What do you say? Should we ever admit defeat with sleep patients? Is it just me or does it seem that men in their 80s are particularly harder to coach and titrate? They tend to fight CPAP and usually come with a library of reasons they can't or won't use it.
My most recent example was in the lab just this weekend. The techs worked with a patient for four hours with mask fittings and acclimation time to no avail. He insisted he could not wear it and would pass out and faint if they "made" him do it. Dutifully the techs had marched in, one after another, hoping to find a way with a mask that would not suck the life out of the aged subject.
Women in this age bracket with the same sort of issues seem to be more willing to be "honest" about their feelings and say "I'm just not going to do it. I don't want it and I don't like it. I've gotten along fine without it all this time, I'll take my chances." Younger men react a little more aggressively. Those who "fail to acclimate" seem to be more high-strung and get angry and frustrated with the process.
It becomes difficult to get them to relax and try the therapy. I had a guy just this week stop in the lab asking if I had any tips to help him use his CPAP. I was thrilled and did. Sadly though, he came to me out of frustration from another sleep professional across town, who told him that he would just have to do it out of sheer determination and will, no other help.
Strangely, I have not had many of these types of experiences with women in the 20-60s range. They arrive ready and willing to do whatever we say as long as more -- or better -- sleep is part of the deal.
What are we to do? In the end patients have to comply in order for any of our "tricks" to work. They do have the right not to accept therapy. When do you say, "It's OK, you can't fix everybody," and admit defeat? Hopefully before they pass out.