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The CPAP Conundrum

SleepingCoupleTo CPAP or not to CPAP, that is the question that an estimated 100 million Americans who suffer from obstructive sleep apnea (OSA) might face in their quest for a better night's sleep. And for many of these patients, this CPAP conundrum -- whether or not and when to wear the device's mask -- may actually revolve around their romantic relationships, a new Penn study has shown.

OSA (commonly referred to as just sleep apnea) is a sleep-related breathing disorder that occurs when the tissue in the back of the throat collapses and blocks the airway, causing the body to stop breathing during sleep. OSA disrupts sleep (both the patient’s and their bed partner’s) and can increase the risk of other health problems such as heart disease and stroke. It can also have a major impact on a person's energy levels and mood.

The gold standard treatment for OSA is continuous positive airway pressure or CPAP. The steady flow of air from a CPAP machine keeps the airway open and restores normal oxygen levels during sleep. This helps maintain a steady, healthy level of breathing through the night.

But even though doctors know that CPAP is extremely effective in helping patients with OSA, research has proven time and again that many patients can’t or don’t want to use the device on a nightly basis.  In fact, one study found that up to 83 percent of patients with obstructive sleep apnea have reported they aren’t sticking with the treatment.

Patients commonly cite a variety of concerns with CPAP therapy -- from the noise the machine creates to facial discomfort from the Darth Vader-like mask they must wear. But the new study from a team of researchers at the Perelman School of Medicine at the University of Pennsylvania, Boston College, and the University of Illinois at Chicago, pinpointed another common, and often difficult to admit, reason that they leave their machines at the proverbial bedroom door: less intimacy with their non-CPAP using partners.

In a study of 91patients with newly diagnosed OSA followed for one week after treatment initiation at the Penn Sleep Center, less intimacy with partners caused by CPAP was the only treatment side effect (from a list that included things like irritated skin, dry nose and mouth, and headaches) that patients said actually impacted their own CPAP use.

This finding, paired with other new sleep research that has shown that patients who use the CPAP machine properly can actually improve intimate and sexual relationships by helping alleviate OSA symptoms, is the ultimate CPAP conundrum. Patients don’t want to use the device because they think it will impede intimacy, but if they do use it, their OSA symptoms will improve, they’ll feel better, and have more energy and enthusiasm for their romantic relationships.

“More than many other diseases and treatments, OSA and CPAP treatment affect not only the patients, but also their partners,” the authors wrote in the study. 

To help with this CPAP Catch 22, the authors say that health care providers need to address the idea that CPAP could put a strain on sexual relationships at the very beginning of treatment and give patients suggestions for how to overcome their concerns, such initiating intimate activities before they need to use their CPAP machines at night.

At the Penn Sleep Center, the medical team is already practicing what they preach.  Patients are offered a follow-up visit with a team of nurses soon after initiating treatment with CPAP therapy to target any problems before they become a major obstacle. By addressing the patient's concerns, both physical and emotional, the sleep clinical care team is working to help patients control their OSA and overcome the CPAP conundrum.




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