The #1 Mistake That First Time CPAP Users Make

The biggest myth perpetuated by the sleep community is that once you start using CPAP, you’ll begin to sleep like a baby again. Just like getting married, the waiting (for your sleep test and another few weeks for the results), anticipation (doctors and techs tell you it’s going to be great) and all the hard work involved (sleeping in a strange bed hooked up from head to shin) is the easy part. Once you get married (you start using CPAP at home), you realize the really difficult part is just beginning.
Mary was one such woman. In her late 40s, her sleep quality had been deteriorating slowly over the past few years. She had put on 5 to 10 pounds every year for the past few years, and her husband was complaining that she was snoring too much. She had no energy to do anything or be productive as an accountant, especially in the afternoons, feeling drowsy and foggy-headed. 
Why Many People Hate CPAP
She mentioned these symptoms to her doctor, who sent her to a sleep physician. Sure enough, an overnight sleep study found that she stopped breathing 45 times every hour. Her oxygen level dropped to a low of 79% (normal is in the mid to high 90s). She was brought back another night for a CPAP titration study, which was very uncomfortable, but an optimal CPAP pressure was found. All throughout the process, everyone was nice and reassuring, telling her that once she started using CPAP, she could sleep much better again.
Once her CPAP was ordered, the equipment company people helped her set it up in her bedroom, and showed her how to use it. They gave her thorough instructions and were very patient in answering all her questions. The first night, she struggled to keep in on for more than one to two hours. The next few nights, the most she could keep it on was three hours. Her mouth was dry, and air kept leaking out around the mask and out of her mouth.
She called the equipment company a week later and they suggested switching to a full face mask, but that didn’t help either. After 2 more weeks of struggling, she gave up and returned her CPAP machine.
How CPAP is Like a Car
Unfortunately, Mary’s story is seen all too frequently. Too many people accept CPAP passively and start using it, expecting to get great results right away. In one way, this is like driving a new car without any driving education whatsoever. You have to know what the car is for (get to from point A to point B).  You have to know to to drive, and know how to troubleshoot problems that may arise such as a flat tire, low wiper fluid, or not enough oil.
Similarly with CPAP, you have to know how to use it and know how to deal with problems that may arise. Most people will have at least a few issues with CPAP when they start, but when dealt with systematically using proven steps, these problems can usually be resolved. The same thing can be said about a car. The problem is that unlike your car, with rare exceptions, the systems that are available for CPAP support through our health care system is inconsistent and in general, very lacking.
The good news is that there are lots of options that are available to help you navigate CPAP challenges in addition to your sleep professionals. Just like before buying a new car or getting married, you have to do your research and be prepared. Educate yourself as much as possible about the most common issues that may arise when starting CPAP, and have responsive resources (sleep lab or equipment company) in place to turn to for questions for problems that may arise. 
Preparation is the Key to Success
In Mary’s case, I saw her 6 months after she gave up on CPAP. Incidentally, it turned out that she suffered from a stuffy nose all her life. Her exam revealed a severely deviated nasal septum, enlarged nasal turbinates and flimsy nostrils. Since medical therapy didn’t work, she elected to undergo nasal surgery. Once she was breathing much better through her nose, I encouraged her to try CPAP again. This time, she found that she was able to keep it on for 4-5 hours at a time initially, and after 2 weeks, was able to sleep through the entire night. For the first time in years, she woke up refreshed in the morning.
Whenever CPAP is first recommended for your obstructive sleep apnea, don’t assume it’s going to work right away. Be prepared by educating yourself and devour as much information as possible. Anticipate the most common problems that can arise and learn how to deal with them effectively. Some people, like Mary, needed nasal surgery to help use CPAP. For others, it may be a  new mask, headgear, mask liner, hose position, or even a different kind of machine. For the vast majority of CPAP problems, there are effective solutions. Just like a good marriage, if you intentionally work at your marriage, after years or decades of hard work, you’ll begin to see the benefits.

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One thought on “The #1 Mistake That First Time CPAP Users Make

  1. Jesus.
    I’ve worked in the field for nearly 15 years, I’ve set hundreds of patients up on CPAP. We do group bookings of six people at a time once a week. Today was the day.

    And the FIRST thing I tell them is that it’s uncomfortable. They WILL get a dry mouth. They’ll get aerophagia (wind). If it leaks, especially at higher pressures, it feels like a hurricane and they can’t take a breath. They’ll panic. That it may take weeks to get it right.

    THEN. I remind them off the health benefits. That the daytime effects might be profound. That the people around them will notice.

    And when I see them at follow up – they have fewer issues. They’ve met, and understood, the side effects of mask leak. They might need some advice about refitting the mask, or optimising humidification, or trialling liners. I often walk them back through their original sleep study results vs the AHI that the machine has recorded (and if you aren’t using equipment that records leak, pressure, usage and AHI then you need to leave the business).

    If people are well informed, prepared for what can go wrong, and educated on how to trouble shoot – your workload goes down, and your compliance rates go up.

    *drops mic*