By Olukunle Ajagbe, MD, Laurel Sleep Disorders Center
Obstructive Sleep Apnea (OSA) affects about 15 to 20 percent of the adult population. The disease condition is still under-diagnosed, and primary care physicians have to be vigilant to find those patients with unexplained daytime sleepiness and refer them to a sleep physician.
Once patients are diagnosed, in most cases they will be started on CPAP therapy. CPAP (Continuous Positive Airway Pressure) prevents the collapse of the upper airway during sleep. Treatment with CPAP will almost always bring an immediate improvement in snoring, daytime sleepiness, fatigue, mood, and the “get up and go” feeling.
The main problem with CPAP use comes with compliance. Medicare requires at least four hours of use every night or CPAP will be taken away from the Medicare beneficiary. This is emphasized to most patients, but a better explanation should be that CPAP should be used whenever the patient sleeps, be it daytime or nighttime.
CPAP compliance issues sometimes stem from the unnatural feeling of pressure or the mask on the face; this can be resolved with gradual desensitization. If the pressure is felt to be too high, it should be discussed with the sleep physician or DME (Durable Medical Equipment) company which supplied the CPAP, as soon as possible. If there is any problem in tolerating the mask, the DME can try different masks. If the pressure is perceived to be too high, it can be reduced with discussion with the sleep physician or a ramp pressure introduced.
CPAP compliance can also be affected by the wear and tear of disposable parts. With the disposable parts falling apart, the CPAP will not be as effective. Masks, hoses, and filters can be replaced every three to six months; this has to be explained to the patient. I once met a patient who had not changed his mask in five years and had to tape it together to prevent it from falling apart. Following up with your sleep physician should prevent that problem.
A lack of understanding of what Obstructive Sleep Apnea is and the long-term effects of being untreated could be another cause of lack of compliance. I take the time to show patients a comparison of their sleep study without the CPAP versus sleep study with CPAP. Seeing the change from a “disturbed” sleep to “calm” sleep always makes a positive impact in keeping patients compliant. I also emphasize the improvement in their energy level and less sleepiness as evidence of what the CPAP is doing for them.
Self-treatment by the patient is another reason for noncompliance. If patient loses weight and rightfully feels their sleep apnea should be better, instead of discussing this with a sleep physician, they decide to stop using CPAP. Unknowingly, they will have a gradual resumption of their old symptoms. Also, if there is weight gain, symptoms come back with a vengeance. In these cases, the CPAP machine could have lost or missing parts, so it cannot be used.
The most important factor in compliance is to work closely with the DME company who supplied the CPAP and your sleep physician. Important points to note are depending on your insurance, you may lose your CPAP if you are deemed noncompliant. Do not stop CPAP without discussing with your sleep physician. Your DME company and sleep physician will always be ready to help you with CPAP compliance. Obstructive Sleep Apnea is a chronic disease condition like hypertension, diabetes, or asthma and it needs follow-up and monitoring by a sleep physician.