Question about split night studies

[palerider]

whose idea is it to have another study?

if yours, why?

you've already got, as others have said, a better tool to determine appropriate pressures, if you just start learning what the data from your machine means.

[MrGrumpy]

I changed sleep doctors recently, because of a problem Ive been experiencing for several years now. It was this new sleep doc's idea to do a split night in the lab. I have not had an in lab sleep study since late 2008, the professional protocol, if you dont know, is if you have lost or gained more than twenty pounds since your last sleep study, they recommend you have a new one. Ive lost 87 lbs, PLUS had my tonsils taken out almost three years back.

Im letting the new doctor figure the problem out because Ive tried to figure out and cant figure it out. Thats what doctors do, if they are any good, figure stuff out and prescribe. Im figuring I need a new pressure. Or there maybe something going on I dont know about that is new.

I already know how to interpet my data, have been doing this since 2007 and have premo machines. But like I said, sometimes sleep medicine problems get too complicated for me to fix, I aint a friggin doctor and dont want to be one, either.

whose idea is it to have another study?

if yours, why?

you've already got, as others have said, a better tool to determine appropriate pressures, if you just start learning what the data from your machine means.

[palerider]

the professional protocol, if you dont know, is if you have lost or gained more than twenty pounds since your last sleep study, they recommend you have a new one.

I'm frankly amazed, after the near complete distrust that you have with insurance companies, at the amount of trust you have in sleep doctors.

did you ever consider that the "professional protocol" and much of the industry, is designed to keep you coming back for VERY expen$ive testing? perhaps that's why many places would rather give out dumb bricks and, as someone else here was told recently, "just come back for a new study if anything changes or you don't feel good". ka-CHING.

at any rate, I DO hope you get all your questions answered in your study, and start getting better sleep.

[MrGrumpy]

That is, the general rule. If things are going well for a long while but then say, something changes for the worse, generally you go to the sleep doctor. Oftentimes more than not, that might mean a new sleep study or a re-titration study. Particularly in the cases of significant weight loss or weight gain, throat or nasal surgery, being put on certain types of sedating medications, etc.

Are you implying that you have been your own sleep medicine physician? Did you titrate yourself?

the professional protocol, if you dont know, is if you have lost or gained more than twenty pounds since your last sleep study, they recommend you have a new one.

I'm frankly amazed, after the near complete distrust that you have with insurance companies, at the amount of trust you have in sleep doctors.

did you ever consider that the "professional protocol" and much of the industry, is designed to keep you coming back for VERY expen$ive testing? perhaps that's why many places would rather give out dumb bricks and, as someone else here was told recently, "just come back for a new study if anything changes or you don't feel good". ka-CHING.

at any rate, I DO hope you get all your questions answered in your study, and start getting better sleep.

[palerider]

Are you implying that you have been your own sleep medicine physician? Did you titrate yourself?

the closest I've ever come to seeing a sleep doctor was discussing technical issues of therapy with okcsleepdoc on the irc channel recently. (things like, do leaks cause pressure to increase (no), can higher PS cause some people to have central events (yes), do leaks affect flow limitation reading (not unless they're REALLY BAD leaks), and other fun subjects).

a friend 'diagnosed' my sleep apnea in 2009 and bought me a used machine off craigslist, with the rudimentary data from that and a lot of reading here, I picked a pressure that controlled my rather severe apnea.

after the *horror* stories my friend told me about the sleep study and titration study he had to go through, how uncomfortable it was, how miserabele he was, and how much it cost him, and how little (a few minutes) 'care' he got from the sleep doctor, .... I had no desire to subject myself to that.

again, as I said, I honestly wish you well, hope you get the answers you seek, and achieve better sleep.

[MrGrumpy]

Dude, with all due respect, you should not be posting here. Ive never in my life heard of anything like this before. Particularly with the advanced type of Bipap machine you have listed...that machine is reserved for very severe, particular types of sleep disordered breathing.

I did not find sleep studies bothersome and am not afraid of being wired up and stuff like you are. What I am concerned about and have experienced two times before, is going thru sleep studies, having my insurance being billed and being blown off by the sleep doctor. It happens all the time.

Another thing YOU should be thinking about is if you have totally self diagnosed yourself and totally self titrated yourself, if you did have some sort of medical emergency and ended up in an ER and told the ER doctor "yeah, Im on autoBipap" and the ER doc asked you, "who is your sleep doc?" and you replied, "I dont have one, I bought my autobipap off craigslist and self titrated," do you know where they'd send you? TO THE FRIGGIN PSYCH WARD!!

I aint joking man. Youre a headcase. With all due respect. You are crazy. Its one thing taking matters into your own hands to an extent once youve been formally diagnosed by a SLEEP DOCTOR and been issued gear at least once, been titrated in a lab, etc. I do that, I buy a lot of my own gear now because its just easier and less hassle because it bypasses health insurance and I hate dealing with the health insurance bs. But honestly dude, youre bona fide psychotic if what you are telling me is the honest truth. There is being "involved" in your own treatment and then there is the "I went insane and became my own sleep doctor and bought an autobipap off Craigslist."

Get some psych help, man.

Are you implying that you have been your own sleep medicine physician? Did you titrate yourself?

the closest I've ever come to seeing a sleep doctor was discussing technical issues of therapy with okcsleepdoc on the irc channel recently. (things like, do leaks cause pressure to increase (no), can higher PS cause some people to have central events (yes), do leaks affect flow limitation reading (not unless they're REALLY BAD leaks), and other fun subjects).

a friend 'diagnosed' my sleep apnea in 2009 and bought me a used machine off craigslist, with the rudimentary data from that and a lot of reading here, I picked a pressure that controlled my rather severe apnea.

after the *horror* stories my friend told me about the sleep study and titration study he had to go through, how uncomfortable it was, how miserabele he was, and how much it cost him, and how little (a few minutes) 'care' he got from the sleep doctor, .... I had no desire to subject myself to that.

again, as I said, I honestly wish you well, hope you get the answers you seek, and achieve better sleep.

[MrGrumpy]

I ask about split night studies and get answered by some dude sounding authorative on the subject WHO NEVER EVEN EVER HAS BEEN TO A SLEEP STUDY BEFORE. LMFAO!

I guess it really is true, the old saying, "I read it on the Internet and therefore it must be true." LOL

<shaking head> Damn Palerider....GO GET SOME PSYCH HELP

[OkyDoky]

While I don't have severe breathing problems and no lung problems, I found it difficult to breath against pressure and I required higher pressures. I was prescribed bilevel and have the newer model of PaleRider's machine.
Here are the indications for bilevel S from ResMed
Indications for S therapy
• CPAP intolerance
• Continued obstructive events at
higher pressures
• Hypoventilation with SpO2 < 90%
• COPD

While there are other more advanced bilevel machines that are for more severe conditions, not all bilevels are the same. Not only can they help with comfort they might also decrease aerophagia with the higher pressures.

This info reguarding Split Night Studies came from this How to interpret your Sleep Study. http://www.daveburrows.com/cpap/sleepst ... pstudy.pdf

Split Night Study
• Initial diagnostic PSG followed by CPAP titration during the same
night
• Typically need 2 hours of sleep prior to applying CPAP followed by 3
hours of CPAP titration
• Compares the 2 sections of the test side by side
• Is an alternative to one full night of diagnostic PSG followed by a
second full night of titration if
– high likelihood for severe OSA
– patient reluctant or unable to undergo 2 full night studies
• Most labs have protocols for performing emergency Split night
studies based on AHI and lowest oxygen level observed

[palerider]

Dude, with all due respect, you should not be posting here. Ive never in my life heard of anything like this before. Particularly with the advanced type of Bipap machine you have listed...that machine is reserved for very severe, particular types of sleep disordered breathing.

dude, with all due respect, you clearly know nothing about bilevel machines, what they're used for, what conditions require them, or how they can be configured, OR who they're appropriate for. based entirely on your quoted, incorrect statement above.

I did not find sleep studies bothersome and am not afraid of being wired up and stuff like you are. What I am concerned about and have experienced two times before, is going thru sleep studies, having my insurance being billed and being blown off by the sleep doctor. It happens all the time.

good for you, not everybody enjoys it as much as you do, many people, if you read on the forum here, find the studies to be quite uncomfortable, and find themselves unable to sleep during them.

Another thing YOU should be thinking about is if you have totally self diagnosed yourself and totally self titrated yourself, if you did have some sort of medical emergency and ended up in an ER and told the ER doctor "yeah, Im on autoBipap" and the ER doc asked you, "who is your sleep doc?" and you replied, "I dont have one, I bought my autobipap off craigslist and self titrated," do you know where they'd send you? TO THE FRIGGIN PSYCH WARD!!

once again, you're 100% wrong... you really should stop talking about things you know nothing about. interestingly, I don't remember anybody here that used their own machine in the hospital being grilled about who their sleep doctor was... but maybe I missed that amusing story.

and, just to show how much you know, I DID happen to end up in the emergency room at the beginning of December, something you'd know if you actually read things here on the forum, instead of just shooting off your mouth. I took one of my spare vpap auto machines (it's not proper to call it an "autoBipap" since bipap is a trademark of respironics, and I have a resmed machine) with me, in the ambulance, knowing I'd need it.

after I'd been in the ER for a while, suffering with the horrible hospital issue full face mask, which was poorly vented and not at all helping the respiration problems I had, I asked if I could use MY mask instead. they called up to the respiratory department, who sent someone down, she talked to me a couple minutes about what I had, she took my, how'd you put it, "advanced type of Bipap machine" out of the case, set it up on a table next to me, and said "oh, I'll need to get an oxygen adapter for this, since you're on supplemental O2 right now", a few minutes later, she was back, handed me my P10 mask, unstrapped the facehugger, and I happily put my mask on.

she said "we'll monitor you closely, and if you start having any problems, or if your sats go down, we'll have to go back to our machine" "ok" I said, knowing that I was fine with my ....how'd you put it "totally self titrated yourself" settings.
I DID have to use their machine a couple times more, when they moved me up to the ICU, and again when they moved me to the ICU stepdown floor, because their machine had batteries in it, and would work while on the move. the rest of the time in the ER, the ICU and the hospital, I used my ... "autobipap off craigslist and self titrated" machine and settings.

I aint joking man. Youre a headcase. With all due respect. You are crazy. Its one thing taking matters into your own hands to an extent once youve been formally diagnosed by a SLEEP DOCTOR and been issued gear at least once, been titrated in a lab, etc. I do that, I buy a lot of my own gear now because its just easier and less hassle because it bypasses health insurance and I hate dealing with the health insurance bs. But honestly dude, youre bona fide psychotic if what you are telling me is the honest truth. There is being "involved" in your own treatment and then there is the "I went insane and became my own sleep doctor and bought an autobipap off Craigslist."

I ain't joking either, man, with all due respect, you're an ignorant, arrogant, fool that loves to shoot his mouth off about crap that he has no concept about, whatsoever. I'm not the only person here that's taken care of themselves, and I'm *FAR* from the only person that as used basic bi-level machines without a doctors approval, much less actual *ADVANCED* ones. ever heard of a servo ventilator? an adaptive servo ventilator? an IVAPS? I thought not.

Get some psych help, man.

excellent advice, you should take yourself up on it.... with all DUE respect.

and, just for shit's and giggles, here's what my, in your so august opinion, "bona fide psychotic" self diagnosis and treatment did last night:


I assume yours, being the product of sleep studies and doctor directives is better, yes?

[MrGrumpy]

My concern with Palerider's claims and weird story is not that he is using the same type of machine you are using. Its that he completely diagnosed himself without an actual Medical Doctor specializing in sleep medicine in charge. And then bought not just a plain ole AutoPap off of Craigslist and is using it, but bought about as fancy and expensive auto device as you can get, a Resmed autobipap NIV.

Its a crazy story. Then he comes on here as if he's some sort of of a patient expert or something. And he aint even ever been to a sleep medicine doctor's office in his life, it sounds like. Sounds like he's scared to from the way he writes.

I dont know whether to feel sorry for this guy and write him off as an Internet kook or to consider contacting the police. The dude is practicing sleep medicine on himself, IF his story is true. Its people like him that makes the Internet a highly unreliable place for good medical information.

While I don't have severe breathing problems and no lung problems, I found it difficult to breath against pressure and I required higher pressures. I was prescribed bilevel and have the newer model of PaleRider's machine.
Here are the indications for bilevel S from ResMed
Indications for S therapy
• CPAP intolerance
• Continued obstructive events at
higher pressures
• Hypoventilation with SpO2 < 90%
• COPD

While there are other more advanced bilevel machines that are for more severe conditions, not all bilevels are the same. Not only can they help with comfort they might also decrease aerophagia with the higher pressures.

This info reguarding Split Night Studies came from this How to interpret your Sleep Study. http://www.daveburrows.com/cpap/sleepst ... pstudy.pdf

Split Night Study
• Initial diagnostic PSG followed by CPAP titration during the same
night
• Typically need 2 hours of sleep prior to applying CPAP followed by 3
hours of CPAP titration
• Compares the 2 sections of the test side by side
• Is an alternative to one full night of diagnostic PSG followed by a
second full night of titration if
– high likelihood for severe OSA
– patient reluctant or unable to undergo 2 full night studies
• Most labs have protocols for performing emergency Split night
studies based on AHI and lowest oxygen level observed

[MrGrumpy]

Youre still a headcase, no matter what you say. Self diagnosing as youve done, with no prior in sleep lab sleep study or home study being monitored by someone else formally trained in this, IS PSYCHOTIC.

Thats all it is....PSYCHOTIC. You are a psychotic.

Dude, with all due respect, you should not be posting here. Ive never in my life heard of anything like this before. Particularly with the advanced type of Bipap machine you have listed...that machine is reserved for very severe, particular types of sleep disordered breathing.

dude, with all due respect, you clearly know nothing about bilevel machines, what they're used for, what conditions require them, or how they can be configured, OR who they're appropriate for. based entirely on your quoted, incorrect statement above.

I did not find sleep studies bothersome and am not afraid of being wired up and stuff like you are. What I am concerned about and have experienced two times before, is going thru sleep studies, having my insurance being billed and being blown off by the sleep doctor. It happens all the time.

good for you, not everybody enjoys it as much as you do, many people, if you read on the forum here, find the studies to be quite uncomfortable, and find themselves unable to sleep during them.

Another thing YOU should be thinking about is if you have totally self diagnosed yourself and totally self titrated yourself, if you did have some sort of medical emergency and ended up in an ER and told the ER doctor "yeah, Im on autoBipap" and the ER doc asked you, "who is your sleep doc?" and you replied, "I dont have one, I bought my autobipap off craigslist and self titrated," do you know where they'd send you? TO THE FRIGGIN PSYCH WARD!!

once again, you're 100% wrong... you really should stop talking about things you know nothing about. interestingly, I don't remember anybody here that used their own machine in the hospital being grilled about who their sleep doctor was... but maybe I missed that amusing story.

and, just to show how much you know, I DID happen to end up in the emergency room at the beginning of December, something you'd know if you actually read things here on the forum, instead of just shooting off your mouth. I took one of my spare vpap auto machines (it's not proper to call it an "autoBipap" since bipap is a trademark of respironics, and I have a resmed machine) with me, in the ambulance, knowing I'd need it.

after I'd been in the ER for a while, suffering with the horrible hospital issue full face mask, which was poorly vented and not at all helping the respiration problems I had, I asked if I could use MY mask instead. they called up to the respiratory department, who sent someone down, she talked to me a couple minutes about what I had, she took my, how'd you put it, "advanced type of Bipap machine" out of the case, set it up on a table next to me, and said "oh, I'll need to get an oxygen adapter for this, since you're on supplemental O2 right now", a few minutes later, she was back, handed me my P10 mask, unstrapped the facehugger, and I happily put my mask on.

she said "we'll monitor you closely, and if you start having any problems, or if your sats go down, we'll have to go back to our machine" "ok" I said, knowing that I was fine with my ....how'd you put it "totally self titrated yourself" settings.
I DID have to use their machine a couple times more, when they moved me up to the ICU, and again when they moved me to the ICU stepdown floor, because their machine had batteries in it, and would work while on the move. the rest of the time in the ER, the ICU and the hospital, I used my ... "autobipap off craigslist and self titrated" machine and settings.

I aint joking man. Youre a headcase. With all due respect. You are crazy. Its one thing taking matters into your own hands to an extent once youve been formally diagnosed by a SLEEP DOCTOR and been issued gear at least once, been titrated in a lab, etc. I do that, I buy a lot of my own gear now because its just easier and less hassle because it bypasses health insurance and I hate dealing with the health insurance bs. But honestly dude, youre bona fide psychotic if what you are telling me is the honest truth. There is being "involved" in your own treatment and then there is the "I went insane and became my own sleep doctor and bought an autobipap off Craigslist."

I ain't joking either, man, with all due respect, you're an ignorant, arrogant, fool that loves to shoot his mouth off about crap that he has no concept about, whatsoever. I'm not the only person here that's taken care of themselves, and I'm *FAR* from the only person that as used basic bi-level machines without a doctors approval, much less actual *ADVANCED* ones. ever heard of a servo ventilator? an adaptive servo ventilator? an IVAPS? I thought not.

Get some psych help, man.

excellent advice, you should take yourself up on it.... with all DUE respect.

and, just for shit's and giggles, here's what my, in your so august opinion, "bona fide psychotic" self diagnosis and treatment did last night:


I assume yours, being the product of sleep studies and doctor directives is better, yes?

[MrGrumpy]

You ever heard of practicing medicine without a license, Palerider? You are practicing medicine on yourself without a license. What if you get in a traffic accident because you are using your autobipap improperly, without MD supervision? And say hypothetically, in the traffic accident, you kill someone unintentionally. Your use of your NIV autoBipap could be used against you in a court of law in a traffic case, EASY. What if your used NIV autoBipap is not quite working right and your actually popping centrals? And you dont know it because you have no MD supervising your venture into practicing sleep medicine on yourself?

Would it not be easier, safer and more legal to at least consult with a sleep doctor once or twice? Would a sleep study be THAT BAD? Ive had five of them, they are not that bad and three of them I looked forward to. Your capacity is impaired, Palerider.

[MrGrumpy]

Palerider, I am (sorta kinda) trying to help you. You are sick but dont realize it. Ive been in the ER a few times for chest pain, shortness of breath, that kinda stuff. Ive also been to Urgent Care clinics for various stuff and Im in a bariatric weight loss clinic.

If youve ever been to a doctor before (have you?), the first thing they want to know is 1) what medications you are being prescribed, if any and 2) are you on any devices or other medical treatments such as oxygen therapy, CPAP/BiPAP, ECT for severe depression, cardiac implants, etc. etc. etc. This is all basic.

Once you tell them, "yeah Im on BiPap," the nurse taking in all the info will always ask you for records reasons, "who is your sleep physician?" They need to know that stuff for both medical consultation reasons as well as for just general background legal reasons. You go to the ER, they want to know who you are, what they are dealing with.

The reason they probably did not bother asking you about your sleep physican is they had already written you off as a headcase, especially if you told them you were using a used NIV BiPap. They probably were patronizing you in the ER, but you did not realize that at that time. I'd bet a silver dollar, your ER records have "NUT" in them.

[quote="MrGrumpy"

once again, you're 100% wrong... you really should stop talking about things you know nothing about. interestingly, I don't remember anybody here that used their own machine in the hospital being grilled about who their sleep doctor was... but maybe I missed that amusing story.

I aint joking man. Youre a headcase. With all due respect. You are crazy. Its one thing taking matters into your own hands to an extent once youve been formally diagnosed by a SLEEP DOCTOR and been issued gear at least once, been titrated in a lab, etc. I do that, I buy a lot of my own gear now because its just easier and less hassle because it bypasses health insurance and I hate dealing with the health insurance bs. But honestly dude, youre bona fide psychotic if what you are telling me is the honest truth. There is being "involved" in your own treatment and then there is the "I went insane and became my own sleep doctor and bought an autobipap off Craigslist."

I ain't joking either, man, with all due respect, you're an ignorant, arrogant, fool that loves to shoot his mouth off about crap that he has no concept about, whatsoever. I'm not the only person here that's taken care of themselves, and I'm *FAR* from the only person that as used basic bi-level machines without a doctors approval, much less actual *ADVANCED* ones. ever heard of a servo ventilator? an adaptive servo ventilator? an IVAPS? I thought not.

Get some psych help, man.

excellent advice, you should take yourself up on it.... with all DUE respect.

and, just for shit's and giggles, here's what my, in your so august opinion, "bona fide psychotic" self diagnosis and treatment did last night:


I assume yours, being the product of sleep studies and doctor directives is better, yes?[/quote]

[OkyDoky]

If you take the time and search the internet you will find the very same titration guides that the sleep labs use. Yes there may be some things that the sleep labs can pick up on that you can't with just a machine, such as RLS or PLMD but a video at night may point you in that direction if you suspect it as a problem and you can talk with your doctor. I'm not against sleep studies and think they can be helpful in many cases but sometimes people for financial (not everyone can afford a sleep doctor) or personal reasons have self titrated their pressures. Some have their GP or dentist write the Rx.

Just because Palerider has his on style of communication doesn't mean he doesn't know what he's talking about. Because he does.

[MrGrumpy]

Yes, I am aware if you look hard enough for the info, you can find much of this titration stuff online. Im also smart enough to know that technically, I could use the 95th percentile for my last thirty days on my Resmed S9, switch my machine over to CPAP mode and just set it for my 95th percentile. Ive tried that and guess what? IT DID NOT WORK.

Thats why I, along with most normal people, need a "touch up" sleep study once in a while. To find out things we cant find out ourselves. I dont have a camera in my room. A normal person is not going to titrate themselves except in rather simple terms. Ive done it in the past where that worked and other times, like now, where it does not work.

Another concern for that guy is he is using a very advanced machine. A Resmed NIV autoBipap. IVe used one actually, asked my sleep doctor if I could try one because i was having trouble with abdominal pains I did not used to have before the tonsillectomy. It did not work for me, that may have been because it was not set up specifically for me, he had the techs just set it up generally with my inhale/exhale pressures and thats about it.

This guy is self titrating one of the most complicated auto-titrating bipaps there is. A machine that requires some major respiratory therapist/sleep tech knowledge. That machine is not just another S9 or S10 APAP or Phillips Respironics APAP where you sleep on it for a month or six weeks on 4 to 20 and punch a few buttons and get your 95th percentile for the last thirty days and voila, you have your pressure for CPAP mode. That machine is WAY MORE complicated than that.

Unless he graduated from sleep tech training (and please dont tell me he has done that), he does not have the technical expertise to do what he is doing. He might think he has, you might think he has, but he could be screwing himself up.

Its just weird, too. Super weird. Like I said, it is not a plain jane AutoPap set 4-20 for thirty days. Thats a fancy ass machine there he has.

If you take the time and search the internet you will find the very same titration guides that the sleep labs use. Yes there may be some things that the sleep labs can pick up on that you can't with just a machine, such as RLS or PLMD but a video at night may point you in that direction if you suspect it as a problem and you can talk with your doctor. I'm not against sleep studies and think they can be helpful in many cases but sometimes people for financial (not everyone can afford a sleep doctor) or personal reasons have self titrated their pressures. Some have their GP or dentist write the Rx.

Just because Palerider has his on style of communication doesn't mean he doesn't know what he's talking about. Because he does.