Managing PAP patients for the long term

“Do I have to use this forever?”

Managing your patients for tonight and the long-term

Who knows

this guy?

Your image and perception◦ Instilled trust

Actions speak a thousand words Use props, posters and materials Understand your influence Features of today’s PAP

◦ Know what your doc prescribes Sleep hygiene and gimmicks

YOU: As the Sleep Tech

Instructing behavior to affect your patients Few consistencies in research

◦ Patients feel “closed in”◦ Disease, age, pressure unrelated

Using theory and your experience◦ Develop consistent strategy

Practice your interactions◦ Most patients have similar concerns

Make yourself available

MET – Motivational Enhancement Therapy

Key concepts and Principles◦ Develop Discrepancy

Help patient understand their choices with PAP and risks without

◦ Express Empathy Avoid being pulled into a debate about PAP

◦ Expect Resistance Ever meet a happy PSG or titration

patient?◦ Support

“Most people take a while to adjust to CPAP and to build the use of it into their daily lives”

MET – Motivational Enhancement Therapy

Consequences of OSA are real◦ Daytime sleepiness◦ Mood changes◦ Depression◦ Irritability◦ Impairment in attention, concentration &

memory Effective Therapy time is…

◦ 4.5 Hours Despite it’s efficacy, 25% of

patients discontinue use during the first year.

MET – Motivational Enhancement Therapy

Conclusion: “Self confidence appeared to be the

strongest single psychological predictor of long-term adherence. Behavior change constructs are among the strongest predictors of PAP adherence in the literature to date.”◦ Brief behavioral Therapies reduce Early

PAP Discontinuation Rates in SAS: Preliminary findings

MET – Motivational Enhancement Therapy

Manufacturers CEU Monographs Professional Societies Trade Journals Networking events Home Testing

Educate yourself

We asked a few of our veteran clinicians about what they’d like to convey to patients at their PSG and titration studies. It’s interesting what we found.

What do home clinicians say?

What do you think they said?

Home Care Clinicians want to…Educate their patients more

on the reasons they’re using PAP.

Suggested open-ended questions for lab night

Do you know much about sleep apnea? Are you nervous? When was your last good night of sleep? What are you doing tomorrow?

Explain in layman’s terms.◦ Often, the side effects of apnea affect patient

understanding Patients need patience

◦ PAP has a period of adjustment Focus on reality

◦ Explain the mechanics of an air splint◦ Educate on why PAP works and co-morbidities

Empathize Encourage contact with home care company

Jeff, LPN – 20 years DME experience

“Imagine if you had never worn a pair of shoes. With your first pair, you gradually get used to them but they can cause pain and blisters. However, you can’t just fix it by changing the pair of shoes continuously."

“I hear the word ‘suffocated’ a lot”◦ Exhaling and mechanics of the PAP

Practice during the day◦ 30 minute increments◦ With mask, with PAP

Educate on variable adjustment period◦ Time frames with CMS patients

‘Walk’ patient through prior to titration◦ What will happen

Humidity◦ Comfort◦ Season

Noel, LRT – 16 years DME experience

Higher AHI patients are easier? Often receive therapy quicker More benefit Tolerance for medical care Do you agree?

Moral to every story

Children’s Books

“The Little Engine that Could”

Difficult problems can be solved when everyone works together◦ Key Virtues

Cooperation Hard work Persistence Helpfulness Self confidence Compassion

Questions?