As 2015 begins, a worthwhile New Year’s resolution for those practicing sleep medicine is to increase positive airway pressure (PAP) adherence among obstructive sleep apnea patients. I recently gleaned some insights, including several tips that may surprise you, by hosting a webcast on this subject.

Face your true adherence rate. Your overall patient adherence rate is worse than you think it is if you are only counting patients who you see regularly—that is, the ones who are doing well. The patients who don’t come back frequently “often don’t make it into our calculations,” said Mark Aloia, PhD. To change your practice to improve the adherence of all patients, customize your approach based on each person’s needs. Personalized interventions are key, Aloia said.

Intervene earlier. Intervening during the titration may already be too late. At the Howard County Center for Lung and Sleep Medicine, the first intervention is handled by a daytime sleep technologist who educates the patient about sleep apnea and has him try various interfaces before the titration, said Emerson Wickwire, PhD, ABPP, CBSM. “Patients start their titration study with the mask they selected during the day,” Wickwire said. Interventions during PAP titration—such as incorporating comfort accessories—can also yield positive results, but satisfactory outcomes are less likely if you wait to intervene until the patient is struggling. Early experiences are predictive, Wickwire said.

Up your patient touchpoints. The Clayton Sleep Institute has an adherence rate in the mid- to upper-80s. Matthew Uhles, MS, RPSGT, attributed this in part to the numerous interactions each patient is given with his care team. “Our average patient has at minimum five to seven different touchpoints, where different people are engaging the patients about sleep apnea and its symptoms, including what they might perceive as unrelated symptoms, such as high blood pressure or diabetes,” Uhles said.

Sree Sleep Review

Sree Roy

Make smart use of technology. Several manufacturers have recently launched free mobile apps that allow patients to review their data without physician involvement. Benefits to this technology include its ability to engage the patient, lower touchpoint costs, and letting practitioners manage by exception. To empower its patients, DME National Sleep Therapy developed its own iPad app, used during the PAP setup process, and also hosts call-in support groups. “We’ve found that if you give people a platform to engage, and it’s on their terms and their time, they’ll do so readily and happily,” said Eric Cohen, National Sleep Therapy cofounder and president.

Following this advice should put you on the road to your highest possible patient PAP adherence rate. From there, you can route patients to alternate tracks, such as combination therapy or alternative therapies, with aplomb.

Sree Roy is editor of Sleep Review. CONTACT