CPAP Machine Data and Compliance

 In CPAP Insurance, Most Popular Posts

There are two requirements for compliance: machine data and face-to-face re-evaluation. If you are going to use your insurance to purchase your CPAP machine, you need to understand what compliance is.

Machine Data

The Centers for Medicare & Medicaid Services (CMS) has set the industry standard for CPAP data compliance at using the machine for four or more hours per night for 70% of the nights in a consecutive 30-day period. These values are monitored during the use of the CPAP via built-in smart cards, communication by modem, or a Web-based system to check both the hours the CPAP machine has been running and the amount of time the CPAP mask was actually in use.

Compliance tends to be less in those who do not understand the risks of apnea. Side effects such as nasal dryness, claustrophobia, pressure, and skin allergies to the CPAP mask materials contribute to the problems CPAP users have with compliance. Most of these issues can be resolved when the user’s CPAP team provides support and educates the user early in the compliance period.

AirSense 10 data card

Leading CPAP manufacturer, ResMed, developed AirView where you can access nightly therapy data, troubleshoot remotely (using the remote assist feature) and change the device settings remotely. The software also gives access to the user’s entire CPAP team to review the data since there is often a discrepancy in run time versus applied time when the CPAP user removes the mask but leaves the CPAP unit running. This can be resolved early to guarantee better results.

Face-to-face Re-evaluation

For many insurance carriers, simply showing that you use the machine every night from your machine’s data is not enough. You must also visit your doctor no sooner than the 31st and no later than the 90th day of receiving your CPAP machine. The face-to-face clinical re-evaluation by your treating physician must document improvement of your OSA symptoms and objective data related to adherence to PAP therapy.


Removing the CPAP mask early in the night is the major cause for early CPAP non-compliance. It is important to have your CPAP team educate you on the advantages and disadvantages of treatment prior to treatment and all throughout your trial.

CPAP users who fail the initial 12-week trial are usually eligible to try again. In order to retrial, most insurance carriers require a new face-to-face clinical reevaluation by the treating physician to determine the etiology of the failure to respond to PAP therapy; and the user must do a repeat sleep test in a facility-based setting (no home sleep test).

Although there can be challenges to using PAP therapy, many users overcome these challenges by working closely with their CPAP team.

Check out our Ultimate Guide to Buying a CPAP Machine for all the pro tips.

Tips on how to be compliant

There are many reasons as to why you could fail to be compliant. But no worries, some of these causes are easy to fix.

Here are some tips on how you can improve compliance:

  • Be proactive! Health Sqyre will check in with you after you receive your CPAP machine, but if you have any questions, or if there are any problems with your machine or mask, reach out to us. Make sure you know how your machine and other equipment works inside out!
  • Use the correct size and best mask for you! If you feel claustrophobic using a full face mask, switch to a nasal pillow or nasal mask. The nasal pillow mask is also recommended if you have facial hair for better adhesion to your face. If you find that you are removing your mask during the night, purchase a chin strap to help your mask stay on. You can also try tightening the straps of your masks, but as long as it is comfortable and not too tight. If your mask is broken or worn out, immediately replace it.
  • Use nasal sprays if you can’t breathe through your nose! If you have a congested nose or sinusitis, you can either switch to a full face mask so you can breathe with your mouth instead. The other option is to use nasal sprays or antihistamines to unblock your nose.
  • Use a humidifier! If you feel that your mouth and/or nose gets dry during treatment, try using a heated humidifier. The moisture can help with the dryness.
  • Use the right machine! BiPAP machines change the air pressure based on whether you are exhaling or inhaling, and APAP machines change the air pressure throughout your sleep. If you’re having trouble with CPAP therapy, consider changing to a BiPAP or APAP machine.
  • Clean your CPAP equipment regularly! Dirty CPAP equipment, especially those that make contact with your skin, can make you avoid using your CPAP machine. CPAP cushions and masks should be cleaned every day or every couple days, and your tube should be cleaned every week. Consider investing in a SoClean machine to minimize the hassle.
  • Replace your filter! A dirty or worn out filter can harm you, because the dust and dirt can travel through the tube and enter your lungs. Your filter should be changed every month, or every two weeks if it is disposable.

You can also check out these posts to help you with improving compliance!

CPAP Mask Problems? 12 Best Solutions

Broken CPAP Machine? The 9 Best Tips

Recent Posts