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Expert Interview: Eric Cohen on How to Achieve 89% CPAP Aderence Rates

In this Expert Interview, I talk with Mr. Eric Cohen and Mr. Jake McCabe of National Sleep Therapy on how their company achieves an 89% CPAP adherence rate. 

Besides revealing their secret to getting very high adherence rates, here are some other questions we covered:

 - Define compliance or adherence, and medicare criteria
- What’s the national CPAP adherence rate average?
- Being compliant or adherent doesn’t necessarily mean that you’re sleeping better, right?
- How does the patient, doctor, and DME work together to raise adherence rates?
- How long do you stay with the patient?
- Do you have any special tools to help the patient?
- What would you say are some of the top things patients can do?

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Sub-Optimal Surgery As Effective As CPAP?

CPAP Success for Sleep Apnea: What You Must Know

CPAP, or continuous positive airway pressure, is one of the first-line ways of treating obstructive sleep apnea. Gentle, positive air pressure is passed through a mask into the nose to keep your throat tissues open. For many people, CPAP works very well, but there are many others that have difficulty adjusting to CPAP and end up giving up. 

 

There are a number of proven, systematic steps that can be taken to improve CPAP usage, and I’ll cover each of these steps in future posts, but theres’s one important factor that determines whether or not you’ll ultimately benefit from CPAP even before you start. This is your mindset.

 

CPAP compliance, or the number of people who are able to use and ultimately benefit from CPAP, ranges anywhere from 29 to 83%. (Compliance is only a measure of how many hours patients actually use their machines. It doesn’t actually measure how well they are benefiting from CPAP treatment. You can be 100% complaint, but not sleep any better.) In the real world, compliance is  much less than 50%. We know that with intensive education, support, and follow-up, CPAP compliance rates can be very high, but in our fragmented health care system with multiple providers for each patients, results are much less than ideal.

 

However, over the past 11 years in clinical practice, I’ve noticed a few observations: Bus drivers and airline pilots accept CPAP therapy readily and are usually very successful in adapting to and benefiting from their CPAP machines. In addition, newly diagnosed sleep apnea patients who have either friends or relatives who have good experiences with CPAP also tend to do well. On the other hand, if they hear horror stories about CPAP, they tend not do do as well.

 

What this goes to show is that your mindset and motivation ultimately affects whether or not you end up accepting or rejecting CPAP. Pilots and bus drivers have their jobs on the line. Until they are treated and cleared by a medical doctor, they can’t return to work. A close friend or family member’s experience using CPAP is also a major factor in how well you’ll be able to tolerate and benefit from CPAP. Imagine having the proper mindset, as well as undergoing intensive education, counseling, support and follow-up. CPAP success rates are sure to go up.

 

What was your motivating factor in succeeding with CPAP? If you couldn’t tolerate CPAP, what was the main reason? Please enter your comments below.

 

Sleep Apnea Success: What Does It Mean?

If you have sleep apnea, success has many meanings. In the ideal situation, it means that you feel great, you don’t have to use any gadget or device when you go to bed, and your sleep apnea score (AHI) is 0. 

 

Unfortunately, the definition of success in the sleep apnea research fields keeps changing depending on who’s reporting it. In general, the surgical definition of success is a drop in the final AHI (apnea hypopnea index) of greater than 50%, and the final number is less than 20. Some use an AI (apnea index) being less than 10. Rarely, some people use 5. Some studies report two or three definitions simultaneously. Studies report anything from 40% to 95%, depending on different types and combinations of procedures.

 

For CPAP users, there are multiple definitions of success. One common definition is when CPAP is used at least 50% of each night for at least 4 out of 7 nights. Actually, this is a measure of compliance, meaning, how well did the patient stick to using the machine? Reported compliance rates using different criteria range widely from 20% to 90%.  

 

Surgical success and CPAP compliance doesn’t measure the effectiveness of the form of therapy. In other words, do you actually feel much better? Is it lowering your blood pressure, or are you feeling less depressed? You can be using CPAP 100% of the time 7 days a week, or your AHI after surgery can drop from 45 to 3, and you may not feel any better. These same concepts apply to oral appliances as well. 

 

What you may find is that although you’re using CPAP every night, your "effective" AHI each night is still relatively high, and not anywhere near the near 0 levels that were obtained during the CPAP titration study. Since the vast majority of CPAP machines that are prescribed will only measure "compliance" data, you’ll never actually know how effective the treatment is when you’re actually using it. Some of the more advanced models are able to tell you what the effective AHI is every night. For only a few hundred dollars more, it’s probably worth giving every patient models with these features.

 

Even if you’re "successful" in the beginning, how will you feel 20 to 30 years from now? Will you still be using your CPAP machine 100% of the time, or will your AHI remain at the same levels just after surgery? Probably not. 

 

As I’ve describe with my sleep-breathing paradigm, all modern humans are susceptible to sleep-breathing problems to various degrees. It’s a normal part of being human, mainly due to our ability to talk. So thinking of any of these treatment options as a cure is a mistake, since the forces that create collapses in your throat will only get worse as you get older. (Find out more about these important concepts in my book, Sleep, Interrupted.)

 

Just like any chronic condition, managing sleep apnea has to be considered a life-long process of constant adjusting and fine-tuning, rather than thinking of these treatments as a one time "cure."

 

Are you a successful sleep apnea patent? How has your mindset changed regarding "success" since you first started treatment? Please enter your responses below in the comments box.

Sleep Doctors vs. Patients: CPAP Data Monitoring

It’s common knowledge that one important way of increasing effectiveness of CPAP therapy is to constantly monitor the data that the machine records, which includes time used, lead rates, effective AHI, and other variables. Traditionally, this data is somehow taken to or transmitted to the patient’s sleep medicine doctor who analyzes the data to monitor compliance and effectiveness, in light of how the patient is doing. 

 

There’s been a growing movement amongst CPAP users to analyze their own data, and some people are even changing their own pressure settings. What I’ve noticed is that these are the most committed users, willing to do anything to get a better night’s sleep. In many cases these people know more about their xPAP machines than the DME vendors (durable medical equipment) or even their sleep doctors. Patients will know all about the latest xPAP models and try new mask models, in many cases paying extra beyond what insurance pays for.

 

There are many vocal arguments for and against this type of self-monitoring, but the issue I want to bring up is a sense that not all, but many sleep doctors are reluctant to have the patient take an active part in monitoring their own therapy. They’re not being told to go elsewhere, but the essential message that patients seem to hear is, "if you do this, you’re on your own." DME vendors are also caught in the middle.

 

Sleep doctors argue that self monitoring is good, but changing pressures should always be done after consulting the treating physician, since improper pressure can lead to problems such as ineffectiveness or even central sleep apnea. Patients argue that they should be able to manage their own condition for the most part, like what a diabetic does. 

 

There’s no black or white issue here—there are some patients that are fully capable and responsible enough to do this on their own, and others that are not. An ideal situation is to have a system in place where patients that want to take more responsibility can do so without feeling like they’re being frowned upon. This takes extra effort on the part of the sleep doctor and a trusting relationship with good communication. 

 

If you’re a CPAP user, where do you lie along this continuum? How much extra effort do you take to maximize your results?

 

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