CPAP: 'Normalize the struggle'

Friday, July 31, 2009

There’s no denying that CPAP can take some getting used to. But one study recently found a surprising correlation between a person’s emotional response to the therapy and how well they adapt to it. Not so important: a person’s ability to take a problem-solving approach to CPAP therapy, says Dr. Robert Glidewell, a clinical psychologist with a certification in behavioral sleep medicine, who spoke with HME news recently about findings from his ongoing research.

HME News: What role does emotion play in how well a person adapts to CPAP?

Robert Glidewell: “Personal control” measures an individual’s ability to control their own reaction to the problem. For example, when faced with having to adjust to CPAP, are they able to control their emotional reactions - their cognitive or thinking reaction - as opposed to can they manage the problem itself? Surprisingly, it wasn’t how they dealt with the problem - it was how they dealt with their own reactions to the problem.

HME: What about a problem-solving approach?

Glidewell: “Strategic planning” measures a person’s ability to break down problems into small manageable parts and come up with a plan of action. It was unexpected that strategic planning was negatively correlated with CPAP use. Essentially, the more they break it down, analyze it, or try to get their hands around it, the worse they do.

HME: So, the typical industry model of fitting a patient with CPAP and making a couple of follow-up calls doesn’t work for all patients.

Glidewell: As an industry, HMEs do a great job of education and management of equipment and related side effects. What we don’t do as well at is engaging the psychological aspects of bringing this thing into your bedroom and having something strapped to your head when you’re supposed to be letting go and relaxing.

HME: Does a strong support network help patients adapt?

Glidewell: Absolutely. They know if there is any problem they have resources to help them deal with it, whether it be that “my spouse thinks I look ridiculous and I am embarrassed” to “my mask is causing sores on the bridge of my nose.”

HME: HME providers aren’t psychologists. What can they take away from this study?

Glidewell: They can begin to prepare people for the process of adjustment before they ever leave the office. Normalize the struggle. Tell the patient to expect that it’s going to take 30 to 90 days to get this figured out and train your body to use it effectively. Just preparing them to enter the process of trial and error takes away the intensity of their reaction when a problem arises.