CPAP Failure - How to Avoid the Worst Case Scenario

By Admin

Treatment compliance is the number-one issue for CPAP and sleep apnea patients, and insurance requirements have made it even more of a pressing issue for those who are just beginning their therapy. But what happens if you fail to comply? The term “CPAP failure” is an unfortunately harsh way of describing a problematic introduction to the therapy. In more reasonable terms it simply means that the requirements of compliance have not been met. And in longer-term cases the failure refers more to the inability of the patient to acclimate to CPAP, despite reasonable efforts to do so. The question many ask is what, after “CPAP failure,” are the options for a patient seeking help for a potentially life-threatening disorder. While the answer to that question may not be a simple one, the situation is often more encouraging than it sounds. Whether you are just beginning your treatment, or have struggled with CPAP for a period of time, there are options to consider before throwing down the mask and calling it quits.

CPAP Problems are Common

All patients should know that a quick and faultless transition to PAP therapy routines is rare. There is always going to be an acclimation period before you get used to the treatment, and the length of this period will vary from one patient to another. Some get lucky and find what they need right away, while others may need to try different masks, machines, positions, or routines before the treatment begins to work for them. The point is that PAP therapy is not simply a matter of turning the switch and going to sleep. For some it may come to that, but only after a learning process in which you develop your own strategies and find your preferences. This will take some time, but only practice will lead you to perfection.

What is CPAP Failure?

CPAP failure is a term generally used to describe a patient’s inability to tolerate CPAP therapy. But more specifically, the term refers to unmet compliance requirements, for example, when insurance companies demand a minimum amount of therapy hours for a reimbursement. This is also referred to as noncompliance. Most insurance providers, for example, Medicare and Medicaid, define compliance as a minimum of 4 hours of nightly use for 70 percent of the time period. When patients fall below this standard, there are a number of ways it can be addressed, and each provider has its own methods of dealing with noncompliant results. A doctor, on the other hand, will have a very different professional opinion about what designates compliance with treatment, but this does not change the recommendations. A doctor may have a more flexible definition of when a patient is compliant or not, but this is because a doctor’s emphasis is on goal-oriented treatment. If a patient is discouraged from therapy due to early difficulties, the worst thing from a doctor’s perspective is a total loss of the treatment device. Since modern CPAP machines are equipped with monitoring technology that is accessible to the insurance providers, a doctor can only make recommendations on a patient’s behalf. Whether a noncompliant record is deemed a “failure” or not, and thus used to deny reimbursement or end support for CPAP treatment, is ultimately the insurance provider’s decision. The good news is that this does not have to be an end to sleep apnea treatment altogether. There are many directions to go from here, and the options will depend on each individual patient’s medical needs and preferences at the time.

Failure is Not Necessarily Failure

If you do experience CPAP failure from the perspective of either your doctor or your insurance provider, try not to get discouraged. If it’s an insurance issue, first talk to your provider about getting another chance. In some cases insurance companies may allow patients to try other forms of CPAP before withholding payment. Depending on the specifics of your case and the structure of your airway, you may qualify for a more advanced form of PAP therapy such as APAP (Auto-PAP), BiLevel or BiPAP, or ASV (adaptive servo ventilation). Or in some cases, something as simple as another mask choice, another device, or the inclusion of heated humidification may make all the difference you need. Don’t be shy about asking for other options when the first choice poses problems. If you have a central sleep apnea (CSA) problem, either on its own or in addition to obstructive sleep apnea (OSA), this will make a big difference in how you react to the devices and settings. Insurance providers should know that CPAP systems are diverse and available in a number of different modes for a reason. And a proposed failure due to noncompliance is a perfect time to consult with your doctor and get a professional opinion about your needs as a patient. Ideally, you, your doctor, and your insurance provider should be able to work together as a team with your health interests in mind. On the other hand, if it is your doctor who is proposing that CPAP is not applicable to your condition, it may be time to consider other options. But don’t be in a hurry to leave CPAP behind. Communicate your reasons for noncompliance clearly and with a willingness to try again and do what it takes to become healthy. If it is your family doctor or general practitioner treating you, it may be a good idea to get a referral to a sleep center or sleep medicine specialist for further tests. These doctors can evaluate your mask choice, check for excessive leak, and retitrate the device for proper pressure settings. If CPAP is no longer an option for you, a sleep specialist will know what to do and how to proceed with alternative treatments. .

CPAP Alternatives

When CPAP is simply not an option, there are alternative treatments available. The easiest, cheapest, and most common alternative to CPAP is the use of oral appliances. In many cases, weight management may be emphasized further to get any physical causes of the condition under control. Used in combination with diet and exercise regimens, oral appliances are reasonable alternatives for patients with mild to moderate sleep apnea conditions. Other options may include positional therapy, which uses alarms or other methods of avoiding apnea-prone positions, upper airway physical therapy exercises that train the muscles to breathe with more vigor, stimulation therapy and implants, and further lifestyle changes to help put an end to the causes of the condition. Some of these treatments, such as the stimulation implant Inspire, are fairly new and still in development, and some residual sleep disordered breathing should be expected. Usually a combination of treatments will be used in these cases, as the alternatives to CPAP tend to work better in patients with less severe disorders. For those with more severe conditions, a surgical solution may be in order. A number of options are available, and will depend on the patient’s physical profile. Some, for example, involve the removal or repositioning of excess tissue in the throat, soft palate, uvula, or tonsils. Volumetric tissue reduction can be used to reduce the airway, or if the nasal septum is the problem, septoplasty can be used to straighten the airway and nasals. In the most severe cases, tracheotomy may be the only option to restore breathing and blood-oxygen levels from life-threatening deficiencies.

No Fault of Your Own

It should be reiterated that in some cases, patients may not even have the option of CPAP to begin with. For those with nasal or sinus structure abnormalities like a deviated septum, swollen turbinates, or problems with the upper palate, surgery will be necessary to solve the problem. In addition, limitations such as allergies, either to the CPAP devices themselves or to something in the environment, may cause congestion or other reactions that interfere with CPAP therapy. Other health conditions can also interfere in this manner, especially other sleep disorders or breathing problems.

Life After Failure

When it comes to sleep apnea, the only true failure is ending treatments entirely. The biggest risk of a failure status due to noncompliance is that you no longer treat your sleep apnea and continue to suffer its impact on your health and well being. Sleep apnea is not only a life-threatening disorder, but can lead to other health problems such as heart disease, stroke, diabetes, brain damage, and even cancer. The most important thing is that you do not give up, and continue to do what it takes to treat the disorder the best you can with the options available to you. Just keep in mind that you are not alone, and there is always help within reach. As long as you are willing to keep trying, your health will improve.