Question about split night studies

Im scheduled to have a split night sleep study soon. I dont know much about them. Last sleep study I had was back in December 2008.

Im already diagnosed with obstructive sleep apnea, have been since 2000, treated with CPAP since 2007. But with the big weight loss and tonsillectomy I have had, Im having a split night sleep study.

Currently, Im running my APAP 4 to 20 and have a 95th percentile of in the low 11s, as of this month.

Ive been reading about how insurance companies are preferring home sleep studies to keep the costs down and I dont give a flying you know what about keeping the cost down. I only care about results, FOR ME.

Previous sleep studies Ive had were all regular, old style studies. You know, first night you sleep without mask and you are wired up to detect OSA as well as stuff like RLS, PLMD, etc. On subsequent studies, they titrated me all night and I wore a nasal mask all night. I had a third re-titration done where i wore my full face mask all night and they increased my pressure a point.

Again, what are split nights usually recommended for? Is it an economic/insurance thing mainly? Or is it the latest craze among sleep medicine? What?

Thanks

I think they are common. I was one of the "lucky" people, had a split study ordered but I didn't sleep long enough and had to come in a second time. lucky lucky me.

MrGrumpy wrote:Currently, Im running my APAP 4 to 20 and have a 95th percentile of in the low 11s, as of this month.

Ive been reading about how insurance companies are preferring home sleep studies to keep the costs down and I dont give a flying you know what about keeping the cost down. I only care about results, FOR ME.

your apap gives you more data FOR YOU than a few hours in a lab ever can.

you should tune your apap settings, instead of staying with the factory default.

a home study, and an apap gives *most* people better service than a few hours in a strange environment does.

I have had two sleep studies and both have been split night and I am very glad that they were! Why? I have an AHI of 80. I cannot sleep without cpap so the first part of the night is torture as I stop breathing, on average, more than once a minute.

When they FINALLY put the mask on for the second half, I can sleep. So, in my opinion, getting a split night study is the preferred option! Note that in order to have a split, they need to have clear evidence of sleep apnea during the first part of the test.

What is it about having a split study that concerns you? Do you have some idea that it is not as thorough or complete? Unless you have a very mild case, half of the night is more than long enough to document that you have sleep apnea and get an idea of pressures needed. The fine tuning comes later, over time, when you are using your machine at home every night.

Not really a concern, just always leary of anything these insurance companies try to do to cut costs. They cut costs means, I get screwed. Ive been thru it before, several times. Ive been treated right only once by insurance on sleep apnea and OSA.

yaconsult wrote:
What is it about having a split study that concerns you? Do you have some idea that it is not as thorough or complete? Unless you have a very mild case, half of the night is more than long enough to document that you have sleep apnea and get an idea of pressures needed. The fine tuning comes later, over time, when you are using your machine every night.

Then don't worry about the split study. It is a perfectly valid way to do a sleep study and easier on the person being tested, especially when they already have a history of sleep apnea.

When they are really trying to do it on the cheap, they have you do a home sleep test which is NOT as thorough or complete and can't detect problems that some people have, like periodic limb movements. Sometimes, the home test needs to be followed up by an in-lab titration although recently, they seem to be leaning towards giving out auto machines that are set wide open - 4-20 - which is less than optimal for most people.

By having a split study, you will have both of these needed steps done with only a single uncomfortable night. Given a choice, I would ALWAYS opt for the split night study.

jonny515 wrote:I think they are common. I was one of the "lucky" people, had a split study ordered but I didn't sleep long enough and had to come in a second time. lucky lucky me.

In 2014, I was scheduled for a split study but didn't qualify which I felt was a big break. I had planned to use the ambien to go back to sleep for the titration but needed it to fall asleep initially. If I had been woken up to put the mask on, I would have had a hard time falling back asleep.

Anyway, if you feel you will have a hard time going to sleep initially and then getting back to sleep when they wake you up to put the mask on, a split study isn't a good idea. If not, then go for it.

49er

The split night study is the norm for initial sleep studies. A follow-up titration study is only required if they are unable to find an adequate pressure to control your OA during the second portion. I had to have a titration study because they could not find the correct pressure within the time limits of the split night study.

Okie bipap wrote:The split night study is the norm for initial sleep studies. A follow-up titration study is only required if they are unable to find an adequate pressure to control your OA during the second portion. I had to have a titration study because they could not find the correct pressure within the time limits of the split night study.

It is the norm but in order to qualify for a split study, you have to meet certain criteria. Unfortunately, I can't find a good link but hopefully someone can on this board.

One of the criteria is showing enough apneas which I did not as evidenced by my diagnosis of mild apnea. One site said the AHI had to be at least 30 per hou. Another possible criteria is needing to sleep a minimum of two hours.

49er

I also "failed" to have enough apneas for a split night study.
The titration was about 3 cm higher than I really needed,
and an apap gives me more comfort and less gas than the cpap I was originally pushed to buy.
A separate titration study may be of use to some, but to me;
it was a waste of time and money, and a barrier to my best treatment.

chunkyfrog wrote:I also "failed" to have enough apneas for a split night study.
The titration was about 3 cm higher than I really needed,
and an apap gives me more comfort and less gas than the cpap I was originally pushed to buy.
A separate titration study may be of use to some, but to me;
it was a waste of time and money, and a barrier to my best treatment.

I also feel a titration was a waste of time and a co-payment. But it is my fault for allowing someone to talk me into it so I have no one to blame but myself. I think I was hoping maybe I would find a mask that worked better but that didn't happen.

49er

49er wrote:

chunkyfrog wrote:I also "failed" to have enough apneas for a split night study.
The titration was about 3 cm higher than I really needed,
and an apap gives me more comfort and less gas than the cpap I was originally pushed to buy.
A separate titration study may be of use to some, but to me;
it was a waste of time and money, and a barrier to my best treatment.

I also feel a titration was a waste of time and a co-payment. But it is my fault for allowing someone to talk me into it so I have no one to blame but myself. I think I was hoping maybe I would find a mask that worked better but that didn't happen.

49er

I also didn't make the split study sleep / apnea level and had to come back for the titration. I have to say the titration study was helpful to me in that it started me off with a Bipap and I didn't have to qualify first with an Apap.

Thats the thing, this is not an initial sleep study kinda deal. Im already diagnosed with OSA, have been since 2000, have been using CPAP very steadily since mid 2007. I dont know why I have to sleep two hours without the mask on. That irritates me.

I mean, every once in a while, like maybe two times a year, I will come home after working out real hard and Im super tired. I will fall asleep on my bed at night before putting the mask on. And end up sleeping all night without CPAP. I wake up and the next day feel like pure hell, like Im hung over. Like, "the old days." I mean, I KNOW I still have OSA, going just by how I feel and what I look like if I DONT use my APAP.

And my APAP goes all the way up to the 11s, sometimes the 12s. My 95th percentile is in the 11s right now. It did drop a lot after the tonsillectomy, to the low 10s and when I first started losing weight, dropped into the mid 9s. But I got a sinusitis flareup last year and while i got that resolved, ever since my pressures have gone back up.

I just done know why they cant do a re-titration all night study like Ive had twice before. Its more thorough.

Im also worried about having "mild OSA" and they decide not to titrate me. Ive actually had doctors (and the insurance) decide not to treat me because in the olden days, it was considered "mild." Im concerned about the insurance using this split night to deep six me. I dont trust insurance for a minute. These health insurance companies are always trying to deep six sleep apnea patients, IMO. They dont wanna pay for stuff, its obvious as hell to me. And they dont care if you die or not.

In my case, my apnea HAS to be treated, even if mild. Because I have serious depression issues. Trying to treat my depression without simultaneously treat the sleep apnea is like...it just does not work. Ive been through it before.

Eh...I could always just cut out the insurance and pay for a sleep titration study out of pocket. That really appeals to me. Cut out the insurance middle man and its just me and the sleep doctor and they get paid cash. Thats the way to do it.

Okie bipap wrote:The split night study is the norm for initial sleep studies. A follow-up titration study is only required if they are unable to find an adequate pressure to control your OA during the second portion. I had to have a titration study because they could not find the correct pressure within the time limits of the split night study.

Had my titration and didn't sleep any better for that. So they gave me AutoPap because they didn't think they could really determine my pressure accurately.

49er wrote: In 2014, I was scheduled for a split study but didn't qualify which I felt was a big break. I had planned to use the ambien to go back to sleep for the titration but needed it to fall asleep initially. If I had been woken up to put the mask on, I would have had a hard time falling back asleep.

Anyway, if you feel you will have a hard time going to sleep initially and then getting back to sleep when they wake you up to put the mask on, a split study isn't a good idea. If not, then go for it.

49er

Thats what I already believe. I just dont know how to do what you are describing, titrate myself. I used to use a minimum pressure of 10 before the tonsillectomy and that pressure was determined in a monitored titration study and was PERFECT. After the tonsillectomy recover was over, I no longer could tolerate 10 anymore as my minimum.

The in lab studies do detect stuff an APAP cant, like RLS, PLMD, stuff like that which I have no ability to detect or figure out. Im getting older too, where people start having stuff like RLS and stuff like that.

palerider wrote:

MrGrumpy wrote:

your apap gives you more data FOR YOU than a few hours in a lab ever can.

you should tune your apap settings, instead of staying with the factory default.

a home study, and an apap gives *most* people better service than a few hours in a strange environment does.