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?
- By Apex Medical Clinical Research Team
- Jun 01, 2021
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
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.
DAYTIME FATIGUE AND VEHICLE ACCIDENTS
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
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
REIMBURSEMENT REGULATIONS (REGIONAL)
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
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
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.
POINTS TO REMEMBER
- 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
- 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
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.