2021 HME Business Handbook: Sleep Therapy
Improving PAP Compliance with New Innovations
With 46% to 83% of OSA patients not complying with therapy, how can providers use new innovations to pinpoint and address the factors undermining their adherence?
- By Carol Gaskamp
- Jun 01, 2021
Of the global population,
one-seventh —
approximately 1 billion people —
are estimated to have obstructive
sleep apnea (OSA). Over the past
four decades, obesity, the main
risk factor for OSA, has risen
dramatically. Of the 25 million
U.S. adults who suffer from
moderate-to-severe obstructive sleep
apnea, an estimated 10 million
remain undiagnosed. Of those
diagnosed with OSA, a significant
proportion either do not initiate or
eventually stop using their device.
Initial experience with positive
airway pressure (PAP) therapy is
important, reinforcing the need for
early education and support in
these patients. Most studies suggest
PAP adherence is associated with
better health, but, depending on
the study, between 46 and 83
percent of patients with OSA do
not adhere to treatment.
Insurance companies often
remotely monitor patient compliance.
Compliance is demonstrated
by device usage greater than four
hours per night at least 70 percent
of the time in any 30-day period
within the first three months of
therapy, with reported health
benefits and reduction in residual
excessive daytime sleepiness. In the
absence of minimum compliance
and benefit, reimbursement and
authorizations are denied to the
equipment provider.
HEALTH IMPACTS OF SLEEP APNEA
Findings from new studies emphasize
the negative effects of sleep apnea on
brain and heart health. A recent study
demonstrated that patients with severe,
untreated OSA had a significant increase
in the prevalence of both fatal and nonfatal
cardiac events. The risk factor was
2.87 times higher than norms. Patients
with severe OSA who were treated
with PAP therapy for greater than four
hours per night had a significant drop in
incidences of fatal or non-fatal cardiovascular
events. These health risks can
be reduced by effectively treating sleep
apnea with PAP therapy.
PROBLEMS WITH PAP THERAPY
The most frequently reported reason for
discontinuing PAP therapy is side effects
— skin irritations and rashes, nasal
congestion, claustrophobia, facial breakages,
conjunctivitis, and aerophagia —
which are experienced by approximately
two-thirds of PAP users.
The most common complaint is mask
leaks. In a recent study, 75.4 percent of
PAP patients reported leaks. Patients
attempt to correct leaks by overadjusting
the interface straps, leading
to skin irritation and breakdown. To
compensate for leaks, the PAP device
increases flow rates, which reduces nasal
humidity contributing to nasal irritation,
dryness, and congestion. Leaking
masks can cause ocular irritation and
even induce conjunctivitis. Aerophagia,
or swallowing of air, often results from
increased PAP pressures.
IMPROVING PAP COMPLIANCE
Fitting masks properly without leaks can
significantly improve results by lowering
PAP pressures and thereby reduce
aerophagia. Patients often modify their
usual sleep position to make PAP therapy
work for them. Minimalist masks are used
to diminish claustrophobia. The use of
a nasal mask or nasal pillow can reduce
air leakage, require lower pressures to
eliminate obstructive respiratory events,
and are associated with improved
sleep quality and better PAP therapy
compliance.
Manufacturers continue to develop
new innovations for PAP masks, including
nasal pillows, nasal masks, full-face
masks, and hybrids. New innovations in
masks and comfort accessories redefine
minimal contact to improve comfort,
seals, and quietness. Some of these innovative
solutions include cradle or foam
cushions, liners, wraps, and securement
accessories that eliminate headgear or
support tubing.
A patient’s ability to acclimate to
wearing a mask each night is the most
important factor in achieving long-term
success with PAP therapy. An uncomfortable
or leaking mask means the user will
struggle to incorporate it into their daily
routine and may ultimately abandon
therapy. When it comes to masks,
comfort yields patient compliance, which
also helps the bed partner who benefits
from a quieter sleep environment.
POINTS TO REMEMBER
- Moderate-to-severe obstructive
sleep apnea affects 25 million
Americans, many of whom are
undiagnosed. Of those who are
diagnosed, 46 to 83 percent do not
adhere to treatment.
- The most common reasons for not
complying with prescribed treatment
is discomfort and irritation
caused by the mask. In particular,
leaks are the dominant complaint.
- New innovations and advances in
PAP interfaces that are lighter and
minimize contact with the face
should prove advantageous. They
offer improved PAP efficacy and
comfort while reducing side effects.
Furthermore, innovative accessories
are now available that improve
patient comfort and reduce leaks.
LEARN MORE
To read more sleep therapy articles and
features, visit HME-Business.com/sleep. To learn more about NozeSeal LLC’s
sleep therapy solutions, visit www.nozeseal.com.
This article originally appeared in the May/Jun 2021 issue of HME Business.
About the Author
Carol Gaskamp, CRT, RCP, is the Marketing Director and Consultant with NozeSeal LLC. She has more than 29 years’ experience treating sleep-disordered breathing in the HME industry. “The simple act of helping others achieve a great night’s sleep with increased health and wellness is my passion,” she says. Reach Gaskamp via email at [email protected].