Compliance - why only 4 hours?

I always read about 4 hours of compliance when you start using a machine -- both with Medicare as well as other insurance companies, and of course needed to get my 4 hours in when I first started.

Why only 4 hours?? What good does it do if you use the machine from 10:00 until 2:00 and then take the mask off for the rest of the night? I always found this very strange and have never understood it. Does anyone know why they came up with 4 hours of compliance, not 7 or 8???

The insurance company is trying to cooperate and not kick people off of cpap, because ultimately it is cheaper to pay for the cpap than the medical problems that can result. They want people to be able to meet compliance guidelines, while at the same time having guidelines to that patients will try to discipline themselves and use the darn things which they might not if they did not have the threat of denying coverage.

With some people it takes time to get used to the machine, so they start out using it an hour or two and then increase the number of hours every night. And a 4 hour average makes it possible to miss a night or two and still meet compliance guidelines. I remember when I was trying to get used to the ASV I gave myself a night off every few weeks because I actually slept better without it than with it (harder to fall asleep because when I'm awake I'm not in sync with its breathrate parameters, waking up because of leaks and pressure surges, etc).

For a lot of folks, life just works out to where getting much more than four hours of sleep some nights just isn't possible. I know in my younger military years, there were lots of times when getting 4 hours a night seemed awfully good. Even now, I don't get in bed without my mask, yet still find life throws curves that result in my getting fewer than 4 hours of bed time a night. Sometimes there just aren't enough hours in the day. On the plus side, my machine seems to add quality to the hours I do get to spend in bed, and it makes the sleep I do get much more effective.

Four hours is a minimal, recordable, verifiable quantity, though not enough for most people.
It is certainly not enough to assure us of a wide-awake OTR truck driver or train engineer,
but it is something, and it is more workable than more ideal treatment hours.

I've been 99% compliant for the year I've been on an APAP, but if the cutoff was 8 hours, I would only have been 7.5% compliant. Even at 7 hours its only 56%, and at 6 hours its better, at 93%. My average is around 7 hours, but there are many nights at 6:30 or less. I don't consider myself a short sleeper - I just can't keep my eyes closed once the Sun comes up.

Also, the goal of compliance is not to punish people who use the machine less than 8 hours a night, it's simply to make sure they are making a reasonable effort to get used to the machine.

A lot of us don't have the luxury of having 8 hours of sleep night. i work the closing shift and I don't get home until 11.30pm, and after winding down and getting into bed at 12.30ish I'm back up at 5am to get the kids up and off to school. And once I'm up... I'm up for the day.

ems wrote:I always read about 4 hours of compliance when you start using a machine -- both with Medicare as well as other insurance companies, and of course needed to get my 4 hours in when I first started.

Why only 4 hours?? What good does it do if you use the machine from 10:00 until 2:00 and then take the mask off for the rest of the night? I always found this very strange and have never understood it. Does anyone know why they came up with 4 hours of compliance, not 7 or 8???

I remember seeing 4 hours 5 days a week somewhere. I found the missing two days weirder. This month I averaged 7.5 hours over 31 days but had one bad night @ 3.5 hours ( and a bad day to follow it as well )

Day_Dreamer wrote: I remember seeing 4 hours 5 days a week somewhere. I found the missing two days weirder. This month I averaged 7.5 hours over 31 days but had one bad night @ 3.5 hours ( and a bad day to follow it as well )

It's not missing two days, it's two days per week of less than 4-hours; actually it's 70% of days with 4 hours or more but that's almost the same.

My 30-day average is 5.6 hours and I'm committed... 30-day compliance is 90%.

I think it's a reasonable bar they way Medicare defines it now... although checking compliance every three months doesn't sound like much of an inconvenience.

I have Anthem PPO, and they paid a total of $275 for my whole package... I can't believe they're that concerned. They didn't pay for the humidifier, heated hose, or extra filters.

sc0ttt wrote:

Day_Dreamer wrote: I remember seeing 4 hours 5 days a week somewhere. I found the missing two days weirder. This month I averaged 7.5 hours over 31 days but had one bad night @ 3.5 hours ( and a bad day to follow it as well )

It's not missing two days, it's two days per week of less than 4-hours; actually it's 70% of days with 4 hours or more but that's almost the same.

.

Thanks Scott

That makes more sense

I am new to Medicare and just got a new device. Prior to Medicare I don't ever remember having to send my card to DME to check for compliance. I did go to yearly sleep Doc visits and a technician in the office would read the card. Do the sleep Docs report the compliance to Medicare and Insurance companies too?

How often does DME need to read the card for Medicare compliance? If the card is read every three months, how does DME verify the 4 hours use 70% of the time within a 30 day period compliance when they have data for the last 90 days?