Sleep Apnea: Improving CPAP Compliance

Image: David Castillo Dominici /

Generally patients like to believe that there is a cure for everything.  Medical professionals know that there simply isn’t.  Not every medical complaint can be eliminated by a course of medication, therapy of some kind or a surgical procedure.  Doctors spend much of their time simply managing illnesses, attempting to alleviate the most dangerous, most debilitating or most distressing aspects of chronic conditions, and therefore not only extend the lifespan of their patients but also the quality of life they experience.

Sleep Apnea

Sleep apnea is often one such condition.  During sleep, sufferers experience repeated short episodes, typically of 10 to 20 seconds when their breathing becomes dangerously shallow or ceases completely.  Naturally this has consequences.  Most noticeable to the person and their family are day time fatigue, instances of inappropriate napping and low mood, but there are also health issues beyond the perils of breathing interruption, including hypertension and changes in atrial fibrillation.
There are three types of sleep apnea:
  • Obstructive sleep apnea accounts for the vast majority of sufferers.  It occurs when the soft tissue at the back of your throat relaxes during sleep, leading to a blockage of the airway, and often characterized by heavy snoring. The condition can occur in children as well as adults, but is then generally due to problems with the child’s adenoids or tonsils and can be fully resolved by their removal.
  • Central sleep apnea is far less common, and results from a failure of the central nervous system to properly control the breathing response during sleep.  As there is no blockage of the airway, such sufferers rarely snore.
  • Complex sleep apnea is a combination of the obstructive and central varieties. 
Research shows that there are ethnic and familial predilections amongst sufferers, and that obesity and smoking are high risk factors.  Losing weight and smoking cessation can bring about improvements, or sometimes resolve the issue, but often the condition is likely to be life long and will require on-going management.  Patients are usually given advice on sleeping positions and establishing regular sleep patterns, and warned against the use of sleeping tablets or sedatives, drinking alcohol, or consuming caffeine or heavy meals too closely to bedtime. 

Technology that helps

However, whilst such strictures may be good advice for all patients, and helpful to some; a large number will continue to experience dangerous interruptions in their night time breathing.  For these patients the solution will generally involve providing artificial assistance through positive airway pressure, which will secure their airway during sleep.  Most commonly in the home a Continuous Positive Airway Pressure (CPAP) machine will be used, but in some circumstances an Automatic (APAP) machine which responds to interruptions in breathing and operates at a lower pressure may be recommended.  Rarely, a Bi-level (BPAP) device which adjusts pressure with each breath in and out will be employed.  BPAP machines are used for other major respiratory illnesses and generally operate at higher pressures, which is why they are not commonly used in sleep apnea cases.
Issues of Compliance

The chief problem with CPAP machines is poor compliance.  Generally the worse the condition is, the better the rates of compliance, but there are a number of factors which influence patient behavior on this matter. These include:
  • A history of previous poor medical compliance in other areas tends towards a similar reaction to CPAP therapy.
  • A failure to appreciate the long term health problems that sleep apnea can cause.
  • Self-consciousness that creates a reluctance to wear the CPAP mask, particularly in the presence of a partner
  • Complaints of claustrophobia and discomfort
  •  Side effects such as nasal drying, increased congestion, sneezing, rhinorrhea, sinusitis, conjunctivitis, claustrophobia, pressure sores on the bridge of the nose, difficulty exhaling, allergic reaction to the mask, air swallowing  and machine noise.
Many patients have a poor understanding of their own condition.  They will spend longer choosing which restaurant to visit or sorting out their credit card transfer than they do understanding the implications of poorly managed sleep apnea.  Therefore, the first three points above can only be properly addressed by health professionals educating their patients appropriately, and re-emphasizing the importance of compliance on a regular basis. 

The problems of claustrophobia, discomfort and other side effects are perhaps more amenable to practical solutions.  There are a large number of different and increasingly sophisticated machines and equipment available on the market, some with very minimal light weight masks to reduce the sense of entrapment, and others designed from materials for those with allergy issues.  It is also possible to attach a humidifier to most machines to prevent issues related to dryness; and both minimal noise and portable models are also available.
If a patient is reluctant or has difficulties in using their CPAP equipment, it is essential that the health professionals involved identify the problem early on during treatment.  This will give the best chance of establishing an early and hopefully enduring pattern of compliance.  It is also important that checks are made on an on-going basis to ensure that a satisfactory regime is maintained.

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tomcruse said...

Thanks for sharing information about sleep apnea supplies .

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