LinkExchange Member

Free Home Pages at GeoCities

Article #55

This was a questionnaire study that focused on the reactions of bed partners to the initial use of CPAP by sleep apnea patients.
Often it is the bed partners' prompting or prodding that first gets the person with sleep apnea to the doctor. The partner may be disturbed from sleep by the noise of snoring or the impact of restless legs and periodic leg movements. Alternatively, the bed partner may be worried by the episodes of choking and audible cessation of breathing. However, there is little data on how these partners react after CPAP is initiated.
The study population consisted of 91 consecutive patients, mostly men (81:10) who had been confirmed as having Obstructive Sleep Apnea (with an AHI greater than 15/hour) and prescribed CPAP within 2-12 months prior to the study. Questionnaires were sent to all these patients, and telephone inquiries made when patients failed to respond. This left six patients unreachable, of unknown status with respect to CPAP use. There was a separate group of 14 who were not using CPAP at the time of the study. So the core group of CPAP users consisted of 71 known CPAP users.
These averaged 51 years of age (SD=+/- 9.9) and 33.4 (SD=+/-7.8) on Body Mass Index (see Glossary). They had abnormally elevated pretreatment Epworth Sleepiness Scores (see Glossary) of 14.3 (SD=/-5.8) and severe sleep apnea as indicated by Apnea Hypopnea Indices (see Glossary) averaging 49.0 (SD=+/-23). At the start of CPAP treatment, their pressures (in cm of water) averaged a moderate 9.5 (SD=+/-2.6). Compared to those known to have stopped CPAP, those who persisted were significantly more obese.
At the time of follow-up, CPAP users had been under treatment for an average of about six months.
Of the 14 no longer using CPAP, 9 described the device as either ineffective or intolerable, three had nasal surgery, and two had yet to receive the device.
Epworth Sleepiness Scores done prior to treatment were compared with follow-up scores in CPAP users. These showed substantial improvement, from 14.3 (SD=+/-5.8) to a normal range of 5.2 (SD=+/-4.3), though evidently some were still excessively sleepy. Also, their BMI fell from 33.4 (SD=+/-7.8) to 32.4 (Sd=+/-6.9), a statistically significant change though it represented only a few pounds.
A total of 55 bed partners responded to a separate questionnaire. The first four questions concerning the partners' sleep showed significant improvement in sleep quality, daytime alertness, mood, and overall quality of life. The next four questions supported the patients' perceptions of their own improvement in sleep quality, daytime alertness, mood, and quality of life, plus a significant improvement in the relationship between the patients and bed partner. These responses seemed much the same whether the patient had been using CPAP for less or more than five months.
In their discussion, the authors pointed out that their data strengthened the expectation that both patient and bed partner benefited from CPAP treatment of the person with sleep apnea. The authors noted with regret that they had not asked whether the patients and partners actually slept in the same room, though they had the impression this was usually the case. Full benefits seem to be obtained within the first few months, but even months later both patient and partner continued to appreciate them.

As far as I know, this is the first paper to begin portraying sleep apnea as part of a family systems issue, with effective treatment useful in resolving conflicts that arose from the untreated symptoms. Denial is so ubiquitous in all sorts of diseases that even here the influence of a concerned close person plays a major role in getting the patient tested and treated. Of course, the situation of people with sleep apnea who lack bed partners is different in ways that may be quite important.
The authors had notably good success with compliance, only about 10% of the total group known to have stopped CPAP because of ineffectiveness or side-effects, instead of the usual 25-50%. Part of this good compliance may stem from the encouraging influence of the bed partner, who quite likely reinforced the patient's perception of improvement and discouraged inclinations to give up in the face of problems. An additional factor here may be the implicit acceptance by the bed partner of the patient wearing the CPAP to bed at night.
Particularly for younger and for single people, the idea of wearing such a stigma to bed every night for the rest of their lives may well raise fears of rejection by the opposite sex, at least until experience shows otherwise. My own impression is that the mental image and concept of the machine, hose, and mask have as much to do with resistance to CPAP as do the specific side-effects, though these may become a focus of complaint.
It is good for all of us sleep apneics to realize that those who love of us are not going to be repelled by the need to wear "machinery" to bed. To the contrary, they will be more comfortable in bed with us and more reassured that they will not awake to find a corpse beside them! In those cases where the partner complains excessively about CPAP noise, etc., one might confront them with their contrasting lack of concern over issues like disability and death that may result from lack of treatment.
As for my own experience, I have been through two long-term relationships, including my current marriage, where neither women showed the least sign of distress over my wearing the machine. Clearly it did not "turn them off" and sexual activity sometimes took place even with it on! On the other hand, between relationships, when I dated women I scarcely knew, I felt too uncomfortable to use the machine in front of them, and as a result often discouraged or avoided staying over at each other's homes. What really broke my self-consciousness over using the machine in front of others, though, was that on two occasions I found myself in hotels lodged with perfect strangers! It was a little hard to explain, but once explained seemed to provoke no further interest. I even used my CPAP lying fully visible on the sofabed of a recreational vehicle with five other people accompanying me!



This page hosted by Get your own Free Home Page