NY Times re Home Testing

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Julie
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NY Times re Home Testing

Post by Julie » Thu Jul 24, 2014 4:26 am

"Ten years ago, I spent two nights in a sleep lab at SUNY Downstate Medical Center, taking the test for sleep apnea, and wrote about it for Science Times.

Back then, “sleep technicians” wired me up like the Bride of Frankenstein: 15 sensors glued or clamped to my scalp, lip, eye sockets, jaw, index finger, chest and legs, two belts around my torso, and a “snore mike” on my neck.

As I slept, an infrared camera watched over me. And I ended up spending 23 hours in that hospital bed because the test wasn’t over until you could lie in a dark room for 20 minutes without dozing off. I had such a sleep deficit that I kept conking out, not just all night, but all the next day.

So this year, when a company called NovaSom offered to let me try out a new home sleep-test kit that promises to streamline the process, I said yes.

In the decade since my ordeal, the pendulum has swung sharply in the direction of the home test, said Dr. M. Safwan Badr, past president of the American Academy of Sleep Medicine, which first recognized home testing for apnea in 2007. Insurers prefer it because it costs only about $300, about one-tenth that of a hospital test, and many patients like it, too.

“Lots of people are reluctant to let a stranger watch them sleep,” said Dr. Michael Coppola, a former president of the American Sleep Apnea Association who is now the chief medical officer at NovaSom.

Doctors estimate that 18 million Americans have moderate to severe apnea and 75 percent of them do not know it.

Home testing is not recommended for those with heart failure, emphysema, seizures and a few other conditions. And because it does not record brain waves as a hospital lab does, a home test can be fooled by someone who just lies awake all night staring at the ceiling. But it’s useful for many people who exhibit the warning signs of apnea, such as waking up exhausted after a full night’s sleep or dozing off at the wheel in bright daylight. And severe apnea can be lethal: starving the brain of oxygen all night quadruples the risk of stroke.

Ten years ago, after my long lab night, I was given a diagnosis of mild apnea.

The likely culprits were that I was overweight, had some bad habits — coffee-fueled evenings at work followed by late wine-fueled dinners at home — and that I had a “crowded airway.” (The doctor looking down my throat said “Wow!” My uvula apparently resembles not a punching bag but a stalactite.)

The Downstate doctors made me abstain from coffee and alcohol for 24 hours and be tucked in just after 9 p.m. I protested that my life was not like that. But it had been years since I had negotiated bedtime with an authority figure. I lost.

After my diagnosis, they offered three options: I could lose weight, drink less and go to bed earlier. I could have airway surgery. Or I could sleep with a CPAP (continuous positive airway pressure) machine blowing air into my lungs.

For me, surgery was out. A cousin said it was the most painful thing he had ever endured, changed the way he spoke and didn’t cure his apnea. I tried the CPAP and hated it: Although for many people it is a lifesaver, I felt as if I were sleeping inside Darth Vader’s helmet. So I joined Weight Watchers and lost 35 pounds.

Ten years later, my habits are still imperfect — I still drink a bit more than I should, and I’ve gained back 15 pounds. In bad weeks, my BMI is 25, right on the border of normal and overweight. As for my snoring, depending on the audience, it has been described as “pretty awful” and “some of the least offensive I’ve heard.”

The home test is done over three nights, and I made them as true-to-life as possible: I did the first with no alcohol or caffeine, then one with my typical amount, then one with too much. On Night 2, to add to the challenge, I invited over a friend and her dog.

The device arrived by mail (and is mailed back later). I was able to wire myself up without help in 15 minutes: a belt clipped around my chest, a finger poked into a blood-oxygen sensor and a breath sensor hooked over my ears and taped beneath my nose. All three plugged into a box the size of a computer modem strapped on my arm.

The best part: By shifting the box or laying it on the pillow, I could sleep almost normally. At the hospital, my 15 wires had felt like marionette strings keeping me on my back. At home, I could flip from side to side, as usual.

The first night was during a major snowstorm. I ate dinner early and drank only water, tired myself out by shoveling a foot of snow and was soon so bored that I went to bed at 8:30. I slept 10 hours and even had dreams. (The usual: Trapped in a giant men’s room. Sounds kinky, but even Freud would agree that its deeper meaning is: “Hey, stupid! You need to go! Wake up!”)

On the second night, my friend and I had dinner with wine and talked till midnight. She said the tape mustache holding the sensor under my nose was not as dashing as Errol Flynn’s. That night was fitful — the house furnace ran too hot, the dog yipped unpredictably. I finally put in my radio earbuds to block the noise, so I didn’t notice that a wire had come loose and the device was telling me off, intoning, “Check finger sensor!” over and over.

On the third night, I met another friend to hash out his marital woes over about five beers, walked home and went to bed woozy. I dropped off fast but woke up soaked in sweat at 3 a.m.

Each morning, as I plugged the device in to recharge, it beamed the night’s data to NovaSom.

A few days later, I got my results in a phone call from Dr. Coppola.

They were better than I had expected.

“It’s plenty of data,” he said. “We got 21 hours of recording time. And you’re all good.”

Apnea is measured on the apnea/hypopnea index — how many times an hour a person stops or nearly stops breathing for at least 10 seconds. Below five times is minimal, five to 15 is mild, 15 to 30 is moderate, more than 30 is severe.

A Sleep Apnea Test Without a Night in the Hospital
By DONALD G. MCNEIL JR. JULY 21, 2014 5:37 PM

My three nights were 1.5, 0.7 and 2.4. So, even on the third, alcohol-heavy night, I was in the “minimal” range, though I’d had a 10-minute cluster of apneas at 2 a.m. that dropped my oxygen level to 78 percent — the normal is 90 percent or higher. “Probably you were sleeping on your back at that moment,” Dr. Coppola said.

One thing did trouble me, I told him: “This says I snored 98 percent of the time? That’s impossible. I have witnesses.”

“That’s not really snoring,” he said. “It’s any loud breathing. The mike is sensitive.”


My previous apnea diagnosis, Dr. Coppola said, was probably a result of the big trail of brain-wave sensor wires forcing me to sleep on my back, which closed my already narrow airway. Lab monitoring, he said, “creates false sleep scenarios.”

“The good news,” he added, “is that your lifestyle changes made a big difference. So keep the weight off, don’t drink more, and you should be O.K.”

Maybe easier said than done. But we’ll see.

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Re: NY Times re Home Testing

Post by Pesser » Thu Jul 24, 2014 10:17 am

Excellent post Julie!

This industry reminds me of the “hearing aid industry”, the “Fuller Brush” salesmen, the old aluminum siding industry etc… If he had OSA while on his back in the first test does he have OSA? If I sleep on my back I will have OSA; for sure! When you’re born they lay you on your back. When you’re injured they lay you on your back. Being on your back is likely the most restful place for all your organs. Isn’t being on your back a good thing when your breathing is right? If your breathing is wrong then you fix it. How is snoring hard, OK for anyone. I’m starting to believe that all of this OSA is under diagnosed and snoring with OSA is very dangerous.

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Re: NY Times re Home Testing

Post by Day_Dreamer » Thu Jul 24, 2014 11:11 am

I also could not complete an in lab sleep test for the numerous reasons outline above. After 2 attempts I was not going through another. I took a home Sleep test and 4 months later (after being prescribed APAP) I can sleep 6-8 hours with only a few interruptions. Previously sleep was extremely fragmented and often less than 5 hours

I did need 5 beers to get to sleep during the HST. My current sleep Doc says no alcohol at all. I miss beer

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Christine L
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Re: NY Times re Home Testing

Post by Christine L » Thu Jul 24, 2014 11:57 am

To get a job writing for a newspaper, do you have to be a big, whiney baby?

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Re: NY Times re Home Testing

Post by Janknitz » Thu Jul 24, 2014 4:28 pm

I'm a big believer in home sleep tests, I NEVER would have done an in lab test, that's just not going to happen. I would be in total panic mode with all the wires, the strange bed, and people watching me sleep. Nope, no way, no how.

The home tests are approved by Medicare and many other insurers because they do provide sufficient data to make the diagnosis. To me it makes great sense to test people in their own beds and sleeping conditions. And titrate at home, too.

I do not think they are inferior to lab tests for run of the mill OSA, though if someone had a more complex issue that may not hold true. I think they are superior for OSA.

And after all the horror stories I've seen here--dirty facilities, surly techs, uncomfortable beds and rooms, gooey wire attachments, techs that disappear in the middle of the night to go outside to smoke or yak on the phone, other patients disrupting sleep, etc? NO thank you!
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Re: NY Times re Home Testing

Post by chunkyfrog » Thu Jul 24, 2014 5:12 pm

Christine L wrote:To get a job writing for a newspaper, do you have to be a big, whiney baby?
If it's a very small local paper, you need little more than the right DNA;
for larger towns, it's a combination of talent and timing, and amazing luck.
To write for Yahoo. who the heck knows? --kneepads?

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Re: NY Times re Home Testing

Post by 49er » Fri Jul 25, 2014 12:41 am

Janknitz wrote:I'm a big believer in home sleep tests, I NEVER would have done an in lab test, that's just not going to happen. I would be in total panic mode with all the wires, the strange bed, and people watching me sleep. Nope, no way, no how.

The home tests are approved by Medicare and many other insurers because they do provide sufficient data to make the diagnosis. To me it makes great sense to test people in their own beds and sleeping conditions. And titrate at home, too.

I do not think they are inferior to lab tests for run of the mill OSA, though if someone had a more complex issue that may not hold true. I think they are superior for OSA.

And after all the horror stories I've seen here--dirty facilities, surly techs, uncomfortable beds and rooms, gooey wire attachments, techs that disappear in the middle of the night to go outside to smoke or yak on the phone, other patients disrupting sleep, etc? NO thank you!
Even though I didn't have a good experience with an HST due to it being a new test and the incompetence of the providers who administered it, I agree with you Janknitz. I do plan to have a full scale test if the person I am seeing next month recommends it. But I will definitely have a med on hand to use in case I can't fall asleep which I greatly fear will happen.

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Julie
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Re: NY Times re Home Testing

Post by Julie » Fri Jul 25, 2014 3:33 am

My only concern would be that not knowing if there were other issues besides plain old OA, having 'just' a home test could leave you with problems that you spend months trying to work out once you get a machine, if you bother to last that long at all, and you never get your other problems (RERA, Plmd, etc.) worked out... I had an in-hospital study and then a home test, but knew nothing useful about anything until later on (mostly from the forum).

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Re: NY Times re Home Testing

Post by 49er » Fri Jul 25, 2014 3:42 am

Julie wrote:My only concern would be that not knowing if there were other issues besides plain old OA, having 'just' a home test could leave you with problems that you spend months trying to work out once you get a machine, if you bother to last that long at all, and you never get your other problems (RERA, Plmd, etc.) worked out... I had an in-hospital study and then a home test, but knew nothing useful about anything until later on (mostly from the forum).
And of course, I could turn out to be living proof of that.

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Sludge
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Re: NY Times re Home Testing

Post by Sludge » Fri Jul 25, 2014 4:00 am

Read the original article:

http://well.blogs.nytimes.com/2014/07/2 ... blogs&_r=0

See what he looked like 10 years ago:

Image

And now:

Image

And what Coppola said:
“The good news,” he added, “is that your lifestyle changes made a big difference. So keep the weight off, don’t drink more, and you should be O.K.”
Which kinda makes this whole thing a pile of batcrap.
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Sludge
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Re: NY Times re Home Testing

Post by Sludge » Fri Jul 25, 2014 4:04 am

But hey, no prob!

Like he says:
...it costs only about $300, about one-tenth that of a hospital test, and many patients like it, too.
Wait'll he comes into the hospital and drops a million dollars on his stroke (assuming he survives. If not, that would certainly be a huge cost-saver).
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Sludge
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Re: NY Times re Home Testing

Post by Sludge » Fri Jul 25, 2014 4:13 am

Christine L wrote:To get a job writing for a newspaper, do you have to be a big, whiney baby?
I don't know, but given his history:
I dropped off fast but woke up soaked in sweat at 3 a.m...

...I’d had a 10-minute cluster of apneas at 2 a.m. that dropped my oxygen level to 78 percent.
I figure his spot should open up within 5 years.
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Re: NY Times re Home Testing

Post by 49er » Fri Jul 25, 2014 4:27 am

Great points Sludge. Nothing like responsible journalism.

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Christine L
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Re: NY Times re Home Testing

Post by Christine L » Fri Jul 25, 2014 6:38 am

And he is happy with what he looks like ten years later? Ewwwww. Shoulda used CPAP.

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Re: NY Times re Home Testing

Post by BlackSpinner » Fri Jul 25, 2014 8:19 am

And of course the false idea that losing weight will mean you don't have to wear the awful cpap machine is nicely emphasized.

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