"You can lead a horse to water, but you can't make him drink." – English proverb
The old adage above speaks volumes about patient compliance with CPAP therapy. All too often we hear about patients suffering from obstructive sleep apnea go through the long, arduous process of investigating their sleep troubles by having a sleep study, getting a diagnosis, receiving a CPAP machine for therapy, selecting a mask, getting educated on how to use their equipment, only to quickly abandon therapy within a few short weeks.
Many of these patients are shown the path to quality sleep and given the tools to change their declining health, but, sadly, they can't be forced to comply with treatment.
The question facing many sleep professionals becomes, "If we can't make them drink, how can we entice them?"
The only real answer is to help patients want to get better. The best way to do that is to have them get proactive about sleeping healthier by using their CPAP equipment. And getting them proactive starts with showing them how to track their own therapy progress.
Why CPAP Patients Should Comply with Therapy
We recently discussed a few tips and tricks CPAP patients can use to stay compliant. In that article we briefly touched upon one of the cornerstones of successful therapy: tracking compliance.
Many insurance companies want to make sure their clients are using the expensive equipment that was paid for. To ensure minimum CPAP usage, some of these insurance companies want a detailed report as often as every three months. For the most part, they want to know how many days a week patients are using their device and how many hours a night they are using it for. And if patients don't meet a minimum standard (usually four hours a night/four days a week) they may ask patients to reimburse the company for the equipment.
Aside from just the fear of having to pay for these expensive pieces of equipment out of pocket, patients should be concerned about the usage rates for their own health.
Sleep apnea is often overlooked as a mere annoyance because of the subsequent loud snoring that is often produced as a result of partial blockage. However, many people may not realize that a slew of medical complications can arise as a result of untreated sleep apnea including cardiovascular problems (ranging from irregular heart rhythms to heart disease, stroke, and heart failure), complications during surgery, mood disturbances, depression, and even driving and industrial accidents resulting from sleep deprivation.
Patients who are serious about their overall health and well-being should take CPAP therapy seriously, and the best way patients can do that is by keeping track of their own progress and having a good understanding of how their machine works, and what they can do to make it work better.
Here are a few ways patients can track their progress:
Remote Monitoring/ SD card monitoring
Many clinics that dispense CPAP equipment include follow up care as part of their treatment program. Most CPAP devices have a slot in the machine allowing for either an SD card to capture data or a remote wireless device that uploads data to a cloud-based system.
Patients issued a machine with an SD card will have to periodically bring their card into the clinic offering the follow-up care periodically. How often they bring it in is either up to the insurance company, the clinic, or the patients themselves. At the clinic, the data can be uploaded and viewed or printed out.
Patients with a wireless monitoring system on their device don't have to worry about bringing anything in to the clinic. Technicians charged with follow-up care can upload data from the device at any time to view how well patients are complying with therapy.
Typical information stored on the machine's SD card or uploaded to the cloud include:
Days above 4 hours of usage
The patient's apnea/hypopnea index (AHI)
Leak rate of masks
- Total blower hours
Total therapy hours
Machine Data Displays
For patients that don't want to leave their therapy completely in the hands of the technicians, nearly all CPAP machines can display the data on the device's screen. Not only do patients have access to track all of the data listed above, they have the option to fine-tune their machine for maximum comfort, which can lead to better compliance.
Nearly all devices have pressure settings that are locked in by the issuing clinic based on the sleep specialist's prescription. And while the pressure setting can't be adjusted by the patient, many comfort features can be. These features include:
Humidifier settings allow patients to select the desired amount of moisture and temperature of the air being delivered.
The ramp feature allows a patient to select a starting pressure for their machine. Patients with high-pressure settings often have trouble being hit with the full volume of their prescribed pressure as soon as the machine is turned on. The ramp allows patients to select a lower pressure to start with that gradually builds to the prescribed pressure.
Mask alert is a feature that can allow patients to be alerted with an audible and/or visual alarm when there is a significant mask leak. This can alert the patient to wake up and adjust the mask for adequate therapy.
Some machines have a pressure relief option, which allows patients to soften the force of the incoming air upon exhalation. When patients exhale, the pressure lowers making breathing feel more natural and comfortable.
Some machines have features that only allow air to flow if the patient is wearing the mask. If a patient removes the mask, the machine will turn off. When the patient applies the mask, the air will begin flowing again.
For users with a Philips Respironics System One device, the video below shows many of the features of the machine that can be monitored and adjusted by users.
Web based platforms/Mobile Apps
For technologically savvy patients or those that are constantly on-the-go, many CPAP device manufacturers now offer the ability to check compliance online or through mobile apps.
Availability of checking data from a computer or mobile device may depend on the machine. Many older devices may not have this capability.
Some of these features/apps may cost a small fee, while others may be free. Check with your provider to see if your device has a free feature for tracking compliance.
For more information on web-based and mobile app tracking software check out the following links based on the manufacturer of your machine.
Respironics System One devices offer SleepMapper for free
ResMed MyAir is available for AirSense 10 and AirCurve 10 patients free of charge
DeVilbiss IntelliPAP can generate compliance reports for a small fee
Regardless of how patients take action to monitor their compliance, the important thing is to make sure they are aware of the options available. For many patients, having a little control over their therapy goes a long way in engaging them with getting the best treatment possible. Patients who can see their mask leakage rates may be encouraged to try a new mask that works better. Knowing they can adjust their device's comfort features can make treatment more tolerable and likely to occur on a regular basis. And being able to see their cpap compliance numbers can influence them to make changes for the better.
And while they can't be forced to drink the water, we can at least hand them a refreshing glass.