Download The Claustrophobic Patient

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
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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:
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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
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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?
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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……
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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.