I’m A CPAP Dropout: Why Many Lose Sleep Over Apnea Treatment

When docs advised Frances Faulkenburg she had sleep apnea, she was greater than prepared for aid from her tired-all-the-time existence. She used to go to sleep at pink lights whereas behind the wheel. At night time, she’d get up gasping for air, coronary heart pounding. Her husband advised her she snored.

But Faulkenburg, 47, couldn’t tolerate the CPAP machine her physician prescribed.

“I just could not get used to the face mask covering both my nose and mouth,” stated Faulkenburg, who lives in Oviedo, Fla.

“It was claustrophobic.”

CPAP, or steady constructive airway stress, is usually one of many first options docs counsel for sleep apnea. With this dysfunction, an individual’s respiratory stops and begins so steadily in the course of the night time that it will probably result in or exacerbate well being issues. The National Sleep Foundation estimates that greater than 18 million American adults have sleep apnea.

A CPAP machine blows a stream of air into the again of the throat to let folks breathe simpler. It prevents muscle mass behind the throat from narrowing, which might constrict the airway, inflicting loud night breathing or disturbed sleep.

Yet Faulkenburg stop utilizing her CPAP and went again to feeling sleepy and drained on a regular basis.

Many folks have a detrimental response to the machines and are tempted to do the identical. The massive whoosh of air in your throat. The restrictive masks in your face. It is usually a lot to regulate to. Studies counsel that from one-third to greater than 50% of sufferers both cease utilizing their CPAP machine or by no means hassle to fill their prescription. They stop for a wide range of causes, however largely as a result of the system will be cumbersome and uncomfortable. Sometimes, they stop due to complicated or stringent medical insurance restrictions.

But the well being results of untreated sleep apnea will be critical. People wrestle with anxiousness, tiredness and low productiveness. There’s even an elevated danger of hypertension, coronary heart assault and stroke.

Mary Mertens, a respiratory therapist on the Cleveland Clinic, helps sufferers work by means of issues with their CPAP machine. Patients usually complain that the quantity of air the machine places out feels too intense.

“Think about it as sticking your head out of a car window with your mouth open at 60 mph versus 25 mph,” stated Mertens. “The high pressure can be very overwhelming.”

So Mertens’ staff goes to folks’s properties to assist troubleshoot issues. That contains explaining sleep apnea and the way a CPAP may help.

“Picture the air passage at the back of their throat like a garden hose with no water in it. The hose collapses down,” stated Mertens. That’s what occurs when an individual with sleep apnea is sleeping.

“When we put a CPAP on somebody, it’s like turning the water on for the garden hose,” she stated. “The hose then pops open and stays open.”

At the Cleveland Clinic, about 70% of sufferers within the Respiratory Home Care program hold utilizing their CPAP, Mertens stated.

Follow-up is essential. Mertens’ staff checks in with sufferers in the course of the first three to 5 days, once more between 30 and 45 days and once more between 60 and 90 days.

Faulkenburg, the affected person in Florida, first tried a CPAP 15 years in the past however by no means checked again together with her pulmonologist when she was struggling. And, she stated, the doctor by no means contacted her. Then a number of folks in her social circle died of their sleep — all of them proper round her age. Those tales shook Faulkenburg, and she or he determined to strive her CPAP once more.

“I got a mask that covered just my nose, which let my mouth stay closed. That ended up being the whole issue,” she stated. “I sleep so good, I can’t sleep without my CPAP now.”

Dr. Indira Gurubhagavatula, a sleep medication doctor on the University of Pennsylvania Health System, stated the look of the system alone will be alarming.

“One of the primary issues that I hear is that the factor itself is intimidating — they see the tubing and masks and it’s blowing air of their face — they’ve actual considerations: ‘Am I actually going to sleep better with that thing?’

“It is an enormous ask to go to mattress with this factor strapped to their faces,” she stated.

Gurubhagavatula stated individuals who really feel claustrophobic ought to put on their CPAP masks in the course of the day whereas studying or watching TV. That may help the nerve endings within the face get used to the masks.

“It’s just like breaking in new shoes or new jeans,” stated Gurubhagavatula. “Once it’s broken in, it’s less of an issue.”

Pulmonologist James Rowley, a sleep medication doctor at Detroit Medical Center, stated the air stress from the CPAP may cause a runny nostril, nasal congestion or dry mouth. He stated he may help by adjusting humidity settings on the machine or prescribing an antihistamine.

Medicare and personal insurance coverage corporations require sufferers to make use of their CPAP very persistently — usually at the very least 4 hours each night time and for 70% of nights every month. Sometimes the utilization is monitored.

Patients who don’t comply could find yourself paying out-of-pocket. That’s the subject of this week’s episode of the podcast “An Arm and a Leg.” Kaiser Health News co-produces the podcast.

Prices range, however a totally geared up machine sometimes prices from $500 to $three,000, with the nationwide common round $850. After that preliminary funding, masks, hoses and filters must be changed two or thrice a 12 months. And customers have the continued value of upkeep provides — wipes and brushes to maintain the machine elements clear.

Gurubhagavatula stated she has sufferers whose machines have been taken away as a result of they couldn’t comply with the insurance coverage firm guidelines.

“They may have child care or elder responsibilities that makes their sleep disrupted. Or they sleep in chunks of time because they work certain shifts,” she stated. “The rule is arbitrary because using the machine, even if part time, is beneficial.”

Nate Wymer, 44, stated his machine is mendacity round his residence someplace in Holly Springs, N.C., however he hasn’t seen it in years.

“When I had the mask on I had to think about breathing out of my nose,” stated Wymer. “That’s not something I normally do. After a couple of nights, I just couldn’t do it.”

“My doctor never really followed up from what I can remember, so I back-burnered it,” stated Wymer. “But, if you get in front of somebody, actually talk to them and make sure everything is going OK, that would have been nice.”

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