At the beginning of every new year people around the world resolve to do something positive in their lives. Many of these New Year’s Resolutions are attainable. Some are not. People resolve to exercise. People resolve to kick a bad habit, like smoking or drinking alcohol. People resolve to be better parents or spouses. Resolutions can be tricky things. You can set a reasonable goal and accomplish it, or you can set yourself up for miserable failure. Historically there has been a compliance problem with patients prescribed CPAP therapy. I wonder how many non-compliant CPAP users have resolved to change things for the better in 2016. 

 The history of non-compliance with CPAP therapy goes back a long way, basically to the very beginning when CPAPs started being prescribed for sleep apnea in the 1980s. Compliance isn’t necessarily a black-and-white type of issue. In fact, I’ve identified three general types of CPAP users: the fully compliant, the chronically non-compliant, and the inconsistent user. 

  The Fully Compliant User 

You know who you are. You use your CPAP machine every night without fail. You can’t imagine going a night without CPAP therapy. You may have purchased a backup machine for redundancy. You don’t need anyone to convince you to use your CPAP. You know it works and you may even tell your friends and family members about the positive impact CPAP therapy has had in your life. You’re a true believer.

The Chronically Non-Compliant

You, too, know who you are. Your CPAP machine is sitting in your bedroom closet – or worse, out in the garage. You tried CPAP therapy because your doctor told you about the hazards of untreated sleep apnea, but you had a difficult time adjusting to it and you weren’t able to see any benefit. You know you should do something about your sleep apnea but you hate the idea of using a CPAP machine with a passion. You’ve looked into surgery and dental devices, only to be discouraged by the cost, the questionable efficacy, and the potential for adverse side effects. You wish you could get a good night’s sleep, but you certainly don’t want to be chained to a piece of medical equipment for the rest of your life. You’re just hoping for the best.

The Inconsistent User

You likely don’t know who you are. You use a CPAP machine regularly or semi-regularly, but you still question its effectiveness. You may need to use the machine to satisfy work-related compliance regulations, and if it weren’t for that you probably wouldn’t use the machine. Not because you don’t want to use it, but because it’s inconvenient. Okay, it’s a total drag. You don’t take the machine with you when you travel or when you go camping. You may use the machine nearly every night when you’re at home, but only for a few hours per night, and you often wake up with your mask on the floor and nothing more than a morning headache to show for your attempt at compliance. During a routine physical you’re slightly evasive and ambiguous when answering your doctor’s questions about your sleep apnea treatment. You hate CPAP therapy.

I’ve personally talked to all of these types of users. Compliance – or rather, lack of compliance - is a big issue in this industry. There are many reasons for non-compliance, including ill-fitting masks, a patient’s psychological resistance to change, a patient’s misunderstanding of the potentially deadly consequences of non-compliance. The list goes on. But an overlooked part of the non-compliance problem is fueled by the narrative set forth by manufacturers themselves. We routinely hear from manufacturers that CPAP therapy is difficult, and that their particular product or program helps to fix the problem and will result in better patient outcomes. It’s a marketing tactic that actually provides a justification for a patient’s negative feelings toward CPAP therapy. I suspect there’s too much of a "see, it’s not just me" type of attitude among the chronically non-compliant and inconsistent users, and that might just be a direct result of too many people suggesting that CPAP therapy is difficult. If you’re one of the non-compliant or inconsistent users, imagine if you had never once before heard that lots of people struggle with CPAP therapy. Imagine if there were a higher standard that suggested that 90% or more of CPAP users were classified as fully compliant. You’d probably think differently about it. (And yes, I do understand the irony of my own words here, but someone has to address the issue.)

Look at it another way. Imagine if you went to the gym and the person leading the exercise class was up front saying, "50% of you can’t handle this", or "Yep, this is too hard for most of you", or "we know you’re going to try, but it’s likely you’re going to fail." That’s essentially the message we keep hearing from the industry experts. I don’t even know for sure if it’s right or wrong, because in our business we tend to deal mostly with people who are in the fully compliant category. But who cares about reality. Shouldn’t the message to new CPAP users be, "millions of people use CPAP therapy effectively, and with the right attitude CPAP therapy can be easy to get used to, and you’ll look back on the day you decided to embrace CPAP therapy and think of yourself as being silly for not embracing it earlier." Essentially, the message needs to be tweaked to set a different standard for patients. And that standard should be that the expectation should be one of compliance, not that it’s understandable when you don’t comply.

I’ve heard many times before that if you can force yourself to do something for three weeks – like change your diet, or change a habit – then you’re good to go. Three weeks seems to be the magic number. So, if you’re sedentary and you want to begin exercising, you need to exercise regularly for three weeks to make it a habit that can stick. I don’t know how true that is, and I suspect it’s different for different people, but I can imagine that any non-compliant or inconsistent CPAP user who forces themselves to comply with CPAP therapy for three weeks would a) develop the new habit from a psychological perspective, and b) feel the positive effects of CPAP therapy from a physical perspective. My challenge to those of you in one of those two groups is to go full steam ahead for three weeks, and then get back to me to let me know if it worked or not. I bet it will.

There’s another complexity that presents itself when people are trying to make a change in their lives. Some people set unrealistic, unattainable goals. Don’t be that guy... or gal. For example, don’t feel the need to go from no use to eight hours per night. Perhaps you could start with a goal of every other night for three weeks. Or at least four hours per night every night for three weeks. Or a minimum of 80% compliance. Whatever you choose to do, try to make it attainable so you can be successful in hitting your goal. Incidentally, some newer machines like the Philips Respironics DreamStation allow you to set goals and view the goal results on your mobile device. Getting this type of feedback can certainly help the non-compliant or inconsistent user track progress and reach their goals. And if you’re already a fully compliant user this type of feature allows you to say, "in your face" to your sleep apnea (you have to shout it, with hand gestures for full effect.)

On January 1, 2015 I resolved to read the Bible every day and finish the entire thing – both Old and New Testament - in 365 days. I used a Bible app that provided a daily reading plan to make it straightforward and consistent. I fell behind occasionally, but since my progress was well documented in the app, it was very easy to correct and catch up. The most problematic times for me keeping up were when I was in China for two weeks and then when I was in Europe for two weeks. But even during those times, I knew specifically how far behind I had fallen. Because of the app I knew exactly where I was the entire year. While I didn’t read the Bible every single day (again, some days I had to catch up for missing other days) I finished it on December 30, 2015, one day early. My point is that technology can improve your chances of success. If you respond well to tracking and feedback and you have a mobile device, then maybe that’s exactly what you need to be successful with your CPAP therapy. (The DreamMapper app for the DreamStation machines would be equivalent to the Bible app I used for tracking progress and achieving a goal.)

If you’re already fully compliant, congratulations! If you’re not, my message to you is that you can easily become compliant. Don’t listen to anyone who says CPAP therapy is difficult. Don’t use other people’s failures as a justification for your own. Just use your CPAP equipment and reap the tremendous benefits of doing so.

Andrew Senske
President is a leading online retailer of CPAP equipment. Located in Spokane, WA has been serving thousands of customers around the world since 2001. Founded on a belief that patients are their own best primary care providers, understands the importance of educating patients and customers on both the effects of and treatment for obstructive sleep apnea. For more information visit or call toll free 1-888-955-2727.

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