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Coping with CPAP

Coping with CPAP. Wafaa El-Bahaey Prof. Of Psychiatry, Mansoura University 29-12-2011. Treatment for OSA. Behavioral…weight reduction, position therapy Medical…CPAP, medication Surgical. Why CPAP?. 2% to 4% of adult population has OSA Many patients who use CPAP are non-adherent

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Coping with CPAP

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  1. Coping with CPAP Wafaa El-Bahaey Prof. Of Psychiatry, Mansoura University 29-12-2011

  2. Treatment for OSA Behavioral…weight reduction, position therapy Medical…CPAP, medication Surgical

  3. Why CPAP? 2% to 4% of adult population has OSA Many patients who use CPAP are non-adherent CPAP use may lead to some physical & psychological problems.

  4. Identify Problems with CPAP Treatment: A- Physical: Nasal congestion Rhinorrhea Skin irritation Nasal dryness Pressure leaks B- Psychological: Feelings of anxiety & Claustrophobia C- Social: Spouse distress

  5. Factors Affecting Adherence to CPAP • CPAP side effects • Apnea severity • Social Variables • Psychological Variables

  6. …..Social Variables • Individuals who live alone are less adherent to CPAP • Individuals whose partners initiate treatment referrals are less adherent than those who initiate themselves. • Approximately 50% of patients report they would discontinue CPAP if it negatively affected the sleep of their bed partner. Thus, inclusion of the bed partner in any treatment program might increase adherence. Hoy CJ, Venelle M, et al (1999). Can intensive support improve CPAP use in patients with SAHS? American Journal of Respiratory and Critical Care Medicine, 159, 1096-1100. Weaver TE, Maislin G, Dinges DF et al (2003). Self-efficacy in sleep apnea: Instrument Development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use CPAP. Sleep, 26, 727-732.

  7. ….Psychological Variables • Mood: controversial data about the impact of Depression • Anxiety: more influential than depression Claustrophobiais reported in 11 to 28% of patients. • Coping Active positive coping strategies are markedly helpful

  8. ….Psychological Variables • Psychodynamic Theories: A. Transtheoretical Model (TM): state of Change B. Social Cognitive Theory (SCT)

  9. “States (steps) of Change” Precontemplation Contemplation Preparation Action Maintenance Termination

  10. Social Cognitive Theory (SCT) Two major factors influencing the likelihood that one will take preventive action: • First, a person must believe that the benefits of performing the behavior outweigh the costs (i.e. positive vs negative outcome expectancies) • Second, the person must have a sense of self-efficacy with respect to performing the preventive behavior under a variety of circumstances."

  11. How to improve coping?

  12. Psychotherapeutic Modalities for Patients on CPAP I- Motivational II-Bahavioral techniques: gradual exposure and desensitization, relaxation techniques,…. III- Cognitive Behavioral Therapy (CBT) A- Psychoeducation B- Modelling (Coping Enhancement)

  13. I- Motivational Enhancement TherapyShannon L. O’Connor Christian, Mark S. Aloia Indications: Patients with OSA and supposed to be good responder to CPAP

  14. Steps of Motivational Enhancement Therapy: two face-to-face sessions, 1 week apart, and, a follow-up phone call at 1 month interval.

  15. Session 1: Patient Assessment of PAP during Titration Night A. Assessment of Motivation to Use PAP B. Information Exchange: Video Clip of OSA Patient C. Review of Patient’s Pre-Treatment (PSG) D. Review of Symptoms E. Review of Mortality Graph F. Negotiate a Plan Based on the Patient’s Readiness and Confidence G. Summary with highlights of the takehome message

  16. Session 1: Patient Assessment of PAP during Titration Night Takehome message: (1) patient concerns about health problems related to having untreated OSA; (2) patient reaction to feedback on the PSG; (3) medical conditions the patient may be at risk for with untreated OSA; (4) benefits the patient experienced after using PAP; (5) motivation to use PAP; (6) patient goals.

  17. Session 2: Patient’s Subjective Appraisal of Adherence to PAP 1. Patient concerns about symptoms of untreated OSA 2. Potential barriers to PAP use 3. Patient benefits from PAP use 4. Current patient motivation and confidence 5. Specific steps the patient will take with regards to PAP use 6. The patient’s ultimate goal 7. Additional resources the patient has identified that can be helpful.

  18. Session 2: Patient’s Subjective Appraisal of Adherence to PAP 1. Patient concerns about symptoms of untreated OSA 2. Potential barriers to PAP use 3. Patient benefits from PAP use 4. Current patient motivation and confidence 5. Specific steps the patient will take with regards to PAP use 6. The patient’s ultimate goal 7. Additional resources that can be helpful.

  19. II- Behavioral therapy:Exposure techniques • Indications: Claustrophobia, anxiety, or panic symptoms which are related to: • wearing the mask (feeling restricted) and/or • tolerating the air pressure (feeling suffocated)

  20. III- Cognitive Behavioral Therapyto Increase Adherence to CPAPDelwyn Bartlett Model I: Psycho-education Model II: Modeling

  21. Psycho-educationDelwyn Bartlett • provide information about: • obstructive sleep apnea (OSA); • educate the patient on the most effective treatment, (CPAP); • educate the individual on the medical and psychiatric risks when OSA is not treated.

  22. Thank You & Happy Dreams

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