Bargaining and balancing life with CPAP: A grounded theory

Abstract

Aim: To explore experiences of using continuous positive airway pressure (CPAP). CPAP is recognised as a cost-effective treatment for obstructive sleep apnoea, which left untreated increases morbidity and mortality. CPAP can be challenging for users, with adherence perceived as poor. This thesis adds to limited evidence regarding CPAP from users’ perspectives, and contributes original knowledge about how users successfully manage therapy. Methods: Adults prescribed CPAP for sleep apnoea (n=12) and their partners (n=4), recruited through a main-centre respiratory service in New Zealand, participated in semi-structured interviews. Using constructionist grounded theory, data were analysed until theoretical saturation was reached. Findings: This study identifies that living with CPAP involves a process of individual change management underpinned by the substantive theory bargaining and balancing life with CPAP. The process comprises three main categories: becoming a team for good-sleep, making choices about CPAP and becoming used to CPAP. Partners and/or family members form a collaborative support team with CPAP-users, positively influencing therapy management through joint problem-solving and decision-making. By making choices, participants balance reactions to needing CPAP with the factors that motivate its use and the consequences of their choices. Using or not using CPAP is contingent upon participants determining which choice helps them to feel most well. Indeed, this study highlights participants as active, reasoned decision-makers in their healthcare who identify personal motivations for CPAP use based on personal experience and knowledge about CPAP and sleep apnoea. Furthermore, propensity to persevere acts as a condition under which users make choices about CPAP. The process concludes once mastery is achieved. Conclusions: By using grounded theory, this study reveals how people live with CPAP. Theoretical models of change management and decision-making underpin the theory bargaining and balancing. True to the principles of patient- and family-centred care, partners should be incorporated in the process from diagnosis to successful CPAP management. Further research should explore the role of partners in the successful management of CPAP and develop this study’s findings regarding elements that hallmark success with CPAP. Interventions should address factors that leverage inclination to persevere with CPAP, and identify those for whom managing CPAP is counterproductive.