Sleep

Fostering Compliance

For patients with obstructive sleep apnea, continuous positive airway pressure therapy generally is the preferred treatment. When properly implemented
by SHARON BAER, MBA, RRT

For patients with obstructive sleep apnea, continuous positive airway pressure therapy generally is the preferred treatment. When properly implemented and used conscientiously by the patient, CPAP is usually effective in alleviating nocturnal symptoms (frequent awakenings, snoring and gasping) and can improve the patient's daytime sleepiness and quality of life.

And yet, it is well known that as many as 50 percent of patients will stop using CPAP within the first few months after starting treatment.

Why would someone with a debilitating condition like OSA willingly abandon treatment? The answers to this question are complex and have been the subject of a great deal of discussion and research. In individual cases, it is difficult to find a single reason for non-compliance. It is far more likely that multiple factors are at work.

Home medical equipment providers need to be knowledgeable — and sometimes creative — to find solutions that will work for their patients.

WHO'S AT RISK?

There is evidence that certain individuals are more likely to be at risk for discontinuing therapy. Some who are at increased risk of immediate CPAP discontinuance include patients who are younger, thinner, depressed or female. Others have a lower AHI (apnea/hypopnea index), few symptoms or complaints, or lower self-efficacy or self-esteem.

From a psychosocial perspective, such at-risk patients may experience a cognitive disconnect between perceived costs and the benefits of CPAP therapy. By understanding these factors, providers can make a rational decision on how to minimize the potential for non-compliance.

ACCLIMATIZATION TO CPAP

CPAP therapy imposes a substantial life-style change on the patient. Along with the obvious therapeutic benefits of CPAP comes a whole range of side effects. Some arise when the equipment is not properly fitted to the patient, while others are a result of sleeping with the apparatus itself. Either way, CPAP can have a dramatic effect on the way a patient sleeps. Such problems can include:

  • Noise, mask discomfort or leakage
  • Air blowing on partner
  • Nasal obstruction and claustrophobia
  • Nasal stuffiness
  • Chill or dryness in the upper airway

A wide variety of mask designs is available and, often, the solution is simply a matter of finding the best mask for the individual patient. Attention to comfort, seal of the mask and security of the headgear is vital.

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