Noncompliance for CPAP/BPAP Use in Sleep Apnea Patients
This is the first of a three blog post series to promote the health of people who suffer from sleep apnea. This first post will discuss the issue of patients’ adherence to sleep apnea therapy. The second in the series will focus on what can happen if sleep apnea patients do not adhere to prescribed therapy. The final post in this series will concentrate on awareness for truck drivers to be tested for sleep apnea.
Sleep disorders can affect everyday life for people with the disorders and those around them. Sleep apnea, in particular, can have devastating health effects. Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BPAP) machines are the recommended treatment for patients with moderate to severe sleep apnea. However, studies have found that patients do not always use their CPAP/BPAP machines. (1) By not following their doctor’s treatment plan, they put themselves at risk for additional health problems.
CPAP/BPAP therapy is considered the gold standard prescribed treatment for sleep apnea. This means it has been shown to be helpful by rigorous scientific studies. One study showed that patients refused to use these machines because of the cost of the machines or not being comfortable wearing the masks. (1)
The cost of a CPAP/BPAP machine is the number one reason why patients do not adhere to this type of therapy. (1) The President of Altra Service Professionals, Bob DeChello, stated that insurance is the first course of reimbursement. (2) Some insurance companies will not reimburse until the compliance data from the machine shows that the patient has been using it per the prescription. When insurance pays for part of the machine, the patient is also paying for services via the home care company, such as a respiratory therapist’s assistance. This is helpful for patients who are new to CPAP therapy, but may not be necessary for patients just needing a new machine.
If insurance still leaves the patient with a high copay or the patient does not have insurance, calling around to various companies selling CPAP/BPAP machines is the next step. Companies are only allowed to publish the manufacturer’s lowest advertised price, but can offer a lower price in a personal discussion. Also, if insurance is not used, look for models that do not have unnecessary, and costly features. An example would be the ability to download the compliance data. (2)
An uncomfortable mask was found to be the second highest reason why patients do not comply to their prescribed therapy. (1) If a mask does not feel comfortable, there are different masks to try. A nasal mask covers the nose only and has a chin strap to keep it on. A full face mask covers the nose and mouth. A nasal pillow actually goes inside the nose with a tube going over the top of the head. If the patient does not like the mask provided, the home care company is reimbursed by the manufacture for the full cost of the mask via the manufacturer’s guarantee, even if the patient tries a different manufacturer’s mask. So, it will not cost the vendor anything to provide the patient with a different mask. (2)
Those that develop habits easily are more likely to adhere to CPAP treatment. If a patient uses their machine as part of a nightly routine for the first month of use, they are more likely to adhere to their treatment in the long term. (2) Encouragement by the staff at the patient’s prescribing doctor office during the first month of treatment would be helpful in creating the habit of machine use. (3)
Once a patient is using their CPAP/BPAP machine as prescribed, keeping the machine working properly will help the patient save money in repairs and feeling their best. See an earlier blog post on maintenance of CPAP/BPAP machines.
1. CPAP adherance of patients with obstructive sleep apnea. Salepici, B, Caglayan, B and Kiral, N. 9, 2013, Respir Care, Vol. 58, pp. 1467-73.
2. DeChello, B. President and CEO of Altra Service Professionals. Ocala, FL, July 3, 2014.
3. Validation of the CPAP Habit Index-5.A Tool to understand adherance to CPAP treatment in patients with obstructive sleep apnea. Brostrom, A, Nilsen, P and Gardner, B. 10, 2014, Sleep Dis, Vol. 2014, p. 929057.
4. Motivational interviewing (MINT) improves continuous positive airway pressure (CPAP) acceptance and adherence: a randomized controlled trial. Olsen, S, et al. 2014, Vol. 80, pp. 151-163.
5. Sleep disorders as a cause of motor vehicle collisions. Tulio de Mello, M, Narciso, F V and Tufik, S. 3, 2013, Int J Prev Med, Vol. 4, pp. 246-257.
6. WebMD. Sleep Apnea. [Online] 2012. http://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea.
Laurie M. DeChello, MPH, CPH
Altra Service Professionals (ASP) does not provide medical advice. If you have questions about your illness or treatment, please contact your doctor.