Acclimating to CPAP for the Treatment of OSA – Part One
Obstructive Sleep Apnea (OSA) is a disorder manifest by snoring and pauses in breathing during sleep. The pauses in breathing or “apneas” are associated with a fall in blood oxygen levels and ultimately lead you to wake up, which then allows you to start breathing again. This process may repeat itself hundreds of times throughout the night resulting in poor quality sleep and daytime sleepiness. In addition, OSA can lead to high blood pressure, heart attack, stroke, congestive heart failure, cardiac rhythm disturbances such as atrial fibrillation, diabetes, increased cancer risk and death.
Continuous Positive Airway Pressure (CPAP) has long been the gold standard of treatment for OSA. However, national averages report that only 40-60% of patients tolerates CPAP and use it regularly. At the Southern California Pulmonary and Sleep Disorders Medical Center over 80% of our patients tolerate and use CPAP on a regular basis.
Why do we have such a high rate of success?
Dr. Popper personally sees all patients in consultation. This assures that co-existing medical conditions that may affect the patient’s use of CPAP in an adverse manner are appropriately addressed. For instance, many patients complain of nasal congestion prior to the use of CPAP. It is vitally important to have a clear nasal airway in order to tolerate CPAP. Therefore, in patients with congested nasal airways, Dr. Popper frequently will prescribe a nasal steroid spray for use in the morning and a nasal anti-histamine spray in the evening to decongest the nasal airway and improve patient comfort.
A well educated patient makes for a more compliant patient. Many patients who are seen at an unaccredited sleep center are never seen by a board certified specialist. They may in fact never see a physician at all. They are simply seen by the technician who performs the study and sends them on their way. They are prescribed CPAP without the benefit of understanding either their illness or the treatment they are prescribed. And that is a prescription for failure! As part of the consultation process, Dr. Popper educates each patient about the nature of OSA, the complications of untreated OSA and all of the treatment options for OSA. When patients understand their diagnosis and the reasons for treatment as well as the potential complications of not being treated, they are much more likely to follow the treatment recommendations given to them by their physician.
At the Southern California Pulmonary and Sleep Disorders Medical Center our technicians have undergone rigorous education and training and follow strict guidelines set forth by Dr. Popper and the American Academy of Sleep Medicine. Meticulous attention is paid to properly fitting each and every patient with the most appropriate size and style of CPAP mask. The use of humidification is used with all studies. Chinstraps are added when appropriate. Mask styles are changed if the patient complains of discomfort or air leakage. We understand, that no matter how effective CPAP may be, you’re not going to use it if it isn’t comfortable.
Lastly, for a patient to continue to use CPAP, they must realize the promised benefits of improvement in their sleep quality and daytime functioning. To this end, Dr. Popper follows up with all patients started on CPAP. Patients are encouraged to follow a protocol and to contact him if they are not readily acclimating to the use of CPAP by the end of the 1st week. Most CPAP failures occur because patients are struggling to acclimate to their CPAP and by the end of the 1st week if they do not see “the light at the end of the tunnel” they simply stop using CPAP. This is the crucial time period when Dr. Popper can put into place a host of interventions to help patients adapt to the use of CPAP before they reach the point of giving up.
Stay tuned for our next blog when Dr. Popper will give specific suggestions for a variety of CPAP related difficulties in order to help patients acclimate to the use of CPAP.