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Adventures in Sleep

Why CPAP Therapy is Failing

Published February 1, 2012 11:09 AM by Amy Reavis
Amy Korn Reavis, RPSGTThere is a huge failure rate for CPAP therapy; some would even say it is as high as 50 percent. That number is being used by insurance companies, home sleep testing companies, and people who do not believe in sleep apnea to prove that we are testing too many people and spending too much money. But we're not. The failure rate results from our failure to educate and assist people who have started therapy.

Follow up in many cases does not happen because no one will pay for it. Decreased reimbursement and capitated contracts have caused many providers to drop off a CPAP machine and never follow up with the patient. But what those companies and the Medicare competitive bidding program have not taken into account is that trained personnel are essential to raising the success rate. These professionals listen to the patient, examine their issues, and come up with the creative solutions to help them become compliant with therapy.  The trained sleep personnel understand how to properly craft a desensitization plan for a patient. They understand the value of proper mask fitting and why different masks work on different faces.

Sleep centers should have the autonomy to change interfaces without a medical prescription. If a patient trials several masks on the night of a titration study, they do not know whether that mask will work long term. The sleep tech does not know if the patient may have issues with skin breakdown or leaking because their pillow is different than the one at the sleep lab. And if a patient loses weight while on therapy and his mask no longer fits, there's no guarantee that he will see his primary care physician and receive a script to refit the mask. A mask change should just be able to happen with a proper fitting at a lab or DME company. 

And although many patients are being followed by a sleep specialist, more are being followed by their primary care doctor. Reimbursement amounts do not cover referrals for follow-up by the sleep labs (although many centers do call patients, have newsletters, and host support groups) or for DME companies that set up the patients. 

In order to change the issues, we need to make it clear that CPAP failure is truly about failure to interact, and interactions must be reimbursed. We cannot save money on trained personnel in the short term without taking into account the long-term effect on therapy success rates. We, as a community, need to make it clear to patients, the medical communities, and the insurance companies that with proper reimbursement enabling proper care of patients, this therapy can be successful.


I also belive that the culture of the provider is to dismiss complaints and feedback from the patient as chronic excuses. I have had machines that when tested proved to be in failure. One machine it took over three months to have looked at and was at the start dismissed as a resistance to the therapy. Solution came when I showed up in the doctors office and forced him to plug it in. The second problem machine it was over 9 months of complaints until I brow beat my doctor for a referal to the sleep hospitals sleep clinic. When tested the machine read it was putting out 8 cm but the meter measured only 3 cm. Also frmo that visit it was determined I was on the wrong machine and that I had the wrong mask. I should point out two facts on this. Both later issues I had questioned and also at the start of the therapy the I had the proper machine which was shortly changed by the doctor and the mask was changed to the wrong mask by the vendor providing the machine. At one point when discussing the lack of air for one of the machines the vendor rep actually told me they did not know how the machines work but know if the pressures are right there can be no problem.

I suspect that the complaints in this therapy is so bad that to protect the ego a culture exist that that dismisses complaints as frivolous,

Dennis Brodeur, Patient May 2, 2015 3:08 PM
Tewksbury MA

I have talked about mask fit before ( here and a little bit here ) but I believe that we can never talk

May 17, 2012 9:52 AM

The big problem I see and have seen for quite some time is the fact that sleep labs as a general rule are geared towards testing of patients. Period. Everything is predicated on doing a procedure that can be billed for. If there's not a CPT code for it it wasn't done.

Even with things like AWAKE support groups and patients who have to see a sleep doc there are few patients who truly get a sit-down consult with an experienced sleep professional after the fact. Few if any places have an equivalent of a diabetic nurse educator for sleep patients due to the fact that you can't bill for it.

Bob Ziegler February 9, 2012 12:03 AM

I totally agree that many patients that I see situations change. Some are started post-op when pt is still sedated. The patient may be compliant at thatr time, but when I get them they are totally noncompliant.%0d%0aMany times I gat a patient who has had a sleep study for years and didn't get use to it. Now the physician want them to wear it. The patient does try but needs to be titrated but doe not, so the patient does not wear it.%0d%0aThese are only some scenarios. there are many many more.

Gregory Norris, Resp - RCP, RIC February 7, 2012 1:09 AM

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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