Sleep Apnea CPAP Compliance Craziness

November 10, 2009

One of my biggest pet peeves is how doctors use the word compliance. If a patient doesn’t comply, it usually implies it was the patient’s fault. In sleep medicine, compliance is often used to measure how well patients use their CPAP machines. But compliance is not the same thing as success.


Various studies report CPAP compliance rates at 29% to 83%. The problem is that the definition of compliance changes from study to study. More recently, we’ve adopted the new Medicare requirement for CPAP compliance, which requires that the patients use CPAP at least 70% of the time over a 30 day period, for at least 4 hours every night. Otherwise, the machine has to be returned.


If you sleep 7 hours every night, it comes to 210 total number of hours per 30 days that you’re sleeping. Seventy percent of 210 hours is 147 hours. If you sleep only 4 hours every night, then this figure drops to 88 hours, which means that you have to use your CPAP machine only 40% of the total time that you’re sleeping to be considered "compliant." This doesn’t take into consideration if you’re actually feeling better or if the machine is being used effectively. 


Since CPAP works only if you’re using it, if only 40% of people are still using CPAP regularly 5 years after beginning treatment, then the CPAP success rate is at best 40%. But not all people who use CPAP will benefit, so this figure is likely to be much lower. Many more people are likely to stop using CPAP as the years go by. 


There are many patients that are 100% compliant with CPAP, using their machines 100% of the time they are sleeping, with no leaks and a low AHI, and still feel no better. Sometimes they can even feel worse than when they don’t use CPAP.


From what I’ve seen with CPAP compliance studies or even with sleep apnea surgery studies, they all manipulate the numbers to make their results look great. In very tightly controlled research studies with frequent follow-up and intensive intervention, results are likely to be good. But in the real world, with fragmentation of care, poor follow-up and lack of patient education, true success (the patient feels much better AND the numbers show it) is disappointingly low, no matter which option you choose. 


Despite all these obstacles, there are proven ways to improve CPAP success. With a systematic and formalized education program, along  with intense counseling, follow-up, and long-term support, many more people can benefit from CPAP. Ultimately, a major part of poor CPAP compliance is due to the health care system that’s dropping the ball.


Am I being realistic or too pessimistic? Let me know what you think of this issue in the comments box below.

36 Responses to “Sleep Apnea CPAP Compliance Craziness”

  1. Sara on November 11th, 2009 2:34 am

    This response relates to CPAP treatment for UARS…

    CPAP treatment puzzles me on many levels. I “failed” at CPAP despite working up to a compliance level that thrilled my practitioner. The failure was due to the fact that I never felt better with CPAP use; in fact, I felt worse. I felt like my sleep was more interrupted by the machine, leaks, having something on my face (I am a bit claustrophobic), being “forced” to sleep on my back, getting “rained” on, etc. Eventually, I was avoiding going to bed either because I hated using the machine so much, or because I felt guilty if I did not sleep with it. I know I sound whiny, but I am not a whiny person. I am a health care provider, and typically, I am a compliant patient with a high level of tolerance and adaptability. I was exhausted after years of sleep disruption, so I was highly motivated to do something to feel better. Andy yet, I was feeling worse, so what was the motivation to use the CPAP, and is it really working if that is the case? I did have decent CPAP support when I sought it out, but that did not change the fact that I never saw any improvement. Since the CPAP treatment failed, my diagnosis was altered to include a secondary diagnosis of idiopathic hypersomnia. I was put on Provigil which made me feel great at first, and then the panic attacks set in (and as I reminded my practitioner, the Provigil was just a mask, as my body was still getting beat up by my sleep disordered breathing).

    As a result of “failing” the CPAP, I switched to a mandibular advancement device. I noted significant improvement from day one, as it allowed my tongue to clear my airway. It has changed my life. I won’t go to bed without it, resulting in 100% compliance.

    So, was CPAP the proper treatment? I was always puzzled that the CPAP treatment encouraged sleeping in supine due to the nature of having so much stuff on the face, putting me in the position that theoretically requires more intervention from the machine due to tongue collapse? I was already arousing 29 times an hour all night long and now I am supposed to sleep with this mask and hose and forced air on my claustrophobic face? It really does not make sense to me. I lost another 9 months with the CPAP. My husband has been struggling with the CPAP for 5 months with the same results; his MAD is bogged down in insurance denials/appeals.

    I have followed the blogs on SleepGuide, and I am pained by the number of people who diligently comply with significant effort and report that it took many months to feel better or still do not appreciate much improvement. And yet they battle on.

    If CPAP does not result in a patient feeling better, is it really doing the job? How long is it appropriate for a patient to use the CPAP if they are not feeling better? I was my own advocate for pursuing the MAD; none of my sleep practitioners encouraged it (an ENT did). I had become armed with knowledge through your book, Sleep Interrupted. My heart aches for those patients who don’t know the ins and outs of the healthcare world and are unable to advocate effectively for themselves (mostly because they are so exhausted and vulnerable).

    I would love to see a study that evaluates those who benefit from the MAD versus CPAP and those who benefit from CPAP versus the MAD.

    I agree 100% that education and good support would be critical in facilitating compliance. CPAP is not a simple thing.

  2. Steven Park on November 11th, 2009 4:15 am


    Thanks for your thoughtful comments. You’re absolutely right. At what point do you give up on CPAP and go on to other options? It’s clear from your story and many others I’ve seen that for some people, CPAP just doesn’t work, no matter how long you use it, even with 100% compliance. I’ve have patients with compliance data reporting optimal usage, with no leaks and a minimal AHI, and patients still don’t feel better. Some go on to dental devices and do well, and some don’t. Others try everything and only surgery is able to help them sleep better.

    You do hear about patients struggling with CPAP for 6 to 12 months and finally feeling better, but that’s rare. The vast majority just give up and get lost to follow-up. It sounds like you exhausted all your CPAP options and made the appropriate choice.

    My theory about why CPAP doesn’t help in some people is that the CPAP itself causes more arousals. In general, people with mild obstructive sleep apnea or upper airway resistance syndrome have hyperarousable nervous systems.

    I’m so glad that you didn’t give up and took the initiative to go for the oral appliance. It just goes to show that with sleep apnea, there’s no one best treatment choice. You won’t know until you try different options.

  3. Julie on February 11th, 2010 9:41 am

    Some people who are use their CPAP but feel worse than they do without may suffer from complex sleep disordered breathing where mixed obstructive & central events are seen during the CPAP titration study.  Usually, the obstructive events start resolving w/increasing CPAP pressure then the centrals appear.  I believe this was first identified at Mayo Clinic, Rochester, MN.  There are advanced BiPAP machines designed to deal w/complex sleep disordered breathing & we have had patients successful w/them.  If a patient is not tolerating CPAP, it may be beneficial to see a sleep specialist.

  4. Drew Devlin on July 19th, 2010 5:53 pm

    i would have to agree completely with Julie on her post. All to often the patient goes to the Sleep Lab for all the right reasons, diagnosised with OSA, during the titration portion they dont notice that although they have removed the Obstructive component, they have now over pressurized the patient causing what i beleive to be Central apneas.
    Although there is no significant data to show that APAP is more beneficial to the patient or does a better job, i do beleive it does make the patient more comfortable, less likely to have have leaks, there by allowing the AHI to increase.
    With the newer technologies available, even if a patient uses the unit 100 per cent of the time does not mean they are compliant due to the air leaks.
    further follow up and review of the technical portion of the machine needs to be investigated.
    I also agree that the BI Level maybe an alternative to these patients that continue to have arousals. the pressure of CPAP is usually only needed to over come the resistance of the obstruction and that during the expiratory phase the patient has an increased arousal due to the difficulties of exhaling against the significant pressure.
    the ASV unit has show to be very significant in the treatment of patients with central sleep apnea and should be considered more frequently

  5. Nalani Santiago-Kalmanson, RPSGT on November 29th, 2010 10:43 am

    As a patient myself, first, and professional second, I must bring up my own experience with sleep disorder diagnostics. There are approximately 77 named sleep disorders, most of which all have overlapping symptoms. It is far more probable that someone has multiple sleep disorders than not. This could be one reason that CPAP users find little to no relief in their symptoms even at 100% compliance. This was certainly the case for me.

    I was diagnosed with Moderate OSA, AHI was 27. Started PAP therapy and had zero relief of symptoms. Since the DME company, or my physician, never followed up with me to see how I was doing… after 2 months suffering on CPAP & losing my job (hence lost insurance), I gave up & stopped using it entirely.

    4 years later I had a complete breakdown, released from my job & was told I had some severe Personality Disorders. I knew they were wrong. My new MD was smart & kind enough to listen to me & worked with me to figure it all out. Ends up – I have narcolepsy with cataplexy… and all the signs & symptoms were there at my 1st study 4yrs earlier. Another round of intensive psych testing, after starting treatment for both OSA & narcolepsy, showed no signs of Personality Disorder… I’d simply been extremely sleep deprived.

    I tell every patient I set up with CPAP that if they feel little to no improvement while using PAP therapy after nightly use for 1 month – to call me & or their sleep specialist immediately – but do not stop using CPAP until told by their MD to discontinue. I let them know it’s possible to have more than 1 sleep disorder & the only way to test for more – is to know that the 1st one is treated, without doubt. And most importantly, I assure them that I am on their side to help guide them through this process – their friend, coach, cheerleader or drill sergeant – whatever they need to keep up with treatment, and then I stand by that statement. Basically – I am for my patients, what I wished someone had been for me.

  6. Benefits of Sleep Apnea Dental Appliances: The Main Pros and Cons | Apnea Treatment Center on June 16th, 2011 2:08 pm

    […] its popularity and high success rate, though, there are still thousands of sleep apnea patients who remain dissatisfied with CPAP therapy and are happier when their doctors recommend dental appliances for getting relief from apnea […]

  7. Cat on February 28th, 2012 9:50 am

    I have been using the cpap machine for over a year. I’m being forced to use it to keep my job. Being a truck driver I have to have 70% compliance on the cpap or I am not allowed to drive. The difficulty I have is I am exhausted after wearing the mask. I get so tired I have to nap during the day, without my mask, and after that two hours I feel so much better! Drivers that are regulated by DOT standards and diagnosed with sleep apnea must meet the compliance of 70% or will be denied a physical card that is required to drive. I am more of a danger now I’m so tired and more cranky, definite mood changes. After reading this article I’m hopeful I can find something to help me.

  8. Eric Bloniarz on April 24th, 2012 3:27 pm

    I have set up hundreds of patients on PAP and currently use Auto Bipap. It took me years to get “compliant”, but I didn’t give up. Maybe it’s because I am in the Home Health Care industry, have access to various supplies and I am a RT. There are many factors that contribute to compliance; patient willingness to accept therapy is first, comfort, and the correct therapy for the patient. Does the patient have complex apnea, what medications is the patient using, what other issues (depression, pain, etc.) is the patient experiencing? Education and follow up are critical. CPAP is tried, proven and safe therapy, but Auto-CPAP, Bipap, Servo Ventilation, Auto-Bipap are alternatives in treating noncompliant CPAP patients. If patients are not “feeling better” from their therapy, did they need it in the first place? I do believe that people that have sleep disorders that are treated with PAP can feel better, but are all the factors being considered? Sure, we can keep your airway open, keep you from desaturating, but if your in pain and having arousals, PAP doesn’t treat that! We need to consider all factors and not just discount the lack of feeling better as the responsibility of PAP therapy.

  9. Wilson L. Hardy on May 15th, 2012 10:01 am

    I have been introduced to the world of Sleep Anpea and my employeer is using it to force me out of the company . i’m not sleepy on the job or tired either but the occupational health department of my company is using it to get rid of alot of workers. now , i have taken every test they have asked me to take and my last test they wanted was a MWT(Wakeful of maintenance test) i passed the test and i feel fine after use of cpap machine doesn’t feel any different than before but i’m trying to keep my life in balance due to the pressure of keeping my job. my doctors have approved me for work and occupational health department of my company has denied it everytime. This problem started for me after i found out i had lead poisoning and no one can give me a answer on how lead effects the patterns of sleep ? Why is sleep apnea being use to hurt employee’s instead of help them ?

  10. Kate on July 17th, 2012 5:46 pm

    About 8 years ago, my physician had me do a sleep study because of my fatigue and difficulty losing weight. I was told I had obstructive sleep apnea, and then I had to come back for a second sleep study with a CPAP machine. It was the most miserable, exhausting night of my life. I couldn’t exhale against the pressure, and if I tried to breath through my mouth the air forced down my throat made me cough and choke. The headgear had to be cinched so tight to get a seal that I had a splitting headache the entire night, which took days to get rid of. I slept only about 30 minutes the entire night. After fighting for every breath the entire night, when I got up I was so exhausted I could barely walk. Even so, the clinic staff bullied me into ordering a CPAP machine before they’d let me leave. After a fruitless day at work (I couldn’t think, remember, or follow conversations), I finally got a decent night’s sleep in my own bed. The first thing I did in the morning was call the health equipment company and cancel the CPAP order. The sales person harassed me for days after that, calling me every day and implying that I was being a baby for not wanting to “give it a good try.” Before seeing the pulmonologist again, I did my research. I told him that I knew there were alternatives to CPAP and I was not going to live in torment every night. I had to be really persistent, but he finally referred me to an ear, nose and throat specialist. The ENT physician prescribed an oral positioning device, which is very comfortable AND effective. I use it all night, every night. I sleep just fine and have no fatigue or sleepiness during the day. I’m 100% positive that if I had caved in and bought the CPAP machine, it would be gathering dust in a closet and I wouldn’t have any treatment at all.

    Because of insurance, I’ve had to give up my really great primary care physician and have started seeing someone new. He’s obsessed with CPAPs and is badgering me to go through another sleep study and buy a machine. Any advice, beyond “just say no”?

  11. Tammy on October 31st, 2012 4:11 pm

    I am a registered sleep technologist and this is in response to Katie. Katie, you obviously were treated by inexperienced poor technologists. Your inability to reathe against the machine indicated the need to Bi-Level therapy, not CPAP. Your mask should not have been anchored to your head. A mask and headgear are to be worn comfortably. A small leak is normal with the mask. If a mask is too tight a patient will experience a headach, pressures sores, etc. This is a primary reason for poor CPAP compliance. I am also a Respiratory Therapist and this is why Ohio mandates that a Respiratory Therapist also be on staff if a Sleep Center is to treat Medicare patients. We understand pulmonary disorders. I hope you do not give up on improving your quality of sleep and treating your sleep apnea, as I can assure you that it will only worsen and the conditions resulting from OSA include: high blood pressure, stroke, and diabetes.

  12. Bobby on March 9th, 2013 10:59 pm

    CDL Requirements are getting tougher and tougher as new tech becomes available No other profession has to go through this even doctors are not required to do drug testing. the government picks on the dirt farmer because they know we do not have the resource to fight them. The use comments is for the kids, for homeland security, public safety or it’s only temp to get things through. Energy kills it doesn’t matter if it’s from a M16 or AK47 they both do damage. A small car can also do damage and they should have the same requirement as CDL’s do for the state to receive Federal Highway and Transportation Funding. We can say it’s for the budget and fairness! My experience with Sleep Apnea doctors are using snoring and anything else they can to call it Sleep Apnea. The guidelines are strict about what is Sleep Apnea which is Hypopnea or Obstructive not snoring! Get your doctor to show you the Standards of what is SLEEP APENA and challenge his claims! I would not hurt to write yearly your congress and senate enough is enough and we want passenger cars to have the same standards to receive federal money

  13. David vasko on March 15th, 2013 10:38 pm

    I.m a safety nut truck driver with 27 years of driving over the road with not one ticket or accident.My DR. gave me a sleep study and now I,m forced to use the cpap or lose my CDL.Now I,m very sick cant stay awake driving and loads are late for the first time.I never had problems with my driving until using cpap.Truck drivers unite quicker and stronger than anybody and we can bring this country to a complete halt if we are pushed.Truck drivers have it hard out there not everyone can do it and make a living please stop the madness.We have a problem its called DOT. REG. overload.Back off and let us feed are families or the brethren will unite and fix this problem the hard way.

  14. Phil Fortin on March 20th, 2013 3:25 am

    On my dot physical renewal they measured my neck at 18 inches so I was told to do a sleep test. So I had one done and they said I had apnea when I sleep on my back and said I needed a caps machine. Got it but I ask for a compliance form from then they refused because they didn’t want to be liable should something happen. So I have to start the process all over again with some one else. Back for another physical for a two month card now my neck is 17 inches. This was all a mistaken measurement in the first place. With 4.3 millions safe miles behind me I’m now in a position were I could loose my job. I’m not tired I sleep great and am the best driver I have ever been. This apnea thing was never an issue before and now it’s a tool to ruin livelihoods . Truck driving is relitivly simple . When your hungry eat something and when your tired take a nap! I don’t need a doctor to tell me that! It’s all a sham.

  15. John on March 27th, 2013 7:14 pm

    I am a psychologist who has specialized training in sleep medicine for insomnia. I work in a neurology practice and my friend is a sleep specialist who did my PSG and I ended up having a AHI of 38 (severe OSA) and was prescribed CPAP. My wife had been telling me for years I snored like a freight train and I guess I was just in denial, being old and fat and all. In any case, I have had CPAP for about 4 months. I hate it. The mask breaks out my skin, there are leaks, I have insomnia using it. I don’t feel better in fact my EDS is worse. I am going to contact my vendor about bpap or another titration but suspect CPAP is not for me. I’m not trying cpap it because I have that much EDS, despite my AHI score. But, I’m not a fool and when I desaturate to 80 during REM, I know I am a heart attack just waiting to happen. I had never seen myself as a non-compliant patient, but cpap sux! If the surgery had good outcome data, I would do that in a heartbeat after my experience with CPAP. But, the one year outcomes are abysmal. I’ll keep you posted.

  16. Linda on April 24th, 2013 2:09 pm

    Don’t know about anyone else but I’ve been totally put off by my insurance not covering the CPAP machine. I have severe apnea and was prescribed the CPAP machine, I understood I would have to be 100% compliant in order for the insurance to pay for the machine. I mailed in a data chip after 3 months so my insurance company could see I was compliant. Even after that they would not pay for the machine. I was told I needed to rent it for 10 months! Of course come Jan 1st insurance doesn’t pay anything on it till I pay my $500 deductible. So in the end I will be paying over $1500. out of pocket for a machine that costs $650. cash. Had I known I would have bought the thing outright back in August when I was diagnosed. Did anyone else have to wait 10 months?

  17. Roy Ijams on May 11th, 2013 12:54 am

    Dr Park I hope you can help those of us that get sick from cpap. Your openness to a slide of hand in making the numbers look good is refreshing. I lost my job and have been told to find other employment. Over 2 million miles safe driving. Now I can’t even be a passenger.

    cpap chemoreceptor air embolism seizure sleepwalk hypoxia

    Post by the scrooge » Mon Oct 29, 2012 10:29 pm
    10/1/12 after trying to sleep all night on cpap I didn’t feel right. Numbness in head like brain fog. Laid down without cpap to clear my head. When I woke up emt’s were at the house try’n to draw blood from me. I Had a seizure which lasted 40min’s. Lost bladder control the tip of my tongue still hurts from biting it. Now I’m unemployed. 6/8/12 I sleepwalked out of semi. My wife and grand daughter yelling at me. I woke up on side of road. Police arrived by to time I was responsive. My wife was driving about 60 and thought I might be just going to check the door. I’ve Never sleep walked before and never had a seizure before using cpap device. Hospital bills and no job. Had frac pelvic frac 3 ribs crushed rt wrist concussion and road rash from 6/8/12 roll down the road. Have found case in GA where 50 investors were scammed by man who said he had a PhD and needed funding for sleep centers. The indictment seeks at least 4 million dollars also 2008 Land Rover. Wire fraud charges carry 20 years in prison. And Dachman charged with 11 counts wire fraud. was a front page story on the Tribune in Oct. I think in 2011. I did not look it up on tribune. I’ve also read they have put newborns on cpap, Cpap industry plans to make billions. Have copy of man who died on cpap during sleep study. Best study I’ve found says people with apnea over age 50 stand better chance of surviving a heart attack. Than those that were on cpap before age 50. Because the body makes more veins around heart to supply oxygen to heart on person with apnea. Person using cpap before age 50 the body doesn’t build the extra veins and has lessor chance of surviving a heart attack. Another report person used cpap 4 yrs had excess air leaking in body changing skin color. It’s grand some people get better sleep. It is not a cure all. It is a money making industry. And people world wide will be put on these devices. I have other posts under the scrooge on site. Have been told I’ll never drive. Now on seizure meds. Last seizure 4/14/13.

  18. Tod Merley on July 18th, 2013 1:57 am

    I think I would call you guardedly optimistic.

    When I can find long term (more than a year) objective (uses data from the machines rather than what the person “remembers”) data it very much looks like actual use of CPAP for more than four hours a night continuing past the one year mark is what most people do not do. Indeed, it seems to be considerably under the 50% mark moving much too close to the 20% or so “placebo effect” rates.

    For most CPAP does not work and for even more it does not work well.

    As long as the medical community has the oppressive attitudes and ways that lead to it’s choice of oppressive terms (e.g. compliance, adherence) rather than dealing with how useable a therapy actually is they will be useless to make the therapy work.

  19. debbie on September 30th, 2013 3:59 pm

    iam going through weight surgery part of the requrements is a sleep test. i was diagnosed with sleep apnea. now i have a cpap job found out and will not let me work with out a complance report.and my cdl is on medical hold.i have not been able to use cpap machine.more than 20 a time i get very claustrophobic and start to panic. what can i do???.

  20. Mike Eacott on January 11th, 2014 4:26 am

    Please do not take the following as a criticism of how my NHS Trust hospital delivers its care for my Obstructive Sleep Apnoea Syndrome. Take what I have written below as some Lessons Learned.
    I have always been and still am very satisfied with the in-patient, out-patient and all other care that has been provided to me.

    These are my observations of the APAP treatment I have undertaking for Obstructive Sleep Apnoea Syndrome for the first 40 days.
    I am 72 years old, had always slept on my back, have a moderate overbite and have had operations twice for a deflected septum and am a “mouth breather”. I snore and was diagnosed after wearing an oximeter overnight as having some 30 sleep apnoea episodes per hour.
    The NHS gave me a ResMed S9 Autoset APAP device and a full face mask 40 days ago.
    I slept on my back for the first two nights. The results after a restless and uncomfortable night showed complete loss of respiratory control with a frighteningly large number of Obstructive and Central aponeas.
    For the rest of the 40 nights I started sleeping on my side wearing a backpack that contained two tightly rolled and taped hand towels to fill the backpack as an attempt to stop me rolling on my back.
    That has been quite successful although I still try to roll onto my back a few times per night when sleeping. At those times I am awoken by the APAP device increasing the air pressure to force open my airway obstruction.
    All nights except for the most recent ones have been uncomfortable, disturbed and shown Central aponeas and some Obstructive ones. Is has been difficult to stay asleep and in bed for more than five hours. The mask fit needs to be tighter than is comfortable so that air leaks are minimised. As such my face ends up a little bruised and one eyelid ends up “drooped” for a few hours in mornings. An unsurprising limitation of my APAP device is that it has a delayed response, certainly to Obstructive apnoeas , by increasing the air pressure and waking me up. After that I often do not fall asleep again or fall asleep after a rather long time.
    The APAP device recorded the details of my sleep for the first 30 days use. After that only summary recording were produced.
    I contend that daily feedback of the data that is recorded by the APAP device onto its SD card is helpful in getting the patient to determine how to change their sleeping environment to minimise aponeas. Currently that does not happen in my NHS Trust nor is feasible with what may be current NHS practice and respiratory professionals time. This should be feasible in the future through technology improvement and effective implementation of internet like information communication and remote computer systems produced analysis and feedback.

    In summary because I am a Physicist and have had a career as a Computer Systems Software professional have been able to monitor my progress on a daily basis and I can see that my night time respiration slowly has improved, Obstructives are rare and absent some nights, Centrals and Hypopnoeas have reduced significantly.
    Last night’s results show an AHI of 3.1 .

  21. PoppaDoc on March 23rd, 2014 5:13 am

    Realistically. I just started and I hate it.

  22. Tim Martin on May 4th, 2014 6:21 pm

    I have severe sleep apnea. I stop breathing as many as 55 times an hour. I’m lucky if I sleep more than three hours a night without awakening. I had a pulmonologist tell me that he didn’t know how I was upright. I suppose that I am the perfect candidate for the CPAP machine.
    I have been trying CPAP for almost seven years, with no success. I have little success in keeping the mask on. The nights I am able to sleep with the mask leave me feeling more spent than I do on the nights I go without the machine.
    In the meantime, my doctors are less than sympathetic. One told me to “Cowboy up”. The other thinks that I fail to comply because I am fearful or claustraphobic as she puts it.
    I’ve tried to explain that because the masks are uncomfortable, because they pond spittle, because they often leak, and because I have great difficulty breathing while wearing the mask (due to COPD and severe chronic asthma) I cannot tolerate the machine.
    Does anyone know of alternatives I can pursue?
    I honestly feel like I am dieing. I am so weak much of the time that I can barely cross the room. I am only 55 and way to young to be sitting in a recliner napping like an old man.

  23. Terry on June 8th, 2014 7:40 pm

    I started using CPAP in May…. the first night I used it I had it on for 9 hours.. when I got up, I felt dizzy, off balance, and as though I couldn’t breathe… I thought to myself what IS this thing doing to me?? now I don’t use it for anymore than 5 hours and I am alright now….Mine is an auto-CPAP machine as I asked for that as I think it is better than a set pressure…sometimes I think it is helping me, but I wouldn’t say I feel totally changed…. I will just have to wait and see.

  24. Mary on June 17th, 2014 7:33 am

    I have been watching my fiancé try to be compliant with his C PAP. I will say the thing is a complete failure.
    Symptoms are…
    Increased depression
    Thrashing and inconsistent sleep pattern
    Nose bleeds
    Sore throat
    Stomach bloating

    Before this infernal machine it took him 30 minutes max to fall asleep. He would sleep comfortably through.
    Now he falls off after about 2 1/2 hours(coughing and choking all that time). His sleep is seriously disturbed. So he ends up loosing sleep.

    The night of his in home study they said he had 20 episodes per hour in an 8 hour period. That night I watched him sleep, at best he may have had 20 episodes over one of those 8 hours. But I assure you NOT the whole 8. Yet it seems what they did was take the highest number and equate that for the whole sleep time. I only wish I had taken video of him during that night to have proof.

    His sleep Dr. said he most likely suffers more from shift workers disease. His original study was done against his “Normal” sleep pattern. His Dr. wants to do another study using his real time sleep pattern.

    I will agree that for a few this machine can be a great thing. For the majority it is not.

  25. dan sagen on November 5th, 2014 9:09 pm

    I need a cdl to do my job I have 36 years on the job with no accidents and no vehicle incidents. I have two traffic tickets on my driving record the last one was 17 years ago and both of those tickets were in my personal vehicle with no accidents. Last September I went in to take my dot physical the dot doc measured my neck and figured out my bmi then said by the new government regulations I had to do a sleep study. Well of course I was diagnosed with sleep apnea I asked the nurse while she was connecting up a thousand wires to my body what the percentage of people who take the studies actually have sleep apnea and she told me that she had been working there for the last 7 years that she only seen 2 people who didn’t have it! I have always slept just fine and could work through the day on 4 hours of sleep with no problem if I had to. I always looked forward to hopping in my nice warm comfy bed and getting a good nights sleep, Now after trying to sleep on a cpap for a month and a half I hate even walking in to my bedroom! I did however make compliance to keep my cdl I breath through the cpap for the required 4 hours a night and once in awhile I even sleep on it for a couple hours a too. I feel like crap! I am tired most days and just hate trying to walk in to my bedroom! I lay there and tell myself, self you need to get some sleep on this thing you need to wear it to keep your job your livelihood and self if you don’t do this your livelihood will end! Then just when I start to doze off ill hear a squeak for a leak or my nose will start itching and I need to itch it omg it is impossible to get a good nights sleep on this thing! We need to get together truckers we need to fight this bullshit!!!!!!!! Its a scam ! does anyone know of any organizations being started yet to fight this crap? If you do please email me at thanks and have a great day I would say night but that’s probably not going to happen if you are a cdl truck driver on a cpap lol thanks!

  26. Mary on November 6th, 2014 6:39 am

    I wish more professional drivers would unite with this. As you stated the response from the nurse it would seem to me EVERYONE who got behind the wheel of any motor vehicle should have to undergo a sleep test.

    In the case with my better half he had his original sleep study. The facility booked him for a follow up retest. his second (in lab) test showed what we already knew.
    He had 0 episodes in 6 hours and 3 over the whole 8 hours. However this test was done over month after original. By that time he was seriously sleep deprived. Going from sleeping 8-10 hours a night to less than 4. He would do the same as you wear the contraption for 4 hours (compliance) and then sleep the rest without it. Mind you the 4 hours he had it on was like watching him at battle, thrashing the whole time. He was concerned every time he got behind the wheel for his safety.

    The lack of set standards & guide lines leaves truck drivers at a disadvantage. Trucking companies have a wide range of thresholds. Compiled with the cost to the driver both financially and physically. Also the growing pop up sleep labs knowing this as a cash cow, it benefits them to fail you.

    There are ways to pass this, sleep in your side or stomach, use sinus spray before, don’t go into your test exhausted, we have a tendency to sleep harder at first that way and mostly it is the first 2-3 hours when they hook you up to the cpap.( I find that stupid. ) they should allow one to sleep the whole time to study the changes throughout.

    There are other ways as well, do some homework and demand a retest. If you have a primary Dr. go there and seek some advice and other options.

    Good Luck! Keep me posted.

  27. Tod Merley on November 6th, 2014 9:44 am

    Mary said:

    >>> I wish more professional drivers would unite with this. As you stated the response from the nurse it would seem to me EVERYONE who got behind the wheel of any motor vehicle should have to undergo a sleep test.<<>> In the case with my better half he had his original sleep study. The facility booked him for a follow up retest. his second (in lab) test showed what we already knew.
    He had 0 episodes in 6 hours and 3 over the whole 8 hours. However this test was done over month after original. By that time he was seriously sleep deprived. Going from sleeping 8-10 hours a night to less than 4. He would do the same as you wear the contraption for 4 hours (compliance) and then sleep the rest without it. Mind you the 4 hours he had it on was like watching him at battle, thrashing the whole time. He was concerned every time he got behind the wheel for his safety. <<<

    First of all how dare they call an in lab polysomnogram a valid way to measure how a person is actually sleeping in their day to day life!! We do not sleep in a lab. We do not sleep all wired up. The circumstances of the test often put such things as livelihood on the line and stress changes sleep in major ways. And as if that were not already much more than enough to invalidate the results of such a test it is only a one night “snapshot” of a process which is very much dynamic and simply changes night to night. I myself know this from years of following my air flow and other data.

    As one who for decades employed the “technology of the day” to facilitate broadcasting I do believe that the technology of this day is more than sufficient to facilitate bringing the entire polysomnogram into the home using self applied technology (remotely managed) wireless, comfortable, and checking many nights not a single night. This should have been done a decade ago. We need to change how we do sleep testing altogether!

    But even if they validly find actual consistent sleep apnea which should be treated – of those they attempt to treat perhaps 30% show long term improvement[1]. The thing is that there is more than simple obstruction in play. Arousal threshold, ventilatory gain, and tongue muscle tone at least are there as well[2]. CPAP is unlikely to treat a significant tongue muscle problem and tends to exacerbate both arousal threshold and ventilatory gain. I believe this is why so many find CPAP unusable. And why so many more find CPAP unusable long term. It only works for some.

    What we need to do is to demand that the medical community provide valid sleep testing procedures and proven effective treatments for this disease. Currently they do not.

    [1] Lo Bue et al. Usefulness of reinforcing interventions on continuous positive airway pressure compliance. BMC Pulmonary Medicine 2014, 14:78

    [2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman “Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets”, American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004.
    doi: 10.1164/rccm.201303-0448OC link:

  28. Bob on January 22nd, 2015 4:07 am

    I am just starting out on CPAP therapy. I have had trouble staying compliant. My therapist has fitted me with a full mask since I have a deviated septum. I simply cannot fall asleep with this thing unless I take a few too many sleeping pills.

    When I do fall asleep with it on, I awake to see I have torn it off my face.

    I have contacted my sleep therapist twice in the 4 weeks I have tried to do this, and each time he just emails me the Fisher&Paykel video of “How to correctly fit your mask”. He assures me I will get used to it.

    The fact of the matter is I’m not getting use to it, and have asked my therapist to consider other masks that I may be able to fall asleep while wearing. So far he has refused.

    I am unable to remain compliant and no amount of begging or pleading is getting the therapist to help me be compliant, which I’m pretty sure is what my insurance company and I are paying him for.

    It’s ridiculous that we can land on a comet in this day and age, but can’t come up with a CPAP device that averages over 25-30% compliance.

  29. Tarun on February 6th, 2015 5:02 am

    CPAP is the worst possible solution to OSA. I was diagnosed with OSA( as I complained of snoring heavily and was overweight)last month and had an AHI of 30 and was told by Doctors to use CPAP. Since then I lost a lot of weight and my snoring has stopped completely but CPAP triggered central apneas and hyperarousals in me which never existed prior to this diagnoses. I have stopped using CPAP and believe that unless you are old and or chronically obese, CPAP should not be offered at all as the first choice. Now I don’t snore at all and sleep better although the arousals (due to central apneas) still continue thanks to a month of CPAP use. The medical community has not studied the impact of pumping pressurised air in a person’s brain and neuro chemical response system which makes a common treatable problem like OSA much worse by triggering central apneas. They only prescribe this device as they get a cut from companies on every CPAP device sold. Weight loss and or surgery(where an airway abnormaity exists) and oral devices should be the first line of treatement for OSA.

  30. Mary on February 6th, 2015 4:47 pm

    In my investigating and own personal working experience. I have found that weight is not the only indicator of SA. In working at a sub acute rehab facility I have seen some of the thinnest people snore the paint off the walls and have SA in some form or another. On another note, one thing hospitals’ look for in newborn babies is episodes of apnea.
    Seems to me we are born with the probability of having apnea episodes. Our sleep is a varied as the weather, it all comes down to the kind of day we have. Doing the one night test is clearly flawed. At that it is not even a whole night. Once you start, say 1 or 2 hours in to sleep they hook you up. Hardly a study of any kind of pattern and more of an excuse to sell another machine. And if you are a truck driver, well then your future is tied to that machine regardless of its negative impact on your health.

  31. Steven Park on February 7th, 2015 8:01 am


    Thanks for sharing. You are right in saying that you don’t have to be overweight to have severe OSA. Since sleep apnea starts off as a craniofacial problem, it starts when you’re born.

  32. mike obrien on February 26th, 2015 1:35 pm


  33. Tod Merley on February 26th, 2015 4:31 pm

    Mike Obrien –

    I am sorry for your loss..

    I lost a career I loved. I lost a lot more. I am glad I did not do this loosing by planting my forty ton truck into say a couple of school buses filled with children!

    Dr. Park recommended “The Promise of Sleep” by William C. Dement, M.D., Ph.D. In that book the doctor relates that “AFTER OVER NIGHT SLEEP STUDIES FOR 200 LONG HAUL TRUCK DRIVERS – “well over 70% were diagnosed with sleep apnea and 13% had a very severe condition.”

    If you are able you are welcome to drive. If you are not able we have a right to live.

    I am sorry for your loss..

  34. Mary on February 26th, 2015 4:35 pm

    To the best of my knowledge there is no Federal Requirement. I understand it was a recommendation and from there it took off. In short, the term “LIABILITY” was thrown out and now…well it’s obvious more and more drivers are being forced to tie their livelihood to the compliance with the CPAP. Even to the detriment of their own health. I watched my better half deteriorate over the course of 7 weeks before he demanded another study. With that it was found he fell well within normal standards (normal being the optimal word here, what IS normal sleep anyway) In the trucking industry’s part in this, that just simply does not exist,

    Trucking companies vary in their own individual standards it ranges from 2 episodes to 15 per hr. during a sleep study. The one night study is clearly flawed.
    Also the trucking industry is huge and getting bigger.

    With the new “recommendation” we have pop up sleep labs with one thing in mind, to see that every person who crosses through those doors for a sleep test will leave with a purchase. The stories I have been told is unbelievable. Drivers have told me they were given sleep medication, forced to sleep on their backs, tested against their normal sleep pattern even in one case the driver fell within normal limits and the sleep lab somehow talked him into purchasing a machine and now he is in a sleepless nightmare. Yes this system is seriously flawed.

  35. Roy Ijams on February 26th, 2015 8:06 pm

    I didn’t keep track of how many times I was cut off. I was hit head on by a car. Part of driving the 40 tons was being safe. I never had seizures before cpap. I should have right to know real risk of cpap. I could of been in a coma from oxygen toxicity. People become dependent on cpap. Not room here to go into the fancy words I’ve learned trying to understand cpap. Air force used a mouth piece years ago. Blood oxygen level not the same in lungs as finger tips. Cpap has blinded some infants. Medicare has been charged millions in fraudulent billing. One man set up clinics was not a Doctor filled bankruptcy and did the same thing in Chicago IL area. Was a Huffington post story. Cpap caused me to have paulups in sinuses. Got cleared up off cpap!

  36. susie on March 25th, 2015 4:35 pm

    I was diagnosed with SA the day before Thanksgiving. I was also suffering from Adult Onset Asthma. Dr. said I had 57 episodes in 2 hours. Cpap machine is set at a pressure of 11. I got the machine Christmas eve. The surgical supply company, the middle man for the insurance company or the insurance company themselves have checked to see how I have been doing. Oh I sent in the SD card. I’m not compliant because I only use the machine 2.7 hours a night although I use the machine every night.
    I do take off the mask in the middle of the night. I don’t however, LOOK AT THE CLOCK to see how long I have had it on. Really….I am losing more sleep using it, worrying about how long I am wearing it than before I had it. My 60 day report is coming up. If I’m not compliant I will lose the machine even though the DR. ORDERED IT!!!!! I would say if I’m using the machine every night for a few hours then that should suffice. Who sets the compliance rules anyway?

Got something to say?

The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.

Flat UI Design Gallery

web hosting, website maintenance and optimization by Dreams Media