Home' Australian Pharmacist : Australian Pharmacist February 2015 Contents Australian Pharmacist February 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Types 3 and 4 studies are referred to
as limited channel studies because
they only measure a limited number
of parameters. At a minimum, they
measure oximetry and heart rate.
They are convenient for patients
because they can be done in their own
home, but pharmacists need to be
aware that types 3 and 4 studies may
not be suitable for all patients and their
physician needs to determine which
study will be the best for the patient.10
How can sleep apnoea be
Treatment options for sleep apnoea
include lifestyle changes such as weight
loss if the person is obese, limiting
alcohol intake, managing nasal blockage
and sleeping on the side instead of
the back. Smoking cessation and
regular exercise can also help towards
managing the problem. People who
are reliant on sleeping pills should be
encouraged to stop.11
If large tonsils are causing sleep apnoea,
they may need to be surgically removed.
Sometimes surgery to the soft palate
or the base of tongue may be needed if
there is a distinct obstruction.11
An oral appliance such as a mandibular
advancement splint (MAS), mandibular
advancement device (MAD), or
mandibular repositioning appliance
(MRA) may be required by some people.
These push the lower jaw forward so
that the throat opens up, reducing risk
of obstruction or vibration (snoring)
during sleep.11 These can be effective
for mild-to-moderate sleep apnoea.
The most effective treatment for
moderate-to-severe sleep apnoea is
continuous positive airway pressure
What is CPAP therapy?
CPAP therapy delivers pressurised air, via
a nasal or oro-nasal mask, to the person's
throat to help keep the upper airways
open.12 The CPAP device has three
main parts -- the air pump, the mask
and a tube which links the two. CPAP is
very effective and works immediately,
however, if the person stops using their
device, their sleep apnoea comes back.12
Several CPAP devices are available with
different options for types of masks and
chin straps. Portable devices are also
available for when travelling.
CPAP therapy has been shown to improve
a person's quality of life with more restful
sleeps, improvements in cognitive
function, reduction in driving risk and
improved cardiovascular health.13
Despite CPAP therapy having high
efficacy to treat sleep apnoea, its
effectiveness is limited by variable
adherence. Between 30--80% of CPAP
patients can be non-adherent to
therapy.14 Adherence is defined as
greater than four hours use per night
and evidence suggests that if a patient
uses CPAP for longer than six hours each
night, it decreases daytime sleepiness,
improves daily functioning and
improves memory. 15
Mr Smith's snoring
Mr Smith has some risk factors for
sleep apnoea -- advancing age, obesity
and regular use of alcohol. He also has
daytime sleepiness and the Epworth
Sleepiness Scale score you determine
for him is 15. You discuss with him what
sleep apnoea is and the complications of
not having it treated.
He said his doctor had once briefly spoken
to him about sleep apnoea. You refer Mr
Smith for further assessment. He returns
two weeks later with a request from his
doctor to have a home sleep test as you
offer this service from your pharmacy. You
refer the results of his home sleep test
to a local sleep physician for diagnosis.
The sleep physician diagnoses Mr
Smith with moderate sleep apnoea and
prescribes him CPAP therapy.
Your well-trained pharmacy assistant
assists Mr Smith with the CPAP device
and correctly fits him with a mask.
She checks that he understands all the
information as it can be overwhelming
and sometimes confusing for patients.
It is important the patient understands
how to use their machine correctly so it
can obtain meaningful and useful data.
The pharmacy assistant makes a
follow-up phone call to see how
Mr Smith is getting on with his CPAP
machine. Mr Smith said he finds the
machine dries out his mouth and he
finds it uncomfortable.
What problems can be
encountered when using a
Most people need time to get used to
the CPAP machine. It is important to
follow up with these patients especially
during the first weeks of therapy as
their experience with the machine
during this time will greatly influence
their adherence in the long term.
Some problems people may experience
with CPAP use are discussed below.16
• Wrong style or size of mask -- people
have different face shapes and need
masks that suit their face shape and
size to work effectively. Ill-fitting masks
can also cause pressure leaks and may
irritate the patient's skin and eyes
causing them to become dry or teary.
• Trouble getting used to using a mask
-- people could trial using the mask
during the day, e.g. while watching
TV, to help them get used to the idea.
Wearing the mask inconsistently will
not help a person's sleep apnoea.
Advise people to persevere as it may
take several weeks to get used to it.
• Dry stuffy nose -- using a heated
humidifier with the CPAP device
can help if patients experience a dry
• Dry mouth -- this is worse for people
who breathe through their mouth.
Wearing a chin strap to hold their
mouth closed or a full face mask
"BETWEEN 3080% OF
CPAP PATIENTS CAN BE
NONADHERENT TO THERAPY."
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