Can specialized support improve the use of CPAP therapy?
When psychological and practical support is started early and continued over the longer term, it can help lower the number of people who stop CPAP 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 apnea snore heavily and experience longer phases of shallow breathing (hypopnea) and breathing pauses (apnea) 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 apnea is CPAP 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 CPAP 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. CPAP 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 CPAP machine. Many only wear the mask for a few hours at night or stop the therapy altogether.
For the treatment to be effective, CPAP 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 CPAP machine for less than four hours each night, which might not give them enough relief from their symptoms.
Breathing therapy with a CPAP mask is the most effective treatment for relieving the symptoms of obstructive sleep apnea. It is therefore worth the effort to find ways to manage this therapy as well as possible.
Studies on support options
Researchers from the Cochrane Collaboration – an international research network – wanted to find out whether specific support leads to increased use of CPAP therapy in people with obstructive sleep apnea. 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 CPAP 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 CPAP 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 CPAP machine was explained and information about it was provided, but no other support was provided.
Intensive support and training courses lead to increased use
The studies show that intensive psychological and practical support can lead to CPAP 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 CPAP 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 CPAP 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 CPAP therapy. With this support, participants used the CPAP 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.
Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2014; (1): CD007736.
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