Can a CPAP machine make you sick?

Healthcare - Sleep Apnea - Less mask frustration thanks to telemedicine

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Patients with nocturnal pauses in breathing are primarily treated with what is known as CPAP treatment. However, the highly effective therapy can be uncomfortable for patients. Around 30 to 40 percent reject the mask sooner or later. Telemonitoring could counteract the high failure rate.

It bothers the face, it creates pressure points, the hoses are in the way and the device makes noise. We are talking about the so-called CPAP therapy («C.ontinuous Ppositive A.irway Pressure »). During treatment, the patient wears a face mask while sleeping. A device next to the bed pumps room air through a hose into the mask and so either through the mouth or through the nose into the lungs.

The small breathing apparatus creates constant pressure on the airways, which can stop the collapse of the upper airways and thus the nocturnal pauses in breathing. A highly effective and effective therapy which, when correctly indicated and used correctly, works after the first night. The therapy is so successful that it has become the gold standard in the treatment of sleep apnea.

In addition to the advantages mentioned, the CPAP mask also has a disadvantage: Who wants to go to bed with such a mask until the end of life?

Telemedicine is important in the early stages

Around 30 to 40 percent of patients stop therapy sooner or later. The initial phase is particularly difficult for new patients. "It has been shown that the first four weeks are decisive for the long-term success of the therapy," says pulmonologist Otto Schoch from the St. Gallen Cantonal Hospital.

If patients do not get used to the mask during this time or if side effects such as dry mucous membranes or pressure points and other disruptive factors occur, there is a risk that the therapy will be discontinued. In order to recognize these problems early and to counteract the rejection of masks, a new technology could be used - telemedicine.

Today's CPAP machines are not just ventilators, but also small computers. They collect data on how long the mask was worn, measure whether air is escaping from the mask and determine whether the pathogenic breathing pauses have actually disappeared during therapy. These are all factors that are very important to the success of a CPAP treatment.

The advantage of telemedical support for patients is that the CPAP device can send the data directly to a center or the treating doctor. If the patient only wears the mask for a short time at night or if other values ​​look suspicious, this is detected by the device and recorded via telemonitoring. Depending on the agreement, the hospital can proactively approach the patient and offer help.

Lung League pilot project

What is sleep apnea?

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When breathing pauses at night, various places in the throat area collapse completely, so that breathing is interrupted several times an hour for a short time. Daytime sleepiness is one of the main symptoms. In addition, patients with sleep apnea often have high blood pressure, which can lead to an increased risk of cardiovascular disease.

The help can be of different types. For example, a mask that does not fit can be replaced or tips can be given on how to use the mask. A comparative study carried out at the St. Gallen Cantonal Hospital showed the advantages of the new method: "Patients who were accompanied with telemonitoring in the initial phase felt safer than patients without the technical support," says Schoch. Many patients appreciated the intensive care, according to the senior pulmonologist.

The Swiss Lung League is also interested in the new technology. In Switzerland, the cantonal pulmonary leagues give the majority of CPAP devices to patients. In addition, she also looks after the patients in handling the mask and maintains the devices. "Because the initial phase is crucial for the progress of the therapy, telemedicine could become an interesting tool for us as health care providers," says Philippe Giroud from the Swiss Lung League.

He also sees potential in annual inspections, for example. If telemonitoring is switched on a week before the check-up appointment, the Lung League can download and interpret the therapy data and, in the event of any abnormalities, discuss them with the referring pulmonologist in advance. "Ultimately, the patient would benefit from an efficient check-up," says the head of home therapy.

He emphasizes, however, that they are currently in the test phase and that the technology is not yet in use in all cantonal leagues. In addition, not all device manufacturers in Switzerland offer such solutions.

Criticism of telemedicine

The next study on the use of telemedicine is already underway at the St. Gallen Cantonal Hospital. Further evidence of a better effectiveness of telemonitoring compared to previous support is sought. Because there are also skeptical voices among pulmonologists. Schoch says: "Data protection in telemedicine is a big issue among professional colleagues."

Many fear that health insurance companies could request the data from the CPAP devices and thus decide for themselves whether it is successful or not, says Schoch. The device also has a kind of monitoring function, because it records how long the patient wears the mask.

For Schoch, the advantages outweigh the rest. Patients are informed and have to give their consent for telemonitoring to be carried out. No data from the system goes to the health insurance companies. "So far we have not seen any increased interest from insurance companies," said Schoch. And if the insurance companies do show interest, they would only give a global medical assessment of a patient - but under no circumstances would they give the data from telemonitoring.

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