Improving CPAP Compliance

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.

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CPAP Therapy

Continuous positive airway pressure (CPAP) therapy was first introduced in 1981 for the treatment of obstructive sleep apnea (OSA). Since then many studies have confirmed and documented the effectiveness of CPAP. Though OSA can be managed with a variety of treatment options, such as medications, oral appliances, positional therapy and surgery, CPAP has become the front line treatment for OSA and is the most widely used. The goals of treatment are to normalize oxygen levels and breathing, eliminate apnea, hypopnea and snoring, while improving sleep architecture and continuity. Benefits also include; ending OSA’s cycle of snoring, airway obstruction, breathing cessation and awakening. CPAP therapy restores restful sleep and can dramatically improve the quality of one’s life by reducing daytime fatigue and sleepiness. Risks for hypertension, heart disease, stroke and congestive heart failure are reduced.

Sleep apnea treatment should always include lifestyle changes, such as weight loss (if necessary), regular exercise and avoidance of alcohol and sedatives. Success depends on routine, sustained nightly use, to see improvements within the first couple of weeks and continued long term benefits. CPAP therapy basically involves an airflow generator, attached to pressure tubing that is connected to a mask interface the blows pressurized air into the back ofthe throat to maintain a patent airway. Continuous airway pressure splints or “wedges” the upper airway open. During sleep, the CPAP system continuously delivers air throughout the night at a specific pressure prescribed by your physician or sleep technologist. Bilevel positive airway pressure and auto-titrating devices have been successful with patients who have difficulty tolerating standard CPAP.

Initial CPAP setups in the home are always best performed by a licensed medical professional. A well trained and dedicated respiratory therapist is critical to achieving consistent, successful implementations and maintaining patient satisfaction. Follow up should also include reliable equipment support and dependable service. Unfortunately, success in the sleep lab environment does not automatically translate into therapy success in the home environment.

Clinicians frequently encounter difficulty with their patient’s compliance (min 4 hrs. per night for 70% of night), some measured as low as 50%. Patient comfort features such as ramp, which allows for a timed, gradual increase to set pressure, and humidification, which can eliminate nasal dryness are essential components of most successful CPAP trials. The mask interface however, without question, is the single most problematic element of CPAP machine- patient harmony. That’s putting it politely. Fit, function and comfort of the mask are crucial. Every mask needs to form an effective seal on your face, so that air doesn’t leak out. There are multitudes of masks on the market, but they generally fall into three major categories: nasal masks, full face masks, and nasal pillows. So which mask is right for me? Visit CPAP Mask Reviews.

Side effects of CPAP therapy are directly related to the mask interface and the prescribed pressure. Eye irritation will occur if the pressurized air leaks underneath the mask and blows into the eyes during the night. Skin irritation, such as redness and visual marks on the face, abrasions or sores on the bridge may occur if the headgear is not adjusted properly or if the mask is the wrong size. Often, every effort is made to facilitate an appropriate fit. However, finding out what works with your face shape and sleep requirements may take some aggravating trial and error.

Finding the right mask is often comparable to a quest for the Holy Grail. So which mask is right for me? Visit Seek, and ye shall find.