Can specialized support improve the use of CPAP therapy?

Photo of a doctor talking to a patient

When psychological and practical support is started early and continued over the longer term, it can help lower the number of people who stop therapy early and motivate them to use the machines for a longer time. The effect of this support on symptoms is not yet known.

People with obstructive sleep snore heavily and experience longer phases of shallow breathing (hypopnea) and breathing pauses () when they sleep. This happens because their airways narrow and sometimes become completely blocked when they lie down to relax. Snoring itself is harmless; but breathing pauses can wake you up and keep you from getting a good night’s sleep.

CPAP therapy: Continuous positive airway pressure

The most common treatment for sleep is therapy, which involves wearing a breathing mask during the night. The mask is connected through a tube to a small respirator that continually pumps pressurized air into the airways. This keeps the airways open, breathing is easier, and snoring is reduced. Studies show that people using therapy are less tired during the day and have a better quality of life.

Wearing the mask takes some getting used to, and some people find it uncomfortable and restrictive. therapy may also cause a blocked nose or a dry throat. Moreover, the valve of the mask makes some low-level noise, which can disturb sleep at night. So some people will have problems getting used to a machine. Many only wear the mask for a few hours at night or stop the therapy altogether.

For the treatment to be effective, machines are recommended to be used for at least five hours each night. However, there is no scientific proof yet that a certain minimum time is required each night. Some people use the machine for less than four hours each night, which might not give them enough relief from their symptoms.

Breathing therapy with a mask is the most effective treatment for relieving the symptoms of obstructive sleep . It is therefore worth the effort to find ways to manage this therapy as well as possible.

Studies on support options

Researchers from the – an international research network – wanted to find out whether specific support leads to increased use of therapy in people with obstructive sleep . They analyzed studies involving participants who not only had conventional therapy, but also attended additional programs. These programs aimed to give the participants a thorough introduction to therapy and then accompany them for a longer time during their treatment. The participants always had a person to talk to about any problems using their machine. Certain types of psychotherapy such as cognitive behavioral therapy were also included in the study.

To find out whether this kind of support is helpful, it is necessary to have a control group (comparison group) in the studies. In these control groups, the machine was explained and information about it was provided, but no other support was provided.

The researchers analyzed 30 studies involving almost 2,050 people. Most of these participants had severe sleep with serious symptoms and were using the machine for the first time.

Intensive support and training courses lead to increased use

The studies show that intensive psychological and practical support can lead to therapy being used longer at night. Support increased the time that therapy was used each night by about 50 minutes on average.

There were major differences between the studies, depending on the type of support, for example. The participants were able to contact sleep specialists either online, by phone, during house calls or in follow-up visits. Participants in all of the studies were provided with basic information on the disorder and on therapy, an introduction to the machine, and advice on what to do in case of side effects.

Studies also show that training courses on operating the machine are also effective. After taking these courses, participants used their mask and machine on average for about 35 minutes more each night.

Behavior-oriented approaches also lead to longer CPAP use

Support focusing on changing behavior patterns aims to help strengthen problem-solving abilities and reach goals. Studies looked at how motivational conversations, regular written feedback, and cognitive behavioral therapy can help. Cognitive behavioral therapy is a form of psychotherapy that aims to find concrete solutions to problems caused by certain patterns of behavior.

The results of the studies showed that behavior-oriented approaches and behavioral therapy lead to longer use of the therapy. With this support, participants used the machines for about 90 minutes longer each night. Additionally, more people used the respirator for four hours or more each night.

It only makes sense to encourage people to use the therapy longer if it relieves symptoms. Some studies do suggest that participants are less tired during the day when more intensive support helps them use their machine longer. But these studies are not very conclusive, and more research is needed to confirm these results.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on January 3, 2019
Next planned update: 2022


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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