Solutions for ‘CPAP Dropouts’ With Obstructive Sleep Apnea

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October 5, 2021


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Are you a CPAP dropout? If your CPAP machine is unused, gathering dust in a corner, it’s time you reacquaint yourself with this very important device that can help your health.

CPAP — continuous positive airflow pressure therapy — is the most-often recommended treatment for people who have obstructive sleep apnea, a serious condition that causes people to stop breathing while they sleep. Sleep apnea is associated with heart disease, high blood pressure and other conditions, says Harneet Kaur Walia, M.D., medical director of sleep medicine at Miami Cardiac & Vascular Institute.


Harneet Kaur Walia, M.D., medical director of sleep medicine at Miami Cardiac & Vascular Institute.

Despite the serious health ramifications, studies have shown that about half the people who are advised to use a CPAP machine abandon it within a year, and many even sooner. Some studies have estimated long-term adherence is as low as 30 or 40 percent.

That means that if you’re a CPAP dropout, you’re far from alone. It is certainly something to address frankly with your physician, who may be able to help you get more comfortable with the device, Dr. Walia says.

“CPAP use can sometimes be challenging, but it is important to stick with it,” says Dr. Walia, who has led numerous clinical trials and research on sleep-disordered breathing. “Sometimes patients don’t realize the importance of treating obstructive sleep apnea.”

If you’re considering giving your CPAP another try, that’s great, Dr. Walia says. Before you get started, however, check with your doctor. Don’t assume your old machine and old settings are still right for you. Phillips, a large maker of CPAP machines, recently recalled millions of its older devices in the United States because a potential health risk from its sound-abatement foam. You should check if you have one of those machines first and determine what to do next. Your physician will be able to guide you.

Addressing Your CPAP Challenges

For some people, the CPAP causes a sensation of suffocation or claustrophobia, difficulty exhaling, sinus discomfort or mouth dryness. Any difficulties should be addressed with a physician, since many problems can be resolved by changing masks, adjusting the CPAP’s pressure setting, adding a chin strap, or with other strategies, Dr. Walia says.

Nasal congestion, for example, can be treated with antihistamines or topical corticosteroids, and nasal dryness can be addressed with topical saline sprays or humidification. If the mask is causing skin irritation, you may wish to consider mask liners.

Sometimes CPAP use may cause the feeling of air in the stomach. You can have your pressure checked and adjusted, and over-the-counter antigas medications can be beneficial. Sometimes, Bilevel positive airway pressure therapy is needed.

If you’re ready to become reacquainted with your CPAP, take the time to find the right mask with a proper fit. The main type of masks — full-face, nasal mask, nasal pillow and hybrid masks — are best-suited for different situations. Just because one type doesn’t suit you, it doesn’t mean one of the others won’t be a good fit.

Ease back into wearing your CPAP by wearing it a little longer each night. In fact, you might want to get more comfortable by wearing it in the daytime while reading or watching television. You can even start out wearing the mask without connecting it to the machine. Eventually, it will feel more comfortable.

Finally, try some relaxation exercises to help reduce your anxiety about wearing the mask at night. Use the “ramp” feature on your machine to start with a low air pressure that gradually increases. This is preferable for many patients.

Why You Should Address Sleep Apnea?

People with obstructive sleep apnea can experience pauses or decreases in their breathing many times per hour. Each such episode, caused when your airway becomes obstructed or collapses, may last from a few seconds to a few minutes. The disrupted intake of oxygen signals your brain to wake you in order to resume breathing. “The body’s fight or flight response is activated,” Dr. Walia explains. “Blood pressure spikes, your heart rate fluctuates and this creates stress.”

This pattern may repeat all night without you noticing it — but your body knows. Sleep apnea has been found to be a risk factor for numerous cardiovascular diseases, including irregular heartbeats, hypertension, stroke, atherosclerosis (hardening of the arteries) and coronary heart disease, not to mention mood disorders, memory issues, diabetes and obesity. Using a mask, the CPAP machine pumps air into the back of your throat to keep your airway open while you sleep. Studies show that when used consistently, it is very successful.

So why do so many people break up with their CPAP? In some cases, they never established a good relationship with it from the start. Early adherence is a predictor of long-term use, Dr. Walia says, so it’s important to work through the adjustment period when you first get your machine.

“We have to evaluate whatever is getting in the way of long-term use,” Dr. Walia says. “CPAP isn’t a ‘when you feel like it’ treatment — you have to use it for it to work. Without it, you will go back to the original problems that sent you to the doctor for a sleep study in the first place.”

Don’t Give Up

CPAP doesn’t work well for everyone, however. For example, people with nasal or sinus abnormalities may have anatomical problems. Other coexisting conditions may suggest a different approach to treating sleep apnea. It’s important to discuss the situation with your physician.

“CPAP is the gold standard, but there are other treatment options,” Dr. Walia says. “The challenge is to find the right therapy to correct your sleep breathing disorder. If CPAP doesn’t work for you, that’s no reason to feel ashamed or give up.”

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