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CPAP and (poor) Compliance.
I have read some of the profiles here on the forum. A number of members have mentioned that they have Sleep Apnea, but are not in treatment.
Of course there can be a good reason for that, waiting for a titration study, waiting for equipment, not severe enough to qualify with your insurance or Health Care System, but it could also be because of poor compliance.
The major problem with compliance numbers is that there is absolutely no consensus about compliance. A lot of studies use different criteria for compliance, and I think this is the reason for the different numbers for compliance.
I think the most used criteria are 4 hours at night at least 5 days a week. I have seen that compliance who meets these criteria is about 60 – 70%
But I think that most of members here would agree with me, that good compliance is using the CPAP ALL the time you sleep, even when you take a nap.
So before we talk compliance, I think we have to define our own criteria for compliance.
The normal sleep is about 8 hours a night. We can call this “Full Compliance”.
If we recalculate the above used criteria to “Full compliance” then it gives a “Full Compliance” at around 25%.
So no doubt, the CPAP compliance over all is very poor.
It would be nice to hear the reason from some of you, who is not in treatment (and I’m sure that on this forum no one will blame you, unlike other forums).
Have you been in treatment, is it insurance problems, is it poor compliance or ???
IF it is poor compliance, I’m sure that a lot of members here is ready to give good advice to you. We are all here to help each other
There are also other treatment options than CPAP.
Henning
Of course there can be a good reason for that, waiting for a titration study, waiting for equipment, not severe enough to qualify with your insurance or Health Care System, but it could also be because of poor compliance.
The major problem with compliance numbers is that there is absolutely no consensus about compliance. A lot of studies use different criteria for compliance, and I think this is the reason for the different numbers for compliance.
I think the most used criteria are 4 hours at night at least 5 days a week. I have seen that compliance who meets these criteria is about 60 – 70%
But I think that most of members here would agree with me, that good compliance is using the CPAP ALL the time you sleep, even when you take a nap.
So before we talk compliance, I think we have to define our own criteria for compliance.
The normal sleep is about 8 hours a night. We can call this “Full Compliance”.
If we recalculate the above used criteria to “Full compliance” then it gives a “Full Compliance” at around 25%.
So no doubt, the CPAP compliance over all is very poor.
It would be nice to hear the reason from some of you, who is not in treatment (and I’m sure that on this forum no one will blame you, unlike other forums).
Have you been in treatment, is it insurance problems, is it poor compliance or ???
IF it is poor compliance, I’m sure that a lot of members here is ready to give good advice to you. We are all here to help each other
There are also other treatment options than CPAP.
Henning
Views: 280
Replies to This Discussion
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Permalink Reply by Mike on
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Have been wondering the same thing myself. Shot this out to the membership to get some personal stories . .
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Patrick, sounds like your problem is that your pillow isn't providing enough support and your face (and mask) are sinking into the pillow, dislodging the mask and causing leaks. could that be?
Mike
Patrick said:It is not for lack of trying on my part in the way of complience. I have only been in treatment for 3 weeks, but have not been able to go through a complete night with my mask on. I put a second pillow under my head last night, so we will give that a sho and see how things go, I have toyed with the idea of changing masks ( I currently use a Resmed Quatro, but I am thinking I might try the Resperonics full face gel and see how that works out. I will keep everyone interest posted of how things are working out.
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Permalink Reply by RichM on
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I just got my wife to start using hers. She has had hers for appox 3 years now and it has taken me a long time to get her to use it again. She just got the ComfortGel™ Full Mask due to her problems with her other mask. I was concerned that they did not fit it right for her. She had problems with leaks last night but at least she had it on all night. On Monday we are going to call and take it along when her machine back to get it fitted with her machine on. I think she should have had a smaller mask. Will hope to get it good for her so she will use it.
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Permalink Reply by Claudia on
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I have been using the CPAP for over two years now. I've tried 4 different masks, from nasal pillow to full face and ALL of them leak. Also have issues with the humidity. If I set it too low I wake up numerous times with extreme dry mouth and throat--at times almost gasping for breath. If I set it to high I wake up with water streaming through the hose which makes a loud popping noise. I still try, every night, to use it. There are weeks and months that I cannot get any real sleep, then I have a stroke of good luck and get one or two nights of 5-6 hours of straight sleep with no awakenings. The days following the good sleep are almost normal! I can see a night at the end of the tunnel. But most of my days are zombie-like and I have no interest in my friends, going out on errands or even outside. I just want to sleep. I have tried the dental appliance but that won't work unless I first get braces. My teeth are too uneven to get a good impression. I also have fibromyalgia which I firmly believe is a result of years of no sleep. I often feel hopeless and wonder if I will ever be ME again.
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Permalink Reply by Jason Pegg on
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What if one doesnt sleep 8 hours per night?I only sleep 5-6, but wear it EVERY DAY(night). Am I in Poor compliance?
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The mask that I use now seems to work the best for me and it new from Respironics OptiLife Nasal mask. Here is the Website URL: http://optilife.respironics.com/
and it allows me to ware my glasses when I am using it. I might have gone though 6 0r 7 mask types in the last 10 years I like this one the best.
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Jason, I don't think you are poor compliance. The key is that you are using it every night and getting the most sleep as you can. The key is how are you feeling the next day when you wake up. I figure that you are doing a whole lot better then you did when you were not using your Cpap.
Jason Pegg said:What if one doesnt sleep 8 hours per night?I only sleep 5-6, but wear it EVERY DAY(night). Am I in Poor compliance?
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Permalink Reply by Henning on
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Hi RichM,
The OptiLife mask seems comfortable to me.
For the moment I'm considering Hybrid Therapy. This is a combination of oral appliance and CPAP. The oral appliance do that you probably can lower the CPAP pressure, and it has no kind of headgear.
If anyone on this forum is using this solution, I would like to hear about it.
BTW. Here is a link to one of our professional members Dr. David Lawler, who perform this kind of therapy:
http://www.centerforsoundsleep.com/Combination-Therapy.php
Henning
RichM said:The mask that I use now seems to work the best for me and it new from Respironics OptiLife Nasal mask. Here is the Website URL: http://optilife.respironics.com/
and it allows me to ware my glasses when I am using it. I might have gone though 6 0r 7 mask types in the last 10 years I like this one the best.
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Personally, I see three problems with my compliance: the physical aspects of wearing a mask, which include comfort, noise, blowing air, facial imprinting; claustrophobia complicating things; and the emotional satisfaction of a night's sleep without the mask and machine.
Masks are not made for the individual. No one's face is exactly like mine. I have tried different DME providers and have yet to find one that will take the time and effort to fit me properly, so I keep trying on my own. The first DME provider fitted me with a mask put together with the parts upside-down. The second held a mask up to my face and told me it would be great. Neither seemed to consider what a shock first using a CPAP is and that it takes a while to get used to the pressure and the mask. It is unreasonable to think that you can decide what will be a good match that first time.
Masks need to be fitted while connected to your machine at the pressure you need and with your individual sleeping habits considered. If you tighten a mask to prevent leaks when the pressure is at its lowest ramp stage, it may still leak as the pressure increases.
I would like to find a way to have access to different masks at home on a trial basis so that a fair test ccould be made about what works for the individual before incurring the expense of purchase. I would be willing to pay some kind of rental fee for the opportunity.
Besides the fit of the mask, I have claustrophobia complicating compliance. It is an irrational fear, but sometimes hard to overcome if the air flow through the mask seems insufficient or stuffy. Then add mouth breathing and sleeping on my side.
My last obstacle is that for some reason unknown to me, sleeping with the mask and machine just is not as emotionally satisfying. Compliance makes me feel better physically and helps me cope with life better, but something is missing.
In any case, the result is worth the hassle. I encourage all those with apnea to keep trying and not to give up.
Good luck!
Mary
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Permalink Reply by sleepycarol on
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In my opinion, getting the right mask is the key to getting good therapy.
Here is a list of all the masks that I have tried and whether I liked that mask or not:
My first mask was a Fisher and Paykel HC431 that the doctor prescribed. It was the mask I used during my titration study and he felt that it was best suited for me. I used it for approximately 3 or 4 months and became aware that there were other options and so began my journey on finding the mask best suited for me.
Among the other masks I have used:
Optilife
Snapp X
Nasal Aire I and Nasal Aire II
Breeze Sleepgear
Ventlab Nasa Cannula System
Infinity HC481
Original Swift
Swift II
Hybrid
Opus 360
Original Comfortlite
Comfortlite 2
Ultra Mirage Full Face Mask
Comfortfull 2 Full Face Mask
MoJo Full Face Mask
ComfortGel Nasal Mask
Ultra Mirage II Nasal Mask
Comfort Classic Nasal Mask
Profile Lite Nasal Mask
Mirage Activa Nasal Mask
ComfortCurve Nasal Mask
Mirage Vista Nasal Mask
Contour Nasal Mask
Simplicity Nasal Mask
IQ Nasal Mask
Soyala Nasal Mask
I was able to try these masks by trading masks with other users, purchasing them from www.cpapauction.com, and by advertising on www.craigslist.com that I was wanting to purchase like new cpap masks.
The mask I settled on and use regularly is the Aura/Headrest mask. It has very little facial contact and sets directly under the nares with the hose being routed up out of the way. It is my mask of choice, but it took me a long time to discover it. I suggest that if you can buy a few masks online at one of the auction sites or by advertising on something like craigslist or local media. Once you have a couple of masks you can try them for a while (give each a few nights or a week to make sure you truly do not like it instead of it being just an off night) and then do some swapping for others that you want to try.
Do not give up until you find the right mask for you. I know some of you may say it is way too much to spend on finding the mask that works, but a great nights sleep is priceless in my book -- and by purchasing at auction sites, etc. the cost is not that great in comparision to finding the one that works.
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I don't know about the other brands but the Resmeds have a Mask Fit option and if you use that when fitting your mask the Resmed will provide either yuor set pressure or 10 cms of pressure, whichever is highest.
Try your own fittings at home like this:
1] Lay down. 2] Lay your mask on your face slightly lower on the bridge of your nose than you are going to want it. 3] Turn your xPAP on. 4] Adjust the straps COMFORTABLY. 5] Pull the mask slightly away from your face and move it UP into correct position on your nose (this turns the edges of the cushion UNDER so they don't cut into the skin on the bridge of your nose). 6] Make any further smal adjustments you might need w/the straps. 7] Run your fingertip along the seam between cushion and facial skin. This turns the cushion edges under and in and usually will eliminate any small remaining leaks.
1] I've found either a very soft pillow that you can punch into shape can help to eliminate shifting your mask when you change positions. 2] I've also found a pillow such as the PAPillow which allows you to sleep w/your head to the edge of the pillow so the mask is over the edge also helps to prevent shifting your mask when you change positions3] Hanging your hose above your head helps to eliminate "rain out" (condensation in the hose and mask) AND tends to eliminate the downward tug of the hose whilst sleeping which pulls the mask down slightly resulting in the edges of the mask cushion turning out and up and cutting into the bridge of the nose. 4] Clipping your hose to your PJs can also help to eliminate the drag of the hose on your mask and bridge of the nose.
1] Placing your xPAP lower than the level of your mattress helps to eliminate "rain out" in the hose and your mask. 2] As mentioned above, hanging your hose above your head helps to eliminate "rain out" reaching your mask. 3] Don't be afraid to adjust your humidifier temperature up or down as needed, every day doesn't necessariily have the same humidity as the day before. 4] Taking your hose under the blankets w/you can also help to eliminate "rain out". 5] There are hose covers you can easily make or can buy that will help to eliminate "rain out". 6] The Aussie Heated Hose while somewhat expensive can eliminate "rain out"
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Hi Carol,
I agree with you. But I think it often depends on the sleep position.
I sleep on my side, making that I am not comfortable with many types of masks, for example a full face mask is not good for me to sleep on the side.
Are you also experienced in the masks, which are best for different sleep positions?
Henning
sleepycarol said:In my opinion, getting the right mask is the key to getting good therapy.
Here is a list of all the masks that I have tried and whether I liked that mask or not:
My first mask was a Fisher and Paykel HC431 that the doctor prescribed. It was the mask I used during my titration study and he felt that it was best suited for me. I used it for approximately 3 or 4 months and became aware that there were other options and so began my journey on finding the mask best suited for me.
Among the other masks I have used:
Optilife
Snapp X
Nasal Aire I and Nasal Aire II
Breeze Sleepgear
Ventlab Nasa Cannula System
Infinity HC481
Original Swift
Swift II
Hybrid
Opus 360
Original Comfortlite
Comfortlite 2
Ultra Mirage Full Face Mask
Comfortfull 2 Full Face Mask
MoJo Full Face Mask
ComfortGel Nasal Mask
Ultra Mirage II Nasal Mask
Comfort Classic Nasal Mask
Profile Lite Nasal Mask
Mirage Activa Nasal Mask
ComfortCurve Nasal Mask
Mirage Vista Nasal Mask
Contour Nasal Mask
Simplicity Nasal Mask
IQ Nasal Mask
Soyala Nasal Mask
I was able to try these masks by trading masks with other users, purchasing them from www.cpapauction.com, and by advertising on www.craigslist.com that I was wanting to purchase like new cpap masks.
The mask I settled on and use regularly is the Aura/Headrest mask. It has very little facial contact and sets directly under the nares with the hose being routed up out of the way. It is my mask of choice, but it took me a long time to discover it. I suggest that if you can buy a few masks online at one of the auction sites or by advertising on something like craigslist or local media. Once you have a couple of masks you can try them for a while (give each a few nights or a week to make sure you truly do not like it instead of it being just an off night) and then do some swapping for others that you want to try.
Do not give up until you find the right mask for you. I know some of you may say it is way too much to spend on finding the mask that works, but a great nights sleep is priceless in my book -- and by purchasing at auction sites, etc. the cost is not that great in comparision to finding the one that works.
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