CPAP Machine Data and Compliance
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.
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.
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.
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.