2021 HME Business Handbook: Sleep Therapy

How to Increase Users' CPAP Therapy Compliance

Users not being compliant with their CPAP therapy can occur due to many different reasons. What are they and how can providers help ensure adherence?

Obstructive Sleep Apnea (OSA) describes a situation when there are frequent pauses in breathing during sleep due to an obstructed airway. Continuous Positive Airway Pressure (CPAP) is a preferred and effective treatment that is the gold standard of OSA therapy. At least four hours of CPAP use is suggested to maintain an effective and long-term therapeutic improvement and reduce the risk of comorbidities associated with untreated OSA.

Although Continuous positive airway pressure (CPAP) is an effective treatment method for Sleep Apnea, being compliant with the therapy remains a problem, which eventually brings down the therapy adherence. The continued use of the machine with a mask is recommended to reap full benefits of the therapy, and many people have experienced great health benefits by getting their sleep apnea under control by doing so.

Users not being compliant with their CPAP therapy can occur due to many different reasons, but it is crucial that a patient adhere to it and work towards improving their quality of life. However, maintaining high compliance with CPAP devices could be difficult for some patients. It might lead to a variety of issues.


OSA patients with poor CPAP adherence may have impaired sleep quality due to the constant interruption of breathing. Sleep fragmentation will cause excessive daytime sleepiness affecting daily life. For example, truck drivers suffering from OSA have a higher risk of vehicle accidents by as much as 250% compared to well-rested drivers. Thus, the patient’s compliance with CPAP therapy can increase the effectiveness of the OSA treatment and decrease the incidence of vehicle accidents compared to untreated OSA patients8.9.


There are several studies10 reported that OSA patients show a high prevalence of the following comorbidities, including cardiovascular diseases (systemic hypertension, coronary artery disease, arrhythmias, ischemic stroke), respiratory diseases (COPD, asthma), and metabolic disorders (diabetes mellitus, dyslipidemia, gout). Also, peptic ulcer disease, gastroesophageal reflux, chronic liver disease, anxiety, insomnia, depression, and even higher chances of getting cancer are identified in OSA patient population10.


The Centers for Medicare and Medicaid Services (CMS) defines adequate CPAP adherence as using the CPAP device for more than four hours for more than 70% of nights (within a 30 consecutive day period). This has become a standard definition, and CMS reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. Thus, the reimbursement plan would be affected for the patients with poor CPAP adherence.

There are many factors that can affect the patients’ compliance with using CPAP, such as dry nose, nasal congestion, and daytime fatigue.

There are several technical approaches for increasing patients’ comfort level while using a CPAP device, such as applying a heated humidifier and, in the case of Apex Medical devices, turning the PVA (pressure variation algorithm) function on. Using a heated humidifier can prevent nose and mouth dryness and the PVA function allows users to breathe out more easily by reducing the air pressure during exhalation.

In addition, the cloud-based patient management system of Apex CPAP device offers timely data transmission to connect with medical professionals and patients. This lets medical professionals monitor patient’s sleep data, provide prompt suggestions, improve the clinical process, and save the time of visits.

Furthermore, choosing a suitable mask is one of the most important considerations for CPAP users in terms of increasing therpay compliance. To have a restful sleep, CPAP users are keen to find a mask with a design that makes wearing a mask convenient while giving them the freedom to change body position during sleep and high comfort level without air leakage issue according to their sleep habit.


  • Better compliance can help avoid daytime fatigue and vehicle accidents. It also can help avoid any Medicare reimbursement hurdles caused due to patient non-compliance to the therapy.
  • Having knowledge about your CPAP machines’ features such as a heated humidifier and PVA function can help in customizing the therapy, which suits the user’s comfort level and can help increase therapy adherence.
  • Choosing the right mask which provides more comfort without compromising the airflow should be taken into consideration.


To read more about therapy compliance and other sleep care issues, visit hme-business.com/sleep. To learn more about Apex Medical’s range of sleep product solutions, visit www.apexmedicalcorp.com.

This article originally appeared in the May/Jun 2021 issue of HME Business.

About the Author

The article was produced by Apex Medical’s Clinical Research Team through their collaborative efforts. In addition to sleep therapy, the team has been successfully writing useful articles focused on respiratory therapy and wound care management segments to educate the patients and the providers.

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