CPAP compliance measures how many hours and nights you use your therapy and if you use it often enough for effective therapy. Insurance companies are the usual monitors of how much you use your CPAP, but sometimes employers can track it too— especially if you drive for a living.
CPAP therapy is the most effective treatment for sleep apnea. Many people who use CPAP therapy report life-changing improvements by getting their sleep apnea under control. Most say they no longer feel tired during the day, for example, and a few even lose weight. The only way to gain the full benefits of this highly effective therapy for sleep apnea, though, is through compliance.
CPAP compliance means that you use your CPAP machine as recommended; noncompliance means you do not use your CPAP machine as often as you should or do not use it long enough when you sleep.
If you are like most CPAP patients, you will establish a pattern of compliance or noncompliance early on in your treatment. Most CPAP patients get into their patterns within the first week. To establish yours, you may have to undergo a CPAP trial that measures how often and how long you use your CPAP machine.
What is CPAP Compliance?
Now that you know you have sleep apnea, you probably want to do everything you can to stop the pauses in your breathing.
At first glance, it seems easy. Simply use your CPAP machine as directed. Next, go for a follow-up appointment with your doctor between the 31st1 and 90th day of your treatment. There, your doctor will validate your CPAP compliance by checking the machine to determine how many hours you ran the machine and the amount of time the interface was actually in use. Your doctor then sends documentation to the insurance company.
Insurance companies typically pay 80 to 90 percent of the cost of durable medical equipment, such as CPAP, after you cover the deductible. To keep costs low, though, insurance companies do not want to cover the cost equipment you aren’t using so they develop guidelines that define CPAP compliance.
Each insurance provider has specific requirements, but most require the use of the CPAP machine for 4 hours a night on at least 70 percent of nights. If your insurance company is like most, it will lease a CPAP machine for you for a short time. This gives you an opportunity to show that you use the equipment and that you tolerate CPAP therapy well.
The lease will likely last about 13 months, at which time your insurer will have paid off the machine and you will own it outright.
If you drive or fly for a living, you may need to share your compliance data with the government. You can also send your documentation to the Department of Transportation (DOT) and Federal Aviation Administration (FAA) as needed2. If you drive a truck or other vehicle for a living and are at high risk for sleep apnea, you may need to submit proof that you are complying with CPAP treatment. Sleep apnea increases the risk of daytime sleepiness, which puts drivers at greater risk for accidents.
While there are currently no federal laws regarding sleep apnea during DOT physical examinations, the (FMCSA) says that professional drivers with a medical history or diagnosis that might interfere with the ability to drive must undergo successful treatment before getting behind the wheel. The Department of Transportation may use your CPAP compliance report as proof of treatment3.
If you have sleep apnea and want to pilot an airplane, the FAA requires that you submit a report that shows you used your CPAP machine for at least 75 percent of sleep periods with an average minimum of 6 hours of usage per sleep period2. You must also submit a signature form4 stating their compliance with CPAP therapy. Finally, your doctor will need to submit a form that says your treatment is still effective.
What the CPAP Report Includes
There are a large number of CPAP machines now available, and they can vary by function, complexity, and price. The best CPAP machines have software that monitors certain aspects of your sleep patterns and record statistics. The results are easy to interpret, especially if you are familiar with the common readings CPAP machines typically measure. The software also makes it easy to send the data to your doctor, DOT or FAA.
Most common CPAP readings
Apnea Hypopnea Index (AHI) records the number of times you experience apnea and hypopnea, which occur when your airway at the back of your mouth and throat collapses. This index will take into account full closures of the airway (apneas) along with partial closures (hypopneas).
The AHI measures how many times you these events occur per hour on average, which helps your doctor determine the severity of your sleep apnea.
Pressure is the amount (usually shown as an average) of air pressure delivered by the CPAP machine. Air pressure holds the airway open to prevent sleep apnea.
A certain amount of air leakage from your CPAP mask is normal, but excessive leakage could indicate a poorly fitting mask or a mouth leak. CPAP leakage can decrease air pressure and compromise the quality of your CPAP treatment.
Usage is the amount of time you wear your CPAP mask. Today’s CPAP machines can tell whether you are actually wearing the mask or if you have just turned on the CPAP machine but did not wear the mask.
Machines with basic tracking typically focus on usage but may not track AHI, pressure or CPAP leak. Advanced CPAP machines track advanced statistics, and some contain a modem that allows you to share the results with your doctor.
The Importance of CPAP Compliance
Because their jobs may depend on showing that they use their CPAP machines as directed, some people actually try to figure out how to cheat CPAP compliance. The truth is that they are only cheating themselves.
While it is important for insurance coverage, commercial drivers licenses and for pilots, the most important reason to use your CPAP machine consistently and correctly is to improve your wellbeing. CPAP therapy can drastically improve the quality of your life.
Clearly, it is important to maintain CPAP usage. If you are like many people who are new to CPAP therapy, however, you might have trouble complying with the treatment. You might find it difficult to adapt to sleeping with the headgear on, for example, or have trouble using the CPAP machine at the right settings.
If you have trouble maintaining CPAP compliance, you are not alone. Research1 shows that 29 to 83 percent of patients do not meet the criteria because they remove the device early in the night or they stop using it altogether.
Noncompliance happens for a number of reasons, but it’s absolutely critical you stick with it. Your health will improve, and you’ll experience fewer symptoms from your therapy overall. There’s no real way to cheat or fake compliance data, and there will be many benefits you’ll reap from being compliant with CPAP therapy.
You can avoid some of the pitfalls that lead to noncompliance by improving your sleep experience with a CPAP machine.
Tips to Improve Your CPAP Compliance
Here are some ways you can improve your CPAP compliance:
- Have Realistic Expectations
- Be Prepared to Make Adjustments
- Educate Yourself on CPAP Equipment
- Get the Right Equipment
- Make Sure Your Mask Seals Well
- Keep track of your data
Listen to your doctor – adhere to your doctor’s recommendations for CPAP therapy. Ask questions and get community support at CPAPtalk.com or call us at 1-800-356-5221.
The more comfortable you make CPAP therapy, the more likely you are to use it. And, of course, the more you use your CPAP therapy, the more you will benefit from this treatment for sleep apnea.
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1. Weaver, TE. “Adherence to continuous positive airway pressure therapy: the challenge to effective treatment”. Published by the American Thoracic Society in 2008. Accessed March 5, 2018.
2. FAA. “Guide for Aviation Medical Examiners” From the FAA Official Website. Accessed Mar. 5, 2018.
3. Federal Motor Carrier Safety Administration. “Driving When You Have Sleep Apnea” From the FMCSA Official Website. Accessed March 5, 2018
4. FAA. “Airman Compliance With Treatment Obstructive Sleep Apnea”. From the FAA Official Website. Accessed Mar. 6, 2018.
David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.