Sleep Tech Tip of the Week
by Steve Ferrin, RPSGT from Lourdes Sleep Center
A common problem facing many sleep technologists today is patient anxiety over wearing that “scary looking contraption on their face”. This is to be expected. Unless you’re a welder, scuba-diver, or a fire-fighter, most of us do not wear bulky equipment on our face, much less to sleep in. So, how does one overcome this anxiety? The first, and most obvious, choice is desensitization.
When desensitizing a patient, it is important to have a good mask choice. Let the patient try on a variety and see which one they prefer. Mask sizing is important, as an ill-fitting mask will lower compliance. Once a proper mask has been found, letting the patient lay there with air running through the mask is often the next step. Allow the patient to get used to this “strange sensation”. It is at this point that it is absolutely critical to LISTEN to the patient. Is the patient getting too much air, or not enough on this trial? Ask the patient, “Are you having any difficulty with the mask?” I have seen many, many times a patient tell a technologist that they are having a hard time breathing, after which the technologist immediately goes in and reduces the pressure. If a patient tells you that they are having a hard time breathing, press them for an explanation. Are they having a hard time breathing in, or breathing out? This is extremely important because their answer will dictate the technologist’s next step. If they are having difficulty breathing out, then it’s likely that the pressure is too HIGH, so a reduction in pressure is called for (usually from 5 to 4), or possibly increase the C-flex if your system supports that. If that doesn’t work, switching to bi-level will oftentimes ease the patient’s effort to exhale. If the patient is having a hard time breathing in, then it’s likely that they do NOT have enough pressure so a slow gradual increase until the patient is breathing comfortably will generally do the trick.
Finally, there’s those patients that are breathing fine, but are just extremely stressed out. What do to with those? I have found an old psychology trick that has given me a great bit of success. Have the patient lie there, and put one of their hands on their chest. Then talk to the patient and tell them to focus on their chest rising and falling, rising and falling, rising and falling. I’ll stand there and talk to them for several minutes while they are focusing on their chest rising and falling. What tends to happen is that the patient focuses on their chest, feeling it rise and fall, they forget about breathing and do it automatically. When you point out that they’ve just spent the last 5 minute breathing fine…it becomes an eye opener. As with all things, it’s not 100%, but I’ve had some great success with it. Hopefully you will too.
Stay tuned for next weeks safety tip: 10 reasons why you shouldn’t wake up patients while dressed like Michael Myers from Halloween.
About the Author: Steve Ferrin, RPSGT is our guest author for the Sleep Tech Tip of the Week and is the director of the Lourdes Sleep Center in New York.
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Tags: cpap acclimation, cpap adjustment, cpap desensitizing, cpap mask, sleep study, sleep study preparation