Sleep Apnea CPAP Compliance Craziness

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.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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162 thoughts on “Sleep Apnea CPAP Compliance Craziness

  1. They do have a mouth piece you can use. Air Force used that method before cpap. Look up normal breathing. While I was on cpap I sleepwalked out of a semi while my wife was driving about 60 mph. I have found fraud in the research. Infants that were left blind after study. Paul Bert effect is a study done years ago. Breathing and disease. I can’t drive now after seizure from cpap use. I’d post more but it would probably would just get deleted.

  2. Thanks for your reply. The more I read on cpap the less I want to use it. I think that it will eventually be consigned to the medical dustbin of history along with leaches, coca nephew and blood letting to name a few.

  3. …a seizure after using CPAP ? Pure coincidence… Infants left blind after the study…??…..what study used infants? …walked out a semi….?…do you mean ‘jumped’?…and how did you keep the door open?

  4. “”John says:
    February 2, 2017 at 12:26 pm
    4hours a nite sounds reasonable but my dot physical Doctor wants 80% which means about 8 hours a nite. Is that reasonable? If that that what I need to do I may never go back to work.”” Being able to function properly and stay healthy on 4hrs sleep/night is incredibly rare. You are an accident waiting to happen. There is great material as to healthy sleep habits which you should read and do.

  5. Tom says:
    January 23, 2017 at 9:09 pm…..The overnight sleep test DOES show when you snore !! and the technicians determine the pressure at which your brain waves show you are sleeping well. I suggest you already had your mind made up it wouldn’t work before you started using it. It does take a while to get used to sleeping with a CPAP mask but it does happen…especially with those who are sincere about doing whatever it takes to prevent dying of sleep apnea.

  6. By: Martha Garcia | Published: April 15th, 2013

    Nearly two dozen universities failed to properly warn parents that a national oxygen study may put their premature infants at risk, federal officials say.

    According to a letter (PDF) issued by the Department of Health and Human Services (DHHS) to the University of Alabama at Birmingham, the lead institution in the study, research institutions involved in the study did not offer informed consent to the parents of the premature infants.

    The study involved 1,300 premature infants between 24 to 27 weeks of gestation. Researchers evaluated the results of increased or decreased oxygen through a continuous positive airway pressure (CPAP) treatment to determine the levels of oxygen saturation and neurological effects on premature infants.

    According to the letter, the institutions involved were aware of the potential adverse affects the treatment may have on the infants, including blindness and even death. The DHHS Office of Human Research Protection says the institutions had sufficient evidence to know such treatment may cause serious consequences, but never properly informed parents participating in the study about the potential risks. The office considers the failing a violation of regulatory requirements for informed consent.

    The study took place between 2004 and 2009 and 130 infants of 654 in the low oxygen level group died, while 91 of 509 infants in the high oxygen group developed a serious eye problem, which can result in blindness.

    The study, published in the New England Journal of Medicine in 2010, was financed by the National Institutes of Health and involved 23 high profile Universities, such as Stanford, Duke and Yale.

    The consent form only mentioned risks involving abrasion of the infants skin, and claimed there was a potential benefit of decreased need for eye surgery if the infant was assigned to a certain oxygen level group.

    DHHS officials say the consent form should have highlighted that the risks of the trial were not the same as the risks of receiving standard care, so parents could make a more informed decision.

  7. I have severe sleep apnea and have for the past 15 years I faithfully use my CPAP
    because I have great difficulty breathing when I lay down and for sure can not go to sleep. I have had a sleep study every 5 years with no problem getting the machines having pressure adjusted and such. Today I was scheduled for a sleep study I arrived and everything was fine I got all the sensors on and was told to go to sleep when I told the tech that I could not sleep without my CPAP because I have to much trouble breathing to go to sleep. He informed me that the test required I sleep for 2 hours without my CPAP If I slept for 2 hours I wouldn’t wake up the funeral would be next week. This test is a joke I left

  8. Dr. Park
    You are absolutely correct. I have been in practice over 50 years and my experience with CPAP is that:
    1. Most applications fail and the apparatus winds up in a drawer.
    2. It is a business created to the benefit of sleep lab specialists and equipment purveyors with the backing of tertiary care (never the real world) studies.
    3. It is in general a huge waste of healthcare dollars when we measure the cost-benefit ratio to the system and to the patient.
    We need a better solution.
    Murray Trusler, MD, FCFP
    Fairmont Hot Springs, BC

  9. Wow! A Dr. not drinking the cpap Kool-Aid. I’m on total disability now after using cpap. With device on I sleep walked out of a semi while my wife was driving about 60 mph 6/8/2012. On 10/1/2012 I had a grand maul seizure after sleeping 8 hours with cpap. I have found cases of fraud, deaths, seizures, and my brother-in-law also sleep walked with his device.
    To breath in 10 seconds hold for 10 seconds and exhale for 10 seconds allows for toxins to be better exchanged through breathing. Which would fail a sleep test. I have many pages of research I could forward. That doesn’t even get into the known billing fraud. Trillions in 2017 just in US. I never sleep walked before using cpap.

  10. I am a former scuba diver. I know all about air pressure and the human body. There is a very big reason why air pressure is scaled way down for divers. Our lungs and bodies can not tolerate a ton of air forced into it at any altitude or depth.

    I been driving for 23 years. Never had an accident in a commercial truck. Then one day someone got a hair sideways up their back side and said truckers have sleep apnea. So the doctors railroaded a lot of us onto the cpap. Since being on the cpap I have had nothing but sleeping problems. Had the cpap turned down 3 times. It is still over pressurizing my lungs. I have headaches every morning.

    So my machine is set to the lowest setting with. Max of 10. I still can not breathe as it is suffocating me and waking me up. I have cornered the doctor about where the pressure is set and the fact they still can not find the test that proves I have sleep apnea. What he say? Lets have you do an in clinic sleep test to see where you stand. I told them to go to hell as I was not spending another $4000 for them to get the actual results that I been telling them. I do not have sleep apnea at all!!!!!!

    Now that the government backed off the sleep apnea issue. Just maybe I can get off mine before I have a serious incident brought on by doctors who don’t have a clue about diving medicine which they should learn before forcing people into something that will kill them faster than a heart attack.

  11. I’ve read about scuba diving and agree with your post.. My sleep test was Springfield MO. Elevation I think is about 1,400 ft. I sleep walked out of our truck in Cheyenne WY. Which is about 9,000 ft.. Doctors said I had polyps in sinuses and to not use cpap. I found research that cpap test were not consistent above 5,000 ft. I the state of CO.