A Patient’s Perspective on CPAP Compliance

• By Joseph Duffy
• Apr 01, 2011

Tracy R. Nasca, founder and senior vice president of Talk About Sleep (www.talkaboutsleep.com), was diagnosed with sleep apnea in 1989. As a sleep disorder patient and CPAP user, she shares her perspective regarding why patients don’t comply and howproviders can help:

Cognitive factors. Patient attitude and an accurate understanding of the diagnosis. Does the patient present with an open mind and positive attitude? Or does the patient bring baggage and a negative attitude? Patients may know someone who had a bad experience on CPAP and come with a doomed-to-fail attitude. I recommend that an early discussion occur to determine any psychological barriers that might present so they can be addressed before CPAP therapy begins. It is best to start with a positive and clean slate.

Realistic expectations of the CPAP therapy. Patients must be made aware that CPAP therapy might initially be challenging and is achieved in part by the process of trial and error in using selected equipment. If they know to expect problems, they will be less apt to give up. Knowing that equipment can be tweaked or changed will encourage patients to report problems as they occur for prompt resolution.

Lack of individualized treatment plan. Each patient is different and must be evaluated to determine the best plan of action for treatment. There should never be a “formula” to deliver the same package of flow gen, mask and humidification to all patients. Staff should be trained to size up any face, at a glance, and be able to determine best possible mask choices. For example, it can be obvious that nasal pillows will be a better choice for the patient who is claustrophobic, has a short face, short nose, narrow nose bridge or closely set eyes. Patients who present with anxieties about the air pressure should have ramp and expiratory pressure relief enabled and with their knowledge thereof. Patients who require full face masks will most likely benefit from and require humidification and be well informed about how to control the temperature settings as needed for variances with seasonal temperature changes in their sleeping environment. Patients who have chronic nasal conditions need a thorough education about the importance of using heated humidification.

Lack of a thorough education about equipment components. Delivery of equipment without allowing patient involvement in choices is a mistake. When the patient is involved in choosing equipment, they become part of the process and take on a role of responsibility. They cannot blame you and give up when challenges arise. The process of patient involvement in choosing promotes a positive psychological benefit and mutual respect. CPAP equipment, at first glance, is intimidating. If patients learn about equipment options, it lessens the fear factor. No one cares more about their sleep health and overall well being than patients themselves. Involve them.

Patients must learn the importance of the three components for treatment: Flow generator, heated humidifier and interface. They should become intimately familiar with how to adjust the patient-controlled comfort features on the flow gen, how to control humidity settings and how to properly fit and adjust the chosen interface. Inform of and implement the 30-day mask exchange programs off ered by the manufacturers.

Lack of follow-up care and abandonment by healthcare patients. Patients are often delivered initial equipment and left to fend for themselves. Sleepy people with memory loss and depression are not well motivated to succeed should they experience even the simplest challenges. Whether true or not, patients can feel abandoned after the initial delivery of equipment. They should be encouraged to call daily if they have questions or are experiencing difficulty. Develop a company protocol for frequent and routine contact with each patient. Resolving compliance issues as soon as they occur will promote the ultimate goal — 100 percent compliance. Make sure your patients know they are not alone during the adjustment period and beyond. Apnea is for life; they need to realize that CPAP pressures may change over time, masks need to be replaced often, that new and better products are introduced annually and you will be there to provide the support they need.

This article originally appeared in the Respiratory & Sleep Management April 2011 issue of HME Business.