What was the benefit of a home sleep test?

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Melanndoll
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What was the benefit of a home sleep test?

Post by Melanndoll » Sat Jan 24, 2015 9:08 pm

I did a home slee test originally to save money. But now I'm here, at the hospital have a cpap titration study which seems very similar to a sleep study. If I had to do this anyway, what was the point in the home test?!

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RogerSC
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Re: What was the benefit of a home sleep test?

Post by RogerSC » Sat Jan 24, 2015 9:24 pm

Well, I for one had a real problem sleeping in a sleep lab for my sleep study, one of the worst nights of sleep (or lack thereof) that I've ever had. Had to try to go to sleep too early, finally got about 3 hours of sleep after about 4 or 5 hours awake, then dumped out of the sleep center to get home in a very sleepy state. If I could have taken a home sleep study, that would have worked much better for me. One of the real benefits for a home sleep study would be if the study subject is found to not have sleep apnea problems, then no need to go try and sleep in a sleep lab. Needless to say, I opted not to have a titration sleep study, and self-titrated on an apap.

While some people can sleep anywhere, there are a lot of us that are light sleepers, that have a problem sleeping on command *smile*. So I, for one, am going to take every opportunity I can to sleep in my own bed with my own pillow and nice, comfortable mattress.

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palerider
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Re: What was the benefit of a home sleep test?

Post by palerider » Sat Jan 24, 2015 9:30 pm

Melanndoll wrote: If I had to do this anyway, what was the point in the home test?!
because the home test is a lot cheaper to find out whether you need the pressure determination session.

some more forward thinkng insurance companies just send you home with an auto machine and let you figure it out for yourself.

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Melanndoll
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Re: What was the benefit of a home sleep test?

Post by Melanndoll » Sat Jan 24, 2015 9:37 pm

Yeah, I wish I would have been able to figure it out at home with an auto or something. I'm just scared that this is going to cost an arm and a leg!

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Re: What was the benefit of a home sleep test?

Post by BrooklynCPAPer » Sat Jan 24, 2015 9:41 pm

I think a home sleep test can be good in some cases, particularly for those who have trouble sleeping in the lab. But, my doctor also told me they underestimate the severity of apnea. My AHI is 8 in lab but came up as 2 on a home sleep test. I suppose if my apnea was moderate to severe, a home study would be more useful.

My titration study though was a whole other story and in hindsight should've insisted on APAP self-titration. My pressures in Sleepyhead never read above 12 and 6-8 is where i spend most of my time but now that I've been using a machine for a few weeks, I now know the tech must've had the machine cranking at least at 15 with a mask tight enough to make orange juice. I think i probably only slept about 3 hours tops and not all in one chunk that night!

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Melanndoll
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Re: What was the benefit of a home sleep test?

Post by Melanndoll » Sat Jan 24, 2015 9:45 pm

Darnit! I really wish I had insisted on that as well. Didn't know that was an option. This whole circus is so confusing!

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Re: What was the benefit of a home sleep test?

Post by BrooklynCPAPer » Sat Jan 24, 2015 10:01 pm

It is indeed a circus but in less than a month on CPAP therapy, I've gotten a lot of support from this forum. One thing I have learned to accept is that I can't go back and change past tests but as I continue with treatment, I can ask more intelligent questions instead of just assuming my doctor will always have my best interest in mind.

I'm also switching sleep doctors but that's been a series of cumulative events and not a decision that I've taken lightly. Good luck - things will work out!

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Neecerie
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Re: What was the benefit of a home sleep test?

Post by Neecerie » Sat Jan 24, 2015 11:14 pm

palerider wrote:
Melanndoll wrote: If I had to do this anyway, what was the point in the home test?!
because the home test is a lot cheaper to find out whether you need the pressure determination session.

some more forward thinkng insurance companies just send you home with an auto machine and let you figure it out for yourself.


Mine did a home test, then sent me home with an auto machine....

Luckily both the Dr and the DME/sleep clinic appear so far to be really good ones, rather than the poor ones people post about.

But I did at least know what to ask about etc, before going in, just in case.

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Re: What was the benefit of a home sleep test?

Post by Sleeprider » Sat Jan 24, 2015 11:25 pm

Melanndoll wrote:I did a home slee test originally to save money. But now I'm here, at the hospital have a cpap titration study which seems very similar to a sleep study. If I had to do this anyway, what was the point in the home test?!
If you're actually sitting at the sleep center posting this, it's probably too late to turn back. Otherwise, call your doctor and express your concern about the costs, and that you wish to have an autoPAP, self titrate, and you're committed to succeeding economically. There is no reason to do a titration study. Your type and severity of apnea is known, and the effectiveness of the machine in treating that is measurable. Less costly, better machine, more success. Cancel, get a prescription from your doctor for an APAP, mask and supplies.

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palerider
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Re: What was the benefit of a home sleep test?

Post by palerider » Sun Jan 25, 2015 12:47 am

Melanndoll wrote:Yeah, I wish I would have been able to figure it out at home with an auto or something. I'm just scared that this is going to cost an arm and a leg!
probably.

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purple
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Re: What was the benefit of a home sleep test?

Post by purple » Sun Jan 25, 2015 7:28 am

A competently run Titration can be a huge help in trying to determine what the Pressure the INDIVIDUAL needs to get useful rest. Notice the term "competently run." A lot of folks quit because they are not getting even a little better, because they have a leaky mask, (which someone at a sleep study could have helped the person choose the right mask for them, and how to get it working right for them), or they have a machine on auto, which might take several hours to get to a pressure which is high enough.

NOW: if any of the manufacturers of Sleep Apnea machines is listening, I will give them a million dollar idea. To give a specific example of what I am talking about, I will use one of my Titration Studies; The initial start pressure is 7, typical. After a few minutes the tech comes in and says the Pulse Ox must have pulled off my finger. Nope it is still there. Why is my O2 less than when I am breathing room air, I am awake both times. It is because the machine not only blows a 7 to stent my airway open, it limits the pressure I pull when I breathe to 7. I need to pull air at a lot higher rate than that to fill my lungs in the time before my body switches to exhale. I need that higher pressure for the same reason I have sleep apnea, my airway is sooo constricted that I have to pull air at a very high rate to fill my lungs. Anyone want to talk about the hours they spend awake in a Sleep Titration Study? It is not just finding the right pressure to stent the airway open, it is because we can not get enough air to keep our O2 up.

Bi-Level will allow for the higher pressure, which is why I am so happy with a bi level machine. Having a machine which would automatically raise the inhale pressure is like a bi level feature, for which we are supposed to pay a great deal more for.

Yes a home study costs a lot less.

If the manufacturers would change the design so we can get enough pressure on inhale, (yeah, centrals are a complication for some), then taking a machine home on auto would be much better. So would changing the search algorithm for the right pressure. Now an auto goes up in little bumps. Instead, if it fails at 7, it should bump to 9, if that is enough, it can start down a bit, but it will probably bump up to ten. A tech can do this while sitting at a computer console watching you. At home what a newcomer would do with that is suddenly have a mask start leaking with a sudden bump to higher pressure.

What we should talk about is the features we need for a true "Complete At Home" system that can not just diagnose but can search for the right titration pressure. We are almost there.

Insofar as me and million dollar ideas. Ha Ha Ha. companies do not pay outsiders. Right now I have spent so much money on my really sore arm and shoulder, I now find I will have to do several days without Lasix because I am out of money. I do not blame companies for that, I blame the Repub domination of government which keeps ratcheting down on what I receive versus true costs.

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englandsf
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Re: What was the benefit of a home sleep test?

Post by englandsf » Sun Jan 25, 2015 8:07 am

I would set a very high bar of having issues with a sleep lab before opting for the much smaller data set a home sleep test can give you. Even 4-5 hrs in a lab will tell a competent doctor way more. They never replicate the full range of sensors or test at home.

I am less sanguine about titration versus an APAP being used to refine a pressure range at home over a few weeks. My titration was quite "inconclusive" but starting with 10-20 I soon found my perfect pressure was 11-20 and am now all set.

YMMV of course and a lot depends on your sleep doctor. Mine's OK.

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Re: What was the benefit of a home sleep test?

Post by Sleeprider » Sun Jan 25, 2015 8:38 am

englandsf wrote:I would set a very high bar of having issues with a sleep lab before opting for the much smaller data set a home sleep test can give you. Even 4-5 hrs in a lab will tell a competent doctor way more. They never replicate the full range of sensors or test at home.

I am less sanguine about titration versus an APAP being used to refine a pressure range at home over a few weeks. My titration was quite "inconclusive" but starting with 10-20 I soon found my perfect pressure was 11-20 and am now all set.

YMMV of course and a lot depends on your sleep doctor. Mine's OK.
I think a home study can reveal complex respiratory problems that need further evaluation using conventional polysomnography, such as central apneas, CSR, Periodic breathing etc. In the case of simple OSA that affects most patients, the home study is economical and reasonably accurate. A titration study can determine the pressure at which obstructive apnea is minimized under study conditions. It unfortunately is used to prescribe a single "magic" pressure to a patient so they may be prescribed a dumb brick of a machine that uses only that prescribed pressure and never changes.

Here is a revolutionary idea; every patient prescribed simple CPAP would be better off with a APAP. The expertise of a RT would be better used to interpret APAP data to help patients help themselves to optimize therapy, rather than to do clinical titrations on OSA patients. The resources of hospitals, clinics, sleep specialists and therapists could then focus on the multitude of people with primary and secondary pulmonary and cardiac complications of sleep apnea, and the individuals that fail APAP therapy.

One can still dream.

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Melanndoll
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Re: What was the benefit of a home sleep test?

Post by Melanndoll » Sun Jan 25, 2015 9:45 am

Thank you all for your replies! I was there, so no, I can't change anything, but I still needed to understand what I was doing. The titration went pretty well. I felt like overall, I liked the machine and could see myself being successful with it! I love the chin strap to hold my mouth closed! And then with the air I felt like I could actually breathe through my nose! I am frustrated that it sound like it will still be awhile before I actually have a pap at home, but doesn't sound like there is much I can do about that:( 1-2 weeks for my dr to get the results and then who knows from there!

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archangle
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Re: What was the benefit of a home sleep test?

Post by archangle » Sun Jan 25, 2015 10:20 am

There are lots of reasons, some good and some bad.

The Medical Mafia loves in lab $leep te$ts, and hates AutoPAPs, and home data collection.

An in-lab $leep te$t does do a better job if the patient sleeps well and will find some subtle problems. Unfortunately, the patient often doesn't sleep well enough for the results to be that good. With the in-lab titration, you can do things like change masks, add a chin strap, etc. You can also detect things like limb movement. EEG and EKG information are also useful.

An in lab titration is less work for the doctor prescribing the therapy. To do it properly at home with an Auto PAP, the doctor has to look at the data from in home use, talk to the patient, think, and make adjustments. Much easier to just hand it off to another mafia member to run a titration and rubber stamp it.

The in-home sleep test is less expensive and can often clearly indicate that a person has apnea. It may make sense to run the less expensive sleep test first, particularly if you don't have a strong suspicion of apnea. Since many people don't sleep well in the lab, the home test might even find some people you'll miss with an in-lab test.

I really think that in-home sleep tests and followup with a good data capable APAP and PROPER remote monitoring and adjustment would do a better job than the current system in most cases. Tough cases could still have an in-lab sleep test or titration. I think the results and costs would be better. Good luck getting the medical mafia to agree and getting the doctors to actually do the work to do it right.

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