LAST CHANCE: 20% off Home Sleep Tests When you buy through our links, we may earn a commission. Products or services may be offered by an affiliated entity. Learn more.
What Is CPAP Compliance?
- CPAP compliance refers to how regularly you use your CPAP machine. It’s often determined by how often you meet the 4-hour rule: using your CPAP machine at least 4 hours a night, at least 70% of the time within a 30-day period.
- Consistent CPAP usage can provide short-term benefits for sleep apnea symptoms along with long term health improvements. Reporting CPAP compliance can also ensure that your insurance continues paying for all or some of the costs.
- Your CPAP machine automatically tracks usage data that doctors review to assess compliance and treatment effectiveness.
If you’ve been prescribed a CPAP machine for sleep apnea, you’ve likely heard your doctor mention “CPAP compliance.” While it sounds formal, the concept is simple: it refers to how consistently you use your CPAP machine as prescribed.
We’ll explain how CPAP compliance is measured, why it’s important for both your health and insurance coverage, and how it’s monitored. We’ll also share some easy tips for improving your CPAP compliance.
Exploring CPAP Machines — But Haven’t Been Tested Yet?
Start with our easy, at-home sleep test. It’s stress-free and effective. Get results within a few days.
What Is CPAP Compliance?
CPAP compliance is measured by monitoring the number of times and total hours people use their CPAP machine. While the ultimate goal is for patients to follow their exact prescription, insurance companies typically define compliance by the 4-hour rule: using your CPAP machine at least 4 hours a night, at least 70% of the time within a 30-day period.
In practice, the 4-hour rule means using your CPAP machine for at least four hours a night for five nights a week or more. (This can also measure out to around 21 days out of the 30-day period.) Unfortunately, nearly half of people prescribed a CPAP machine use their device for less than four hours each night. Even in those who previously had good CPAP compliance, symptoms of obstructive sleep apnea (OSA) can return after just one or two nights of insufficient use.
Why Is CPAP Compliance Important?
CPAP compliance is important for both your health and your wallet. Using your CPAP machine consistently can ensure that you get all of the long- and short-term health benefits. It can also help assure that your insurance continues to cover your equipment and supplies.
Getting the Benefits of CPAP
Compliance is vital to obtaining the to obtaining the full benefits of CPAP therapy. Without sufficient treatment, disruptions in breathing from OSA can lead to drops in your blood oxygen level and interruptions in sleep. Both factors can cause uncomfortable symptoms and a wide range of long-term health risks.
Consistent use of a CPAP machine can help reduce the frequency of breathing disruptions and may alleviate some or all symptoms of OSA. Studies show that good CPAP compliance can improve a person’s quality of life and helps them:
- Sleep better
- Feel less tired and more awake during the day
- Function better at work
- Have lower blood pressure
Insurance Coverage
Health insurance companies often require that doctors monitor CPAP compliance. Medicare, for example, will discontinue coverage at 90 days if you don’t meet compliance requirements. These requirements typically follow the 4-hour rule. Private insurance companies usually follow similar requirements, though the specific guidelines may vary by plan.
How Is CPAP Compliance Determined?
CPAP machines measure compliance by recording how often a person uses their machine. While CPAP machines usually monitor both how long the device is turned on and how long a person is wearing their CPAP mask, only time spent with the mask on is used to calculate CPAP compliance.
Information about CPAP compliance is stored on the CPAP machine and can be downloaded by a doctor or another healthcare provider. Doctors can use information stored on a CPAP machine to monitor compliance, assess the effectiveness of treatment, and determine whether any changes in treatment are needed.
Doctors commonly review this data during the first 30 days of CPAP therapy to determine if the device is being used consistently. After the first 30 days, doctors may review CPAP data at least once every year or when there is a change in a person’s symptoms.
CPAP Compliance Report
When your doctor accesses the data from your CPAP machine, they often generate a compliance report that shows your usage patterns and treatment effectiveness over a specific time period. This report can include factors such as how many days you used your device, how many hours per night you used it, and what percentage of nights you met the 4-hour threshold.
Some reports may also include additional information such as mask leak rates, remaining apnea-hypopnea index (AHI), and pressure settings. Your doctor can use this data to determine whether you’re meeting insurance compliance requirements and whether your therapy is effectively treating your sleep apnea.
How Do You Improve CPAP Compliance?
While four hours of use at least five nights a week meets the minimum standard for insurance, research suggests that nightly use for longer periods of time are associated with increased health benefits. For this reason, many new and long-term CPAP users seek out ways to continually improve their CPAP compliance:
- Start slowly: New CPAP users may find it helpful to use their CPAP machine only a few hours during the first night, then gradually increase the time they use the device over the next several days. Some machines also have a ramp up setting, which will gradually increase pressure throughout the night.
- Practice during the day: Wearing the CPAP mask for 15-30 minutes during the day can help you acclimate to the feel of the mask when there is no pressure to sleep. Watching TV, using a computer, or reading can be helpful for distraction during these practice sessions. If the air pressure is not applied, the mask should be disconnected from the CPAP tubing.
- Talk to loved ones: It may help to ask bedpartners, roommates, and family members for support. Loved ones can also provide reminders to use the CPAP machine consistently every night.
- Schedule check-ins: Regular follow-ups with a doctor are an important way to monitor for challenges, side effects, or changes in CPAP compliance. Doctors can make sure that the CPAP mask fits well and recommend ways to make using a CPAP machine more comfortable.
- Seek out support: A doctor may also be able to recommend a health professional experienced with CPAP therapy or a support group for people adjusting to treatment.
Studies have shown that people who develop good CPAP compliance within the first few months are more likely to continue using their device long term, so it is important to address challenges early.
If poor compliance is due to discomfort or side effects, doctors can recommend a variety of strategies, including trying a new mask, adding heated humidification, and adjusting the machine’s ramp feature to gradually increase pressure as the user falls asleep.
Still have questions? Ask our community!
Join our Sleep Care Community — a trusted hub of product specialists, sleep health professionals, and people just like you. Whether you’re searching for the perfect mattress or need expert sleep advice, we’ve got you covered. Get personalized guidance from the experts who know sleep best.
Jay Vera Summer is a writer, editor, and wellness coach. She holds a Bachelor's of Science in psychology and Master's degrees in both writing and public policy.
Audrey Wells, MD attended University of Michigan Medical School and went on to train at Washington University School of Medicine in pediatrics and pediatric pulmonary medicine. It was during this time that she developed a specific interest in adult and pediatric sleep medicine. She returned to her home state of New Mexico to complete a sleep medicine fellowship.
References
2 Sources
-
Das, A. (13 July, 2023). Downloading data from positive airway pressure devices in adults. In N. Collop (Ed.). UptoDate.
https://www.uptodate.com/contents/downloading-data-from-positive-airway-pressure-devices-in-adults -
Weaver, T. E. (2021, September 28). Assessing and managing nonadherence with continuous positive airway pressure (CPAP) for adults with obstructive sleep apnea. In N. Collop (Ed.). UpToDate.
https://www.uptodate.com/contents/assessing-and-managing-nonadherence-with-continuous-positive-airway-pressure-cpap-for-adults-with-obstructive-sleep-apnea
