We all know someone who started using a CPAP machine, and then within a month or two, it ended up in a box in the closet. CPAP (Continuous Positive Airway Pressure) has long been the “Gold Standard” for the treatment of Obstructive Sleep Apnea (OSA) if used properly. The drawback is patient compliance. The term “CPAP intolerant” probably comes to mind. Despite great strides including different types of masks, enhanced portability and a quieter pump, adherence rates remain between 30% – 60%.
The CPAP machine is not the most convenient device for travel, nor is it appealing to your significant other or bed partner. If you live alone, or your partner is not involved in your OSA treatment, CPAP use is significantly less than if there is support present. Some people have claustrophobia issues with the mask, some say it is inconvenient to tote around and some cannot even afford the basic cost of the CPAP/maintenance. Whatever the reason may be, the recommended 7 hours of CPAP use per night remains uncommon for users.
According to several studies over the years, the number of people prescribed a CPAP who either stop using it altogether or don’t use it enough is sizeable, quite possibly the majority. For example, if the CPAP is prescribed to someone with mild OSA who exhibits minimal symptoms, they probably won’t feel obligated to use it. Additionally, most people aren’t getting 7 hours of sleep per night, especially during the work week, so they may only use it on the weekends.
Factors that influence CPAP adherence:
- Disease & Patient Characteristics
- Subjective sleepiness
- Airway structure & nasal anatomy
- Treatment Titration Procedures
- Auto-titrating PAP vs. CPAP
- Psychological & Social Factors
- Depression and/or anxiety
- Patient perception of symptoms
- Claustrophobia
- Technological Device Factors & Side Effects
- Nasal masks vs. Full face masks
- Cheap humidifier vs. top rated dehumidifier
There are various age groups that the CPAP would be prescribed for. Even though the standard treatment for OSA in children is a tonsillectomy/adenoidectomy, CPAP is prescribed for those who don’t respond to the surgery or those whom the surgery is not recommended. Compliance at this stage in life is high, because it is the parent forcing the child to use it. Teenagers are less compliant and have different sleep patterns. They may choose to not wear their CPAP for social reasons. The social awareness of OSA and CPAP continues to grow however, probably due to the relationship between childhood obesity and OSA.
For adults, adherence tends to be higher when they see an improvement in symptoms. In addition to support that they get from home, if their daytime sleepiness is lower and sleep disturbances are reduced, there is a good chance they are going to stick with the treatment. The caveat here is patients suffering from insomnia. These adults tend to be more aware of the CPAP discomfort since they spend a large portion of their night restless and awake. Also, if the adult patients have several other chronic health conditions, it will be harder for them to adhere to CPAP therapy.
No matter what age group it involves, CPAP compliance is highest when:
-the patient is educated about OSA diagnosis and treatment
-realistic goals and expectations for treatment are set
-initial assistance in the set up/use of CPAP
-available resources for troubleshooting/problem-solving
-clinical follow-up is set during the early stages of use
-a support person is included/involved in the entire process
To read more about the American Academy of Sleep Medicine’s clinical guidelines for the management of CPAP-treated OSA, please click on the following link:
http://www.aasmnet.org/Resources/ClinicalGuidelines/OSA_Adults.pdf
If you are currently unhappy with your CPAP device, or know of someone who is, please contact Dr. Klein for information on CPAP alternatives. Here at the Michigan Head & Neck Institute, we specialize in counseling patients about their OSA and offering various treatment modalities. For more information, please call (586) 573-0438.
At Michigan Head & Neck Institute, we exclusively offer treatment for Obstructive Sleep Apnea that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the CPAP compliance requirements of each patient. Each patient that chooses an oral appliance (OA) as their treatment will receive follow up sleep studies (either at-home or a in a sleep lab) to ensure the OA is positioned accordingly.
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