From Home Sleep Testing to AutoPAP: The Key Role of Patient Education
It has always been important that a patient is educated on their sleep disorder to increase the chances of them following through with their therapy. Now it is more important than ever before. More and more patients are opting for home sleep tests (HSTs) and then going directly to AutoPAP with no time spent in the sleep lab.
The time spent in lab with a sleep technologist is time spent being educated on sleep disorders and CPAP usage, and often actually using positive airway pressure (PAP) therapy. The process is long and involved. You need to see your physician, schedule the polysomnogram (PSG), have the test, receive a diagnosis, return for a PAP titration, make an appointment to see a sleep physician, get in to see the sleep physician, receive a script and finally get set up with PAP therapy. The interval between these many steps can be quite long.
The sleep disorders center at Northwestern Medicine was looking for a way to both speed up the process for patients and to increase PAP compliance outcomes. We focused on patient education on both the sleep disorder and PAP therapy as a way to accomplish this.
HST’s are becoming extremely common today for a variety of reasons. One reason is that devices are easier to use and usage instructions are more advanced. In many cases, the instructions given to the patient on device usage is not done in person, rather it is done by video or via printed materials. At our sleep center, we still have patients come into our center to be instructed by an RPSGT. This both assures that the patients understand how to properly use the devices and that they can be educated on sleep disorders.
Some of our patients have seen a sleep physician, but most have not and are prescribed a HST by their primary care physician. After the HST is interpreted and the need for PAP therapy is decided by the physician or insurance company, AutoPAP with patient education is ordered. The patient then comes to our sleep center and meets with the clinical sleep educator. The patient is educated extensively on their sleep disorder: what causes it, how the symptoms and comorbities they have are affected by it and how it causes cardiovascular and metabolic problems if left untreated. An untreated sleep disorder can also cause psychological, cognitive and emotional problems. The clinical sleep educator reviews the patient’s sleep study and explains the specifics to them, including apnea hypopnea index (AHI) and oxygenation. PAP therapy is explained to the patient: how it works to treat obstructive sleep apnea (OSA); how it will positively benefit their overall health and well-being; the importance of good compliance, good humidification and how to choose a mask option that will work for them.
Once this education is completed, the patient can then be set up on PAP therapy. Most patients are motivated at this point and are ready to use their machine. We continue to educate during setup, reinforcing important points of successful therapy use. This entire process from HST through PAP therapy setup is much quicker than the previous process. With this process patients start prescribed therapy sooner and potential problems are more quickly identified.
An educated, informed patient is much more likely to follow through with treatment and have good adherence to and outcomes. Taking the time to properly educate the patient regarding their sleep disorder and explaining and reinforcing the importance of follow through with therapy is very beneficial and rewarding for both the patient and the clinician.