Adherence to therapy can be challenging for some CPAP patients. Therefore, it is beneficial for HME providers to be able to recognize the signals and to have an effective strategy in place to provide education and support to ensure acclimation and compliance.
When receiving a referral for CPAP set-up, HME providers should consider incorporating an approach that involves "treating the whole patient"; to decrease the major hesitations patients may have, including the stigma of having a sleep disorder or fears or discomforts related to the look and feel of CPAP, all of which compromise treatment compliance.
Many providers have heard some of the same concerns, such as:
"Wow, this is attractive!";
"I look like the Elephant Man!";
"How will I sleep wearing this?";
"What will my girlfriend think if I wear this?";
Patients often have various poor mental images or physical problems related to CPAP therapy. Some patients enter treatment with preconceived false or socially negative notions about CPAP. They fear they will look unattractive to significant others or that the noise of the machine will keep their bed partners awake, even though research proves that bed partners' sleep (and marital relationships) actually improved through the benefits of using CPAP.
The good news is that through education and support, patients can lessen their anxieties and excuses for not complying with their therapy. However, your role is critical in changing their behavior.
Patients view you as a competent provider of patient care services, so they will look to you for help. Harness the strength of your expertise and the resources you have available to help them. Most likely, their interaction and experience with you will make or break their treatment experience, especially during the first few nights of therapy.
Here is a scenario to consider. The patient asks, "I have to wear this to bed every night?";
You respond by saying, "I know it's hard, but don't give up. I'm going to give you some tips to help you.";
By doing this, you helped the patient by acknowledging the fear and letting him know you understand. You also helped the patient by minimizing the fear and giving him hope for a solution.
Physical Issues
First of all, recognize the physical side effects of CPAP therapy. There are solutions to most, so it is advantageous to acknowledge them in the beginning. (See accompanying chart for some of the most common side effects.)
Humidification can be beneficial in relieving most physical side effects of CPAP therapy. Let patients know that resolving these symptoms can improve the comfort and quality of their therapy. It is helpful to explain that the therapy creates a new climate for nose and upper airway because airflow is greater than what the body is accustomed to humidifying, so additional humidification is necessary.
If skin allergies or tenderness become an issue, work with the patient to find the right supplies. Masks come in a variety of materials, so find one that is most compatible. Many standard masks are made with latex-free cushions and forehead pads, which minimize allergic reactions. Also, replaceable silicone cushions can provide a seal with low pressure for comfort, thus reducing pressure points on the face.
Social Issues
The social and emotional impact of having a sleep disorder varies. Many patients experience a decreased interest in intimacy, impotence, strained relationships with their spouse due to snoring, forgetfulness, fatigue and daytime sleepiness. Additionally, their disease can impede participation in family events, increase relationship stresses and decrease work productivity.
Still, many are resistant to therapy. Encourage patients to see the positive results that will occur and remind them that they are treating a medical condition that needs to be addressed. By keeping their spouses involved in the process and "normalizing"; the therapy, the transition can go more smoothly and can keep the patient reminded that it is beneficial for them and their family.
For patients who are resistant, consider using graded exposure therapy, a technique that is widely used in cognitive behavioral therapy. Exposure treatment is used for a variety of anxiety disorders and has also recently been extended to the treatment of substance-related disorders and behavioral sleep medicine, such as for people with claustrophobic problems with wearing CPAP masks.
The basic purpose of exposure treatment is to decrease a person's anxious and fearful reactions (emotions, thoughts or physical sensations) through repeated exposures to anxiety-producing material. This reduction of the patient's anxiety response is known as "habituation."; A related purpose of exposure treatment is to eliminate the anxious or fearful response altogether so that the patient can face the feared situation repeatedly without experiencing anxiety or fear.
Helping patients adjust to CPAP therapy is an involved process that must address both physical and emotional issues. As you help them through the process, make sure you set the tone for optimism, convey a positive attitude and minimize the impact of any past negative experience the patient may have experienced.
Teach the patient to be proactive in his or her own treatment regimen by sharing available resources for self-help and peer support through patient mentors and online and live support groups. Above all, keep them mindful of the positive effects they will experience by adhering to therapy.
Theresa Shumard is a longtime sleep technician and medical columnist who works for DeVilbiss Healthcare in the role of clinical sleep specialist, sleep advocate and manager of education and clinical services. She publishes a blog titled "Let's Talk Sleep" at www.letstalksleep.blogspot.com for medical professionals in the sleep disorders community. You can reach her at theresa.shumard@devilbisshc.com.
