Top Five Incentives for CPAP Treatment Adherence

By Admin

CPAP adherence is a major topic in sleep medicine and a challenge for many new patients. Many of us know someone with sleep apnea who is not adhering to prescribed treatments, and often, the reasons for this are as familiar as the condition itself. People have trouble sleeping with the mask on, they have problems with the device itself, or they have side effects such as dryness, headaches, or feeling uncomfortable or claustrophobic. According to studies on CPAP adherence, average rates in the last 20 years have remained stagnant at just below 66 percent, though assessments can vary depending on the criteria. At the same time, research consistently shows that proper use of PAP therapy effectively reduces or eliminates sleep apnea symptoms, which in turn reduces traffic accidents, work accidents, and work-related fatigue. Bridging this gap between low adherence and potential benefits is now a top priority among health providers focused not only on proper treatment, but also on the prevention of potentially life-threatening comorbid conditions. The following is an overview of the most common reasons for non-adherence and the most effective ways to counter those tendencies with intervention, planning, and continued access to medical care and support.

Reasons for Non-adherence

According to research published in the journal Sleep Medicine Review, the most common reasons for CPAP non-adherence are discomfort, dryness or congestion, technological issues, and feelings of increased anxiety or claustrophobia when wearing the mask. But these experiences alone do not lead to non-adherence in high numbers. Each patient’s decision will depend on a number of additional factors such as the type of symptoms, initial CPAP experiences (for example, during the titration process), level of device compatibility, and social or psychological well being. With these considerations in mind, you begin to see how fragile the diagnostic and prescription process can be, as well as how providers can strengthen the process using a multifaceted approach. Patients, for example, who move quickly through the diagnostic process, purchase a device on their own, and have difficulties attempting to initiate treatment in their homes, are in great need of intervention and support.

Another factor associated with low adherence levels is disease severity, or lack thereof. While it may seem logical that people with less serious conditions might be less likely to adhere to a demanding treatment option, some investigators have noted that patient perceptions of the condition, as well as the cost-benefit ratio of the treatment, may have more to do with their decision than the actual diagnosis. In other words, how a patient feels about treatment can matter the most. Through intervention, education, and continued support, providers can offer a more objective view of treatment goals and expectations.

Incentives for Optimal Adherence - The Big Five

In response to current research on the subject of PAP-therapy adherence, health providers are focusing on intervention methods to offset some of the most common pitfalls. In a general sense, this involves more long-term reinforcement and monitoring, with more attention given to networks of care and social support, thereby increasing access to care and diversifying treatment options. More specifically, this includes the following list of considerations, organized by their level of significance in the objective of sustained, long-term treatment adherence.

Knowledge

Research literature on CPAP adherence, such as the above mentioned study in Sleep Medicine Review, almost always mentions education as a first priority. In fact, studies have shown that education, when used throughout the diagnostic and titration process, can boost long-term treatment adherence. Thus, a patient who is given information consistently from the moment of diagnosis onward will gain the knowledge required for troubleshooting problems and optimizing treatment. This also increases self-efficacy, which empowers patients to find their own solutions and develop coping mechanisms when problems arise. Knowledge is first on the list because it is difficult to adhere properly without it, and every patient should have a good understanding of how the devices work and what options are available. Getting to know your device is the first step to a long and healthy relationship with CPAP.

Support

Support is as important to patients as education because information alone does not always provide solutions for every problem or concern that arises. Support and education go hand in hand in giving patients the knowledge as well as the guidance to achieve the best possible treatment circumstances. Like education, support should be both immediate following diagnosis and ongoing throughout the patient’s treatment. According to research on treatment compliance, patients often establish their treatment routines in the first three months of therapy, making their decisions early about whether or not they will continue to adhere. This is sometimes referred to as the treatment threshold, as the earliest experiences can have a significant impact on long-term outcomes. In general, having someone available to reinforce the important benefits of therapy, to help troubleshoot any problems, and to provide support and education, creates an incentive to continue using the device. When this initial window of opportunity is missed, it becomes much more difficult to achieve long-term treatment success, and can endanger the health of the patient. This is also why support should not end when the patient leaves the clinic. It should continue in the home, in social circumstances, and in online patient communities. This kind of feedback, both from peers and health professionals, can be extremely valuable to patients, especially in the early months of treatment.

Equipment Needs

Equipment needs are a top priority because every mask and device is designed with a specific set of circumstances in mind. More than a mere preference, the right device and mask will provide optimal treatment for each condition. For example, a person with central sleep apnea (CSA) will benefit most from a BIPAP or ASV machine, which can adjust pressures and support breathing more effectively to suit CSA symptoms (i.e. apnea events not caused by blockage of the airway). Other patients will have difficulties with some masks and not others. In general, those who are mouth breathers during the night tend to benefit more from full-face masks, while nose breathers may want to use nasal or nasal pillow masks. Of course, the best decisions are informed decisions, which makes equipment needs part of the education process as well. The more information a patient has, the better informed their purchases will be, and proper guidance from support networks gives patients the kind of detailed information they can’t always get from individual health providers. Oftentimes a simple equipment adjustment, such as adding a humidifier, can solve problems of discomfort or side effects.

Tolerance

Tolerance is on the list because some patients fail to tolerate CPAP and stop adhering to the treatment as a result. This can result from any of the reasons mentioned above, but the general perception is that negative effects seem to outweigh the perceived benefits. Every patient is free to decide whether or not to adopt PAP therapy as a treatment, but in some cases, personality traits and tendencies can hamper progress in this area. While side effects are legitimate issues of concern, the solution may require a higher level of tolerance as well as a possible device adjustment, a prescribed medication, or other means of improvement. Tolerance is important because not all problems are solved immediately. Sometimes it takes a little trial and error to find the right setup for your needs. New patients in particular should try to address these issues early, rather than allow them to consume the therapy experience. Over time, the benefits of using CPAP should become more obvious, but it does take a while to adapt and adjust to the changes. A high level of tolerance for potentially disruptive changes will make things a lot easier along the way.

Discipline

Discipline should always be considered when addressing CPAP adherence because it is far too easy to bring a device home after a titration process only to set it aside and forget about it. Others may use the device for a time, but set it aside at a later date. Unfortunately common, this tendency to put off treatment leads to what some people call “the closet CPAP.” This is why, as mentioned above, those first few days of therapy are extremely important for establishing a good routine and recognizing the benefits. In many cases, the patient never makes it to the real benefits of CPAP because they give up too early. Closely related to the issue of tolerance, discipline keeps the long-term goals in mind while focusing on the day-to-day requirements of proper treatment. Discipline is the glue that holds these five considerations together, making it much more likely that a patient will continue to adhere and continue to live a healthier life with CPAP.