CPAP therapy is the most effective treatment option for obstructive sleep apnea (OSA) but research has found low rates of CPAP adherence. A study published in 2013 found that one year after being given a CPAP machine, only one third of individuals were still using it on a nightly basis, with another third not using it at all, and the final third using it only intermittently.
By the fourth year, roughly two-thirds of patients were not using their CPAP machines.
Why don’t people with OSA use their CPAP machines?
Research published in the Journal of Clinical Sleep Medicine in 2017 set out to identify reasons why people use (and fail to use) CPAP machines.
Participants in the study expressed a number of concerns about CPAP machines. These included feelings that CPAP was:
Not user friendly
Not a cure for OSA
Interfering with their ability to travel
Interrupting sleep and their breathing
Something that made them feel disabled
Interestingly, the study also found that one in three participants were skeptical about the accuracy of their OSA diagnosis and even those who adhered to CPAP treatment and enjoyed an improvement in their daytime and nighttime symptoms did not credit the CPAP treatment as the only reason for these improvements. Instead, they wondered whether other factors such as reduced stress, weight loss, and exercise had contributed to symptom relief.
An article published in Current Sleep Medicine Reports in 2016 identified the following key themes from patient feedback related to CPAP use. These included:
Trouble using CPAP (noise, mask leakage, dryness, runny nose, condensation)
Having to persist through initial and recurring frustration (often due to a lack of information and support)
Difficulty recognizing symptom improvements
Accessing help and the variability of available support
How to improve CPAP adherence and outcomes
Research suggests that having a positive attitude towards CPAP treatment has a big influence on CPAP adherence — and that these beliefs are particularly important before starting CPAP treatment.
This indicates that there is an opportunity to increase adherence through more education and better clinical and peer support.
Education and support
A 2013 study found that when individuals who adhered to CPAP treatment shared their experiences, coping strategies, and techniques for using CPAP machines with newly-diagnosed participants, CPAP adherence rates increased. Furthermore, a study published in 2017 found that having a supportive spouse was associated with increased CPAP compliance at six months.
A 2013 literature review published in the Journal of Sleep Disorders & Therapy found that one ongoing problem with CPAP adherence was the availability of educational information. It also suggested that behavioral interventions such as cognitive behavioral therapy can help.
Studies that have investigated the effect of different masks and humidity levels on CPAP adherence have reported mixed results. With that being said, it makes sense that any technique that increases user comfort may also increase CPAP adherence.
If you are struggling with your CPAP machine, do not give up! Talk to your doctor about your concerns. (You may even be eligible for alternative treatment options.)
If you’re married or in a relationship, seek the support of your partner. The American Sleep Apnea Association can help put you in touch with an education and support group in your state, while online communities such as CPAP Talk and Apnea Board can offer support and advice if there are no groups in your local area.