Continuous positive airway pressure (CPAP) remains the dominant treatment for moderate to severe obstructive sleep apnoea (OSA) in Australia in 2026. The adherence data from Australian sleep clinics, when the practitioner looks across the practice population rather than across individual patients, is showing the pattern that the international data has been showing for years. The May 2026 read is worth writing down for practitioners and for the health services that fund the therapy.

The Australian adherence picture in 2026:

The 90-day adherence rate (defined as use of more than four hours per night on more than 70 percent of nights) across the typical Australian sleep clinic population sits in the 55 to 65 percent range. This is broadly consistent with the international 90-day adherence literature. The patient cohort referred from primary care with mild-to-moderate symptoms is at the lower end of the range. The cohort referred with severe disease and clear symptom impact is at the higher end.

The 12-month adherence rate drops materially from the 90-day rate. The patient who is using the device at 90 days is more likely to continue than the patient who is not, but a meaningful percentage of 90-day adherent patients drift downward over the following nine months. The Australian 12-month adherence rates from clinic-based data are in the 45 to 55 percent range.

The 24-month adherence rate continues the drift downward. The clinic-reported 24-month adherence sits in the 35 to 45 percent range. Beyond 24 months the picture is harder to characterise because patient follow-up is incomplete.

What the data is telling clinicians:

The early-engagement period is critical. The patient who has a positive first-month experience with the device, the mask, and the pressure setting is the patient who is more likely to remain adherent. The clinics that invest in early follow-up — typically at week two and week four — are seeing better 90-day numbers than the clinics with a single 90-day review.

The mask fit is the single most consistent factor in adherence. Patients with mask problems within the first 30 days are at high risk of discontinuation. The clinics with a structured mask review pathway and a willingness to change mask type promptly are seeing better adherence outcomes.

The pressure tolerance issue is sometimes a misdiagnosis. The patient who reports they cannot tolerate the pressure may actually be experiencing leak issues, expiratory difficulty, or claustrophobic anxiety, each of which has a different management pathway. The clinics that have moved to a structured discontinuation assessment are recovering more patients onto therapy than the clinics that accept the discontinuation at face value.

The remote monitoring and adherence data that comes off modern CPAP devices is now a routine input to the clinic workflow. The patient with the device sending the nightly data to the clinic platform is in a different management loop from the patient with the device that is not networked. The adherence intervention is more timely and the patient feels more supported.

The funding posture in 2026:

The private health insurance subsidies on CPAP equipment have remained broadly stable. The DVA and Medicare arrangements for specific patient categories continue. The out-of-pocket cost of a new CPAP setup remains a meaningful barrier for some patients, particularly those without private cover.

The state-level government supply schemes for selected patient categories vary across jurisdictions. The patient pathway differs accordingly.

What is changing in the equipment side:

The new generation of devices launched through 2025 and into 2026 has continued to improve on the quietness, the user interface, and the integration with sleep tracking software. The behavioural-design work in the patient-facing apps has improved adherence support meaningfully.

The mask range continues to broaden. The nasal pillow and minimal-contact mask designs have improved and are working for patients who could not tolerate the more traditional designs.

For Australian sleep clinics in May 2026, the practical read is that adherence remains the central clinical issue in CPAP therapy. The clinics that have built structured adherence support into the patient pathway are getting better outcomes. The clinics that hand the patient a device and a six-month review are seeing the international literature pattern of declining adherence. The data is now clear enough that the discussion is about how to do better, not whether to.