SOURCE: Bakker JP, et al. Motivational enhancement for increasing adherence to CPAP: A randomized controlled trial. Chest 2016;150:337-345.

Even though obstructive sleep apnea (OSA) causes immediate (daytime sleepiness, memory impairment, decreased functionality) and long-term (hypertension, increased cardiovascular event rate) problems, it may come as a surprise that the majority of users of continuous positive airway pressure (CPAP) machines do not even achieve four hours of use nightly, on average. This is particularly concerning since benefits of CPAP on adversities related to OSA are most substantial when using CPAP for 5.5 hours or more per night.

Motivational interviewing is a technique that has been successfully employed to improve outcomes ranging from smoking cessation to compliance with antihypertensive medication. Practitioners of motivational interviewing believe patients naturally often feel some ambivalence about interventions offered to them and that by helping the patient identify such ambivalence, steps can be taken to address obstacles to success. Central to the mechanism of motivational interviewing success is the role of the interviewer as facilitator rather than director. That is, patients are encouraged both to identify their own sources of ambivalence and also to explore which obstacles they might wish to address, as well as how they might best address them. Considering that the textbook explaining motivational interviewing (Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Third Edition. Guilford Press; 2012) encompasses more than 400 pages, the above explanation obviously is a dramatic over-simplification. Nonetheless, practitioners of motivational interviewing techniques (psychologists, physicians, and other clinicians) often find it a useful tool.

In a 12-month, randomized, controlled trial of motivational interviewing vs. placebo (n = 83), Bakker et al found that recipients of motivational interviewing demonstrated (on average) more than 90 minutes greater utilization of CPAP per night than those in the placebo group. This benefit was achieved through two in-person, hour-long motivational interviewing sessions with a psychologist, followed by six phone sessions over 32 weeks (10-30 minutes each) with the same psychologist.