Published on April 26, 2013

Increasing Treatment Compliance For Sleep Apnea

Genesis Home Medical Equipment program elevates CPAP use

At a stoplight, Lee Guay fell asleep with his foot on the clutch and the engine running. It was the middle of the day. He awoke when cars honked at him.

Another time, he was playing poker with friends. He nodded off in the middle of a sentence. They nudged him, he awoke, and, finished the sentence. “The guys I was playing with thought that was hilarious,’’ he said.

Lee Guay - Director Genesis Home Medical EquipmentLee Guay, director of Genesis Home
Medical Equipment, is an advocate
for the diagnosis and treatment of
obstructive sleep apnea. Guay, who
has the sleep disorder, shows off a
continuous positive airway (CPAP)
mask similar to the one he wears
every night while he sleeps.

Guay, director of Genesis Home Medical Equipment, has become one of the health system’s leading advocates for diagnosis and treatment of obstructive sleep apnea. He knows there is nothing humorous about the risks of undiagnosed sleep apnea.

“Heart failure, stroke, diabetes, obesity are all physical risks of untreated obstructive sleep apnea. But you want to know the scariest risk? It’s death in a motor vehicle. The risk of a vehicle accident is much higher for people with obstructive sleep apnea,’’ Guay said.

Guay could have been one of the statistics the day he fell asleep at a stoplight. Had his foot slipped off the clutch while he was asleep, he could have been in the middle of the intersection against the light.

He now owns two CPAP machines -- one unit for home and a lighter unit for travel -- but it still took his wife to get him into a sleep clinic for a sleep study. The CPAP machine has a mask that fits over the nose and/ or mouth and gently blows air into the airway to help keep it open during sleep.

“If someone isn’t sleeping, it’s a good bet the spouse isn’t sleeping. When I had untreated sleep apnea, my wife said half the night she wanted to smother me with a pillow because of the noise and the other half she was freaking out because I was not breathing,’’ he said.

Guay is now at the forefront of a Genesis effort to get more people to understand sleep disorders, have the disorders treated, and, comply with treatment protocols. About a year ago, Genesis Home Medical Equipment discovered four of 10 patients who had a CPAP machine weren’t using the machine at all; they weren’t using it enough; or, the air flow wasn’t adjusted correctly for them. Nationally, compliance among patients who have been prescribed a CPAP machine is about 55 percent.

Since he took the position with Genesis Home Medical Equipment, compliance for patients who have purchased a CPAP from Genesis has soared to about 90 percent. By prescribing CPAP machines with a “real time” modem to monitor compliance and training employees to read the data on a daily basis, compliance is improving significantly.

Each day, clinically trained Genesis staff go to a website to monitor the previous night’s compliance of 300 patients who have received a CPAP from Genesis in the previous three months. A total of 4,500 patients have received CPAP devices from Genesis.

Compliance in the first three months is critical for two reasons: “Not only is it better for their health if they are using the machine and using it properly, but Medicare and health insurance companies are now requiring compliance before reimbursing the cost of the machines,’’ Guay explained. “It’s good for the patient in two ways if they are using their CPAP.

“If you are spending $2,000 or more on a machine, you want to be reimbursed for it. The respiratory therapist and nurses can monitor compliance remotely. They can see if and how long the CPAP is being used, whether it is leaking and if the air pressure is calibrated correctly.”

The clinicians become health coaches who call on non-compliant CPAP users to try to work out issues keeping them from using the machine. If a CPAP user understands the health risks, there is a better chance they will remain compliant.

Another indicator of compliance is the apnea-hypopnea index (AHI), which measures the length of pauses of at least 10 seconds in breathing each hour. An AHI value of 5 to 15 pauses per hour is considered mild sleep apnea. A value of 30 or more pauses per hour is severe.

“Before I had a CPAP, I was at 53 AHI. Now I’m at 0.3,’’ Guay explained. “I don’t know how I got by without my CPAP. It was impossible for me to get past 2 p.m. without needing a nap.”

Some Patients Don’t Want To Know

Reluctance to receive a diagnosis of obstructive sleep apnea is an issue across the country.

“It’s a change that some people, mostly men (about 70 percent of obstructive sleep apnea suffers are men) don’t want to make,’’ he said. “You have to change your routine. You may go to the bedroom, get in bed, and watch TV until you fall asleep. With a CPAP, you strap this mask to your head, it can block your vision, it blows air at you and you hopefully go to sleep. There is also maintenance with the mask, keeping water in the humidifier and cleaning the mask.

“But by not using it, you are possibly going to become a much higher risk for heart disease, diabetes, obesity and a tragic vehicle accident if you fall asleep at the wheel.’’

Guay said over-the-road trucking companies are making CPAP usage mandatory if a driver has been diagnosed with obstructive sleep apnea. They are using the same wireless technology Genesis uses to monitor compliance.

Another step Genesis has taken is to require CPAP compliance by surgical patients who have obstructive sleep apnea. The concern, supported by statistics, is a higher risk for serious complications if an apnea patient having surgery has not been using their CPAP.

Obstructive Sleep Apnea

Obstructive sleep apnea occurs when the muscles in the back of the throat relax and momentarily close off the airway. The blood oxygen lowers. The brain senses this decrease and briefly rouses the person from sleep so the airway reopens. This pattern can repeat itself 10 times or more each hour all night, making it difficult to reach the deep, restful phases of sleep.

The pauses in breathing can last 10-30 seconds or more and occur up to 400 times a night. They can lead to serious health complications -- from high blood pressure, heart disease and stroke to depression and memory problems.

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