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Why CPAP Compliance is Important & Tips on Improving Your Therapy

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CPAP therapy is the most effective treatment for sleep apnea. Many people who use a CPAP go on to report life-changing improvements after getting their sleep apnea under control. However, the only way to gain the full benefits of this highly effective treatment is by using your machine on a regular basis.

Like most CPAP patients, you will establish a pattern 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. The way this is measured is through CPAP compliance readings.

What Is CPAP Compliance?

CPAP compliance refers to whether you use your CPAP machine enough for it to be effective. To be CPAP-compliant, you must use your CPAP machine for at least 4 hours per night, 21 nights per month. Insurance companies usually require you to be compliant before covering the cost of CPAP therapy.

In some cases, your employer may also require proof of CPAP compliance in order for you to continue working. This practice is fairly common for people who fly or drive for a living, as driving with untreated sleep apnea makes you 2.5 times more likely to get into a car accident.

CPAP Compliance for Health Insurance

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 31st 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 of CPAP machines and equipment that 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.

CPAP Compliance for Employees

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 needed. 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 treatment.

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 period. You must also submit a signed form stating their compliance with CPAP therapy. Finally, your doctor will need to submit a form that says your treatment is still effective.

What Does Your CPAP Report Include?

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 records 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

Here are some of the CPAP readings that your doctor or health insurance company may use to determine if you are CPAP compliant and if you are responding to your sleep apnea treatment plan.


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 these events occur per hour on average, which helps your doctor determine the severity of your sleep apnea.


CPAP 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.

CPAP Leaks

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 with your CPAP machine turned on. 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

Unfortunately, some people actually try to figure out how to cheat CPAP compliance because their jobs may depend on showing that they use their CPAP machines as directed. 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 well-being. 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 or have trouble using the CPAP machine at the right settings.

If you have trouble maintaining CPAP compliance, you are not alone. Research 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 CPAP Data

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.

  • David Repasky

    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.

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10 Responses

  1. I have been trying to sleep with the CPAP equipment for a week. Only one night I have slept with it on.
    That night I slept until 3:00 am. I am much sleepier and tired during the day since I have started this
    than I was before I got it. The reason I can’t go to sleep with it on is that I have to get a deep breath
    periodically. I can not do this with the mask on. I have to take it off to get a deep breath. I was tested
    for sleep apnea and tests showed I have apnea.
    I lost 71/2 inches in height while being treated for Osteoporosis or Osteopenia with Fosamax and then
    Actonel. So my problem is that my lungs are too crowded. I can lean over to get a deep breath. Or I can
    rest my arms on chair arms and push myself up and breathe. So, is there any chance that the CPAP
    can help me breathe?

    1. Hi Letha, I am very sorry to hear that you are having some trouble breathing. Are you currently using an Auto CPAP Machine? If so, you may try speaking with your doctor to see if your minimum pressure could be increased. If you are having problems exhaling, please confirm that your exhalation relief feature is set. If none of the other options are successful, you should consider switching to a Bi-Level Machine.

      If you need assistance with troubleshooting, or have other questions, please reach us at: 1-800-356-5221, or e-mail: cpap@cpap.com.

      Have a wonderful day!

    1. Hi Ruth, I am very sorry that you were not able to sign up for our Newsletter. I managed to sign you up under your listed e-mail address.

      If you have any further questions, or concerns, please feel free to reach us at: 1-800-356-5221.

      Have a wonderful day!

  2. I work nights and sleep a few hours at a time. Does the machine calculate the hours in a 24 hour period or just at night. I’m not in compliance at 70%.

  3. Yeah yeah I get why this is important- after all I was the one who looked into sleep apnea and got the study, but I can’t keep compliance and this friggin tone isn’t helping.
    So let’s look at the major issues with me here:
    1) I need freedom of movement because I toss and turn.
    2) I hate the feeling of being “stuffed up” by pressure in my nose. Again, can’t sleep when that happens.
    3) I have awful allergies and congestion issues.

    So okay according to that I shouldn’t use a nose mask, awesome! However the nose/mouth mask I was given isn’t wide enough. Okay so I go up in one size and all is good, right? EFFIN’ NOPE. Mask creators have decided that there’s only one gd mouth size, and they adjust only the nose size. So the next step up is a full face, which is where that freedom of movement issue comes in.

    So okay, back to the nasal mask then. NOPE AGAIN. Congestion problems galore. Every cpap guide under the sun says to up the humidity, but lemme tell you, I have that on 5 and I’m still congested. With the heat off it’s like I’m getting slapped in the face with a weirdly concentrated bit of ocean, and with the heat on it’s all the comfort of a balmy brazillian rainforest on my friggin nose. And. Neither. Of. Them. Do. Anything. Still congested, and now I’m suffering while congested. MAN, I WONDER WHY I CAN’T SLEEP.

    So I oscillate between my garbage face mask that makes my tmj awful and doesn’t work, and my nasal mask which is awful and doesn’t work. And then at some point in the night I either pass out from exhaustion, or half asleep, I rip the mask off and finally get some z’s. Oh but THEN I’m not in compliance and my insurance company will make me pay a grand for a machine that I need, but don’t have the resources to use correctly.

    Like, on those magical unicorn days when I have a clear nose and the nose mask doesn’t make everything worse, I get great sleep. I would love to be able to use this device properly. I would love to be able to settle down for a friggin nap and not wake up 10 hours later, day wasted. I would love to not fall asleep at my desk. But! Manufacturers have decided that there’s not an option for me, and shrug when I explain that full-face masks hit my claustrophobia and give me panic attacks.

    So yeah. Please explain to me what I’m supposed to do here.

    1. Hi Copper, i’m sorry to hear that your having such a tough time with your therapy! What I gather from your passage, is that the nasal mask may be okay for you, if you weren’t congested so much.

      I would recommend you using a Saline Rinse, before going to bed each night and when you wake up every morning. Please see the links below for a few options to help with your congestion. If you decide to try the Saline Rinse, I would also recommend you decrease the humidity from 5 to 4, kinda trial and error increase/decrease until you find the setting that is most comfortable for you.



      You may get some relief from your congestion by using Aromatherapy also. Please see the link below for one of the options that we have available.


      Please see the link below to view a few of the full face masks that we have available which are designed for claustrophobic patients. I can’t say for sure that these suggestions will improve your CPAP therapy results, but its worth a try.


      If your congestion continues, I would recommend you speak with your doctor for alternative treatment.

      I know it’s frustrating to try suggestions from doctors, or other users and nothing seems to work, but keep in mind that you are not alone. I have linked our cpaptalk.com blog below so that you may read what other CPAP users are saying.


      For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      We wish you the best, don’t give up on your therapy!

  4. I am currently at 76 percent usage time but my sleep time only shows 34 percent. How can I increase that 34 percent to 70 percent within a weeks time?

    1. Hi Valston,
      Usually, your sleep time only increases if when you have your machine on and wearing your mask, you’re actually sleep.

      I’m not certain how long it will take to get to 70 percent sleep time though. What is the name of the machine? This information is needed so that I may better understand what report you’re viewing your usage and sleep time.

      Please feel free to call us at: 1-800-356-5221, or email us at: cpap@cpap.com, with further questions, or concerns.

      Have a great weekend!

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