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By: Rita Brooks on February 27th, 2018

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Here's Why CPAP Adherence is So Critical

Sleep Technologist Advice

CPAP, which stands for Continuous Positive Airway Pressure, is a common and popular treatment option for patients with obstructive sleep apnea (OSA). During sleep, patients wear a nasal or full face mask. This mask connects to a generator that delivers a positive flow of air through their nasal passages, which helps to keep their airways open.  Almost all insurance providers pay for some form of sleep testing and CPAP therapy.

Are Your Patients Adherent?

A big concern for sleep technologists is that their patients maintain adherence with their CPAP therapy. CPAP adherence includes how freuently and for how long your patients use their CPAP device, and if it's improving quality of life for them.

When it comes to Medicare, your patient isn't considered adherent if they're using their device less than 70 percent of nights or less than four hours nightly.  A patient needs to use their device at least four hours a night, 22 days out of the month to be adherent. Therefore, even if they only were a minute off the four-hour mark, Medicare could find them non-adherent.

Also, the patient's physician has to tell Medicare they're adherent. The patient can't just download information from the device to show they are adherent. A visual inspection of the device or reading of hours of use isn't enough either. The patient needs to see their physician and get a confirmation of their adherence.

If your patient doesn't meet adherence measures, they have a few options under the new guidelines for Medicare. They either have to pay for the device themselves, the device will be removed by the home care company, or you have to perform another sleep study on your patient to determine if they still require CPAP therapy.

Reasons your Patients May Not be Adherent

There are a number of reasons why your patients aren't maintaining adherence with their CPAP therapy.

Mask is Uncomfortable

A common reason that patients are not adherent is discomfort. To help remedy this, you may need to show them how to adjust their mask so it fits properly or provide a different interface with a better fit.

Their Nose is Stuffy or Runs Wearing the Mask

Use heated humidification can often alleviate these symptoms. CPAP machines with built-in humidification generally allow the patient to adjust the humidification level.

Make sure they are fitting their mask properly since if their mask is leaking, it can dry their nose out. They may want to use a nasal saline spray before they go to bed at night to prevent over-drying of their nose.

Not Used to Wearing a Mask

Your patients may have difficulty getting used to wearing a mask during the night when they're trying to sleep. Offer them some suggestions like wearing their mask while they're up reading a book or watching television. This helps them to get used to wearing the mask so they can wear it comfortably at night.

They Can't Fall Asleep with the Mask On

If your patient is new to CPAP therapy, a typical and temporary issue they will likely experience is having trouble falling asleep. Inatruct them on how to use the machine's "ramp" feature so that pressure is increased gradually as they fall asleep. They should also practice proper sleep hygiene, such as getting some exercise early in the day, avoiding caffeine, and avoiding alcohol before bedtime.

They're Allergic to Their Mask

Have them stop wearing their mask right away and come in to see the physician. Allergic reactions to a mask tend to happen the first night your patient wears it.  Masks today are generally made from silicone or gel material. Ask them how often they clean their mask. It may not be an allergic reaction, but instead, a skin infection or reaction due to not cleaning their mask often enough.

They Feel Claustrophobic

A lot of people are claustrophobic. Have your patient practice wearing their mask while they're awake. Tell them to first hold the mask up to their face without using the straps. Then, once they're comfortable, have them wear the mask with the straps — again while awake.

They may try relaxation exercises as well as progressive muscle relaxation, which reduces  anxiety when they put the mask on. They may even want to try a different mask style and size or nasal pillows.

They Keep Taking Their Mask Off at Night

Some patients wake up and find they've taken their mask off during the night while they were asleep. This could be due to them moving around a lot. They might have involuntarily pulled their mask off because their nose was congested. If they continue pulling the mask off, suggest they set an alarm so they can wake up during the night to ensure it's still on. They can then gradually set their alarm later and later during the night until they find they're keeping the mask on all night.

They Can't Tolerate the Forced Air Pressure

CPAP devices have a "ramp" feature that lets your patients start with a lower air pressure at first, and then the machine gradually increases it automatically until it reaches the prescribed pressure. You can adjust the "ramp" feature for your patient to a longer ramp time, if needed, or they can reset the ramp if they wake during the night and have difficulty with the pressure.

The CPAP Machine is Too Loud

While their CPAP device is probably much quieter than their snoring, noise may still be an issue for them. There are a few options you can offer them in this case. They can try using a fan to make "white noise" that blocks out the CPAP machine's noise or wear earplugs. Most CPAP machines are virtually silent today. Have them ensure the air filter on the machine is not blocked and is clean, since this could be what's making the noise. If this isn't helping, have them bring the machine in so you can check to see if it's working correctly.

So, Why is CPAP Adherence So Important?

Untreated OSA has been associated with cardiovascular complications. CPAP therapy is found to improve cardiovascular disease outcomes and reduce elevated blood pressure. It reduces daytime sleepiness significantly in OSA patients and has been linked to daily functioning and memory improvements — all possibly attributed to better and longer sleep at night. CPAP therapy has also been shown to greatly improve executive function and verbal memory in some patients.

Non-adherence with CPAP therapy can result in daytime sleepiness and negatively impact daily functioning as well as increase blood pressure. OSA patients who aren't adherent with their CPAP treatment are more likely to use medical services and medications than those who are adherent. This leads to increased medical costs for patients who are not adherent and better health for those who are adherent.

CPAP therapy non-adherence may even affect mortality rates more than smoking due to severe cardiovascular mortality and morbidity linked with untreated OSA.

Patients with OSA have shown significant long-term survival improvement with CPAP therapy. Not only this, but patients who are adherent with their CPAP therapy have the added health benefits that come with treating their OSA. Using their CPAP therapy consistently can help improve your patients overall quality of life in many ways.