Listen up, partners and spouses of people with sleep apnea: Treating obstructive sleep apnea with CPAP works best when it's a team effort. That's the takeaway from a recent research review, which examined dozens of studies in an effort to identify the most effective ways to help patients comply with their CPAP regimen. What they found was that having a partner involved and engaged with CPAP treatment increases the likelihood that the patient will stick with their treatment plan.
More than 18 million Americans suffer from obstructive sleep apnea (OSA). It is among the most common sleep disorders. And CPAP -- continuous positive airway pressure -- is the most commonly prescribed treatment for OSA. Obstructive sleep apnea occurs when the muscles in the back of the throat collapse, blocking the airway. People with OSA stop breathing briefly, anywhere from a handful of times to hundreds of times in a night in severe cases. The health risks associated with sleep apnea are serious: In addition to disrupting sleep and lowering blood oxygen levels, OSA is associated with higher risks of high blood pressure, heart disease and diabetes, as well as mood and memory problems. CPAP works by pushing air constantly through the airway, keeping it open and allowing uninterrupted breathing through a night's sleep. It's a safe, effective, well-tested treatment for OSA that has proven results. The biggest challenge to CPAP success? Getting patients to use the device consistently.
The CPAP machine delivers the air pressure that keeps the airway open by a face mask that covers the nose, which must be worn by the patient during sleep. Sleeping with the CPAP mask can be a daunting prospect for newly diagnosed OSA sufferers. Some people may find it embarrassing to wear in front of a partner. Others may find that wearing it feels uncomfortable or odd at first. As effective as CPAP can be if its used consistently and correctly, there are real risks of patients abandoning the treatment, especially in the very early stages, because they feel it's too intrusive, disruptive or uncomfortable. Finding the best ways to encourage continued use of the device is a critical area of research.
A group of researchers at Penn State reviewed 80 CPAP-related studies, searching for evidence of the most important factors in successful CPAP therapy. They found that social support increases the likelihood that a CPAP user will continue to use the device. Spouses and partners who provide active support for the CPAP can help a patient feel more relaxed and comfortable with, and also more accountable to, following through with the treatment night after night. And it's this follow-through that makes all the difference in whether or not the CPAP treatment is allowed to work as successfully as it can.
This finding echoes other research that shows CPAP works best when couples work together in support of the treatment, and that -- rather than drive partners away from sex and intimacy, CPAP can actually lead to improved intimacy between partners:
• One study indicated that men whose wives continue to sleep in the same bed with them when using the CPAP are 60 percent more likely to continue with the treatment than if they are sleeping alone.
• Another study examined sexual and intimate relationships in men with obstructive sleep apnea, and found then whereas OSA had a negative impact on men's sex lives, regular use of CPAP for three months resulted in improvement in their sexual and intimate relationships. And the more serious the OSA to begin with, the greater the improvement was after using the CPAP.
It's very common for the snoring that can accompany obstructive sleep apnea to drive partners to sleep in separate beds. So often, when the CPAP treatment begins, couples are already sleeping apart. The initial reluctance to return to the same bed is understandable -- both partners may feel self-conscious. There's no question that it takes work: trust, open communication, perhaps a decision to plan for sex and intimacy in different ways. But this is work that is worth doing -- not only for the health of the person with OSA, but also for the health of your relationship.
There is no single right way to approach integrating the CPAP into your life. Researchers in the current review found that CPAP success is best promoted on a case-by-case basis, with individualized treatment regimens that take into account a patient's life circumstances, the particulars of their disease, as well as their psychological and social circumstances. For example, for patients without partners, telecommunications strategies such as regular phone calls and wireless telemonitoring may be able to provide the social support and connection that appears to be so effective.
The bottom line? CPAP treatment not only can help alleviate OSA and improve a patient's health, it can also bring couples back into the same bed -- if both patient and partner are willing to accept the device, and not let short-term, initial discomfort or awkwardness become entrenched. The discomfort is fleeting, but the benefits -- including renewed intimacy in the bedroom -- are long-term.
Michael J. Breus, PhD
The Sleep Doctor™
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