5 Steps to Improving CPAP Adherence

Christopher J. Lettieri, MD


March 06, 2012

In This Article

Educating the Patient

1. Educate patients on the effects of untreated OSA and emphasize the need for treatment. Discuss treatment options and all patient concerns in detail.

A better understanding of the adverse effects of untreated OSA and the potential benefits of CPAP therapy is perhaps the most important, but often overlooked, aspect in long-term adherence. Patients must understand that untreated OSA has numerous adverse consequences to both health and quality of life. Discussing the list of known or suspected associated medical conditions may increase the willingness of patients to accept treatment and help them understand the cause of some of their symptoms or diagnoses. Even if they do not currently have a particular symptom, educating them on all potential effects of OSA can increase patient buy-in and promote better adherence.

Discontinuation of CPAP most commonly occurs at the onset of therapy, often because of initial intolerance as patients become accustomed to the mask interface. It is important to counsel patients on the benefits and effectiveness of CPAP therapy. This can help motivate them to continue treatment during the initial transition period.

Common effects of OSA include the following:

  • Headaches (due to ineffective ventilation and CO2 retention);

  • Depression and irritability (due to sleep fragmentation);

  • Weight gain (due to elevated stress hormones);

  • Chronic pain and inflammation (due to sleep fragmentation and insufficient slow-wave sleep);

  • Nocturia (due to natriuresis from transient elevations in intrathoracic pressures);

  • Arrhythmias and palpitations, especially atrial fibrillation (due to atrial stretch from transient elevations in intrathoracic pressures);

  • Impaired memory and executive function (due to sleep fragmentation and hypoxia);

  • Cardiovascular diseases, such as hypertension and increased risk for heart attack and stroke (due to endothelial dysfunction resulting from intermittent hypoxia and an elevated sympathetic tone);

  • Glucose intolerance and/or diabetes (due to elevated stress hormones);

  • Erectile dysfunction and decreased libido (due to sleep fragmentation and endothelial dysfunction); and

  • Increased risk for motor vehicular collisions and death.


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