5 Steps to Improving CPAP Adherence

Christopher J. Lettieri, MD

March 06, 2012

Determining the Need for a Sleep Physician

Although a comprehensive, step-wise approach to CPAP can be very effective in both promoting better CPAP adherence and improving outcomes, it may not address or resolve all issues in some patients. When these issues persist, patients should be referred to a sleep specialist for further evaluation. Common reasons to refer patients include the following:

The patient has a residual AHI >5 and/or persistent sleep fragmentation despite adjustments to CPAP pressure;
The patient has concomitant insomnia or coexisting psychological conditions that are preventing the use of CPAP or is causing impairments to health or quality of life;
Central or complex sleep apnea is clinically suspected, or frequent central apnea is noted on the CPAP data;
The patients is unable to tolerate CPAP despite implementing potential solutions as described above;
The patient requests alternative therapies to treat OSA (surgery, oral appliance); and
The patient has persistent symptoms despite adequate therapy and/or has clinical suspicion for concomitant sleep disorders causing excessive sleepiness and sleep fragmentation.

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Cite this: Christopher J. Lettieri. 5 Steps to Improving CPAP Adherence - Medscape - Mar 06, 2012.

Introduction
Educating the Patient
Assessing Therapeutic Response
Assessing Patient Adherence
Identifying Barriers to CPAP Use and Effectiveness
Measures to Improve Sleep Quality
Determining the Need for a Sleep Physician
Conclusion
References

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