Sleep Medicine · OSA · Clinical Pearl
PAP adherence problems are often interface and pressure problems — not motivation problems
Lede: Before labeling a patient ‘noncompliant,’ look for a fixable barrier such as mask leak, nasal obstruction, pressure intolerance, dryness, aerophagia, or residual events.
Why it matters
PAP adherence is multifactorial, but equipment and treatment-related barriers are common and actionable. Interface choice matters: nasal interfaces generally perform better than oronasal masks for pressure requirement, leak, residual AHI, and adherence, while early follow-up and active troubleshooting can improve treatment use.
The pearl
Treat PAP intolerance as a diagnostic problem. Identify the mechanism of failure before concluding that the problem is motivation.
