The Treatment Threshold: Some All-Too-Common Reasons Why Sleep Apnea Goes Untreated

By Admin

While studies continue to support the effectiveness of PAP therapy as a gold-standard treatment for sleep apnea, the high number of individuals who remain undiagnosed or noncompliant with treatment remains a problem for both the patients and their healthcare providers. Far too often, it seems, people are hesitant to seek treatment for the disorder despite its effects on health and quality of sleep. Researchers have looked at the most common reasons for noncompliance, including mask discomfort and intolerance of pressure, and a pattern of early commitment appears to distinguish those who stick with treatment from those who quit. Whatever reasons a patient has for quitting therapy, it tends to happen early. Often, individuals with sleep apnea symptoms are even reluctant to get tested, perhaps keeping focused on other priorities while the disorder more than likely progresses over time. While the number of patients treated for sleep apnea has gone up in recent years, it is still a fraction (15-20 percent) of the total number of people who currently have the disorder. Meanwhile, health organizations around the world are spreading awareness of the disorder and educating the public about its health effects, not only encouraging people to get tested but also urging doctors to offer follow-up support to keep people treated once they are diagnosed. This “threshold” of early treatment can be problematic due to the specific, often diverse needs of individual patients, but the more encouragement and support they are given at the outset, the better off their chances will be for long-term compliance.

Not Getting Tested

Out of the estimated 22 million people with sleep apnea in the U.S. alone, roughly 80 percent have never been tested for the disorder. This is a primary focus area for public awareness and education campaigns because many of those who never get tested may be unaware or uninformed of the condition’s harmful effects on the body. Many individuals fit the profile for a person with sleep apnea, but never realize just how easy it is to develop this extremely common disorder. Even among those who do know about sleep apnea and its symptoms, there may be a variety of reasons why they are reluctant to get tested. Fears or apprehensions, procrastination, misinformation, or simply not prioritizing the issue can keep them putting it off for years. Some may even ignore the problem altogether, an issue of perspective or personality type, which can influence a person’s view of the treatment options. They may doubt the benefits of using CPAP or seek alternative treatment methods such as snore guards without getting a professional opinion. But without a proper test and diagnostic process, they will never know for sure if they have the disorder. The most common type of sleep apnea, obstructive sleep apnea (OSA), is thought to be present in 2 to 4 percent of the adult population as a syndrome, which means that its symptoms are moderate or severe, but in men aged 40 to 59 years, the number is closer to 20 percent. And with high body mass as a consideration, the number is even higher, yet even among those who do get tested, adherence rates remain as low as 50 percent, making it difficult for providers to treat the disorder effectively.

Getting Diagnosed But Never Purchasing a CPAP

Another major problem is that once diagnosed, not everyone decides to purchase a CPAP right away, if at all. New patients may feel trapped, insecure, or reluctant. Some may even disregard the doctor’s recommendations, seeking a second opinion or alternative treatment methods. Of course, getting more than one perspective on an important life decision is a good idea, but not if it leads to indecision. Prolonging the decision-making process can do more harm than good when a serious health condition is in need of proper treatment. Oftentimes, when alternative treatment methods fall short of the health benefits a patient is looking for, it can become difficult to make up for lost time. Another common reason for not purchasing a CPAP device is the cost involved. New devices can cost anywhere from a few hundred to a few thousand dollars, depending on brand name, features, and patient preferences. But there is also the option of buying a used device, which can be much cheaper and get thoroughly cleaned and sterilized using a “multi-patient disinfection” process that involves high-grade sterilant compounds. In either case, the price of buying and maintaining a machine can be a significant barrier when it is not covered by an insurance plan. If you have been diagnosed with sleep apnea, it is important to first check the details of your insurance coverage and determine what the guidelines are for medical equipment and co-payments (or reimbursements). Keep in mind that insurance companies may have very specific rules about where to purchase equipment and may have their own network of DME providers, sometimes called preferred provider organizations (PPOs). In these cases, if your provider is in the PPO network, there will be pre-negotiated rates for a PAP device. There may be a sizable difference between the cost of an item from a PPO and one from a provider that accepts your insurance, but is not in the network. The first requirement of insurance purchases is compliance. Insurance companies want to know that a device is needed and will be used before making a purchase. Often, they accomplish this with rental agreements.

Most compliance guidelines require that you show proof of using your device for a minimum of 4 hours per day at least 70 percent of the time. Companies will often pay for devices on a monthly rental basis until compliance is verified using the machine’s data. These periods tend to last from 3 to 13 months. When the rental period ends, you own the device. But they may also want you to choose a specific type or brand of machine or mask. Some plans are more stringent than others on price ranges for equipment. For someone who has recently been diagnosed with sleep apnea, the best thing to do is call your insurance provider for details on how to make your purchase. If you find that your insurance plan does not cover PAP devices for your needs, there is always the option of buying or renting a device yourself. Many online equipment providers such as SistemmaCPAP.com will take credit payments and ship to you directly. This will give you the freedom of purchasing any device or accessories you want without constraints.

Purchasing a CPAP But Never Starting Treatment

This problem is getting so common that almost everyone knows someone who owns a CPAP device but doesn’t use it. Known as the “closet CPAP,” the unused device gets neglected, and unfortunately, so does the patient. Just as potential patients put off getting tested, new patients can put off treatment even after buying a brand new device. This scenario poses a number of problems, but the first issue is lack of treatment in the short term. Statistically, the more time that passes between purchasing a machine and setting it up to begin treatment, the less likely the patient will follow through with long-term compliance. By never reaching the “treatment threshold” of initial setup and trial, a patient is more likely to leave the idea of treatment behind and leave the device in the closet. This is also true for those who actually use the device for some time before setting it aside. Even though they technically reach the threshold and initiate treatment, the process is cut short and remains incomplete without full nights of therapy. For example, a new patient may begin therapy but turn off the machine in the middle of the night, failing to meet the four-hour minimum for compliance. In addition, without a complete therapy session, the patient may not know if the device is a good choice for their therapy needs. Device settings, titration, mask type, and other factors need to be taken into account when initiating therapy for the first time.

Starting Treatment But Not Continuing

When patients use PAP- therapy for the first time, they have entered the treatment threshold. This is the most important part of the treatment experience. Studies have shown that patients who overcome challenges early on, when the treatment is first initiated, have overwhelmingly better odds of continuing with treatment for the long term. But there are times when patients make it past the initial months only to lose momentum as time goes on. This can happen for a number of reasons, but often a sense of complacency or even overconfidence can set in that gives patients the feeling that the worst is past them, and the benefits are here to stay. This, of course, is a dangerous way of thinking that can end up doing as much damage as a negative attitude or lack of confidence. The result is the same: treatment has ended, or at least has tapered off. To make it past the treatment threshold only to lose momentum and lose therapy hours is an unfortunate setback, especially after coming so far, but turning things back around should not be difficult. At this point a patient knows what treatment is like and what to expect, and should also know its benefits, at least in the short term. But to get back into the routine of treatment, it is important to remember what therapy does for the body and mind on a nightly basis, as the symptoms of untreated sleep apnea can not only disturb your sleep and threaten your health, but also endanger the lives of others.