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Sleep Apnea (Expert Forum)
Non-compliant C-PAP use
Answered by
Steven Y Park, MD - sleep-breathing disorders
Private Practice
New York - NY
Questions in the Sleep Breathing Disorders Forum are being answered by Dr. Steven Y. Park.
Non-compliant C-PAP use
by onesontwocats, Oct 29, 2009 11:40PM
What can be done to increase compliance in C-PAP use? I have obstructive sleep apnea and have used a C-PAP for over 14 years. I have a brother and a sister who also have obstructive sleep apnea. My brother tells me "he can't" use a C-PAP (can not or will not?) and my sister who has used a C-PAP for a few months tells me that she feels worse using it and is thinking about stopping it.
I know sleep apnea can cause heart disease and death. I have often wondered if the way the treatment was explained to me influenced my use of a C-PAP (long before they were quiet, lightweight and had heated humidified air)?
1. My doctor told me I may have sleep apnea. If I had it the treatment options were 1). surgery which had about a 40% success rate and may have to be repeated 2). a dental appliance which has about a 60% success rate or 3). a c-pap machine which may take a while to go used to, but has close to a 100% success rate for treating sleep apnea--- it was a no-brainer to me.
----I also wonder if part of my success was because I was diagnosed and treated by a sleep specialist at a respiratory hospital in a nearby city. I also had a separate session with a respiratory therapist to fit my mask. It took awhile (over 30 minutes) to try different sizes and different brands in order to get a good fit.
---I am really worried about my brother. I have even suggested that he take up the digger-do. Is there anything else besides weight loss or a tracheotomy to help someone with sleep apnea that will not use a C-PAP?
I know sleep apnea can cause heart disease and death. I have often wondered if the way the treatment was explained to me influenced my use of a C-PAP (long before they were quiet, lightweight and had heated humidified air)?
1. My doctor told me I may have sleep apnea. If I had it the treatment options were 1). surgery which had about a 40% success rate and may have to be repeated 2). a dental appliance which has about a 60% success rate or 3). a c-pap machine which may take a while to go used to, but has close to a 100% success rate for treating sleep apnea--- it was a no-brainer to me.
----I also wonder if part of my success was because I was diagnosed and treated by a sleep specialist at a respiratory hospital in a nearby city. I also had a separate session with a respiratory therapist to fit my mask. It took awhile (over 30 minutes) to try different sizes and different brands in order to get a good fit.
---I am really worried about my brother. I have even suggested that he take up the digger-do. Is there anything else besides weight loss or a tracheotomy to help someone with sleep apnea that will not use a C-PAP?
Doctor's Answer
by Steven Y Park, MD, Oct 31, 2009 09:17PM
, Oct 31, 2009 09:17PM
There's no easy answer. Unfortunately, overall CPAP compliance is not too good. In theory, with great counseling and intensive follow-up and support compliance and effectiveness (two different things) can reach 80 to 90%, but in the real world, it's probably way under 50% long term. There are systematic steps that can be taken to improve compliance and effectiveness, but not everyone will be able to use CPAP or benefit from it. There are some people who are 100% compliant, but don't feel better, or feel even worse. Everyone's different. They is why treatment has to be custom tailored for the individual.
As part of my monthly expert interview series, I've interviewed respiratory therapists on this very important issue with more sessions coming in the future. If you sign up for one of my free reports on my website at doctorstevenpark.com, you'll automatically get notices on how to listen in on these free teleseminars. This month, I have a report on surgery. If you give me your email address, I can give you a link to the last one that I did on CPAP.
As you pointed out, expectations can affect CPAP success. In my experience, bus drivers and pilots who have sleep apnea are much more likely to benefit from CPAP, since their jobs are on the line.
I also question the success rates that you were told regarding dental devices and surgery. Dental devices have success rates up to 80-90%, but again, in the real world, it's much less. It really depends on the individual as well as the expertise of the dentist. The 40% success rate that you were told about surgery is a common misconception. This is if you only address one area of obstruction — the soft palate. Most people with sleep apnea have multiple levels of obstruction, and if you address ALL the areas appropriately, success rates go up to 80%. If you go further and widen the jaws, then 90-95%.
As you can see, with all the different treatment options, it's all relative.
As part of my monthly expert interview series, I've interviewed respiratory therapists on this very important issue with more sessions coming in the future. If you sign up for one of my free reports on my website at doctorstevenpark.com, you'll automatically get notices on how to listen in on these free teleseminars. This month, I have a report on surgery. If you give me your email address, I can give you a link to the last one that I did on CPAP.
As you pointed out, expectations can affect CPAP success. In my experience, bus drivers and pilots who have sleep apnea are much more likely to benefit from CPAP, since their jobs are on the line.
I also question the success rates that you were told regarding dental devices and surgery. Dental devices have success rates up to 80-90%, but again, in the real world, it's much less. It really depends on the individual as well as the expertise of the dentist. The 40% success rate that you were told about surgery is a common misconception. This is if you only address one area of obstruction — the soft palate. Most people with sleep apnea have multiple levels of obstruction, and if you address ALL the areas appropriately, success rates go up to 80%. If you go further and widen the jaws, then 90-95%.
As you can see, with all the different treatment options, it's all relative.
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