Making choices about CPAP: Findings from a grounded theory study about living with CPAP

Untreated sleep apnoea incurs high societal and personal health costs. Although continuous positive airway pressure is a recognised, cost-effective treatment, concern exists that patients under-use this therapy. However, there is limited evidence regarding users' views of this treatment. Therefore, we aimed to explore experiences of living with continuous positive airway pressure from participants' perspectives.Sixteen participants, recruited through a main-centre respiratory service in New Zealand, participated in semi-structured interviews during four months of 2011 and six months of 2014. Adults prescribed positive airway pressure for sleep apnoea (n = 12) and their partners (n = 4) participated. Using grounded theory methods, data were analysed until theoretical saturation was reached.This paper reports the second of three main categories from the grounded theory: bargaining and balancing life with CPAP. The second category, making choices about CPAP, emphasises participants' ability to self-motivate and develop supportive strategies via a dynamic choice-making process based on clinical information, personal opinion and belief about treatment. Based on personal choices about therapy participants chose whether and how to integrate therapy into daily life. Participants overcame barriers, such as the perception of stigma, and allowed time to persevere with decision-making and therapy management.This study highlights participants as active, reasoned decision-makers in their healthcare, who can identify choices that motivate positive airway pressure use. Focusing supportive interventions on motivations identified by participants may optimise choices for positive airway pressure use. Future studies should examine the efficacy of targeted and tailored interventions that support patient decision-making when choosing this therapy.