220 JOURNAL MSMA July 2012 I ntroductIon Obstructive sleep apnea (OSA) is a major sleep disorder affecting about 25% of American adult population. It is characterized by loud snoring, observed apneas, choking or snorting during sleep, morning headache and feeling tired or sleepy despite spending adequate time in bed. The complications of untreated sleep apnea include poorly controlled hypertension and diabetes, atrial fibrillation, increased risk of stroke and motor vehicle accidents, along with overall increase in mortality. Polysomnography is the gold standard for diagnosis of sleep apnea while continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) are the major treatment modalities available at this time. CPAP/BiPAP has to be used nightly to achieve the full benefit of treatment of sleep apnea. Because of its cumbersomeness, CPAP compliance among OSA patients are only about 60-70%, 1 which can improve to 85% only with consistent follow up and trouble shooting by the providers. 2 In this article, we will discuss the key issues faced by the patients while using CPAP, and how to address them. Key words: Obstructive sleep apnea, CPAP, compliance 1. Motivation: Lack of risk perception is one of the major causes of non-adherence to CPAP therapy. 3 Discussing the risks of untreated obstructive sleep apnea with patients help them to be motivated to use the therapy. 2. Finding the right mask: Selecting the appropriate mask is one of the most important steps in being compliant. Patients, who are mouth breathers usually do well on full face mask which covers both nose and mouth, but those with claustrophobia may opt for a nasal mask or nasal pillows that fit under the nose. Addition of a chin strap may minimize the mouth breathing. About How To Improve CPAP Compliance for the Treatment of Obstructive Sleep Apnea Sadeka Tamanna, MD, MPH and M. Iftekhar Ullah, MD, MPH • Top 10 FacTs you should Know • 3. Getting used to the mask: Adherence to CPAP use in the first 4 nights can determine the overall CPAP compliance in the future. 4 Patients usually have difficulties sleeping well for the first few nights with the new mask on. They need to be encouraged to wear it nightly and be reassured that most people eventually get used to it if used regularly. 4. Nasal dryness: CPAP may cause significant nasal dryness which can be prevented by using a heated humidifier attached to the CPAP unit and can be adjusted as needed. Use of normal saline nasal spray prior to sleep as well as steroid nasal spray may be helpful. 5. Dryness of mouth: People who breathe through the mouth or sleep with the mouth open can suffer from dryness of mouth. A full-face mask or adding a chin strap with the nasal mask can solve the problem. 6. Tolerating the air pressure: “Ramp” button is a unique feature in the CPAP device which helps to start CPAP at a low pressure and increases gradually towards the prescribed setting. The ramp time can be adjusted if the patient needs longer time to fall asleep. 7. Mask leak: A leaky mask fails to deliver the optimal pressure and trying to adjust them inappropriately can cause skin irritation, bruises on the face and irritation of the eyes. This should be fixed by adjusting the pads and straps to get a better fit and by changing the mask if adjustment fails. 8. Involuntary removal of CPAP at night: It is not uncommon for patients to wake up at night and find the CPAP mask displaced. Patients may involuntarily remove the device during sleep, or it may become