Why is CPAP Compliance Rate Low?

“Life is really simple, but we insist on making it complicated.”
- Confucius

Various studies and articles have stated that the CPAP non-compliance or poor adherence rate may be as high as 70%. This means that more than 15 million people are non-compliant or failing on sleep apnea therapy using the machines! Why is the CPAP compliance adherence rate as low as 30%?
The figure of 15 million comes after discussions with an executive at one of the major equipment suppliers. When asked how many machines had been sold, I was advised that it was "way more than 20 million". Therefore, if we use the figure of 25 million at 70% non-complaint or failing, the number is 17.5 million. Conservatively, let us use 15 million.

Why are so many people non-compliant or failing? The sleep apnea machines and the equipment in particular the masks which have been produced over the last 5 years or so are absolutely fantastic!

Below is a link to an article by Doctor Steven Park which looks at CPAP compliance craziness.

The definition of CPAP compliance requires that patients use CPAP at least 70% of the time over a 30 day period, for at least 4 hours every night. 

It would be rare in the long term for someone to only use the machine for 4 hours every night and wake up feeling refreshed and energized.  Personally, I believe that a patient should be able to use the sleep apnea machine for 6 hours at least 80% of the time. 

Further, add in those people that despite optimal treatment are still having continued sleepiness and fatigue estimated at 10%. This figure is from a comment made by Professor Susan Redline, Professor of Sleep Medicine at Harvard Medical School. 

Refer to the following blog article on My Apnea forum or Google “CPAP No Improvement” and the article is the 3rd/ 4th topic on the first page. “6 months in, why don’t I feel better? https://myapnea.org/forum/t6-months-in-why-don-t-i-feel-better. This point was also referred to in the article by Dr Steven Park mentioned previously. 

So if we take the 70% of people who are non-compliant and failing and add an extra 10% for the people who the Medical Specialists would say are compliant, the actual reality is that non-successful patients is more likely to be 80% or 15 to 20 million people! 

To further support this high non-compliance and failing rate, I spoke to 3 medical practitioners who all agreed that many patients were failing. One of the medical practitioners that I spoke to advised that “the rate may be more than 70% in his practice; the patients keep coming back and I refer them to another sleep specialist!” Therefore, a reasonable person may conclude that there is more money going to the specialists. Is this one of the reasons why the specialists are busy and have long waiting times? 

When I discussed this high non-successful rate with an executive in the sleep medical industry, I was told “What would they know? They are only medical practitioners!” It is an attitude like this within the industry that is one of the reasons for the high non-compliance or poor adherence rate. 

Go onto the various sleep apnea forums (listed on right hand side) and there are hundreds and hundreds of people on these sites at any one time for 24 hours every day. The first time I viewed the forums, I was absolutely shocked and horrified at the number of people and the various issues that they were having with their sleep apnea therapy and the CPAP machine. From personal experience, many CPAP side effects and issues can arise which I had to deal with and overcome to have success by having a great night's sleep. 

There are hundreds and hundreds, maybe thousands of websites on the internet offering advice as to how to overcome your issues. Again, I ask the question: Why are 80% or 15 to 20 million people unsuccessful using the CPAP machine? Many sleep medical specialists will argue the CPAP machine is the “Gold Standard” in treating obstructive sleep apnea. 

The low compliance adherence rate is supported by my own personal experience with a sleep medical specialist. In 2010, I was diagnosed with obstructive sleep apnea and was prescribed a CPAP fixed pressure machine. In my last meeting with the sleep medical specialist in 2011, I advised that I was having air coming through my eye tear duct and out of the eye, bad aerophagia and high leaks according to the sleep machine. 

I still clearly remember the replies:

1. I asked whether the high leaks were an issue. The reply “No, It doesn’t matter!” 

2. Would an auto adjusting pressure machine assist in reducing aerophagia? The reply “It would make no difference!” 

3. What about the air coming through the eye tear duct and air coming out the eyes?

The reply “There is nothing I can do for you!” This from a sleep medical specialist and an Associate Professor at University! 

At this point the appointment was over. The appointment had gone for 4 to 5 minutes at most. I was handed a Bill for payment for the specialist to tell me that “there was nothing he could do!”  Once again it is the attitude and lack of understanding by the people working in the sleep apnea industry that is one of the reasons for the high non-compliance or poor adherence rate. 

I was having terrible sleep and in pain every morning from aerophagia and had not slept properly with the machine since buying it. In addition, I was so angry and frustrated that I wanted to do something to the specialist that I cannot repeat on this blog. It wasn’t going to be nice! 

I now know that having major leaks on a ResMed machine of greater than 50 litres/ minute all night due to mouth breathing will stop you having proper sleep therapy. The recommended limit is 24 litres/ minute. Why didn't the specialist recommend a chin strap to fix the problem? In addition, an auto adjusting pressure machine would have fixed or reduced aerophagia.  

From the articles noted and from my own personal experience and from others detailed on the various sleep apnea forums, it is clear that a number of the medical specialists and others working in the sleep industry are arrogant, lacking any understanding of the issues that patients are facing and above all, have a lazy attitude to educating themselves and their patients as to how these sleep apnea machines truly work. 

For those patients who have been diagnosed with sleep apnea, it is estimated 80% of them have obstructive sleep apnea (OSA). Obstructive sleep apnea is when the throat muscles obstruct your upper airway, blocking air from entering and leaving your lungs.  

The sleep apnea therapy for obstructive sleep apnea is Simple. Yes SIMPLE! Contrary to what the sleep medical specialists and others working in the industry are saying, it is NOT complex.

From the sleep apnea forums, the medical specialists and the equipment suppliers say that the high non-compliance and failure may be due to the patient. They take little responsibility for the high non-successful rate of patients. It is their belief that the patient needs to try harder and that it takes time for the therapy to work. Whilst this may apply to some patients, to have 15 – 20 million patients being unsuccessful is absolute NONSENSE! In addition, there are conflicts of interest in the sleep apnea industry. Avoid them at all costs as it may be to your detriment.

How long is required for the patient to be successful with their therapy? 6 months? Is 12 months sufficient to be successful? Is 18 months or 2 years enough time for successful therapy? The medical specialists have no idea for many patients!

How would you feel if a doctor prescribed medicine for a bad flu and you did not get better? Would you feel angry, frustrated and a bit “ripped-off” that you had spent and wasted your time and hard earned money?

I repeat: Sleep apnea therapy for obstructive sleep apnea is SIMPLE! It is for this reason Why a CPAP Referral should not be required for majority of people.

The medical specialists purport to be experts in the use of the sleep apnea machines. However, they do not truly understand how the machines work. A great example of the lack of understanding by the sleep medical specialists of how the sleep apnea machines and sleep apnea therapy truly work is how to stop CPAP air coming out of the eyes. As the sleep specialists are not educating themselves and their patients, it will be up to you to educate yourself!  

The two Aha moments that gave me the answer are on the blog post Stop Eye Tear Duct Air Regurgitation. Machine settings to use are detailed on CPAP Settings to Stop Air coming out the Eyes.

They have made something simple, complex. This is best stated by the following quotes:

“Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius – and a lot of courage to move in the opposite direction.”
- E. F. Schumacher (German Economist & Statistician – 1911 - 1977) 

“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.” 
- Edsger Wybe Dijkstra (Dutch Essayist & Scientist – 1930 - 2002) 
This Blog is to assist all users of sleep apnea machines including CPAP, Auto Adjusting CPAP and Bilevel (also known as BiPAP or BPAP) machines to overcome the many CPAP side effects and issues. For you to achieve success using the sleep apnea machine and to have a great nights’ sleep! More details are on the blog page Secrets to Success: Answer is FREE.

Should you be having issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.  

"Have courage. Be adventurous and Go for It! Overcome your fear."

1 comment:

  1. I have been using my bipap machine every night since I brought that bad boy home. (2 1/2 yrs) It’s made a big difference but now I’m getting way to many central apnea’s. Thanks for all of your informative information here. I’m so glad I found this blog today.