Your Personality Type Can Affect Your CPAP Adherence

By Admin

A personality defines how a person experiences the world, so it is no surprise that these characteristics can have an influence on personal health and treatment outcomes, especially in regard to CPAP. Treatment compliance has been a challenge for PAP therapy since its introduction in the late 1980s, causing some to question its “gold standard” label when so much depends upon daily adherence rates. But the good news is that personalities can be adjusted. This doesn’t mean that patients should change who they are as a person, but in regard to PAP therapy, having a tolerant attitude and a proactive approach to problem solving can lead to great improvements. Researchers have been stressing the importance of personality-based assessments for some time, but in recent years the effects of a “Distressed” personality have become increasingly more apparent, encouraging health providers to assess these risk factors and address them accordingly, often with education, intervention, and follow up.

Personality Types and Health

Personality types were first developed by American cardiologists Meyer Friedman and Ray Rosenman in the 1950s, but the idea of the type A personality, with its high stress and high frequency of coronaries, had a significant effect on the development of health psychology, which focuses on the connections between physical health and mental health. Described as a potential risk factor for heart disease, the type A personality was characterized as assertive, organized, and extroverted, but at the same time high-strung, impatient, and anxious. The type A became an ambivalent stereotype, known for achievement as well as stress and illness. The type B personality, by contrast, was defined as low-stress, unanxious, and calm. Over time there were studies that discounted these clear-cut distinctions, but some of the more common patterns were difficult to ignore. One trait in particular, a high level of distress, continued to emerge among disease-prone patients, especially in relation to coronary heart disease. By the mid-1990s, the term "type D personality" was coined by Belgian psychologist Johan Denollet to describe individuals who are particularly prone to distress. Dr. Denollet gave a series of personality tests to patients enrolled in a cardiac rehabilitation program and immediately found a strong link between distress traits and early mortality. Among those patients who had been classified as type D, nearly 30 percent were deceased within eight years, compared to 6 percent of those without the type D traits. The typical “type D” personality is described as emotionally distressed, irritable, and introverted, often associated with frequent negative emotions. These traits can be problematic when perceptions of the world are often negative as a result. Individuals with type-D tendencies can develop social difficulties, worrisome thoughts, and a general intolerance for new or disruptive experiences in their lives. And from a health perspective, these are all potentially damaging behaviors.

Though we all feel distress at times, and stress (and even anger) can be a routine experience in our lives, regular or habitual negative emotions can lead to serious problems. While Denollet’s original studies explored the connection between type-D personality and coronary heart disease, other research has expanded the type-D hypothesis, linking distress-prone behaviors to a range of adverse health effects that includes low treatment compliance, a lack of willingness to seek help or guidance, and low success rates for prescribed therapies such as CPAP.

High Distress and Low Compliance

While there are many reasons for adherence issues, researchers have consistently found links between low compliance and type D behaviors. In one study, type D patients had more complaints of adverse effects from CPAP therapy, as well as a higher rate of sleepiness and overall dissatisfaction with the results. The study states in its conclusion that the presence of type D personality “increases noncompliance and poor treatment outcomes due to negative affectivity, social inhibition, unhealthy lifestyle, and a reluctance to consult and/or follow medical advice.” But type-D inhibitions can be much less dramatic for some, resulting in just enough reluctance to give up on the treatment, rather than seeking a solution. Coping skills, as well as a tendency to show initiative and seek help when needed, are often described as the missing links between type D patients and healthier lives. And let’s not forget that sleep apnea causes type D problems. Depressive symptoms and anxiety are often seen in sleep apnea patients, especially those who do not adhere to treatment. The goal then, for treatment providers, is to address these symptoms simultaneously. As studies have shown, overcoming difficulties with PAP therapy early, during the first month of treatment, can lead to extensive benefits in the long term, reducing fatigue and depressive symptoms as the apnea events diminish, giving patients a greater quality of life.

What to Do About It

With PAP therapy adherence rates stagnating between 46 and 83 percent, clinicians should be using all the tools and resources available in order to improve and sustain patient treatment plans. By looking for type-D patterns, clinicians can gain important insights into the likelihood of a patient’s adherence to treatment, allowing providers to be more proactive about patient health. When a patient shows clear and observable risk factors for noncompliance, providers can offer them education materials, refer them to support groups or specialists, or schedule additional follow-up visits to assess treatment progress. Any improvement to PAP therapy compliance is likely to have a significant impact on patient health, not only treating sleep apnea but increasing energy and vitality, and greatly reducing the chance for life-threatening comorbid conditions.