Looking for ideas

I'm a registered nurse new to CPAP personally, but I've been using it on patients for nearly twenty years. Personally, I wish I'd gotten my machine about a decade or so ago because I fell in love with how I felt after the very first day with it (I work nights, so yeah, day). After a week of therapy, I discovered I couldn't even nap without my machine! So if I start feeling drowsy, on goes the mask.

Having had this personal experience, I find I'm far more frustrated with non-compliant patients than I was previously. I currently have a patient with a history of respiratory failure who has a BiPAP. The first thing out of my mouth when I unpacked her new machine was, "Oh, I have almost the exact same mask!" Perhaps this is why I seem to have established a good therapeutic relationship with her. For a long time, she wouldn't let anyone but me put her mask on. Once I showed her how to unclip her headgear so it wouldn't need re-sized every night, she did allow others to help her. But even when I did it, she couldn't stand wearing it for more than a few hours. Now, this patient is on constant oxygen at 4lpm, with 3lpm bleed-in while on BiPAP and her pressures are similar to what I use on my CPAP (11 for me, 13 on high for her). So I have a pretty good idea of where her mask leaks and have been able to help with that. Some good ideas from this forum were a huge help for us both, by the way. But I still can't get her to continue her therapy for more than a few hours. The longest on my watch was four hours.

I have had several conversations with her. I am not the type of nurse who is "my way or the highway" and I always respect the patient's right to choose, so I do tell her that it is her decision to use her therapy or not. But even though she admitted she did sleep well during the few hours she had her mask on, she still won't use her full therapy. Her reason: she is afraid that she won't get help getting her oxygen on when she wants the mask off on nights I am not there. I have told her flat-out that this will not be a problem. But the idea seems to disturb her even more than the claustrophobia of the mask. I've encouraged her to try wearing her mask a bit during the day to desensitize. She was also recently ordered an antianxiety med that I encourage her to take to help with her fear at night. And of course I share how much I appreciate my machine. I understand she's been through a lot, even being on a vent at one point, so it's not surprising she has anxiety related to her breathing issues. You folks have a lot of good advice. Any suggestions for this lady?

I'd probably get arrested if I said what I think , you've done all you can and sometimes it's all you can do.

Julie wrote:I'd probably get arrested if I said what I think , you've done all you can and sometimes it's all you can do.

My dear, I'm Asperger's. My sister once asked me if I thought her pants made her ass look fat. I told her that they did not, but they made her legs look like stuffed sausages. She ran off crying and yelling that I was hateful.

Bottom line, I wouldn't ask for advice if I wasn't willing to take whatever gets thrown in my direction, no matter how sticky or smelly. You folks have had a lot of good ideas, so figured there would be no harm in picking your brains.

Zoopshine wrote:

Julie wrote:I'd probably get arrested if I said what I think , you've done all you can and sometimes it's all you can do.

My dear, I'm Asperger's. My sister once asked me if I thought her pants made her ass look fat. I told her that they did not, but they made her legs look like stuffed sausages. She ran off crying and yelling that I was hateful.

Bottom line, I wouldn't ask for advice if I wasn't willing to take whatever gets thrown in my direction, no matter how sticky or smelly. You folks have had a lot of good ideas, so figured there would be no harm in picking your brains.

Hi Zoopshine,

First - let me say I admire you going above and beyond to help your patient get compliant with her treatment. It is true that we cannot force anyone to do what they are not willing to do, however, you also have the benefit and insight with this lady to know you can likely encourage her to be even more compliant. Kudos to you for not simply giving up as many others would do!

I think you are on the right track with your patient and are definitely doing the right things by listening and validating her fears. Validation is a huge part of the emotional process with anxiety-related issues. When people's fears are dismissed or they are put down, and/or are basically told in so many words ' it''s all in their head,' the anxiety worsens and they will become even more non- compliant. Also - very good idea to ask your patient to wear her cpap for a short period of time during the day- do you know if she is doing this? I would recommend at least one to two hours per day, and perhaps while napping in a chair or someplace other than her bed. My idea behind this is to not have her associate her CPAP with bedtime/ bed only. From what you are saying, her anxiety is rising before bedtime, right?

Another idea could be to try a nightlight in her room if she doesn't already sleep with one. At night, arrange to have a staff member wake her to ask her if she is okay after 2-3 hours. If she wants to remove her mask at that time and just go to oxygen, allow her to do so. Explain all of this to her if you decide to use this waking/ checking. What you are doing here is allowing her to take control over her fears, and to be proactive in her medical care. Most likely, you will not have to do this waking/ checking for long, as she will adapt if there are no other complications.

I understand how it can be frustrating when others aren't compliant with treatment. Try to think of it this way for a minute- you have a background and experience with OSA in the medical field which most people don't have when they are diagnosed, and I had both knowledge and exposure to someone with OSA when I was diagnosed. You and I both took to the treatment like 'ducks to water,' from the sounds of it. Yet, we are the anomaly. The vast majority (sadly) struggle so much with adapting So, try to remember that most of your patients will likely be somewhere in the struggling population, and praise them for every little baby step they manage to take. When they yell "STOP," listen to them, let them rest for a bit -tell them it's only temporary-encourage them to try again-and let them know they are not alone. Give them the web address to this forum. They don't have to join if they don't want; they can just read the tons of valuable information and wonderful words of wisdom and advice. (I found this forum to be a Godsend when I was newly diagnosed and completely confused, even though I had some previous knowledge!)

Keep up the great work that you are doing, Zoopshine, and please keep us informed on how your patient is progressing in treatment