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Adventures in Sleep

Sleep Defeat

Published January 16, 2014 9:34 AM by Penny Mehaffey

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.


You could try this: I tell the person that if they try as long as they can to wear the mask - even if only an hour- at night, for 4-5 nights. Then keep a small log on how tired they felt, fell asleep when they didn't want to, even pain. Then go with out the use of a mask and log about the same things of sleep, tired, pain. Often by second day the person can feel the difference, and it convinces them the mask use is what they should do. Just comparing the to logs after a few nights helps convince the person it does help.  

I also explain that O2 is like a water table in the body, when a drought -caused by the apnea/hypops- over time reduces the available O2.  Just as a hard rain doesn't help a drought much because it is to much to quick, it took a while to get down to this low level so it will take a bit of time to get back to the proper balance. It seems to be a way to engage the person in a way that they can reference to.

Barbara J, Sleep Tech - RPSGT, Unity Health February 9, 2014 7:55 AM
Rochester NY

Here is the technique I use when doing a set up before I even start getting the equipment out to set it up in the home.  I first explain why their physician ordered it the objective and then what cpap/bipap means what it does to me education is the key to compliancy.  Also I tell them you have lived (whatever their age is) years without this piece of equipment put it on wear it as long as you can tolerate it when you cant tolerate it any longer take it off roll over and go to sleep then the following night set your self a 10-15 min goal to keep it on longer then you did the previous night persistence is the key to successful compliancy but don't deprive yourself of sleep, because then you get frustrated and wont use it at all.  Persistance is what I focus on with a newbie.

Karen Wampler, Sleep - Respiratory Therapist February 7, 2014 9:40 AM
Portage IN

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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