NY Times re Home Testing
NY Times re Home Testing
"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.
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.
_________________
Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
Humidifier: IntelliPAP Integrated Heated Humidifier |
Re: NY Times re Home Testing
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.
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.
-
- Posts: 286
- Joined: Tue Apr 01, 2014 1:19 pm
Re: NY Times re Home Testing
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
I did need 5 beers to get to sleep during the HST. My current sleep Doc says no alcohol at all. I miss beer
- Christine L
- Posts: 193
- Joined: Mon Dec 17, 2012 6:56 pm
Re: NY Times re Home Testing
To get a job writing for a newspaper, do you have to be a big, whiney baby?
Re: NY Times re Home Testing
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!
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!
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: DreamWear Nasal CPAP Mask with Headgear |
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm
- chunkyfrog
- Posts: 34390
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nebraska--I am sworn to keep the secret of this paradise.
Re: NY Times re Home Testing
If it's a very small local paper, you need little more than the right DNA;Christine L wrote:To get a job writing for a newspaper, do you have to be a big, whiney baby?
for larger towns, it's a combination of talent and timing, and amazing luck.
To write for Yahoo. who the heck knows? --kneepads?
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |
Re: NY Times re Home Testing
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.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!
49er
_________________
Mask: SleepWeaver Elan™ Soft Cloth Nasal CPAP Mask - Starter Kit |
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
Additional Comments: Use SleepyHead |
Re: NY Times re Home Testing
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).
_________________
Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
Humidifier: IntelliPAP Integrated Heated Humidifier |
Re: NY Times re Home Testing
And of course, I could turn out to be living proof of that.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).
49er
_________________
Mask: SleepWeaver Elan™ Soft Cloth Nasal CPAP Mask - Starter Kit |
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
Additional Comments: Use SleepyHead |
Re: NY Times re Home Testing
Read the original article:
http://well.blogs.nytimes.com/2014/07/2 ... blogs&_r=0
See what he looked like 10 years ago:
And now:
And what Coppola said:
http://well.blogs.nytimes.com/2014/07/2 ... blogs&_r=0
See what he looked like 10 years ago:
And now:
And what Coppola said:
Which kinda makes this whole thing a pile of batcrap.“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.”
You Kids Have Fun!!
Re: NY Times re Home Testing
But hey, no prob!
Like he says:
Like he says:
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)....it costs only about $300, about one-tenth that of a hospital test, and many patients like it, too.
You Kids Have Fun!!
Re: NY Times re Home Testing
I don't know, but given his history:Christine L wrote:To get a job writing for a newspaper, do you have to be a big, whiney baby?
I figure his spot should open up within 5 years.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.
You Kids Have Fun!!
Re: NY Times re Home Testing
Great points Sludge. Nothing like responsible journalism.
49er
49er
_________________
Mask: SleepWeaver Elan™ Soft Cloth Nasal CPAP Mask - Starter Kit |
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
Additional Comments: Use SleepyHead |
- Christine L
- Posts: 193
- Joined: Mon Dec 17, 2012 6:56 pm
Re: NY Times re Home Testing
And he is happy with what he looks like ten years later? Ewwwww. Shoulda used CPAP.
- BlackSpinner
- Posts: 9745
- Joined: Sat Apr 25, 2009 5:44 pm
- Location: Edmonton Alberta
- Contact:
Re: NY Times re Home Testing
And of course the false idea that losing weight will mean you don't have to wear the awful cpap machine is nicely emphasized.
_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine |
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear |
Additional Comments: Quatro mask for colds & flus S8 elite for back up |
71. The lame can ride on horseback, the one-handed drive cattle. The deaf, fight and be useful. To be blind is better than to be burnt on the pyre. No one gets good from a corpse. The Havamal