Let’s begin with an honest assessment of a dismal situation. CPAP therapy is the front line, single most effective treatment option for patients who have been diagnosed with obstructive sleep apnea. As a practicing homecare respiratory therapist, I have enjoyed listening to dozens of successful CPAP patient testimonials, each in their own personal and unique way, describe both the dramatic and subtle improvements in the quality of their lives since they began therapy. These patients are the exception rather than the rule. More often than I care to admit, many of my CPAP patient’s enthusiasm and motivation fade, giving way to eventual noncompliance. Time and time again I hear the same litany of explanations, “the mask leaks”, “my skin gets irritated”, “it doesn’t work for me”, “my throat gets dry”. I am reminded daily of why CPAP compliance is consistently reported in the 50 percent range after the first year. So here is a logical and yet practical strategy that I use in order to improve my CPAP compliance rates.
Continuous use of positive pressure therapy is required for treatment success. Sustained motivation is necessary for continuous use. Patient education is necessary for sustained motivation. If improved CPAP compliance is directly proportional to the quality of relevant patient education, then what should the syllabus be? May I suggest beginning with a dose of empathy, since we all can identify with the effort required to learn a challenging new subject. Intrinsic patient motivation is absolutely essential. Patients must believe the endeavor is important, worthwhile and understand the abstract incentives. “What’s the big deal?”, “Why do I need all of this?”,”What’s in it for me?” Set reasonable, yet challenging short term goals to be achieved. Clarify specific objectives, how many hours per night, how many nights per week. “What do I do when I have a problem?” Balance the difficulty of the goals. “Try these mask fitting techniques first, read the literature you have, brainstorm for solutions, problem solve on your own, then call me if you are still having trouble.”
Keep in mind that motivation is the primary driver in the accomplishment of our goals. Assure the patient of the support systems available, including family members, especially in the initial CPAP trial period when monitoring is vital. As a clinician, I work hard to pay special attention to the personal relationships I establish. My successful CPAP patients learn to become active and self-managed participants in their treatment. By instructing on patient comfort features and troubleshooting techniques for common problems, I encourage confidence in their belief that they have the capability to perform the actions required to achieve positive outcomes. “Be open to the therapy, embrace it and give it a fair chance for two weeks, then you will be able to feel the difference.” I challenge my patients to be tenacious, and not let any obstacle come between them and getting the quality sleep they know their bodies yearn for. When it comes to my patients CPAP compliance, I stay positive and eat this elephant one educational bite at a time.