THIS ISSUE IS DEVOTED TO THE GREATEST BARRIER TO EFFECTIVE SLEEP APNEA TREATMENT !

COMPLIANCE (def): the act of conforming or agreeing to do something

The treatment of Sleep Apneas involves three steps; Diagnosis (professional medical identification of your condition), Prescription (the therapy required to control your symptoms) and, lastly, and most importantly, Compliance (your role as the patient in the treatment).

Once the initial shock of a diagnosis of Sleep Apnea has worn off and the routine of CPAP treatment is underway, all too many patients find every night, all nightlong compliance is not all that easy. Problems can arise with uncomfortable masks or nasal pillows, irritation of the nasal membranes, the cleaning of the headgear or just plain motivation to adhere to the prescribed new life style occasioned by CPAP treatment.

If so, you are not alone! It is the rare patient that has not experienced one or more of these problems and “taken a night off.” Fortunately, most promptly return to CPAP therapy. However, some don’t or they return with irregularity. The following comments are designed to assist this later group.

Motivation to maintain compliance is the key. Sometimes we forget that Sleep Apnea can be a life-threatening disorder, if not shortening of your life or that of someone else’s after falling asleep at the wheel!

Prolonging life should be a more than sufficient motivation to re-establish treatment. Perseverance!

Effort can then be concentrated on solving the other problems of comfort, nasal irritation and the boring routine aspects of CPAP treatment.

As to comfort…….there are so many masks and nasal pillows on the market now that finding one that fits and is comfortable becomes a matter of working with your equipment specialist. Don’t give up – the perfect fitting mask for you is out there somewhere. Again…. Perseverance!

As to nasal irritation, there are over-thecounter saline nasal sprays to relieve irritation. If this doesn’t do it then talk to talk to your Respiratory Physician about prescription medications. Nasal irritation due to CPAP can be controlled and almost totally eliminated. Again…. Perseverance!

As to the bother of cleaning masks, headgear, tubes, etc. You probably spend more time cleaning the windows of your car or your kitchen counter in a week. The complete disassembly, washing and reassembly of a complicated mask (like my ResMed’s Mirage Activa) takes less than 15 minutes a week! Again…. Perseverance!

As to a boring night after night routine – yes it is boring…but its sure beats the alternative!

Lack of compliance is the same as having untreated sleep apnea. It brings with it all of its potential risks and complications present before you were diagnosed and before therapy was prescribed.

If you need help in maintaining compliance; first have a good motivational talk with yourself, then seek help from your equipment specialist, your Respiratory Physician and your Support Group. Remember you are not alone and your problems are not unique!

 

LOWER PG&E RATE FOR CPAP USERS

Chuck Carroll of Walnut Creek, a reader of the “Sound Sleeper” (now I know I have at least one!) passes along the following:

PG&E considers CPAP “life saving medical equipment.” As such, it qualifies for reduced electricity rates. Chuck writes, “After registering with PG&E as a CPAP user, I am saving several hundred dollars per year from my electricity bill. Fellow Sound Sleeper readers may profit from my experience.”

To obtain these rates, you must submit a form signed by your doctor.

Information on the “Medical Baseline Program,” instructions and application forms can be found at: www.pge.com/myhome/customerservice/financialassistance/medicalbaseline/index.shtml Fill out the form and mail it to your CPAP doctor for signature. Mail the form to PG&E. You may wish to follow up with PG&E to see how your approval is going. Eventually, your monthly PG&E bill should indicate that you are getting a medical rate, which will be lower.

THE PHYSICIAN’S CORNER
by Harry J MacDannald MD

 

CPAP COMPLIANCE (sticking with it!)

 

Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnea syndrome (OSAS). CPAP is a device that uses air pressure as a pneumatic splint to hold the airway open, and prevents collapse of the airway. The key to improving CPAP compliance is maximizing success in the early treatment period.

CPAP significantly reduces the OSAS symptoms for a vast majority of patients. Some symptoms include, morning tiredness, excessive daytime time sleepiness and fatigue, poor daytime mental functioning, snoring, hypertension, relationship discord, sexual dysfunction, mood changes, and depression. Successful application of CPAP can dramatically improve these symptoms and health-related quality of life for patients, transforming somnolent individuals into energetic and more productive people. Moreover, the use of CPAP can decrease systemic blood pressure and improve cardiovascular performance, and thereby decrease cardiovascular related disease and death associated with OSAS. A recent study showed that patients whose sleep improved the most on their first CPAP night had the highest levels of CPAP compliance.

However, CPAP therapy is often difficult for patients to tolerate and many stop using it because of discomforts, claustrophobic reactions, poor understanding of its benefits, or difficulties in using the equipment. The nasal mask interface may cause pressure sores, persistent air leakage, nasal congestion, and other side effects that may lead to sub-optimal compliance.

Studies have shown that the most crucial period for CPAP success is the first four days, and that patient instruction and understanding is vital for success. A successful program for maximizing CPAP compliance should include the following activities:

– Maximize comfort with the patient device interface. Identify the best mask for the patient.
Styles include nasal masks, oral/nasal masks and masks that allow the patient to breathe through their mouth only. Other comfort features include a ramp function, where pressure builds up gradually after the patient falls asleep.

– Optimize the patient’s experience with CPAP during the early treatment period.
Patients should receive anticipatory guidance, extensive education on what to expect and how to use CPAP. Frequent follow-up provides support and troubleshoots problems and insure that the equipment is correct. Sedative medication may help patients to relax and sleep when first starting on CPAP.

– Treat side effects.
Humidification reduces nasal and pharyngeal dryness, improving tolerance. Congestion and rhinorrhea typically resolve after a short period of adaptation but may require nasal steroids, anticholinergic nasal sprays or decongestants. Bi-level PAP may be helpful for people complaining of high pressure and leaks.

– Provide long-term support.
This includes follow-up with medical personnel and patient support groups. Programs utilizing these features have been shown to improve CPAP compliance.

– Educational and Support Activities
Most patients will go to their training alone; however, many clinics and educators involve spouses and bed partners as well. Here are some topics to cover:
• Training on use of equipment–mask, flow generator, humidifier, etc
• Training on how to clean equipment– mask, tubing, humidifier, etc
• Possible side effects and how to treat them; autotitration and humidification to treat nasal irritation and sensitivity to higher pressures, mask selection and fitting for facial discomfort, etc
• Education on the associated health risks of untreated sleep deprivation; auto accidents, depression, stroke (and TIA), hypertension heart disease, etc
• Introduction to support groups and online chat rooms and message boards–see list below
• Follow-up visits with primary physicians and homecare providers especially in the first months of treatment

 

Useful Web Sites for Patients

American Sleep Apnea Association: http://www.sleepapnea.org
American Academy of Sleep Medicine: http://www.asda.org
National Sleep Foundation: http://www.sleepfoundation.org
Sleep Quest: http://www.sleepquest.com
Talk About Sleep at: www.talkaboutsleep.com