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The Claustrophobic Patient Claustrophobia • Wikipedia describes this as an anxiety disorder that can result in a panic attack • Two symptoms: - fear of confinement - and fear of suffocation • Fight or Flight Surprise! • The claustrophobic patient appears when you least expect it. • No previous history • Split studies – probable increased likelihood Common Denominators • • • • • Obvious fear, sheer panic Negative body language Verbalizing – terminating the study Tears, embarrassment Extreme symptoms such as inability to breathe, chest pain What’s the Common Denominator: – All had Obstructive sleep apnea, hypoxemia, fatigue – Projected a ‘fight or flight’ response when the cpap pressure was applied • Theorizing, it felt like these particular patients had that ‘fight or flight’ internal stimulus turned on all the time since they experienced at least some repetitious degree of hypoxemia on a nightly basis, that somehow this status was elevated 24/7 over normal sleepers * Rushing patient into wearing the mask or accepting the pressure made their symptoms WORSE Is there a Resolution? What was I dealing with and how to get past it? How to encourage the positive side effects of a good night sleep with CPAP? *It is our Responsibility and our JOB to help them accept therapy. We (often) get ONE chance to make a good impression with CPAP…. Causes of Claustrophobia Classic Conditioning – • past childhood experiences: lost or separated Learned Behavior• watching parents or peers behaviors Biology: Smaller Amaygdala; part of brain used to process fear* *Fumi Hayano, Medical News Today Genetic vs Psychological: • “Prepared Phobia”Claustrophobia and other phobias are a dormant evolutionary survival mechanism • Survival Instinct within our genetic code once crucial to human survival but is no longer needed*. *Medical News Today Sooooo…. Plan of Action: Always Be Prepared: • The claustrophobic patient WILL be a challenge • CAN NOT RUSH PATIENT, you set them up for failure. • Their failure is your failure.. • Take extra time…step out of room. Give patient time to relax • Look to colleagues for support, exchange ideas, success stories. Processing Time Works • • • • Freedom Options Control Encouragement Educate! • Ask the patient level of understanding: why are they at the lab? What does it all mean? • Offer explanations of sleep disorder breathing in SIMPLE terminology • Share your own experience: Have you had a sleep study, slept with cpap, know what it feels like? • Remind them of the benefits of treatment: Sleep Well, Live Well Patience of Job! • Use your experience to narrow mask selection then have the patient choose from limited selection • Have patient hold the mask… they remain in CONTROL • Practice deep, slow breathing as they apply mask to face. • Acclimate period: Ramp up pressure slowly. Always apply mask with pressure. – Better fit, better experience – Repeat if needed Fight or Flight • Most Critical Time: some patients just can not continue and opt to leave • The pace is determined by the patient during this most difficult time. • Strong encouragement, positivity, the offer of different masks and ‘comfort features’ can help in this setting. • If the patient doesn’t run away, you both are making progress. • Answer any questions and encourage questions, explain as simply as you can. • Ask the patient if they are okay with you leaving the room for a few minutes (you do still have another patient) -This gives time for them to check it out for themselves and reassure themselves • Make sure they know how to take mask off. • You are building confidence and trust! Proceed Cautiously • Continue patiently to get patient into bed, with mask The next critical phase in getting the claustrophobic patient to adapt The patient still needs to feel control – let them control the pace, body position, etc It’s My Baby….. • Expect patient to take breaks from mask • Provide positive Encouragement • Provide Patience • This is a good time for suggested goals feeling better in the day time lowering blood pressure, being more alert, etc. FIND OUT WHAT IS IMPORTANT TO PATIENT: connect success with CPAP to their priorities Additional Tips: • Elevate head/body with pillows can help acclimation and overall comfort: *Remember, patient is “used to” compensating for months/years with sleeping position, routine, habits. • Encourage patient to call out or wave their hand if they need you • Build confidence! Document, document, document for the physicians and home care companies! • Inform all HCP of experience to make them aware to continue to give extra support! • The insurance company may need documentation for further steps: Switching mask styles BiPAP rescue continued coverage Did I…… • • • • • • Have a plan of Action Patience is a virtue! Education – decreases fear Practice – offers comfort Goals – gives the ‘burn’ to succeed Documentation – will they know what this patient is going to need? Bonus! • Become an Advocate for “best practices” • Viewed as RELIABLE RESOURCE • INCREASE productivity of lab and effectiveness of your role. • Word Of Mouth Advertising: Successful and Healthy Patients will spread the word of their experience. -Remember negative experiences spread faster than positive. Create a positive experience! Success! You have the ability to change someone’s life in a single night and become a PATIENT FOR LIFE.