What is the success rate of CPAP?
I’m A CPAP Dropout: Why Many Lose Sleep Over Apnea Treatment
When doctors told Frances Faulkenburg she had sleep apnea, she was more than ready for relief from her tired-all-the-time existence. She used to fall asleep at red lights while behind the wheel. At night, she’d wake up gasping for air, heart pounding. Her husband told her she snored.
But Faulkenburg, 47, couldn’t tolerate the CPAP machine her doctor prescribed.
Health care — and how much it costs — is scary. But you’re not alone with this stuff, and knowledge is power. “An Arm and a Leg” is a podcast about these issues, and its second season is co-produced by KFF Health News.
“I just could not get used to the face mask covering both my nose and mouth,” said Faulkenburg, who lives in Oviedo, Fla.
“It was claustrophobic.”
CPAP, or continuous positive airway pressure, is often one of the first solutions doctors suggest for sleep apnea. With this disorder, a person’s breathing stops and starts so frequently during the night that it can lead to or exacerbate health problems. The National Sleep Foundation estimates that more than 18 million American adults have sleep apnea.
A CPAP machine blows a stream of air into the back of the throat to let people breathe easier. It prevents muscles in the back of the throat from narrowing, which can constrict the airway, causing snoring or disturbed sleep.
Yet Faulkenburg quit using her CPAP and went back to feeling sleepy and tired all the time.
Many people have a negative reaction to the machines and are tempted to do the same. The big whoosh of air in your throat. The restrictive mask on your face. It can be a lot to adjust to. Studies suggest that from one-third to more than 50% of patients either stop using their CPAP machine or never bother to fill their prescription. They quit for a variety of reasons, but mostly because the device can be cumbersome and uncomfortable. Sometimes, they quit because of confusing or stringent health insurance restrictions.
But the health effects of untreated sleep apnea can be serious. People struggle with anxiety, tiredness and low productivity. There’s even an increased risk of high blood pressure, heart attack and stroke.
Mary Mertens, a respiratory therapist at the Cleveland Clinic, helps patients work through problems with their CPAP machine. Patients often complain that the volume of air the machine puts 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,” said Mertens. “The high pressure can be very overwhelming.”
So Mertens’ team goes to people’s homes to help troubleshoot problems. That includes explaining sleep apnea and how a CPAP can help.
“Picture the air passage at the back of their throat like a garden hose with no water in it. The hose collapses down,” said Mertens. That’s what happens when a person with sleep apnea is sleeping.
“When we put a CPAP on somebody, it’s like turning the water on for the garden hose,” she said. “The hose then pops open and stays open.”
At the Cleveland Clinic, about 70% of patients in the Respiratory Home Care program keep using their CPAP, Mertens said.
Follow-up is key. Mertens’ team checks in with patients during the first three to five days, again between 30 and 45 days and again between 60 and 90 days.
Faulkenburg, the patient in Florida, first tried a CPAP 15 years ago but never checked back with her pulmonologist when she was struggling. And, she said, the physician never contacted her. Then several people in her social circle died in their sleep — all of them right around her age. Those stories shook Faulkenburg, and she decided to try her CPAP again.
“I got a mask that covered just my nose, which let my mouth stay closed. That ended up being the whole issue,” she said. “I sleep so good, I can’t sleep without my CPAP now.”
Dr. Indira Gurubhagavatula, a sleep medicine physician at the University of Pennsylvania Health System, said the look of the device alone can be alarming.
“One of the first things that I hear is that the thing itself is intimidating — they see the tubing and mask and it’s blowing air in their face — they have real concerns: ‘Am I actually going to sleep better with that thing?’
“It is a big ask to go to bed with this thing strapped to their faces,” she said.
Gurubhagavatula said people who feel claustrophobic should wear their CPAP mask during the day while reading or watching TV. That can help the nerve endings in the face get used to the mask.
“It’s just like breaking in new shoes or new jeans,” said Gurubhagavatula. “Once it’s broken in, it’s less of an issue.”
Pulmonologist James Rowley, a sleep medicine physician at Detroit Medical Center, said the air pressure from the CPAP can cause a runny nose, nasal congestion or dry mouth. He said he can help by adjusting humidity settings on the machine or prescribing an antihistamine.
Medicare and private insurance companies require patients to use their CPAP very consistently — often at least four hours every night and for 70% of nights each month. Sometimes the usage is monitored.
Patients who don’t comply may end up paying out-of-pocket. That’s the topic of this week’s episode of the podcast “An Arm and a Leg.” Kaiser Health News co-produces the podcast.
Prices vary, but a fully equipped machine typically costs from $500 to $3,000, with the national average around $850. After that initial investment, masks, hoses and filters need to be replaced two or three times a year. And users have the ongoing cost of maintenance supplies — wipes and brushes to keep the machine parts clean.
Gurubhagavatula said she has patients whose machines have been taken away because they couldn’t follow the insurance company rules.
“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 said. “The rule is arbitrary because using the machine, even if part time, is beneficial.”
Nate Wymer, 44, said his machine is lying around his home somewhere in Holly Springs, N.C., but he hasn’t seen it in years.
“When I had the mask on I had to think about breathing out of my nose,” said 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,” said 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.”
CPAP Alternatives – Worthington, PA
Do you wake feeling refreshed in the morning? If you get at least 7 hours of sleep but don’t wake up feeling well-rested, it may not be the result of a bad mattress. If you struggle with chronic snoring as well as daytime fatigue, you might have a condition called obstructive sleep apnea. The disorder causes several interruptions in breathing frequently throughout the night. Often, it’s treated using a CPAP machine. While it’s effective, it can be quite bothersome. You’re not out of options. We offer CPAP alternatives in Worthington using oral appliances. You can breathe better to get the rest you need with a simple, custom-fit device.
Understanding Obstructive Sleep Apnea
There are 3 types of sleep apnea; however, the most common is caused by an obstruction in your airway. As you sleep, your tongue and the soft tissues in your mouth relax, causing them to collapse and block the airway. The obstruction blocks your airflow, causing you to stop breathing frequently throughout the night.
Untreated sleep apnea can cause several symptoms, like chronic snoring, daytime fatigue, and sleep deprivation. You might wake choking for air or with a headache. Over time, the inadequate oxygen levels will affect your general wellbeing. You will have a heightened risk of several health concerns, like cardiovascular disease and depression.
CPAP Machine VS Oral Appliance
A CPAP machine is the most traditional treatment for obstructive sleep apnea. A mask is worn over the mouth or nose to deliver a steady stream of air. The gentle pressure keeps the airway open to prevent pauses in breathing.
While it’s effective, many people can’t tolerate sleeping with the machine. Not only can it be loud and restrictive, but patients can feel claustrophobic. If you tend to travel a lot, carrying the machine around can be inconvenient.
An oral appliance resolves the disadvantages of a CPAP. The device moves the lower jaw forward and holds the tongue in place to prevent your soft tissues from collapsing and blocking the airway. When used correctly, it’s shown effective for treating mild-to-moderate forms of sleep apnea. An oral appliance can be used alone or with a CPAP machine.
Benefits of an Oral Appliance
When used correctly, oral appliances have a high success rate. In fact, patients report a 95% improvement in their sleep quality and symptoms within just 1-2 weeks of using the device. Overall, you’ll enjoy added benefits not possible with a CPAP, including:
- Custom fit for your comfort.
- Effective for reducing interruptions in breathing.
- Speak clearly while wearing it.
- Drink water while wearing it.
- Convenient for traveling.
- Easy maintenance and care.
- Affordable solution.
Is a CPAP Alternative Right for Me?
If you’ve been diagnosed with the disorder, you need sleep apnea treatment in Worthington. We’ll discuss your diagnosis and learn more about your preferences to determine if you’re a candidate for oral appliance therapy. Contact our office today to learn more or to schedule your consultation. Dr. Lawrence J. Adam has the solutions you need to breathe better.
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Tuesday: 10 a.m. — 6 p.m.
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CPAP Might Not Be Worth Trying Again for Dropouts
While CPAP (continuous positive airway pressure) is considered the gold standard for sleep apnea treatment, it has a very high failure rate. The problem is that CPAP is not a very pleasant treatment. It’s uncomfortable and inconvenient for many people. It can be hard to maintain and hard to sleep with.
As a result, many people give up CPAP treatment. Doctors and medical care providers describe them as “CPAP dropouts,” as if the problem is with the people and not with the treatment. Assuming that this is where the problem is, doctors, nurses, and others urge CPAP dropouts to give the treatment another try.
However, there are many people for whom it’s just not worth it to try CPAP again. If CPAP isn’t a good fit for you, you still need sleep apnea treatment, but you should find a CPAP alternative.
How Many CPAP Dropouts Are There?
Just how many people give up on CPAP treatment? It’s hard to know, in part because of the intellectual dishonesty sometimes employed by CPAP supporters.
Let’s consider a recent study about the 10-year compliance rates of CPAP users. This study reports that only 56/181 patients (30.9%) dropped out of CPAP treatment in 10 years. That seems pretty good, and implies that nearly 70% of patients continued using their CPAP for 10 years. However, in the very next sentence, we find that, in actuality, only 54 (29.8%) patients actually kept using their CPAP for 10 years. In other words, the compliance rate for CPAP over ten years, as they observed it was 49%–less than half. Other studies are less optimistic. This long-term review shows that CPAP compliance might be as low as 34%, or one in three.
Looking at these studies, it’s likely that, for every six people prescribed CPAP, there are three or four dropouts.
CPAP Failed You
The use of the term CPAP dropout implies that these are people who failed. They gave up on a treatment that was working. However, the sheer numbers of people who just can’t adapt to CPAP shows that it is, in large part, the treatment that fails, not the people.
When CPAP works, it works great, but it is not for everyone–or even most people. CPAP cannot be our only population-wide sleep apnea treatment. When we try to steer CPAP dropouts back to treatment, we shouldn’t be steering them back to CPAP, but to CPAP alternatives.
When Trying CPAP Again Isn’t Worth It
If you have sleep apnea, you need to get it treated. Sleep apnea is dangerous and failure to treat it puts you at serious risk for death in the near future from a number of causes, including heart attack, cancer, stroke, dementia, and car accidents.
However, that doesn’t mean your treatment has to be CPAP. If you already have a CPAP machine and want to give it a try again, go ahead. On the other hand, you might not want to try CPAP again if:
You really tried it
Your CPAP doesn’t work
You need to replace CPAP equipment
You have moderate sleep apnea
Already Tried CPAP
Not everyone gives CPAP a fair try. Some quit before they start or after just a couple weeks. If you gave CPAP a fair try the first time, though, you shouldn’t feel obligated to give it a second try. Giving CPAP a fair try means trying it for more than two months, getting multiple titrations, trying different masks, using CPAP variants like BiPAP, and/or trying CPAP options like heaters and humidifiers. If you’ve gone through that process once, there’s no need for you to do it again.
Broken or Worn CPAP
We don’t know how long you’ve carried around your old CPAP machine, but if it’s so old, worn, or damaged that it doesn’t work anymore, maybe you shouldn’t just buy a new CPAP machine. Instead, it might be time for a different treatment for your sleep apnea.
Expired CPAP Equipment
The CPAP machine is only one part of the expense in getting CPAP treatment. You also have to pay for hoses, masks, humidifiers, and more. These are designed to be replaceable over time as the plastic degrades and becomes inflexible. Replacing all this equipment can be almost as expensive as replacing the CPAP machine. Again, maybe it’s time to consider an alternative to CPAP treatment, rather than try the treatment that failed you once before.
Moderate Sleep Apnea
The truth is that there’s no reason for anyone with moderate sleep apnea to feel obligated to try CPAP. Not the first time, and not again. That’s because CPAP alternative oral appliance therapy works just as well to treat moderate sleep apnea as CPAP. Plus, it’s more comfortable and has better compliance rates.
Get a CPAP Alternative in River Edge, NJ
If you’ve tried CPAP and found it wasn’t for you, or if you don’t like the thought of trying a treatment that’s only 50% likely to work for you, the River Edge Dental Center for TMJ, Sleep Apnea, & Reconstructive Dentistry can help. Sleep dentist Dr. Marlen Martirossian has extensive training in treating sleep apnea with oral appliances. He has helped hundreds of people from New Jersey and New York get healthy, deep, restorative sleep every night.
Please call (201) 343-4044, request a video consultation, or use our online form to make an appointment at our office in River Edge, NJ.