Continuous positive airway pressure therapy remains the first-line treatment for moderate to severe obstructive sleep apnoea in Australian clinical practice. The long-running challenge — patient adherence to therapy over time — has not gone away. Adherence rates at 12 months in Australian sleep clinics in 2026 continue to sit in the 55-70% range, depending on definition and patient cohort.

The 2026 picture shows both incremental progress and a clearer understanding of which patients struggle most.

The current adherence picture

Twelve-month adherence to CPAP in Australian sleep clinics in 2026, defined as use of four or more hours per night for at least 70% of nights, sits at around 60% across published cohorts. This is consistent with the international literature and roughly stable compared to ten years ago, despite improvements in device design, mask comfort, and remote monitoring.

The patients who struggle most are well characterised. Younger patients with milder symptoms. Patients with claustrophobic responses to the mask. Patients with concurrent insomnia. Patients whose partners report being woken by the device. Patients whose primary symptom is fatigue rather than daytime sleepiness and who therefore find the trade-off less compelling.

What is improving

Device technology continues to improve incrementally. Auto-titrating devices are now the default rather than fixed-pressure devices for most new starts. Mask design has improved, and the range of mask options now allows most patients to find a workable configuration with persistence.

The remote monitoring infrastructure has become a meaningful clinical tool. Australian sleep physicians and CPAP suppliers routinely use cloud-based usage data in the first 90 days of therapy to identify struggling patients and intervene early. The clinical evidence supports the value of this early intervention.

The complementary therapies

A meaningful subset of patients who cannot tolerate CPAP are now successfully managed with mandibular advancement devices (typically prescribed by sleep-trained dentists), with positional therapy for positional OSA, with hypoglossal nerve stimulation for selected patients, or with weight loss interventions where appropriate. The 2026 Australian clinical position acknowledges that CPAP is the first line but not the only option for moderate-to-severe OSA.

Pharmacological options remain limited in 2026 for the obstructive sleep apnoea population specifically, though research into pharmacotherapy is active.

The cost and access picture

The Australian access to CPAP therapy is mixed. Private patients with health insurance generally have reasonable access through the device suppliers and the sleep physician network. Public patients in some states face long waits for sleep studies and for CPAP titration, particularly in regional areas. The remote-monitored home sleep study has improved access in some specific cases but has not closed the gap for complex patients who need attended polysomnography.

The Medicare review and the ongoing discussion of sleep medicine funding in Australia continues. The 2026 fee structure for sleep studies remains a point of ongoing professional discussion.

The clinical implication

For Australian sleep clinicians in 2026, the practical adherence question is the same as it has been for two decades — how do we identify the patients who will struggle, intervene early, and maintain a working therapy relationship over time. The remote monitoring data, the device technology, and the broader treatment toolkit are all incremental improvements. The clinical relationship and the patient education remain the central work.

This is general clinical information. Patients with concerns about their sleep or their CPAP therapy should consult their sleep physician.