In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situations? (Even if you have not done some of these things recently, try to work out how they would have affected you.) Use the following sleep test scale to choose the most appropriate number for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Berger/Henry ENT Center
Jamestown Medical Building
Chestnut Hill Medical Building
The Oaks Medical Center
Date Posted: Tuesday, February 17th, 2015 by Alan Berger
Recently, a sleep apnea patient came to my office after stopping his CPAP therapy. He was fit for the CPAP mask about 6 weeks ago. During the exam, he raised some issues that we commonly hear from patients.
Initially, he felt much better rested after using the CPAP for the entire night in the sleep lab. However, over time he began to struggle using it for 8 hours every night in his home. Some nights, he would awaken to adjust the mask, other nights he would just remove it altogether. While the fatigue he experienced from sleep apnea had curtailed, he still felt that he wasn’t getting the benefit from CPAP therapy that he knew he should be getting. He expressed frustration that he couldn’t use his CPAP every night, felt like he didn’t have any options beyond the mask that he was using, so he stopped using it. The worst part of the experience was that he felt like a failure.
What’s important to note, I told him, was that he took the first step to address his sleep apnea. Second, he was, at times, successful in using the CPAP mask. So, just because the mask, over time, made him feel a bit uncomfortable in no way made him or the experience a failure. Moreover, his experiences were not uncommon.
While it can take a couple of weeks for a patient to acclimate to CPAP therapy, there are successful adjustment strategies employed by some of my other sleep apnea patients that have shortened the acclimation window. For example, prior to using the CPAP mask at home on the first night, I recommend putting it on while awake. Watch TV with it on, read a book, a magazine, surf the internet on your tablet. Do the things you normally do but with the mask on. While you’re doing these things, make all of the adjustments to the mask or straps to ensure comfort. Wearing the mask while alert and awake for 20-30 minutes a day over a period of several days helps sleep apnea patients get comfortable with it. And then, when the time comes to go to bed, the feeling of comfort that you’ve achieved carries over. Attempting to make adjustments to the mask at bedtime or during the night is not optimum because you’re focused on getting your 8 hours of sleep. Finding yourself awakened will cause initial frustration because you’re losing the time to sleep and subsequent frustration the next day when you feel tired at work.
There are many different types of CPAP masks. If you are struggling with one type, it is reasonable to try other masks. It is not unusual for patients to try several types of masks before they find the most comfortable one.
We also discussed his compliance data. The majority of CPAP devices have data cards that record a sleep apnea patients’ usage of CPAP and its effectiveness. The first 2 weeks of usage showed that he was using the CPAP about 4 hours per night with resolution of his apnea. While we would prefer patients to use their CPAP all night, we believe that partial treatment is better than not using the CPAP at all.
At the end of the visit, we agreed to try a new mask. The patient agreed to use his CPAP for 1 month and then return to assess his response. In many instances, the CPAP mask can be made more comfortable and tolerable for sleep apnea patients. With practice, patience and persistence most issues with CPAP can be and are resolved.
Don Sesso, D.O.
Pennsylvania Snoring & Sleep Institute