Patient education combined in a music and habit-forming intervention for adherence to continuous positive airway (CPAP) prescribed for sleep apnea

Patient Educ Couns. 2009 Feb;74(2):184-90. doi: 10.1016/j.pec.2008.08.008. Epub 2008 Sep 30.


Objective: As many as 50% of patients diagnosed with obstructive sleep apnea stop adhering to the prescribed medical treatment of continuous positive airway pressure (CPAP) within 1-3 weeks of onset. Thus, a theory-based intervention using music to support habit formation was designed to improve CPAP adherence at onset. The intervention materials included directions for CPAP nightly use, a diary for recording nightly use and writing about CPAP benefits or problems. In addition, an audiotape with softly spoken instructions for placing the CPAP mask comfortably, using deep breathing and muscle relaxation along with the slowly decreasing music tempo was provided to listen to at bedtime each night.

Methods: Effects of this music intervention were tested in a randomized, placebo-controlled trial of 97 patients with 53 males (55%) and 44 females (45%). Moderate to severe apnea/hyponea scores (per sleep laboratory data) and medical diagnosis of OSA were required for study inclusion.

Results: Compared to placebo controls, a greater proportion of experimental patients were adhering (chi(2)=14.67, p<0.01; a large difference, Phi=0.39) at the end of the first month of CPAP onset. There were no differences in CPAP adherence at 3 (X(2)=0.065, p=0.79) and 6 (X(2)=.118, p=0.73) months. Patients' diary data and satisfaction survey results indicated the intervention was rated as helpful and guided formation of a relaxing, habitual routine of CPAP nightly use.

Conclusion: The intervention had a strong effect for improving adherence to CPAP at 1 month.

Practice implications: Adherence at the onset of treatment is critical and the audio music intervention was easily administered. Other interventions that target problems interfering with longer-term CPAP adherence are needed.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Continuous Positive Airway Pressure / psychology*
  • Depression / etiology
  • Female
  • Follow-Up Studies
  • Habits*
  • Humans
  • Male
  • Middle Aged
  • Music Therapy / methods*
  • Obesity / complications
  • Patient Compliance / psychology*
  • Patient Education as Topic / methods*
  • Psychological Theory
  • Relaxation Therapy
  • Severity of Illness Index
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / etiology
  • Sleep Apnea Syndromes / psychology*
  • Sleep Apnea Syndromes / therapy
  • Surveys and Questionnaires
  • Tape Recording