What's up with this 4 hours?

[ppowers]

OK, here is the question. Since I've started pap therapy in 2012, I have heard 100 times reference to a 4 hour block of pap therapy.
I have heard that this is for insurance company compliance. I have also been told by physicians that a 4 hour block of therapy will cut down your chances of complications from SA significantly. I have heard other things as well about this 4 hour question, but no one seems to know the real answer. Anyone have any insight to the big 4 question???

[OpalRose]

OK, here is the question. Since I've started pap therapy in 2012, I have heard 100 times reference to a 4 hour block of pap therapy.
I have heard that this is for insurance company compliance. I have also been told by physicians that a 4 hour block of therapy will cut down your chances of complications from SA significantly. I have heard other things as well about this 4 hour question, but no one seems to know the real answer. Anyone have any insight to the big 4 question???

Hi ppowers,
This varies depending on your insurance. Most insurance/medicare pay a rental to your DME for a set amount of months. I know with medicare that they will pay a rental for 13 months, and then transfer ownership to you. Now during the first 90 days, the insurance will usually require a report by looking at the SD card or print out. What they are looking for is compliance from you...which means using the machine a minimum of 4 hours a day for a block of 20 or 30 consecutive days.
If they determine you are not in compliance, then they might not pay for your CPAP machine.
Again, this varies with your insurance.
OpalRose

[AshSF]

Its an arbitrary number set by some early researchers when they were doing clinical trials on CPAP therapy and its effects on xyz variables. Once some research is set on a no., the follow up research follows the same no. of hours. And that 4 hr number stuck. And then insurance adopted it.

Its not very different from how the following things stuck for a long time and are still stuck:
1) Dietary Cholestrol is bad for you.
2) Saturated Fat is bad for you.
3) Statins are good for you.

The real message should be - Use your xPAP every time you sleep or take a nap for the whole duration.

[Sleeprider]

Four hours of daily use is the minimum required to demonstrate compliance under Medicare. As far as Medicare is concerned, you are not compliant unless you are using your machine at least 4 hours each night for 70% of the nights. So, if you use your machine 22 days out of 30 for at least 4 hours a night you are compliant.

This is kind of arbitrary, and the fact of the matter is, CPAP should be used all the time, everytime you sleep. The stress of apnea causes changes in the heart and can affect your mental and physical well-being. If you can get by on four hours of quality sleep, good for you, but that doesn't cut it for most of us.

[quiescence at last]

and the studies I have seen never claim that if you get 4 hours of sleep you'll regain mental acuity, eliminate excessive daytime sleepiness, lack of concentration, depression, headaches or any number of other symptoms.

the studies did say that if you have MODERATE or SEVERE obstructive sleep apnea, and you used the machine >4 hours "consistently", the probability of severe outcomes including death are reduced to the level of the non-apnea control group.

by the way, I am pretty sure this is the root of another arbitrary number, AHI=5. and why most sleep docs don't step beyond controlling to the AHI < 5, and probably won't participate in driving down beyond 5.

QAL

UPDATE - one of the studies is found here - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727690/

[quiescence at last]

another note, the study did not find significant differences in mortality for MILD apnea (AHI of 5 to 14) over the general population. another reason some docs dispense only advice and not machines for MILD cases.