Anyone that is active in the positive pressure therapy industry, whether as a patient or a provider, can see that there are many shortcomings. Whether these failings source back to physicians, sleep study centers, or durable medical equipment providers can become a very diverse and opinionated subject; and rightfully so. As positive pressure therapy use is moving forward into the future and stepping out from the taboo state it has held for years in the eyes of patients, I truly hope that some of these shortcomings can be solved and better services can be provided to users. Whether that is a lofty goal or not, we can always have hope!
An area of concern that I feel should be addressed with new users, and veteran patients alike, is the goal of the positive pressure therapy mask used during the sleep study titration and the mask intended for long-term home use. The approaches from the respiratory therapist, sleep technologist, or technician will, or should be, very different depending on the scenario and factors involved. The communication about this approach to patients is typically not addressed by these healthcare professionals (we all understand that some of them are not professionals) and, in my opinion, reveals yet another failure to communicate crucial information.
So I hope to address the issue from my perspective when communicating with patients before the study and when I would work with users on their home positive pressure therapy. I cannot speak for the industry as a whole and its approach, but I will try to comment on it and why my approach is different!
When a patient arrives, I typically have a portion before the sleep study begins that I label “orientation” and this is nothing fancy. I simply review the procedure and what to expect from the night. If the study is a titration sleep study or a split-night sleep study, then I always make a focus on reviewing positive pressure therapy and mask expectations. Not only to hopefully ease any anxiety but to also help clarify the process as a whole to aid a user in compliance to using positive pressure therapy moving forward. In that portion of the orientation, I may take 15 to 30 minutes reviewing and answering questions. From my experience, it seems that the extra time took at this point truly does help ease concerns.
I start with the process of when the positive pressure will be provided and quickly move to what mask is recommended. When addressing what mask to use I first question the patient if they have a preference or a recommendation to what mask that he/she prefers. If there is a specific mask, I briefly talk about why the mask could be a good option and the potential problems that could arise. For example; if the patient requests to use a nasal pillow style of mask I like to talk about the possible risks that are associated with that style that is typical for new users to “PAP” therapy. Such as if the patient struggles with severe sinus congestion and an irritated nasal passage; we may discuss a different style of nasal mask to accommodate better.
Once that is addressed, or the patient does not have a recommendation, then I move into the mask preference that I would likely have. I discuss facial structure, nasal congestion/pain, mouth breathing, claustrophobia, and humidification. As I address each specific point, a better understanding of why I may recommend a Resmed Mirage FX nasal mask compared to Fisher and Paykel Eson nasal mask is clearly explained. It may very well mean the difference between suggesting a nasal style of mask over a full face style; or vice-versa. While on that, I typically always try to use a nasal style over a full face mask when starting therapy to help with patient comfort if the patient and I both feel comfortable with doing so. As my mask recommendation is given, we discuss any problems that may arise and the solutions to help fix them during the study if needed.
When the patient and I both agree on the mask to be utilized, I take a moment to review the difference between the goal of the mask used in the study versus the mask they may receive when they get the home positive pressure device. The goal of the mask provided during the study is to provide as much comfort as possible, but to also provide the best seal possible not only under lower pressure but higher pressure if needed so that the optimum pressure settings can be found while the patient is sleeping. The mask used during the study does not have to be the mask that is received for their home use, but can be if the patient requests. I hope to assure the patient that the mask recommended will hopefully yield the best diagnostic data possible so that the positive pressure therapy optimum pressure will be achieved to cater not only to these factors but also to their facial structure.
As you can see, I have a lengthy bit of information to give to patients to aid in their experience not only with the sleep study but also as they move forward into home treatment. Whether this is something you feel is effective or not, it truly seems to be working well for me. The goal is to bridge better the gap between sleep study and home therapy as the mask used in each have different goals, and this is where the “shortcomings” I mentioned before come into play. I know a great many of technologists that lean greatly towards full face masks for the simple reason that it makes their jobs easier throughout the studies they perform. I understand that a full face mask can be very much needed by some patients (and there is nothing wrong with that), but for a great many they are utilized improperly (in my opinion). There are many different instances where patients are given very poor information and fitted even more poorly. If technologists were better trained and a focus on mask fitting was more specific by the American Academy of Sleep Medicine and the Board of Registered Polysomnographic Technologists, I feel that the compliance by patients would be much more assured. However, that is a much longer blog for a different time.
Remember, if you are a new user to positive pressure therapy or a veteran, the mask used in the study has a much different focus than the mask used for home use. During your sleep study, the pressures needed are unclear, and a mask that will assure an adequate seal under low and high pressure with possible body movements must be taken into account. Wherein home uses the mask utilized has a specific prescription pressure and a much clearer objective, so the options are much broader.
I hope that the way I approach this particular issue has “shed some light” on the subject for you and helps you better understand the process of receiving a mask from sleep study to home use!