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Older man wearing a PAP mask

Compliance & Adherence

What is compliance and why does it matter to me, the patient?

Compliance is how often Positive Airway Pressure (PAP) is used; including both the number of days and the number of hours. Guidelines set by the Centers for Medicare and Medicaid Services (CMS) are used to determine if you are considered complaint or non-compliant.  According to CMS, the minimal goal for compliance is to wear PAP a minimum of 4 hours per night for 70% of the time within a consecutive 30-day period within the first 90 days of having the equipment. (Retrieved from: Centers for Medicare and Medicare Services)

In easier to understand terms, you have a full 90 day (or 3-month period) to wear your CPAP for a minimum of 4 hours each night for 70% of the time. To break it down further, 70% usage is the same as 21 days out of 30 consecutive days.  As a patient, compliance is important for overall success with the therapy.  PAP can greatly improve the quality of sleep, not just the quantity or length of time spent sleeping.

Acclimating to PAP for good compliance is not easy for some patients. Sometimes there are barriers or things that prevent people from using their PAP therapy.  Maybe the mask doesn’t fit well or maybe your nose ends up dry.  Maybe you travel for work and keep forgetting to pack your PAP.  Maybe you just aren’t motivated to put it on after a long day.  All of these are common for many, many people.

Easy Tip & Reminders

  • Create a routine that includes your PAP machine nightly, especially in the early days when you first start therapy.
  • If your mask is the main issue and not the pressure, contact your home care company and see if you can try another mask that may work better for you
  • If you frequently fall asleep before you put it on, set an alarm beforehand to wake you so you can put it on for the remainder of the night.
  • If you have difficulties making it to the 4 hours for wearing it, try increasing the time in small increments throughout the week rather than all at once.
    • Increase usage by 15 minutes at a time, by the end of 7 days your overall usage can improve by 30 minutes or more
  • If the pressure is the issue call your home care company to check settings that can help you adjust easier to the pressure(s)

Why does my doctor want to know how I’m doing with PAP?

Your doctor wants to know how things are going with your PAP use in order to check that the therapy is working for you and that you are benefiting from wearing PAP. A typical compliance report contains:
  • Percentage of use by days per month (Example: 27 days out of 30 or 90%)
  • Percentage of use over 4 hours per night (Example: 15 days out of 30 or 50%)
  • Average hours when PAP is used (Example: 5 hrs. 23 minutes)
  • Leak rates
  • AHI (Apnea Hypopnea Index)-the number of respiratory events (apnea) that occur on average

If there are any values that seem to be outside of normal range then a change may be necessary to improve the PAP therapy by increasing or decreasing the pressure(s), suggesting a mask change, or encourage greater PAP use in general.

If compliance is poor or Positive Airway Pressure (PAP) remains intolerable despite adjustments, then alternative treatments or therapies may be explored.

Reviewing compliance data is very important for the physician in determining the course of your treatment for sleep apnea and overall sleep health.

What is the difference between being “compliant” and “adherent”?  Aren’t they the same terms?

The terms are similar in meaning, but actually ask different things from you, the patient. Being complaint with your Positive Airway Pressure therapy means you are following and meeting the set guidelines and usage as prescribed by your doctor.

Being adherent with your PAP therapy means a bit more; you are working with your doctor to make the changes needed to have long term success with your therapy. The road from being simply compliant to adherent can be tricky at times but not impossible to navigate.

If you would like to have help with improving your adherence, you can work with a sleep coach from the sleep center which can be contacted either by calling the Upstate Sleep Center or sending an email.


Contact the PAP Sleep Coach