CPAP Basics - 22 - Compliance

[mollete]

So, quite a few people will fall by the wayside in their CPAP journey, and the reasons for this are many.

Are some OSA people not good candidates for CPAP?

I mean, if one has a case of mild (AHI 5 - 14) OSA (and even this number is somewhere between misleading to confusing depending on the scoring standard)(and more so if we use RDI), without EDS, and after a sincere and prolonged attempt at "compliance", Sleep Efficiency drops to the point where now one does have EDS which affects their lifestyle, is that a legitimate reason to stop?

And if one stops, is it the responsibility of the medical community to find an alternative?

And if it is the responsibility of the medical community to find that alternative, can they/should they "force" the person to seek any solution (while they can't "force" per se, they can certainly make life miserable. For instance, writing a letter to DMV saying the patient should not drive unless they use CPAP).

On the other end of the scale, perhaps a patient with severe (AHI >45) desaturating OSA with ESS = 24 and MSLT = 0.0 needs their license revoked if they do not comply in order to protect the public at large.

As this is undoubtedly the toughest issue surrounding OSA (and one we're not going to solve (completely, anyway), we need to spend some time here.

One thing for certain, "compliance" will increase proportionally with the amount of knowledge and effort applied, so ("IMHO") 90% is easily attainable.

BTW, "compliance" is an antiquated term, we really mean "adherence" (although it's unlikely the CPAP manufacturers will rewrite their software) and more importantly "persistence" (i.e., DWingers may not be adherent but may be persistent, but set that argument aside for now).

[mollete]

Defintions.

Adherence. The extent to which a patient’s behavior coincides with medical or health advice.
Persistence. Continuation over time with long-term therapy prescribed for the management of chronic conditions.

Does xPAP work essentially 100% of the time. Yes.

[mollete]

Something to chew on:

Adherence and/or persistence is not exclusively a CPAP problem. All chronic therapy has essentially the same failure rate:

http://circ.ahajournals.org/content/119/23/3028.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

http://www.aao.org/publications/eyenet/ ... aucoma.cfm

Epileptics, heart attack victims, asthma, glaucoma, polypharmacy, diet/weight control, smoking, drinking, gambling...

People don't do what they're supposed to!!

[Denial Dave]

I've seen quite a few new folks confused on Compliance, so just adding a thought..

Compliance is defined by most as a person using the machine and mask for a minimum of 4 hours every day

[mollete]

I've seen quite a few new folks confused on Compliance, so just adding a thought..

Compliance is defined by most as a person using the machine and mask for a minimum of 4 hours every day

We will need to touch on hysteresis a bit...

[mollete]

Compliance is defined by most as a person using the machine and mask for a minimum of 4 hours every day

And you can get to 80% "compliance" using that definition standing on one foot:

http://www.medscape.com/viewarticle/558230

[49er]

Something to chew on:

Adherence and/or persistence is not exclusively a CPAP problem. All chronic therapy has essentially the same failure rate:

http://circ.ahajournals.org/content/119/23/3028.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

http://www.aao.org/publications/eyenet/ ... aucoma.cfm

Epileptics, heart attack victims, asthma, glaucoma, polypharmacy, diet/weight control, smoking, drinking, gambling...

People don't do what they're supposed to!!

Ok, I may regret responding but what the heck. Maybe people don't do what they are "supposed" to do because they intuitively know that what they have been advised to do isn't working.

Dr. Park mentions on this site, http://doctorstevenpark.com/sleep-apnea ... -craziness, that many people feel worse in spite of using the cpap throughout the night and having great data. I know you're going give me the mantra that the cpap doesn't fix all problems and perhaps these folks have issues that the machine can't address. Fair enough but this needs to be addressed.

Regarding diabetes, many people on the diabetic boards felt like the high carb diet advised by the ADA made their blood sugar fluctuations alot worse and did better on a paleo type diet. Said that the doctors looked at them like they had "goat horns".

Polypharmacy in many cases (not all) is due to doctors medicating side effects with more meds instead of spending the time to find a medication that works for patients with minimal side effects.

My point is that if treatment isn't working, there are damm good reasons they aren't in many cases. Instead of blaming patients which many medical professionals like to do, they need to problem solve with their patients to come up with a solution. Sadly, in this era of 15 minute medicine, that is not going to happen.

49er

[mollete]

Does xPAP work essentially 100% of the time. Yes.

A comment by this poster comes to mind that gives thought to the concept of "working":

So anyway, we're doing this presentation, and one of the lecturers is a hospital nutritionalist. She starts out by asking the group "OK, which diets work?"

Nobody volunteered to answer, so I says "What the hey" and sticks my paw up in the air.

"All of them" I replied.

The original article:

http://content.nejm.org/cgi/content/full/359/3/229

SAG

[mollete]

Gay and Strollo recovered a ton of patients by simply going to a comfort modality:

http://www.aasmnet.org/jcsm/Articles/030708.pdf

[mollete]

Living alone is predicator of adherence:

http://www.journalsleep.org/Articles/270118.pdf

[mollete]

These guys note that when it's the partner's idea to seek treatment, adherence drops (Wow. What a BF surprise.):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679572/

[mollete]

Stanford

[mollete]

Terri and Amy

[mollete]

The Top 10

[DoriC]

Great reading, thanks!