So, you got the results of your sleep study and they say you have pretty bad sleep apnea. Now what? They want you to use a Positive Airway Pressure (PAP) device with a mask when you sleep, but you say, “No way!” You’ve probably been going along pretty well all these years without sleeping with a mask on your face, so why start now? In this blog, I propose 5 steps to have a successful relationship with your PAP.
Let's begin with a little background. Apnea comes from the Greek word apnos, meaning "without breathing." Sleep apnea is a chronic sleep disorder that prevents you from breathing in your sleep and has serious medical consequences. In the case of obstructive sleep apnea, the tissues of your upper airway relax when you sleep and partially or fully block air from getting from your nose or mouth into your lungs, causing blood oxygen levels to drop. When the brain detects that the oxygen level in your blood is dropping, it responds by waking up and telling the muscles of the back of the throat to open so that you can breathe again. In severe cases, this process might happen hundreds of times per night. For some people, that signal from the brain may not contribute to a full awakening, but only an “arousal,” which means a very brief episode of wakefulness that is too short to be remembered the following morning. So, in your memory, you slept all night, but you feel sleepy during the day. If you would like to know how many times you had an apnea (a full airway blockage) or a hypopnea (partial airway blockage with significant drop in the blood oxygen level) per hour, look on your sleep apnea test report for your Apnea/Hypopnea Index (AHI). If you scored more than 5 per hour, your future likely will involve developing a new, long-term relationship with a PAP machine. Here are my top tips for building a happy relationship with it:
1. Get acquainted
Don’t run away after your first impression. If you’re a little skittish or claustrophobic with your new PAP mask or pressure, don’t sleep together on the first night! Get to know your PAP one piece at a time before you expect to sleep with it all night long. For example, take the PAP machine out of the bedroom and put it in the living room. Start by just holding the mask against your nose for a few minutes. This can be done without the machine or headgear on. Just get comfortable with the feeling of the mask on your face. Try to breathe deeply when doing this. Then, if you’re comfortable, turn the air pressure on. Sit there in front of the TV with the mask on, straps on, and air on for about 15 minutes. If at any point, you feel claustrophobic, take it off. There’s no rush. Get comfortable with one part of the device. Remember, this is a long-term relationship you’re building, so why rush into things? There are hundreds of masks on the market, so don’t settle for the first one you get. Browse the wide selection at Singular Sleep here.
Sometimes in a new relationship you might feel suffocated at first. You might wonder, is this the way it’s always going to be? With PAP therapy, the answer is "no." You may feel suffocated with the air pressure at first because it is new to you, but as you become accustomed to the pressure, it should get better. Fortunately, most machines have a “ramp” button on the machine (indicated by a button with a triangle on it) which tells the machine to start at a low pressure and gradually increase it so that you can fall asleep before it reaches full pressure.
You might also wonder if your provider has an ulterior motive. Some new PAP owners have asked me if I’m getting “kickbacks” from the PAP companies to tell people they need PAP. PAP prescriptions are based on your sleep study results, wherein a specially-trained technologist has reviewed every minute of your sleep and painstakingly counted the number of times you stopped breathing. This data is then reviewed and interpreted by a sleep doctor who prepares the sleep study report. According to the practice parameters of our governing body, the American Academy of Sleep Medicine, if your Apnea Hypopnea Index is greater than 5 per hour, you meet the diagnostic criteria for sleep apnea. There is no benefit for sleep medicine professionals telling you that you have sleep apnea. The data is the data. So, the PAP is a piece of medical equipment with only good intentions, i.e. to help you breathe at night.
3. Be committed
It takes commitment to make any relationship last. Studies show that people who use PAP consistently for the first two weeks are more likely to continue using it on a regular basis. There is a minimum criterion of use that the insurance companies recommend to determine if you are “complying” with your PAP. Typically, this is at least 4 hours per night on 70% of nights. Why? Because studies have shown that the benefits of PAP are associated with at least 4 hours of nightly use. Be committed to it and try to replace the mask if it falls off, or if you unknowingly take it off in your sleep. Studies show that when your are compliant with PAP, you are at lower risk for heart attacks, strokes, and other consequences. It can even boost your mood; studies show that after three months of wearing PAP, depression gets better. If you just give it a chance, it will help you.
4. Perform a selfless act
Do you remember a time in a relationship when you did something that you didn’t want to do, but you did it because you loved your partner? If you snore loudly and your bed partner dragged you kicking and screaming to the sleep doc’s office, this might apply to you. By using PAP, you are giving a gift to your bed partner and the entire family. The gift is a quiet environment in which they can sleep well. In my practice, I meet numerous patients (typically women) who complain about their husbands' disruptive snoring. They further complain that their husbands refuse to seek help. This interferes with the sleep of those within the home, and may compromise the entire family's physical, and perhaps mental, health. If you were snoring loudly and now use a PAP consistently, I want to congratulate you. You’ve performed a selfless act.
5. Believe in the relationship
Believe in the process. Nightly PAP use has numerous benefits including, but not limited to, reducing the risk of:
- heart disease
- car accidents
- daytime sleepinesss
- poor concentration and mood
- medical expenses
If you don’t believe me about the consequences of untreated sleep apnea, read about the story of the late NFL player Reggie White, who also had sleep apnea.
These are just a few ways for you to strengthen your long-term relationship with PAP treatment. If things are not going well, please reach out to your doctor. Good luck!
Deirdre A. Conroy, Ph.D. D, ABSM, C.BSM is the founder of Happy Healthy Rested, an integrative nutrition and sleep coaching program, and a past chair of the American Academy of Sleep Medicine's Insomnia Section. She is a Clinical Associate Professor of Psychiatry at University of Michigan where she serves as Clinical Director of the University's Behavioral Sleep Medicine Clinic.