Sleep therapy compliance
Consequences of non-compliance
CPAP treatment has been proven efficacious, but adherence to therapy can be challenging. Lack of compliance is recognised as the key factor that significantly compromises the potential benefits of treatment. Until recently, it has been unclear exactly how many hours of CPAP use are required to gain benefits. Increasingly, research is now showing that while any CPAP usage is better than none, the greatest improvements are correlated with the most hours of use.
The literature relating to fatal and non-fatal cardiovascular events is scarce. However, current knowledge indicates that even as little as 1 hour CPAP usage can improve outcomes, with more significant improvements being seen in over 4 and 6 hours usage.1
Reductions in blood pressure have been studied more frequently, with literature from 6 studies concluding that patients need to use CPAP for at least 4 hours per night to see improvements, while higher usage of more than five and a half hours leads to more pronounced blood pressure drops.2-6
Excessive daytime sleepiness appears to improve with as little as 2.5 hours per night, with multiple studies supporting a linear dose-response relationship of higher CPAP use leading to greater improvements7-10. Studies show that cognitive functions including memory, functional outcomes of sleepiness and executive function may require at least 6 hours use per night before improvements are seen.11,12
Techniques to Improve Compliance
CPAP usage can be accurately determined using data stored in the CPAP device.13 If patient adherence to therapy is poor the following techniques may be used to improve compliance:
- Increasing patient education about both sleep apnoea and CPAP treatment through use of printed materials, videos, websites and discussions. 14
- Using positive peer support groups, buddy systems and ensuring spousal support.15
- Increasing support from care providers, including more face-to face physician time, nurse time, phone calls and follow up appointments.15,16,17,18
- Using telemonitoring services to remotely monitor patients can be used to identify and intervene when patients are non-adherent.18
- Psychological interventions such as cognitive behavioral therapy, and relaxation therapy may assist patients overcoming anxieties associated with wearing a mask.15
- Improving mask comfort and reducing mask obstructiveness by trying different mask types and sizes.
- Overcoming side effects from the equipment. Common complaints include dryness of the nose and mouth, nasal symptoms, and intolerance of high pressures. These can often be overcome by adding heated humidification to the system; using an Auto adjusting (AutoSet) device to keep median pressures lower; or adding EPR to reduce pressure on each exhalation.
- ResMed provides sleep therapy devices that combine a number of additional features that support better PAP usage, including a smart humidification system with heated tube, tailored algorithms and reduced noise.