Studies show that obstructive sleep apnea (OSA) patients make the decision about whether they will use their prescribed CPAP device early on, typically within days. And that early adherence predicts their future adherence—which in many ways determines patients’ overall health outcomes.

Many sleep medicine providers know these statistics, and the importance of early intervention. Why then are so many failing to address a basic concern that virtually all adult patients have when starting therapy? That is, how to ensure CPAP promotes an active sex life, versus getting in its way. Instead of treating sex and CPAP as the elephant in the bedroom, providers should address sexual concerns with patients up front to improve the likelihood of a lifetime of CPAP adherence.

In a study of 91 newly diagnosed adult patients followed for 1 week after CPAP therapy initiation at the Penn Center for Sleep Disorders, only one CPAP side effect from a list of 19 (which included irritated skin, dry nose, and headaches) was linked with reduced CPAP use: less intimacy with partners. “This suggests the need to assess the impact of CPAP on intimacy and sexual relationships and discuss with CPAP users methods to enhance this important activity such as engaging in sexual behavior prior to applying the headgear and commencing therapy,” the authors write.

One sleep professional who has a track record of success having “the talk” with patients is Ann M. Cartwright, MPAS, PA-C, a physician assistant at the Sleep Medicine Clinic at National Jewish Health. “The bedroom should be a haven of comfort and relaxation. Bringing medical equipment into that space can be a big deal,” Cartwright said during a recent Sleep Review webinar. One strategy that works for Cartwright is getting the patient’s bed partner involved from the start.

Cartwright encourages patients to invite partners to clinic visits, including mask fittings and acclimatization sessions. She then has both patient and bed partner get in the clinic bed. During the webinar, she advised, “Have them cuddle; get in their usual positions. Sleep apnea is impacting both of them.” She uses this time to bring up, among other topics, CPAP and sex, noting that “a lot of people won’t bring it up unless you do.” Perhaps most refreshing is the unabashed “motto” she came up with to tell couples: “CPAP can be taken off faster than pants.” With such an open discussion up front, it becomes easy to imagine that the patient will have the confidence to work through their initial concerns in a supportive environment.

At National Jewish Health, the line of communication remains open. The center offers twice-weekly small group classes, as well as a CPAP support group on Saturday mornings. To start your own “CPAP Saturday” program, Cartwright advised: “You can do different topics and speakers. You can just have open discussion. You can have Q&A sessions.”

Many sleep medicine providers are familiar with the long-term benefits that CPAP therapy can have on sex, such as ameliorating erectile dysfunction in men and lessening excessive sleepiness in both sexes. But by waiting until patients bring up intimacy-related concerns on their own, you may well be intervening too late. Instead, address these concerns before starting patients on CPAP: they—and their partners—will thank you for it.

Sree Roy is editor of Sleep Review.