Adults Need Bedtimes Too

CPAP compliance for sleep apnea was better among adults with regular bedtimes

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) If you thought regular bedtimes were only for children, think again. Even adults can benefit from a regular bedtime – especially adults who have sleep apnea and require CPAP treatment.

CPAP is the most common treatment for obstructive sleep apnea. It stand for "continuous positive airway pressure."

It involves pushing air into a person's airways through a face mask during the night while they sleep.

Treatment with CPAP has been shown to improve patients' sleep apnea symptoms, daytime sleepiness and other sleep outcomes. But CPAP only works if patients use it.

"Establish a regular bedtime."

The study, led by Amy M. Sawyer, PhD, RN, an assistant professor at Penn State University School of Nursing, examined whether sleeping schedules were related to patients' use of CPAP.

The researchers included 97 adults in the study who had just recently been diagnosed with obstructive sleep apnea during a sleep study.

The group included mostly white participants (87 percent), with about half men and half women who were mostly obese.

They all had at least 10 events each hour when they stopped breathing or did not breathe sufficient oxygen while asleep.

The average number of times this occurred for the participants in the group was 36.7 times, which indicates severe symptoms.

The participants filled out a sleep diary of the hours they slept for one week.

Then, one month later, the researchers checked in to see if the patients were using the CPAP regularly for at least four hours a night.

At the end of the first week, the average use of CPAP was 4.5 hours a night among the participants.

Both the 63 patients who were using CPAP and the 34 who were not adhering to CPAP treatment had similar bedtimes at the start of the study. Their bedtimes did not appear to influence their use of CPAP at one week after the study began.

At one month, the average use of CPAP among the participants was 4.25 hours a night.

However, when the researchers looked at differences in bedtimes between those who did and did not use CPAP at one month, they found that bedtime did make a difference in whether patients were following their treatment plan.

At one month, 59 patients were regularly using CPAP, and 38 were not adhering to their treatment with CPAP.

The bedtimes of those who were not using their CPAP treatment varied by about a 67 minute window from one day to the next.

Yet those who were regularly using CPAP only had a bedtime window of about 49 minutes.

Therefore, the patients whose bedtimes varied about 20 minutes less were much better about following their treatment plan with CPAP at the 1 month follow-up.

"Addressing sleep hygiene, specifically regularity of sleep schedule, prior to or with CPAP initiation may be an opportunity to improve CPAP adherence," the researchers wrote.

“By stabilizing bedtime schedules, or promoting consistency in bedtime patterns and routines prior to initiating CPAP treatment," more patients are likely to follow their treatment and use CPAP, said Dr. Sawyer in a prepared statement about the study.

William Kohler, MD, the director of the Florida Sleep Institute in Spring Hill, Florida, and a dailyRx expert not associated with this study, said that compliance with CPAP can be a problem with many sleep apnea patients.

"Anything that could improve compliance needs to be practiced," Dr. Kohler said. "This study showed that routine bedtimes were associated with better compliance."

However, Dr. Kohler added that the bedtime's relationship with compliance may not be cause-and-effect.

"On the other hand, it's possible that the personalities of the people in the study that would be more compulsive to do things on a routine basis would also be more likely to obey the doctor and utilize the CPAP on a regular basis," Dr. Kohler said. "There are many factors that could be contributing to the compliance."

CPAP machines require a prescription and can cost anywhere from $150 to over $5,500, though most insurance plans will cover some or all of the expense. CPAP masks range from $30 to $200.

The study has not yet been published in a peer-reviewed journal and therefore has not been reviewed by other sleep experts. Its findings are preliminary.

The findings will be presented June 5 at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC in Baltimore, Maryland. Information on funding and disclosures was unavailable.

Reviewed by: 
Review Date: 
May 21, 2013
Last Updated:
August 5, 2013