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Blog Feature

By: Rita Brooks on September 5th, 2017

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8 Tips to Increase CPAP Adherence in Sleep Apnea Patients

Sleep Technologist Advice

As a sleep technologist, you treat patients with sleep apnea on a regular basis. Continuous positive airway pressure or CPAP is an effective and widely used treatment for the condition. Patients use the non-surgical treatment when sleeping to open the airways.

According to the National Sleep Foundation, more than 18 million people in the U.S. have the condition. It’s, therefore, no wonder that the topic of CPAP is so well recognized among the sleep technologist community. Something else that’s well-known is that it’s crucial to help your patients find ways to adhere to their therapy.

In this article, we take a look at why CPAP adherence is so important, why it's difficult for patients to adhere to, and eight ways you can help increase CPAP adherence in your sleep apnea patients.


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Why is CPAP Adherence so Important?

According to a 2012 article in MedScape, around 50 percent of people prescribed CPAP are either non-adherent or discontinue their therapy. However, CPAP adherence is crucial to sleep apnea patients as the condition returns rapidly if or when treatment is stopped.

A small randomized trial showed that after just two weeks without CPAP, hourly arousal events had more than tripled. Additionally, apnea-hypopnea instances had increased 17 times, according to a 2011 article in MedPage Today.

Although objective measures of sleepiness didn’t significantly change, subjective sleepiness and OSA returned within days of ending CPAP treatment. By the study’s end, morning heart rate, blood pressure, and urinary catecholamines increased significantly, and endothelial function had significantly decreased compared to people on CPAP.

So, you see that it’s crucial that patients adhere to their therapy for the sake of their ongoing health.

Why is CPAP Adherence So Hard for Patients?

There are various pressure, patient, and mask-related issues that may negatively impact patient tolerance and adherence to CPAP. As a sleep technologist, being familiar with the most common complaints and problems related to CPAP use allows you to identify risks for nonadherence.

As our article, Top 10 Most Common CPAP Mask Problems and Discomfort (& How to Solve Them), indicates, there are many common complaints associated with treatment. These include:

  • Feeling the CPAP mask is uncomfortable and that they can’t get used to it.
  • Worrying that they’re allergic to their mask.
  • Being unable to tolerate the forced air from the mask.
  • Experiencing a stuffy or a runny nose after wearing the CPAP mask.
  • Feeling claustrophobic when using the mask.
  • Having difficulty falling asleep when wearing the CPAP mask.
  • Experiencing a dry mouth after wearing the mask.
  • Constantly removing their mask during sleep.
  • Being unable to put up with the noise of the machine.

New CPAP users may experience any of the above issues and suddenly stop their treatment. For this reason, it’s imperative to discuss potential CPAP problems and their solutions with your patients.

What Can Sleep Technologists Do to Boost CPAP Adherence?

As a sleep technologist, it’s important to provide patients the resources, information, and support they need to become comfortable with CPAP treatment and, in turn, boost adherence. You can do this by doing the following:

1) Educating Patients Before Treatment (& Continue Through Treatment)

Before giving your patient the CPAP mask, make sure they understand all of the aspects of the machine, the therapy, common issues, and how it will help them with their sleep apnea symptoms. Prepare them for all of the common objections, and let them know how to deal with each of them as they come.

Make sure they know the risks of stopping treatment, and that while it may be uncomfortable at first, they will get used to it over time. Your patients need to know that untreated sleep apnea has many adverse consequences on their quality of life and health. Discuss all known or suspected associated medical conditions. This may increase the likelihood of them accepting their treatment plan and taking more control over their health.

Discontinuation of treatment tends to occur most often in the initial stages of therapy. The CPAP mask can feel very foreign when its first worn. It’s therefore advised that you counsel patients of the effectiveness and benefits of CPAP therapy. This may motivate them to continue on with their treatment during the initial transition period.

2) Taking Time Finding the Proper Mask

Many patients experience issues because they aren’t using the right mask. Taking the time to show your patient all their options beforehand will increase adherence, because typically after they have a bad experience with one mask type, they’re wary of trying another.

There are three main types of masks:

  • Nasal pillows. These rest at the entrance of the nostrils below the nose. Patients can wear nasal pillows with glasses without obstructing their vision.
  • Full face masks. Full face masks cover both the nose and mouth. These are a good choice for patients who breathe through their mouths.
  • Nasal masks. Nasal masks cover the nose and are lighter and smaller than full face masks. They also provide better coverage than a nasal pillow.

Be sure to go through the pros and cons of each type of mask to help your patients understand the best choice for them.

3) Checking In Often & Being Available for Support

For new CPAP users, make sure you’re checking in with them often about their level of comfort with the treatment and track their adherence so if their adherence rates drop, you can correct the bad habits early on.

It can be bewildering and strange to have to wear a mask to sleep each night. Your patients are going through many changes in terms of their health. By being there for them and by exercising understanding, you can ensure they feel as comfortable as possible throughout their treatment. They’ll also find it easier to approach you if they do have any problems or issues.

4) Starting Small

Don’t push new CPAP users who are having difficulty with the therapy to wear the mask the entire night right away. Encourage them to just try wearing it a little longer each night, which will help ease them into wearing the mask. Give them small, attainable goals that lead up to wearing the mask full-time. For example, they can practice wearing their mask while they’re awake.

To begin with, they can hold the mask to their face without attaching anything else. When that feels comfortable, they can try putting on the mask along with the straps. They can then try holding the mask to their face with the hose connected to the machine with the ramp feature turned on and at a low-pressure setting. They should do this while they’re awake. When they feel comfortable enough, they can try sleeping with the mask on.

5) Showing Patients Relaxation Exercises

A common reason for CPAP non-adherence is anxiety. Showing patients relaxation exercises, like progressive muscle relaxation, can help reduce their anxiety with wearing the mask at night.

6) Trying the “Ramp” Feature of the Machine

This allows them to start with low air pressure, followed by a gradual increase. This is far preferable for many patients to have higher air pressure immediately. They have time to get used to the new sensation and to relax.

7) Trying Heated Humidification

Heated humidification solves the common “dry nose/mouth” complaint by patients, and can make the mask more comfortable for them. Some patients may breathe through their mouths at night or could sleep with their mouth open. Under these circumstances, CPAP may worsen a dry mouth. A chin strap could help them keep their mouth closed. It can also reduce air leaks if they have a nasal mask.

8) Letting Them Know You’re Open to Looking at New Treatment Methods If All Else Fails

It’s important to be sure you’re listening to their complaints, and properly evaluating if another treatment is better for them and will boost their adherence to therapy. As with many other medical conditions, your patients need to make general health and lifestyle changes to support their well-being. Measures such as elevating the head of the bed while sleeping in a lateral position may decrease the effects of gravity on upper airway obstruction.

Additionally, patients should avoid overusing sedatives and alcohol. Maintaining a healthy body weight is also crucial to improve overall health. You should also discuss general sleepiness in risky situations like driving and operating machinery.

Conclusion

There are many treatments for sleep apnea. It’s important to have all the facts before suggesting one to your patients. In the case of CPAP, patient adherence can be problematic. Educating them about the real need to treat their condition and on how CPAP can benefit them is crucial.

Through rapid identification and resolution of any problems or potential barriers to CPAP use, you can prevent therapy discontinuation -- thus, promoting enhanced treatment adherence and optimal treatment response and outcome.

Additional Resources

For more helpful information, download our Increase PAP Adherence e-book. The essential guide enables you to educate yourself on how to monitor CPAP adherence, increase adherence rates in your facility, train yourself and your staff members to become leaders in CPAP, and more.

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