Trouble Wearing CPAP? (Common Problems, Causes and Solutions)
Negative CPAP side effects can cause patients a lot of stress. From dry mouth and headaches, to claustrophobia and sore nose, for many patients the cons of treatment can outweigh CPAP benefits. Inadequate patient education can lead to non-compliance, but sleep technologists can help their patients realize there are few effective alternatives to CPAP for sleep apnea.
If your patients are having trouble wearing CPAP—or if your patients find they are uncomfortable wearing CPAP—here are some tools to help guide them to compliance.
AAST CCSH Designated Education Program Recorded Modules
CPAP Problems and Non-Compliance
First and foremost, patients need to understand why they need a CPAP to understand why CPAP adherence is so important. Starting with patient education basics can be an eye-opening experience. While sleep technologists understand the importance of proper sleep hygiene, most don’t understand the critical role it plays in other parts of their health.
If patients do not understand the larger health implications of untreated sleep apnea, they’re more likely to not comply with CPAP. Given the onus is largely placed on patients to follow through with their treatment alone, underlining the “why” is essential.
There are a few different approaches to breaking down patient education basics.
Patient Engagement and Activation
Sleep technologists should walk their patients through the CPAP process and how it functions. This should also include proper CPAP care (including how to clean the CPAP hose).
- Allow patients to physically handle a CPAP before trying it on.
- Explain to patients how a CPAP works.
- Demonstrate proper CPAP care and handling.
- Discuss any concerns patients may have before trying the mask on.
Once a patient has had a thorough explanation of how CPAP works, it’s important to assess any existing issues that might affect their CPAP experience.
- Are they a mouth breather? There is CPAP treatment for mouth breathers, which can include a full face mask or a traditional nasal mask/pasal pillow mask with the addition of a chin strap.
- Do they have a deviated nasal septum? This can cause difficulty breathing through the nose, and might affect the comfort a patient has with certain types of CPAP.
- Do they have a history of allergies or sinus issues? For a CPAP patient experiencing nose blockages, using a machine in conjunction with other medication (or a dehumidifier) might be the best course of action.
It’s also important to desensitize patients to the CPAP mask, introducing PAP therapy gradually and allowing a patient to try the equipment on. Let the patient try on the mask (or hose), connecting the nasal exhaust port to the hose and interface, and allow the patient to breath. From there:
- Start with a CPAP pressure of 4.0cm/H20 or Bilevel pressure of 8 IPAP/4 EPAP
- Have patient hold hands over interface opening to feel the air pressure
- Remind the patient that this is not forced oxygen – something that can be a concern for some.
- Place the mask over the nose and instruct the patient to break in and our through the nose with the mouth closed.
- Have patient practice breathing with the inference for approximately three to five minutes.
- Always positively reinforce positive breathing techniques.
Common Problems with CPAP
While a CPAP is the most effective solution to treating sleep apnea, there are many common problems with CPAP that can make it overly burdensome for some patients. There are some common CPAP problems, and there are some specific areas a sleep technologist should look at when addressing those concerns. It’s important to be specific when asking these questions.
The most common cause of CPAP dryness is a lack of humidification. A dry mouth can cause a slew of issues: scratching and irritation, difficulty swallowing, bad breath and the growth of bacteria. This is most commonly caused by the influx of air that dries up the mouth when using a full-face CPAP (or if the patient’s mouth remains open during a nasal CPAP). Dryness can also be present when the mouth is closed due to high air pressure. CPAP humidification can help ease the dryness.
Choosing a comfortable mask is critical to adherence. Depending on the way a mask fists on the face can affect not only the efficacy of the mask, but how likely a patient is to use it in the first place. CPAP machines come in various shapes and sizes, and sleep technologists should be encouraged to try different types of masks if a patient reports they’re uncomfortable.
As stated above, nasal congestion of any kind can greatly impact how well a CPAP works. If a patient is reporting any nasal issues, it’s important to get the airway open so the treatment is effective. For some, this might mean medication (especially if they have allergies or a sinus issue). Talk to your patients about their possible nasal issues if they find this is a consistent problem.
Some patients might report difficulty exhaling with CPAP. If this is the case, you might need to see whether a bi-level PAP (BiPAP) or an autoset PAP (APAP) device is a better option. These devices can have lower pressure when the patient breathes out, making it seem more natural.
A leaking CPAP mask is not only annoying, it makes treatment less effective. Even if a mask fits on a patient at the time of consultation, once the air fills it up, it can affect the way the CPAP mask fits. Fixing a leak might be as simple as adjusting the headgear or making sure the mask is on the right part of the face. There are other factors to consider, too. Does the patient have oily skin? Do they have a beard? If troubleshooting there doesn’t help the fit, it’s possible the mask isn’t the right size, or has holes and cracks in it.
Other CPAP Concerns
CPAP, while effective, can feel large and intimidating to patients. For many, the social and psychological downsides of CPAP can outweigh the health benefits. If a patient is struggling to mentally prepare themselves for CPAP treatment, it can affect their follow through.
Depression and Anxiety
Some patients reporting feeling claustrophobic with CPAP. Having a large facemask on can cause people to feel trapped and/or a sense of anxiety. CPAP claustrophobia is very common, and is largely present while a patient is first adjusting to their device. Sleep technologists can help aid in this by using masks that are vented, and explain how those vents work to patients. Also consider exploring whether a non-full mask CPAP option is available for the patient. If anxiety persists, patients should be encouraged to wear it during the day to get used to it—especially during leisure activities.
The social costs of CPAP are significant for some patients, especially if they’re single. CPAP masks are not known for their arousing design aesthetic, and it can be hard for patients who might consider it a romance killer to wear it regularly. But some research shows CPAP improves the sex life for those with obstructive sleep apnea. Beyond that, underscoring the fact that overall health (which is greatly improved for those with sleep apnea by using CPAP) can lead to a happier, healthier sex life.
Traveling with CPAP
Logistically, CPAP isn’t the easiest thing to carry around. While patients might want to leave their CPAP at home while on vacation, continuous compliance is important for care. Traveling with CPAP doesn’t have to be a hassle. TSA recommends taking the CPAP as a carry on in case your luggage is lost or stolen. In the security line, it must be removed from its carrying case to forgo x-ray screening. It can be in a plastic bag while being screened.
AAST CCSH Designated Education Program Recorded Modules
AAST launched the AAST CCSH Designated Education Program Recorded Modules to allow those with their RPSGT to become eligible to earn their CCSH. Upon completion of this seven module series and receiving a passing score on the post-test, RPSGT credential holders who have re-certified at least once will be eligible for the CCSH credential, under a newly created pathway. Candidates must provide proof they passed the post-test with a greater than 70% score to receive a certificate of eligibility to apply. BRPT also requires currrent BLS certification for eligibility. Click the link below to learn more today!