2021 HME Business Handbook: Sleep Therapy

Improving PAP Compliance with New Innovations

With 46% to 83% of OSA patients not complying with therapy, how can providers use new innovations to pinpoint and address the factors undermining their adherence?

Of the global population, one-seventh — approximately 1 billion people — are estimated to have obstructive sleep apnea (OSA). Over the past four decades, obesity, the main risk factor for OSA, has risen dramatically. Of the 25 million U.S. adults who suffer from moderate-to-severe obstructive sleep apnea, an estimated 10 million remain undiagnosed. Of those diagnosed with OSA, a significant proportion either do not initiate or eventually stop using their device.

Initial experience with positive airway pressure (PAP) therapy is important, reinforcing the need for early education and support in these patients. Most studies suggest PAP adherence is associated with better health, but, depending on the study, between 46 and 83 percent of patients with OSA do not adhere to treatment.

Insurance companies often remotely monitor patient compliance. Compliance is demonstrated by device usage greater than four hours per night at least 70 percent of the time in any 30-day period within the first three months of therapy, with reported health benefits and reduction in residual excessive daytime sleepiness. In the absence of minimum compliance and benefit, reimbursement and authorizations are denied to the equipment provider.


Findings from new studies emphasize the negative effects of sleep apnea on brain and heart health. A recent study demonstrated that patients with severe, untreated OSA had a significant increase in the prevalence of both fatal and nonfatal cardiac events. The risk factor was 2.87 times higher than norms. Patients with severe OSA who were treated with PAP therapy for greater than four hours per night had a significant drop in incidences of fatal or non-fatal cardiovascular events. These health risks can be reduced by effectively treating sleep apnea with PAP therapy.


The most frequently reported reason for discontinuing PAP therapy is side effects — skin irritations and rashes, nasal congestion, claustrophobia, facial breakages, conjunctivitis, and aerophagia — which are experienced by approximately two-thirds of PAP users.

The most common complaint is mask leaks. In a recent study, 75.4 percent of PAP patients reported leaks. Patients attempt to correct leaks by overadjusting the interface straps, leading to skin irritation and breakdown. To compensate for leaks, the PAP device increases flow rates, which reduces nasal humidity contributing to nasal irritation, dryness, and congestion. Leaking masks can cause ocular irritation and even induce conjunctivitis. Aerophagia, or swallowing of air, often results from increased PAP pressures.


Fitting masks properly without leaks can significantly improve results by lowering PAP pressures and thereby reduce aerophagia. Patients often modify their usual sleep position to make PAP therapy work for them. Minimalist masks are used to diminish claustrophobia. The use of a nasal mask or nasal pillow can reduce air leakage, require lower pressures to eliminate obstructive respiratory events, and are associated with improved sleep quality and better PAP therapy compliance.

Manufacturers continue to develop new innovations for PAP masks, including nasal pillows, nasal masks, full-face masks, and hybrids. New innovations in masks and comfort accessories redefine minimal contact to improve comfort, seals, and quietness. Some of these innovative solutions include cradle or foam cushions, liners, wraps, and securement accessories that eliminate headgear or support tubing.

A patient’s ability to acclimate to wearing a mask each night is the most important factor in achieving long-term success with PAP therapy. An uncomfortable or leaking mask means the user will struggle to incorporate it into their daily routine and may ultimately abandon therapy. When it comes to masks, comfort yields patient compliance, which also helps the bed partner who benefits from a quieter sleep environment.


  • Moderate-to-severe obstructive sleep apnea affects 25 million Americans, many of whom are undiagnosed. Of those who are diagnosed, 46 to 83 percent do not adhere to treatment.
  • The most common reasons for not complying with prescribed treatment is discomfort and irritation caused by the mask. In particular, leaks are the dominant complaint.
  • New innovations and advances in PAP interfaces that are lighter and minimize contact with the face should prove advantageous. They offer improved PAP efficacy and comfort while reducing side effects. Furthermore, innovative accessories are now available that improve patient comfort and reduce leaks.


To read more sleep therapy articles and features, visit HME-Business.com/sleep. To learn more about NozeSeal LLC’s sleep therapy solutions, visit www.nozeseal.com.

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

About the Author

Carol Gaskamp, CRT, RCP, is the Marketing Director and Consultant with NozeSeal LLC. She has more than 29 years’ experience treating sleep-disordered breathing in the HME industry. “The simple act of helping others achieve a great night’s sleep with increased health and wellness is my passion,” she says. Reach Gaskamp via email at [email protected].

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