How accurate are the home sleep studies and are they really necessary?

[zonker]

It seems to me that Apnea is a lot like alcoholism in that if you think you have it, you probably do, or you would never have thought about it.

not for me. i wasn't even thinking of sleep apnea. was complaining to my gp about waking up so often during the night to pee and how i never really ever got any sleep.

he recommended me to a sleep doctor. and off i went from there.

[palerider]

I think I got it this time. Should I start a new thread to keep things clean?

NO! keep all your stuff in one thread.

Read this: viewtopic/t172378/Sticky--Newbies-PLEAS ... aace1e7363

[palerider]

When the pressure gets too high, it wakes me up

I have a theory about that... some people are wedded to the theory that "pressure increases wake people up"... I think it's much more "you have events (apneas, hypopneas, snores, flow limitations, leaks) that are *documented* to cause sleep disturbances, arousals, and *THAT'S* what wakes you up... at the same time the machine is raising pressure. so you wake up, and assume "oh, the pressure went up, that's what woke me up". Just a theory

I haven't tried the EPR setting. I read online that EPR doesn't really do much, for most users.

EPR makes things nicer for a lot of people, does nothing for others, and causes issues for a small number.

I raised my min pressure from 5 to 6 last night. I'll put it on 7 or 8 tonight.

I concur that you need a higher min pressure... maybe even higher than 8, but it's a good place to start.

[jnk...]

If they send people home and it tests positive, they send you to the real sleep study. In the off chance that it doesn't show positive, they also send you to the real sleep study. Brilliant!

Depending on the system in place: If the home diagnostic test is positive, that may earn you a titration study but it may only earn you a trial use of APAP.

As a general rule, though, if the home test is positive, that saved the price of the lab diagnostic test.

I am not defending either system, myself. A lab diagnostic gives a better baseline against which to measure the titration. But I consider the lab titration more valuable than the lab diagnostic, since a lab titration sees reaction to pressures and whether any other sleep issues are unmasked once sleep-breathing is calmed down.

The argument for home testing and then home APAP for titration is an attempt to get more people diagnosed and on PAP more quickly and at a less-expensive price.

My personal position for helping the most people with simple OSA (a postion not endorsed by anyone in the industry) is that xPAPs should be mass produced cheaply and sold OTC at drug stores, since it makes no sense economically to me that we spend thousands of dollars to run tests just to earn someone the right to try a simple harmless machine that should only cost in the low hundreds in that larger market. For those people who turn out to have bad, or insufficient, response to therapy, THEN more expensive testing could be pursued.

My hose-dreams of a more practical system will never make sense to those whose livelihoods depend on the present system, though, I'm afraid.

[palerider]

If they send people home and it tests positive, they send you to the real sleep study. In the off chance that it doesn't show positive, they also send you to the real sleep study. Brilliant!

There are two types of sleep 'studies', the test, and the titration. the test, which just determines if you have sleep disordered breathing, is what you took at home... that could have been done in the lab for 10 times the expense.

The second type is the 'titraiton', where you're hooked up to a machine and they determine what pressures are needed to resolve the SDB, this sounds like what your second, in lab, test was.

It also was wasted on you since they sent you home with an auto machine pretty much set to factory defaults.

[palerider]

That alien analogy is spot on. My mask is nice enough. Doesn't leak much at all. It hurts the bridge of my nose a little, but I'm developing something similar to a callous. After a while, it will be fine.

I think after a month or so, the alien in my subconscious will go away, or perhaps it will erupt from my chest and that will be that.

I'll try out the EPR settings tonight.

If you turn on EPR, then raise your min pressure by however much you turn on EPR.

So, you were going to set min to 7 or 8, if you use EPR 3, then set your min to 10 or 11. If EPR 2, then min to 9 or 10. makes sense?

[palerider]

My personal position for helping the most people with simple OSA (a postion not endorsed by anyone in the industry) is that xPAPs should be mass produced cheaply and sold OTC at drug stores, since it makes no sense economically to me that we spend thousands of dollars to run tests just to earn someone the right to try a simple harmless machine that should only cost in the low hundreds in that larger market. For those people who turn out to have bad, or insufficient, response to therapy, THEN more expensive testing could be pursed.

What he said, a thousand times what he said.

[DUG]

I understand that since I was going to set my min to 8, then I set the EPR to 3 and then raise the min to 11. Got it.

As far as sending me home with factory settings, they didn't send me home with anything. They wanted to send me to the local DME with my insurance card of free money to rent a machine. The local DME doesn't rent to self-pay people (Im guessing when its real money, people bitch about prices, when its insurance money or government money, who cares, its free money!) When I said I was paying myself, they said I should just go anywhere and get a better deal. I found cpcaptalk and I saw some praise for 2ndwindcpap, so I called them. Tim Quist is who I talked to and he's great. He's still following up with me to get the settings correct.

I knew I had apnea at least 5-10 years ago. Not for sure, of course, but when I've always snored heavyweight and 3 different people told me I choked and stopped breathing to the point that they checked to see if I needed help. Plus, my dad has it, and we sound identical. I figured it out pretty quick. So the tests, to me, were just a formality. Yes, it's possible I had some other thing, but odds are, I was correct.

I was basically ordered by the family to get the tests done. There was no doubt I was doing poorly.

And yes, palerider. You are correct with my bad terminology. I took a home test, and the second test was a titration, not a second test. Although, they were such nice folks, they offered to do the 2nd sleep test that day and a titration test the following week, for another $700. I passed and just did titration.

Now, if I had just bought the machine used, I would have spent half as much, and would still be at the same point in my therapy, asking questions of strangers. That sleep doctor was annoyed that I even called him to discuss my titration results. It was his opinion, that was my GP's job. My GP is great, but he's not a sleep specialist.

Maybe I'm just upset for lack of sleep, but this whole process has been a shitshow. The only valuable info I have had so far, is this forum, and it's free!

[Jas_williams]

Maybe I'm just upset for lack of sleep, but this whole process has been a shitshow. The only valuable info I have had so far, is this forum, and it's free!

That what we are here for

[palerider]

As far as sending me home with factory settings, they didn't send me home with anything.... When I said I was paying myself, they said I should just go anywhere and get a better deal. ...

Maybe I'm just upset for lack of sleep, but this whole process has been a shitshow. ...

Ah, ok, my bad, for a long time, we'd see people sent home with an auto set to 4-20, (factory), then recently, it's been 5-15 (might as well be factory). So when I saw yours started at 5... I just ASSumed, my bad

If you have the results of your titration, share them, it *might* help, otherwise, it was a waste of time and money.

The local DME should be applauded for sending you elsewhere, instead of fleecing you with their normal prices.

And yes, the shit show you got is altogether too common, no matter what some idealistic nurses think.

[jnk...]

only valuable info I have had so far, is this forum, and it's free!

What? You mean, no one here has told you about the "suggested donation" thing yet?

[DUG]

I don't have any graphs from the titration at all. I only have a summary that the sleep testing center sent to my GP.

I'm not positive, but I think it says they wanted to start my machine 5 min 10 max. What sense does that make? I guess they expected me to go to the DME and have them adjust it every week or something, for a fee I assume. Ill get the report after work and maybe I can scan it on here.

My titration session ended just as they hit 18, the pressure blew out the mask and woke me up. So, Tim at 2ndwind set me for 5/18 to start and move it up or down after a week or so. Now, I have it 6/14. Tonight will be 11/14 with a 3 EPR setting.

Oh, and they used a F/P size small FFM on me, no wonder 18 blew it out into my eyes. They must have run out of large and just used what they had. Who knows? I almost bought size S online, because that's what the report says, but again, Tim sorted that out. We measured my face and I'm closer to maxing the L, than fitting into S. Maybe it was a typo, who knows?

The DME manager is a guy I know from the volunteer fire dept. Maybe that had something to do with the referral to buy online. I broke my hose the second day I had it. Yanking on the hose and not the connector isn't good. DME charged me $25, online they are $16, unheated, just the basic hose.

[DUG]

only valuable info I have had so far, is this forum, and it's free!

What? You mean, no one here has told you about the "suggested donation" thing yet?

If someone needs donations, I'll donate. But, now that you say that, I think cpap.com sponsors the site, in order to make sales. So, I'll shut up about that other place before someone bans me.

[Pugsy]

We talk about secondwindcpap here all the time. No hard feelings. There's a time and place for both online retailers as secondwind can do some things that cpap.com can't.

[jnk...]

Feel free to talk about any place that you want. At least I do.

And the "suggested donation" is just that you point others to this free site for help. Nothing more. CPAP.com generously keeps this site going, so I try to buy something from them once in a while and mention them to others. But that's just my choice. Doesn't have to be anyone else's.

The full titration report should be kept by you forever in your personal records. If you post it, or some of it, here, be sure to hide any of your personal identifying info and any info that would identify the lab, the doc, or any of the other medical people, just as a courtesy to them.

It may be a hassle that led you to where you are, but find some joy that you found a good place to get FREE help from others, here.

-jeff