Sleep Lab in a Box

[Todzo]

Currently sleep testing is in lab, expensive, often inaccurate.

Currently titration is done in a sleep lab.

I think this would work better:

We make this a government sponsored development project. This gets rid of the current start up capital issues and crazy stunted development due to proprietary secrecy issues.

Basically – take all of the sensors and make them usable by the person in his home. Should take less space than my desktop computer.

The person would come in for a couple of weeks of classes to learn how to put on, take off, use, and maintain the equipment. Practice would be done under the supervision of the instructor and/or helpers. At the end of this set of classes he would leave with the suitcase the little box was in.

The sleep testing portion would take several nights to get a base – or – the titration portion would start if the persons OSA was so bad that to wait longer would be medically unwise.

Titration / acclimation should be done over the next three to six weeks and part of what the contents of the box are designed to do.

Then the kind of general use machine can be determined, additional classes scheduled if needed, and the person brings back the “Sleep Lab in a Box” to exchange for is daily PAP.

The daily PAP would be connected by the cell phone network or Internet to a data analysis center. The persons data would be available to him over the web for lifestyle management feedback. The data would also be automatically parsed and e-mails or calls would be made to the person and his doctor if problems arise.

Very very slow titration would be done regularly to follow the persons actual pressure needs. Perhaps half a cm/H2O change checked for ten or so days – determine direction – move again if deemed wise.

Once the initial development was done the boxes would be mass produced – low cost.

The boxes would be reusable.

The overhead of building and staff would be considerably less.

I hope we do find a way!

Todzo

[stage0a]

Currently sleep testing is in lab, expensive, often inaccurate..................Lab is the gold standard ad very acurate. also, i am a honest 3rd party in evaluation

Currently titration is done in a sleep lab....

I think this would work better:

We make this a government sponsored development project. This gets rid of the current start up capital issues and crazy stunted development due to proprietary secrecy issues....Which makes a beareaucrat in charge and still expensive

Basically – take all of the sensors and make them usable by the person in his home. Should take less space than my desktop computer.....Who want to place leads on the scalp, measure, paste, accuracy etc

The person would come in for a couple of weeks of classes to learn how to put on, take off, use, and maintain the equipment. Practice would be done under the supervision of the instructor and/or helpers. At the end of this set of classes he would leave with the suitcase the little box was in.... So your saying turn a one nite PSG into a 2-3 week ordeal

The sleep testing portion would take several nights to get a base – or – the titration portion would start if the persons OSA was so bad that to wait longer would be medically unwise... so the patient comes in every day to be looked at for OSA

Titration / acclimation should be done over the next three to six weeks and part of what the contents of the box are designed to do... does the box come with a variety of masks, sizes, colors maufactueres

Then the kind of general use machine can be determined, additional classes scheduled if needed, and the person brings back the “Sleep Lab in a Box” to exchange for is daily PAP. More cost to have someone there to change it out

The daily PAP would be connected by the cell phone network or Internet to a data analysis center. The persons data would be available to him over the web for lifestyle management feedback. The data would also be automatically parsed and e-mails or calls would be made to the person and his doctor if problems arise.... So ev1 has an internet connection now

Very very slow titration would be done regularly to follow the persons actual pressure needs. Perhaps half a cm/H2O change checked for ten or so days – determine direction – move again if deemed wise... The companies that make 1/2 CWP machines stopped due to cost

Once the initial development was done the boxes would be mass produced – low cost... ONE box fits all thinking...sorry

The boxes would be reusable... uhh, yeah, like i would want to use a box from a ill, contageous person would you.

The overhead of building and staff would be considerably less... true this....i can go to a warehouse

[Todzo]

Lab is the gold standard ad very acurate. also, i am a honest 3rd party in evaluation

not from what i have read

[stage0]

I have met the ppl that cheat on the PSG to obtain SSI, MediCal and OTR license. Do you think that a trained 3rd party doing theri job, under the scrutiny or another person, doing their job; would be better than the person that takes home the box and just trust him/her to be honest.

[49er]

I have met the ppl that cheat on the PSG to obtain SSI, MediCal and OTR license. Do you think that a trained 3rd party doing theri job, under the scrutiny or another person, doing their job; would be better than the person that takes home the box and just trust him/her to be honest.

Dumb question - How can someone like myself cheat on a PSG so I can obtain SSI and Medical?

Since I don't have health insurance, I would love to know Of course, I would have to get the money for the study but one step at a time.

49er

[stage0]

In an actual clinic, with a RPSGT and a AASM doctor.....no. Belive it or not, some have tried to fool me here. It is not going to happen on my watch. Home sleep studies can be skewed, fooled and the gov't is clueless to this. Except DOT which requires OTR drivers to have a clinical PSG.

[49er]

In an actual clinic, with a RPSGT and a AASM doctor.....no. Belive it or not, some have tried to fool me here. It is not going to happen on my watch. Home sleep studies can be skewed, fooled and the gov't is clueless to this. Except DOT which requires OTR drivers to have a clinical PSG.

I am still not following you.

Are you saying someone will deliberately get the results manipulated so they can qualify for disability? Even if that was happening, it is very hard to get SSI from what I understand as you have to prove a major impairment.

People I know have legitimate disabilities have had to to apply several times before it was accepted.

49er

[49er]

Todzo,

I have to agree with Stageo, as I don't see what you are proposing as being more efficient.

I agree the sleep lab doesn't always provide the most accurate tests. Dr. Krakow has said that he feels his patients needs to come back about 3 times to really get an accurate result.

However, I think from what I have read, it is more accurate than a home study. And if the doctor thinks that the person has other sleep disorders besides apnea, a lab study is definitely necessary.

It definitely may be in my situation. For example, in looking back at my data, without using the neck collar, I have been unable to get an AHI below 5 even at pressures of 17 EPAP and 19 IPAP. I also seem to have centrals that while they don't seem to be huge in number, seem to be a constant factor. Obvious in my case, another home study would not be useful in my opinion.

For other people, a home study and a week titration would be appropriate assuming it is pretty clear that they have apnea and nothing else.

As in many areas of medicine, I just don't think you can make blanket generalizations. By the way, I say this as someone who previously did this with meds, labeling them as bad. But as I learned with my sleep issues, it isn't an either or situation.

49er

[deltadave]

Dumb question - How can someone like myself cheat on a PSG so I can obtain SSI and Medical?

I can fix it so you'll get a new European PaceWave ASV CS2!

Just PM your name and address so I can file a qui tam afterwards.

Just do it by next Friday. I need Christmas $$$.

Thanks!

[49er]

Dumb question - How can someone like myself cheat on a PSG so I can obtain SSI and Medical?

I can fix it so you'll get a new European PaceWave ASV CS2!

Just PM your name and address so I can file a qui tam afterwards.

Just do it by next Friday. I need Christmas $$$.

Thanks!

[stage0]

Sorry for my ineptitude in words 49er....I am saying that some ppl that come to my facility for a PSG want me to falsify the test....which I would not do...AND....that the home sleep studies can be fooled/skewed.

[49er]

Sorry for my ineptitude in words 49er....I am saying that some ppl that come to my facility for a PSG want me to falsify the test....which I would not do...AND....that the home sleep studies can be fooled/skewed.

Nah, you're good

I guess I am just finding it hard to believe since I can think of better ways to cheat than ask someone to falsify a sleep test.

And as I mentioned previously, even when you have a legitimate disability, particularly invisible ones, getting SSDI is very hard to obtain.

49er

[Todzo]

Todzo,

I have to agree with Stageo, as I don't see what you are proposing as being more efficient.

I agree the sleep lab doesn't always provide the most accurate tests. Dr. Krakow has said that he feels his patients needs to come back about 3 times to really get an accurate result.

However, I think from what I have read, it is more accurate than a home study. And if the doctor thinks that the person has other sleep disorders besides apnea, a lab study is definitely necessary.

It definitely may be in my situation. For example, in looking back at my data, without using the neck collar, I have been unable to get an AHI below 5 even at pressures of 17 EPAP and 19 IPAP. I also seem to have centrals that while they don't seem to be huge in number, seem to be a constant factor. Obvious in my case, another home study would not be useful in my opinion.

For other people, a home study and a week titration would be appropriate assuming it is pretty clear that they have apnea and nothing else.

As in many areas of medicine, I just don't think you can make blanket generalizations. By the way, I say this as someone who previously did this with meds, labeling them as bad. But as I learned with my sleep issues, it isn't an either or situation.

49er

Hi 49er!

Consider that the average smart phone has - what - thousands of times the computing power of our strategic air command of days past.

Technology has moved on.

I believe that today they are doing active research taking the entire PSG capabilities into the home – using the new hardware designed to do this - finally - to show the true difference with the expensive lab setting.

So we take that ENTIRE PSG capability and put it into a box with hardware designed so a person can use the whole thing themselves.

We have likely more than 18,000,000 diagnosis to do. In terms of cost and lab availability with what we currently have that will never happen.

So the cars come off the road, the tractor trailers as well, productivity drops, relationships fail, and our hospitals are filled with the strokes and heart attacks and failed kidneys of those who will never work again.

We can not afford not to do this!!!

What I have proposed here is a rough system sketch. People are dieing. Lets start building!!

And do have a great week 49er!

Todzo

[Janknitz]

It's already been done.

Kaiser uses the Itamar Watch Pat device for home testing, and then does home titrations via PR System One Auto Paps. They do this on hundreds of patients a week.

If you have run of the mill OSA, it's a great way to be tested, IMHO. It is done in your own bed, your own sleeping conditions. You don't have to be hooked up to a lot of wires (there are two wires that are put on two fingers, the device is strapped to your forearm), you don't have some stranger watching you all night.

The titration at home takes place over the course of a week. That way you get a better picture of your pressure needs than doing it in a single night (or half night) in a very foreign environment.

This may not be best for people with more complex SA, RERA's, RLS or PMLD, but it makes huge sense for probably 80% of the SA population. And it can certainly screen for those who need more specific testing in a sleep lab.

A lot more people can be screened and set upon treatment plans, at a lower cost and lower stress and anxiety for the individuals who have sleep apnea. It's not flawless, but I personally think it's a good process.

[Todzo]

It's already been done.

Kaiser uses the Itamar Watch Pat device for home testing, and then does home titrations via PR System One Auto Paps. They do this on hundreds of patients a week.

If you have run of the mill OSA, it's a great way to be tested, IMHO. It is done in your own bed, your own sleeping conditions. You don't have to be hooked up to a lot of wires (there are two wires that are put on two fingers, the device is strapped to your forearm), you don't have some stranger watching you all night.

The titration at home takes place over the course of a week. That way you get a better picture of your pressure needs than doing it in a single night (or half night) in a very foreign environment.

This may not be best for people with more complex SA, RERA's, RLS or PMLD, but it makes huge sense for probably 80% of the SA population. And it can certainly screen for those who need more specific testing in a sleep lab.

A lot more people can be screened and set upon treatment plans, at a lower cost and lower stress and anxiety for the individuals who have sleep apnea. It's not flawless, but I personally think it's a good process.

Hi Janknitz,

I have been following the whole Kaiser - rather innovative - probably way ahead of the curve process (from a great distance) for several years.

I see in the testing and titrating process several great needs:

The process needs to be done in the home. Testing done out of the home is not valid due to the fact that being out of the home is very much not the same as in the home. From a scientific stand point, the person must be in their natural environment. If you did sleep in a lab every night an in lab sleep test would be great.

The process needs to take enough data. The WatchPAT looks only at PAT - and I think oximetry is added. I am talking about FULL PSG. I see no technical reason this cannot be done.

The process needs to be done over several days (testing) or weeks (titration). We do not sleep the same every night - indeed other than an occasional "0.0" I cannot recall ever seeing the same AHI twice! I believe the new research will show this conclusively.

I am talking about scrapping the system that we have, that clearly does not work, and building something that will!!!!!

Thanks for the post!

Have a great weekend!

Todzo