Non Compliant

Hi all, i’m wondering if anyone can help with any advice on my issue. I am recently diagnosed with sleep apnea and was given a CPAP machine. i’ve had it for about 3 months. I tend to take it off during the night while I sleep, unknowingly to me. My insurance called and demanded I pay for it and return it.

Any one else been through this?? Any help on what to do?


HI Pearl27.

Well about your insurance, am not sure how your system works, (I take it your in America) but I do know that Many insurance companies, including Medicare and PPO plans, are now requiring authorizations for more and more services, so you will have to look into that one as far as I am concerned, as here in Ireland we do not need the cover you do over there.

Anyway, you have only been using a machine for a short while, and are still getting used to how it feels when wearing the mask, so yes you will be tending to remove the mask till you adjust to it, as you do not say about what pressure settings you have its hard to advise correctly, but it seems your just not used to having this mask on your face as yet and in your sleep you will remove this foreign body from your face, also because your not used to the pressure you will fight with the mask during the night and tend to tighten it, this will give that claustrophobic feeling thus you removing the mask, another thing that does happen is that when your head is on the pillow your mask will move around your face as you move during sleep, if this is happening try using a body pillow on top of your normal pillow, as this will help your head mold into it thus helping the mask stay in place.

It will take time and a lot of trial and error I am afraid its something we all have to go through.

hope this helps.

Hey Pearl, sounds like you’re in a world of insurance on this one. Insurance companies want 70% compliance on usage for 10 months and then you own the machine. That means you have to use it for at least 4 hours per night 70% of the days. If you are tearing it off or not using it then you are not compliant. Either give them the machine back or pay for it. Or call and let them know you’re having trouble with the machine because it doesn’t fit properly, you can’t get used to it and you’re not getting the help yo need from your supplier. My supplier would call me if i didn’t use my machine for a week. Perhaps you can talk them into restarting your trial run.

More importantly, you are not getting your nightly therapy from using the system. I would tape the velcro straps at night and see how that works.

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I had to show continual usage first 6 months for insurance to pay for it.

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Yes you must show that you are complient. You need to tell them you’re having troubles with your mask and need to try some others. And when you get a good fit you must find a way to keep it on. I think I had to “condition” my mind to accept the fact that I must keep it on. I also had a hard time getting used to not pulling it off during the night. I hope you get this worked out. Your health depends on it.

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I strongly suggest you contact you doctor and advise him/her of the problem you are having adjusting to the mask. Your doctor may prescribe a different type mask that you can adjust to/tolerate. You should talk to your doctor and request their assistance with your insurance company. Your doctor can work with the insurance company much better than you can alone. I think that if your doctor tells the insurance company that your sleep apnea requires the use of CPAP for medical reasons it will more impact than if you try to explain that your use of the CPAP is involuntary. I strongly recommend you engage your doctor and maybe the medical supply company that provided and set the pressure, etc. for your CPAP. Don’t try to fight the insurance company alone use the resources available to you. Wishing you success. I have been on CPAP for over 26 years and believe me it can make a difference in your life, if used properly.

In addition to the excellent advice on getting help on selecting a mask and consulting your physician, I suggest using the CPAP mask & machine an hour before bedtime. Read, watch TV, just log some time in before sleeping. Hopefully, this will get you to the minimum hours of usage required. This can help with your insurance issue for the moment while you are working out the problems you are experiencing with the CPAP.

Hi J. Yes, I think the fit is critical. I was given a medium sized mask at the sleep clinic, and had a terrible time keeping it on well, so I tended to either fail, or take it off too early.

Hi Pearl. As others have indicated, you may need a different kind of machine, or different size of mask, even if they fitted you at a sleep clinic… It took me 6 weeks of struggling to just get some masks on my own and finding out that I needed a smaller mask. Then after that, I found out that the DME provider I use would have given me several sizes to try, so be sure to check with them. Also, they can help you with the insurance rather than just toss you out. Please let us know how you do and where you end up!

Hi Pearl,
Like the other posts stated, the insurance companies want proof you are using it 4+ more hours a night/day and want to see 70% compliance; otherwise you are responsible for the cost. I almost lost a job because my sleep apnea issues were discovered during a physical and I had not used my CPAP for a couple of years because I kept getting bad sinus infections and when I ended up with colds, I couldn’t breathe through the nose mask anyway, so I didn’t use it. I did see the doctor and he was able to get the sinus issues under control; however, I could not start my new job until I showed 70% compliance for 4 continuous weeks. By the way, I was driving a company vehicle which is why the employee doctor was so concerned. Please keep giving it a try and talk to the doctor or company that handles your CPAP because it’s not worth the aggravation in the long run.


My job won’t let me work if I don’t use it…

How are you doing now with it?