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CPAP Compliance

Written by Elizabeth Rausch-Phung Staff Writer
Reviewed by Gerard Meskill Medical Reviewer
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Whether you’re just getting started using a continuous positive airway pressure (CPAP) machine or have been using one for a while, CPAP compliance is important to make sure you’re getting the most you can out of your sleep apnea treatment. If you don’t use your CPAP as often as your doctor recommends, then your symptoms may not improve or may return back to their original severity.

About half of all people who were prescribed CPAP machines use them for less than four hours per night, while the best evidence for reducing cardiovascular risk was demonstrated with 6+ hours per night. Some people who have difficulty tolerating CPAP therapy may feel more comfortable after making adjustments to their mask or to their machine settings. If you experience difficulties using a CPAP, talk with your doctor to find a solution that works for you.

What Is CPAP Compliance?

CPAP compliance is the number of hours per night and nights per week that an individual uses their CPAP machine. Some sleep experts also call CPAP compliance “CPAP adherence”.

Most CPAP machines measure the amount of time that they are on and that an individual wears the mask, but some older machines only measure how long the machine is on. These older machines may overestimate CPAP compliance. For example, if a person takes off their mask but leaves the machine running, an older machine may record that time as CPAP compliance.

Most insurance companies in the United States consider people who use their CPAP machine for at least four hours per night and at least five nights per week to be compliant. However, studies have found that people who used their CPAP for more hours had greater improvements in their sleep apnea symptoms and risk factors. Talk to your doctor about how much you should use your CPAP.

Why CPAP Compliance Matters

CPAP compliance is important because when people with sleep apnea use their CPAP machine for more hours, they receive more improvements to their health and symptoms. Studies have found many benefits to CPAP compliance:

  • Less daytime sleepiness
  • Improved memory
  • Higher quality of life
  • Improved daily functioning
  • Lower blood pressure
  • Fewer motor vehicle accidents

Early CPAP compliance is important for long-term treatment success. People who routinely use their CPAP machine as recommended during their first three months of treatment are more likely to still be using their CPAP machine over the coming years. 

However, this does not mean that you should give up if you were not successful in your first three months. “Many times non-compliant CPAP stems from one or more treatment variables being wrong, rather than from lack of will power,” explains Dr. Gerard Meskill. “The initial pressure at the beginning of the night, the pressure range throughout the night, the mask type and fit, the humidifier settings, and the exhalation relief setting can all impact a patient's ability to tolerate CPAP therapy. These devices aren't just plug and play, and you cannot ‘just get used to it' if the settings are incorrect. Patients should seek a sleep specialist who is experienced in managing all of these variables.” Talk to your doctor early if you have any discomfort or side effects while using your CPAP machine. 

People whose symptoms do improve while using a CPAP machine may notice that their symptoms return soon after they stop or reduce CPAP use. Research has found that reducing CPAP use is linked to an increased apnea-hypopnea index (slowing or stopping breathing during sleep), more daytime sleepiness, and higher blood pressure and pulse rate.

Understanding a CPAP Compliance Report

Most CPAP machines can create reports with information on CPAP compliance, effectiveness, and air leaks, as well as more detailed reports with additional information. These reports can be downloaded using Wi-Fi, modem, or a digital data card. 

Most doctors check over CPAP reports every few weeks to months while you get used to using a CPAP machine. Once you are using your CPAP machine regularly, your doctor will probably check your CPAP machine reports at least once a year, and any time you have new or different symptoms related to sleep apnea. Since many newer devices are accessible remotely, this means it’s possible for you to contact your doctor's office with a specific complaint (e.g., the pressure feels too high). The doctor can log into the machine, look at the detailed data, and make a change to your device – all without you having to bring the device to the office.

The CPAP compliance report will show a graph, table, or both showing the number of days and hours you used the CPAP machine over a particular period of time. The report may contain additional information, such as the average number of hours the CPAP machine was used per night, or the percentage of nights during which it was used for four or more hours.

If the report shows that you are using the CPAP machine less than 4+ hours per night for at least 70% of nights, then your doctor may recommend changes to improve your compliance. However, your doctor may recommend you increase your CPAP use even if you meet these targets, particularly if your symptoms don’t improve after starting CPAP therapy.

Dr. Meskill explains, “If you sleep 8 hours per night, then using the machine for 4 hours per night for 70% of nights is only using the machine for 35% of your total sleep! That may meet the Medicare compliance definition, but it still leaves 65% of your sleep untreated. The goal should be to use it every time you sleep, if possible.”

How to Adjust to CPAP Therapy

It’s okay if you aren’t able to wear your CPAP machine all night on your first night using it. Most people adjust to CPAP therapy within their first two weeks to three months. However, it’s important to talk to your doctor as soon as possible if you have any difficulties with CPAP therapy. Your doctor can help you troubleshoot CPAP problems, such as:

  • Adjusting the pressure if it’s uncomfortable
  • Refitting or changing the mask if it is painful or causes dry eye or claustrophobia
  • Warming and humidifying the air if it irritates your nose
  • Adding a chin strap if you have air leaks
  • Allergy testing or decongestant nasal spray if you have a stuffy nose

In addition, your doctor may also recommend you attend one or two group sessions with other people who use CPAP therapy and get check-in phone calls. These sessions and calls can help you to feel more confident and better meet your goals.

Tips for Using a CPAP Machine

Experts recommend tips that people who use CPAP machines can try at home to improve their CPAP compliance:

  • Ask your bed partner or roommate, if any, to support and encourage your CPAP therapy
  • Adjust mask straps if they feel too tight or too loose
  • Use your CPAP for brief periods during the day to help you get used to it
  • Slowly increase the length of time you use your CPAP until you meet your goals

Still have questions?

Sleep apnea products can be confusing. If you need individualized assistance, send us an email at [email protected] with your questions and we'll help find the best fit for you.

Written by

Elizabeth Rausch-Phung, Staff Writer

Dr. Rausch-Phung is a board-certified preventive medicine physician and a freelance medical writer specializing in health, wellness, and prevention with a passion for health communication.

Reviewed by

Gerard Meskill, Medical Reviewer

Gerard J. Meskill, MD is board certified in both neurology and sleep medicine, and he is the founder and CEO of Tricoastal Narcolepsy and Sleep Disorders Center. The “Tricoastal” moniker references his background: he completed neurology residency on the East Coast at Long Island Jewish Medical Center – where he served as chief resident, sleep fellowship on the West Coast at Stanford University, and he now practices sleep medicine and neurology on the Gulf Coast in the greater Houston, Texas area.