outside the laboratory setting to detect movement and infer sleep and wake based on wrist activity.
• CPAP Adherence [ Time Frame: Past 7 days, at 1 week after treatment ends ]
  Average daily CPAP use.
• CPAP Adherence [ Time Frame: Past 7 days, at 3 months after treatment ends ]
  Average daily CPAP use.
• Clinician Administered PTSD Scale for DSM-5 (CAPS-5) [ Time Frame: Change from baseline to 1 week post-treatment (after 6 weeks) ]
  This 30-item semi-structured interview provides a dimensional and categorical measure of PTSD. The severity score is based on frequency and intensity of PTSD symptoms. Categorically, it determines presence of both lifetime and current PTSD. Current and lifetime PTSD will be assessed at pre-treatment. Only current PTSD will be assessed at post-treatment. This interview also assesses the onset and duration of symptoms, distress, impact of symptoms on functioning (social and occupational), change in symptoms since a previous administration, response validity, and dissociative subtype of PTSD.

• Sleep Apnea Syndromes
• Insomnia Disorder
• Stress Disorders, Post-Traumatic

• Behavioral: Apnea and Insomnia Relief (AIR)
  This treatment will be offered over six sessions. All appointments will be conducted via telehealth and will last 60 minutes. The main components of the AIR protocol are (a) psychoeducation, (b) motivational interviewing, (c) PAP adherence strategies, and (d) cognitive behavioral therapy for insomnia.
• Behavioral: Sleep Education (SE)
  This treatment will be offered over six sessions. All appointments will be conducted via telehealth and will last 60 minutes. Topics covered include the sleep cycle, sleep across the lifespan, sleep and the mind, evening activities and the sleep environment, and daytime activities and sleep.

• Experimental: Apnea and Insomnia Relief (AIR)
  This treatment will be offered over six sessions. All appointments will be conducted via telehealth and will last 60 minutes. The main components of the AIR protocol are (a) psychoeducation, (b) motivational interviewing, (c) PAP adherence strategies, and (d) cognitive behavioral therapy for insomnia.
  Intervention: Behavioral: Apnea and Insomnia Relief (AIR)
• Active Comparator: Sleep Education (SE)
  This treatment will be offered over six sessions. All appointments will be conducted via telehealth and will last 60 minutes. Topics covered include the sleep cycle, sleep across the lifespan, sleep and the mind, evening activities and the sleep environment, and daytime activities and sleep.
  Intervention: Behavioral: Sleep Education (SE)

Inclusion Criteria:

• Veterans diagnosed with sleep apnea with Apnea Hypopnea Index of at least 5 via sleep study at San Francisco VA Healthcare System and recommended for PAP therapy
• Meet DSM-5 Criteria for Posttraumatic Stress Disorder
• Meet DSM-5 Criteria for Insomnia Disorder
• Willing to attend all treatment and assessment appointments
• English literacy and cognition sufficient to participate in treatment and assessment

Exclusion Criteria:

• Psychosis or manic episode in last 5 years
• Moderate or severe substance use disorder in past 6 months
• Started or ended psychotherapy for a sleep disorder or mental health diagnosis within the last 1 month or plans to discontinue this treatment during the trial
• Started or ended an antidepressant, anxiolytic, or sleep medication with the last 1 month or plans to discontinue this treatment during the trial
• Prominent suicidal or homicidal ideation requiring alternative treatment for patient safety
• Untreated sleep disorders that may interfere with successful treatment (up to discretion of Principal Investigator)
• Having travel of personal plans that would disrupt regular treatment engagement (up to discretion of Principal Investigator)
• Working night shifts or rotating shifts that include night shifts
• Lack of stable housing
• Pregnancy