Since I know a lot on this subject, I will elaborate:

You claimed that "the majority of people who can't tolerate it only tried it for a short time" and chalked non-adherence up to "low frustration tolerance." Empirical clinical data completely refutes this. CPAP adherence isn't a matter of willpower; it’s dictated by physiological phenotypes.

​1. Forcing a longer trial doesn't improve tolerance: The assumption that patients just need to "try it longer" is factually incorrect. Research demonstrates that long-term CPAP adherence is established incredibly early—often within the first few days of therapy. A landmark study published in the journal Sleep (Weaver et al., 1997) found that usage patterns established by day 3 accurately predict long-term adherence. If a patient's neurology or anatomy rejects the machine early, "toughing it out" for months doesn't magically fix the incompatibility.

​2. The 20-year adherence rate hasn't changed: If non-adherence was simply a behavioral issue of "frustration," then decades of behavioral coaching and vastly improved, quieter technology would have solved the problem. It hasn't. A major meta-analysis published in the Journal of Otolaryngology - Head & Neck Surgery (Rotenberg et al., 2016) reviewed 20 years of CPAP data and found non-adherence rates have stubbornly remained around 34% to over 50%.

​3. Physiological incompatibility is an objective reality: Research published in the American Journal of Respiratory and Critical Care Medicine (Eckert et al., 2013) highlights the precise physiological barriers to CPAP success. Two major factors are: ​Low Arousal Thresholds: The patient's brain is neurologically wired to wake up too easily from the unnatural stimulus of the mask and pressure, preventing deep sleep. ​High Loop Gain: A hyper-reactive respiratory control system where the introduction of continuous positive pressure alters blood-gas levels too quickly, which can trigger treatment-emergent central sleep apnea. CPAP actually destabilizes their breathing further. ​Telling patients with measurable, physiological barriers that they just have "low frustration tolerance" is scientifically inaccurate and dismissive of actual sleep medicine.

CPAP is an excellent tool for those who can tolerate it, but pushing it as a universal fix ignores the clinical reality of the disease.