Sadly, there are probably as many users of PAP Therapy as there are those who have tried and failed to use it. In fact, the number of SDB patients who once used a PAP device may outnumber those who are still using it.
There are many reasons for this lack of success, and I personally had to travel down many of these paths before I could find success with my current bilevel therapy. My struggles occurred during the early phase of the writing of Sound Sleep, Sound Mind; and, these barriers served as a major motivating influence to push me to find solutions for myself and others who were frustrated in their efforts.
While my book goes into more depth on this problem, the following list reflects the biggest issues I have found that prevent SDB patients from succeeding with PAP Therapy:
Wrong mask or poorly fitting mask
Wrong pressures or wrong pressure delivery system
Inadequate problem-solving or coaching from the supplier of the PAP Therapy device or prescribing sleep facility
Failure of the sleep facility to schedule PAP retitration tests to fine tune pressure settings and facilitate compliance
Anxiety or fear about PAP Therapy
Pain or discomfort with any aspect of the treatment
Embarrassment, shame or guilt triggered internally by your sensitive personality or by a non-supportive family environment
Co-occurring psychiatric conditions such as depression, anxiety, and PTSD that trigger frequent episodes of insomnia
Co-occurring medical conditions such as chronic pain syndromes, diabetes, asthma, and heart disease that compromise functioning in general, which then limits the SDB patients ability to fine tune and follow through with all the necessary adjustments that must be made on a daily basis.
These barriers are sometimes quite large, but virtually all of them can be overcome. When you work with the right mix of sleep professionals, from the sleep staff to the sleep technologists to the sleep physician to providers of the PAP equipment, then your chances of achieving success skyrocket. These professionals will help you directly or motivate you to "help yourself" seek and apply solutions to the various barriers in your way.
In the past, you may have used CPAP to treat a sleep breathing disorder, discovered that the treatment worked somewhat well, but not well enough to put up with the general hassle. We can expect that you would remain highly motivated if your benefits were obvious, even while the breathing mask is difficult to use.
More commonly, we see patients who tried CPAP, but did not receive any benefit and found it a huge hassle. If you fall into this category, your motivation is of course much lower. Even though you may initially have been eager to gain something from treatment, your negative experience may have triggered a belief that future treatment efforts will also be negative, a hassle, or simply not worthwhile.
If you have stopped using PAP Therapy and still have a machine to use, we recommend starting with our PAP Therapy Checklist. The items on that list can help you organize your thinking to pinpoint where you need to focus for starting up again.
If it's been awhile and you no longer have a PAP Therapy device, returning to the sleep lab is the ideal way to start again, or you could contact your sleep physician to discuss your perceived barriers before returning to the lab.