The Webs We Weave in Sleep Medicine | November 2009
Enlisting patients as more active participants in their treatment.
In the years ahead as health care reform invades, infects, or inspires (take your pick) the medical community toward new models of practice, sleep medicine physicians and technologists must discover innovative treatment pathways. Currently, the most widely used sequence begins with a patient-physician clinic appointment to assess sleep complaints and develop a plan, which typically moves through testing in the sleep lab to long-term use of positive airway pressure therapy (PAP-T).
How effective is this system? Not so impressive judging by PAP-T adherence rates often hovering above 50%.
When I started in clinical sleep medicine 16 years ago, the conventional wisdom declared that treatment adherence was often limited by the inability of the sleep apnea patient to conceptualize the disease process. Because patients slept through sleep apnea, they could not appreciate the pathophysiology of a sleep breathing problem, or if they did accept the diagnosis, they could not embrace the notion of wearing a mask while asleep. For these reasons, my patient-physician encounters included a motivational interviewing technique (think Socrates with a bit more give and take).
Ideally, this method raises enough questions that a patient's answers eventually spell out all the necessary information about sleep apnea; however, because the ideas emerge from the patient's mouth in their own words, retention is greater. To enhance the presentation, we used wall illustrations to aid the patient in picturing the process. Also, patients handled masks, or, for anxious patients, our sleep techs provided a tour of the lab.