Compliance with CPAP varies but can be improved notably with patient education and patient support. Health care professionals who probe to find the cause of the patient's problem with CPAP can then offer the patient solutions to the problem. Complaints can typically be easily addressed. Asking the questions below can help you efficiently improve your patient's compliance:
Does the patient find the mask comfortable?
--Does it fit properly?
--Does the patient like the style?
Does the machine have all the features the patient needs to address, for example, difficulties exhaling and dryness as well as patient lifestyle?
--ramping, bi-level or auto-titrating, humidification (cold or heated), dual voltage, altitude adjustment, etc.
Is nasal obstruction a problem?
Does the patient need to be desensitized to the machine? (see the section on "CPAP MASK DESENSITIZATION TECHNIQUES" below)
--gradual initiation
--acclimation of the mask only, outside of the sleep period
--practice sessions
Does the patient accept the idea of being treated?
--Is the patient aware of the consequences of the untreated sleep apnea?
--Does the patient understand the benefits of therapy?
Is the CPAP properly set up in the bedroom for ease of use and acceptance?
--Can outlets be reached easily?
--Is noise an issue?
--Is the machine's placement a barrier?
Is the bedpartner and/or other family members supportive of the treatment plan?
Does the patient understand cleaning procedures and the importance of them?
CPAP MASK DESENSITIZATION TECHNIQUES
Gradual initiation of CPAP therapy is one accepted desensitization technique. Rather than having the patient lie down and immediately begin CPAP therapy at the prescribed pressure, first let the patient become acquainted with the mask and machine. Then, with the patient seated upright and the machine on but at a low pressure setting, let the patient hold the unstrapped mask loosely against his/her face for brief periods until he/she can breathe while holding the mask in place for a minute or more. After the patient is comfortable with the mask in place, strap the mask on and make sure it is comfortable (not so tight that it hurts and not so loose that leaks irritate the eyes). Once the patient can breathe with the mask strapped on and while still sitting up, let the patient breathe while the CPAP is "ramping" gradually to the prescribed setting. Once the patient is comfortable with that stage, let the patient lie down. This short investment of time with the initial titration study or mask fitting can be extremely beneficial to patients--and pay off in the long run.
Getting the patient acclimated to the mask only, outside of the sleep period and away from the bedroom, is another desensitization technique. It is natural for patients to need a period of time to adjust to sleeping with a CPAP mask on their face; no one is used to sleeping with such a mask. Patients who state that they cannot sleep with the mask on their face can become accustomed to it by wearing just the mask--with the exhalation port open--away from the bedroom while they do something relaxing, such as listening to music, for a while each day, preferably not just before bedtime, until they can wear the mask. (Patients who take the mask off during the night without knowing specifically why do well to try this method as wearing the mask while awake for a while may let them determine the site where the mask may become uncomfortable. Once the site is discovered, the better fit or style may be found.)
Patients can also practice using the machine with it turned on at a very low pressure, while they are awake and engaged in something relaxing and sedentary, for an hour or two each day or evening until they can breathe with the machine. Using it for short naps may also be beneficial and gives patients a measure of progress in acclimating to CPAP.
Encouragement at all stages of CPAP desensitization is helpful to patients.
