Have a sleep lab type question?

[montana user]

Sorry, forgot to log on before I answered Muse-Inc.

[montana user]

I wanted to know what sleep labs are doing to make sure they don't have bedbugs. Hotels are very prone to bedbugs since new guests are sleeping there every night--but sleep labs do, too. GOOD MORNING AMERICA talked about the presence of bedbugs in hotels this morning. Someone I know believes he got bedbugs in a sleep lab since it was the only place away from home he had stayed in the months before he got them.

Our labs are different. I work in a hospital setting, She works in a private lab. The laundry is done the same way though. Bleach the sheets, and the comforters are taken off the bed before the patient can sit on it or lay on it while waiting for us. I have seen many reports on TV about hotel beds, and it seemed the number one problem was the comforter as they would only wash them once a month. And God only knows what happens on them in that months time!!

[Slinky]

We use the Resmed M series. They are not the typical CPAP machines as we can make them do all 3 settings(CPAP,Bi-level, SV). The software we use is called PC direct. This is wired to the CPAP machines so we can change all settings needed on the computor and do not have to go in the pt. room to make adjustments. As far as software that collect the data, there are numerous ones. Alice 5, Somnologic, Sandman, to just name a few. They all record the exact same data, but each program has a few functions that are different. ( the way you type your tech notes, to the way the program starts). ...

Giggle! Forgive me, Montana! Please. BUT - while I'm delighted that you've chosen the Resmed S8 Elite II w/EPR as your personal CPAP - Resmed does NOT make M Series devices, Respironics does. I'm really rather curious as to why the majority of sleep labs seem to use Respironics devices for their titrations.

I've read and been told that the conversion charts between the Respironics and the Resmeds aren't really all that reliable and accurate. Has that been your experience? Have you had patients titrated on the Respironics who were provided w/a Resmed and needed a pressure adjustment due to this?

[josef]

I went in for a split night study (Hospital setting). I personally felt as if I never nodded off once as if I was ever close, 1 of the tech’s would come in and start fiddling with the leads explaining that I was moving too much and pulling them loose. Eventually, he replaced them saying they must be bad. This was very close to morning. He explained to me that he didn’t get much but felt like I needed to do another night to be titrated. I came back for a second night (ended up paying for 2 separate sleep studies) was fitted with a full face mask and hooked up. Once again, I personally felt like I never once dozed off as 1 of the tech’s was constantly coming in and telling me I was moving around too much and knocking my mask loose and he would readjust it and tighten it more. I ended up loosing much of the skin from my nose and surrounding area from pressure sores. I was diagnosed with Sleep Apnoea November of 2008. My titrated pressure setting was determined to be 16 cm h2o. The machine I was supplied with was a Fisher & Paykel HC 233. It didn’t take me long to determine the machine wouldn’t give me any feedback. I had trouble with my mask from the git go since it was now determined I couldn’t use a full face mask with my nose like it was. After many bad nights and long studying (1 year and numerous different masks) Now back to a full face mask as I have many nasal problems, broken nose, allergies etc. making a nasal mask a poor choice compounded by the 16 cm of h2o. I determined after personal studies on the internet and this site that I needed an APAP. I had had numerous discussions with my DME and even ended up talking to the head man about why I was given such a bare bones machine. His answer was that it was all that my insurance would pay for. ( "this is the largest in home supplier") He stated flatly that in all the years he had been associated with them, they had never placed an APAP Machine in a private home as they were far too expensive and insurance just wouldn’t pay. Of course when I queried my insurance company, they couldn’t give me a straight answer either but would just point me toward some clinical policy study as if this answered my question. This study was 70 pages long. After much studying, I finally determined that if my Sleep Doctor wrote a prescription for an APAP, my insurance would pay for it. The Fisher & Paykel HC 233 on CPAP.com retails for $300.00 for which I was paying $900.00 a year rent.
My Doctor gave me a hard time about it saying I wouldn’t be any better off with an APAP as 16 cm h2o is still 16 cm h2o no matter what machines I use and the leaks would stay the same and it would just end up costing me a lot more. With great reluctance, He wrote a prescription to my supplier for an APAP. My equipment supplier set me up with a Rem Star auto M with c flex. My DME stated, "I have never placed such an expensive machine in a patients house before". Remember, this is South Texas. The machine was set for 4 to 20 cm h2o. Right from the gitgo, I had a very good night. I bought the software and viewer for the machine. Using these reports and advice from the good people on this site, I have adjusted the pressure to 10 to 13 cm h2o with a c flex setting of 2. I sleep very well, leaks are just about 0. I guess my first question would be, what happened to the 16 cm h2o that I paid $4,000 to get. If this is support, what would non support look like. In a few weeks, I go back to my sleep Doctor for the 1st time since I received the new machine. I’m not real sure what our discussion should be. I asked my PCP to write me a prescription for an APAP which I sent to CPAPauction.com and CPAP.com. I am bidding on APAP’s at CPAPauction.com and intend to move away from a DME altogether. I personally feel like I could set up my own sleep lab with my APAP and software and give a far better product than I received.

Pissed in South Texas.

Josef

[JohnBFisher]

Josef, please understand I'm neither a sleep lab tech, nor an RT, nor a medical doctor. However, I do have almost 20 years of experience with xPAP therapy. I've probably had at least eight sleep studies over the years. So, all I offer is a response based on that experience.

... Of course when I queried my insurance company, they couldn’t give me a straight answer either but would just point me toward some clinical policy study as if this answered my question. This study was 70 pages long. After much studying, I finally determined that if my Sleep Doctor wrote a prescription for an APAP, my insurance would pay for it. ...

Good for you! You kept asking questions. When they tried to bamboozle you with a clinical study that should "shut you up" you dug into it and determined your rights under the system. Essentially, you decided that it is your healthcare insurance, your body, and you have the greatest interest in "getting it right". Good for you!

... My Doctor gave me a hard time about it saying I wouldn’t be any better off with an APAP as 16 cm h2o is still 16 cm h2o no matter what machines I use and the leaks would stay the same and it would just end up costing me a lot more. With great reluctance, He wrote a prescription to my supplier for an APAP. ...

Most doctors don't use xPAP therapy themselves, so they don't understand the situation from the point of view of the patient. They think - because they've been taught this - that the pressure determined by the lab is the pressure you will always need.

... I have adjusted the pressure to 10 to 13 cm h2o with a c flex setting of 2. I sleep very well, leaks are just about 0. I guess my first question would be, what happened to the 16 cm h2o that I paid $4,000 to get. If this is support, what would non support look like. ...

Two questions there...

First, the pressure that was determined by a lab, where you were in a very unusual situation and were wired up. It's quite likely they saw an apnea that only seemed to be solved with a pressure setting of 16cm H2O. You seemed to tolerate it (no apnea events, not respiratory effort related arousals (RERAs). So, they prescribed CPAP to "solve" the problem. Unforutnately, CPAP is a one size fits all solution. APAP essentially takes into account that your needs change over time. By using the software and data, you found a setting range that works well for you. You may occassionally have an apnea that might require a higher setting. But if your current pressure solves 90 to 99% of the events and you sleep well, then you've done what should occur in the lab. But it is very, very hard to find the right settings in the lab with all the strange situation for the patient and all those wires and the interruptions.

Second, non-support feels as if you're tossed off the plane at supersonic speeds, with a parachute that someone decided you ought to have (at the last minute), but without any training on how to use it. Those aboard that supersonic plane don't need to use a parachute. They just go about their lives, land safely, and wonder why you are complaining. That's why I appreciate the sleep techs and doctors and respiratory therapists who come to this site. They understand it's pretty dang tough using that parachute without some support.

... In a few weeks, I go back to my sleep Doctor for the 1st time since I received the new machine. I’m not real sure what our discussion should be. ...

I would keep it unemotional. Provide a sample report (perhaps of your last week) that shows the pressure ranges. Explain how you determined the minimum and maximum pressure. Explain how you track the data to help guide the therapy. Help show the doctor that a determined patient, who wants to manage their own situation can do so successfully. Oh, and it always helps to have some articles:

http://www.ncbi.nlm.nih.gov/pubmed/10947032
http://www.ncbi.nlm.nih.gov/pubmed/15683142
http://www.ncbi.nlm.nih.gov/pubmed/11902425

Also, I will try to find Rested Gal's pointer to some studies that show that effectively patients can manage their own therapy pressure.

Why do I recommend this approach? Even if you change doctors, you can make life easier for the next patient if you show how this helped you. Your doctor may remember it and recommend use of APAP for the next patient who has problems with CPAP therapy.

... I asked my PCP to write me a prescription for an APAP which I sent to CPAPauction.com and CPAP.com. I am bidding on APAP’s at CPAPauction.com and intend to move away from a DME altogether. I personally feel like I could set up my own sleep lab with my APAP and software and give a far better product than I received. ...

Unfortuantely, the current system (with doctors, sleep labs and DMEs) fails to help with two areas.

First, there is virtually no education for patients. As with any chronic condition, the patient should be in charge of the situation. Generally this medical community does not see this as a chronic condition. They assume the sleep study provides the answer, the DME provides the equipment, and if it fails, it's just because the patient fails to comply with the therapy. That is the mindset - as you've seen. Education and support - as any chronic condition requires - should be considered and addressed.

Second, this system does not follow up the patient. And - though DMEs are required by Medicare to demonstrate they do check the patient compliance with the therapy - there is VERY little follow up. Because of that rule, my current DME has an automatic phone survey (on a periodic basis). That's not follow up. I won't talk with an automated service. Instead you did the right thing. You took matters into your own hand and insisted you needed help. You came to this forum. You decided to take control of your therapy. And you listened to both your body and the data. Both helped guide you toward an effective therapy.

Most doctors and healthcare professionals feel threatened when their patients see them as consultants on their healthcare team. I make it very clear to my doctors that I am looking for their advice to guide my ongoing therapy. I explain that they won't have complaince problems with me, if they help convince me of the course of action. I explain that I want their advice but it is both my life and my insurance money they want to spend.

Anyway, good for you that you took a proactive approach to your situation. Don't beat up your doctors with the data. Just present it, unemotionally, showing the effectiveness of the approach and the results (as confirmed by the data and how you feel).

[Wulfman]

We use the Resmed M series. They are not the typical CPAP machines as we can make them do all 3 settings(CPAP,Bi-level, SV). The software we use is called PC direct. This is wired to the CPAP machines so we can change all settings needed on the computor and do not have to go in the pt. room to make adjustments. As far as software that collect the data, there are numerous ones. Alice 5, Somnologic, Sandman, to just name a few. They all record the exact same data, but each program has a few functions that are different. ( the way you type your tech notes, to the way the program starts).

What makes you think your tech had no accreditations? We also like to hear what other techs are doing "wrong" so we can measure ourselves against them.

I was curious about what particular model has ALL of those modes......and can be remotely manipulated. (I notice Slinky picked up on the brand/model "typo". ......I think I knew which one you were talking about)

The person who monitored my sleep study basically told me that her "normal" job was at the local hospital, but she was helping out or filling in till they found somebody permanently. I gathered that they showed her what needed to be done and how to run the equipment and she did it. The actual sleep study was then shipped to the main facility in Billings where it was interpreted by someone there. The reason I know that is because I (and my insurance) got a bill from that person for reading my sleep study. "Odd" thing was that my local sleep doctor ALSO tried to charge for reading the sleep study. I'm not sure if his bill actually got paid......my insurance refused to pay it, but I'm not sure whether I actually did, because this was during the time when my deductible was getting used up and it was difficult to figure out who paid what. In any case, I was (and still am) pissed about being charged twice for the same thing. And I DID call the local office and pitched a bitch about it back then.


Den

[SingleMom]

Why is the leak rate in the lab so insanely high? I recently had another study, and brought my mask just in case they didn't have one. The tech wouldn't let me use it because it compromised the data. So I tried on another FF mask, but couldn't stand it. She finally let me try mine. But she made me pull it wayyy toooo tight. I have a very, very low leak at home, nor do I ever feel anything. So I felt no leak anywhere in the lab, but she said the leak rate was 50 (just 50, no units) and basically begged me to put on the other mask again. So I did, again way too tight and uncomfortable. She said it was much better and the leak went down to 20.

So what's the deal here? I know how to put on my mask nice and comfy and have no leaks.

[josef]

[/quote]
In any case, I was (and still am) pissed about being charged twice for the same thing.
Den[/quote]

I not only paid for the sleep study twice but the sleep Doctor charged me twice to read my report even though it was a split night study that turned into 2 nights. I have an extremely hard time understanding why it wasn't all the same report.

[fadedgirl]

I recently had another study, and brought my mask just in case they didn't have one. The tech wouldn't let me use it because it compromised the data.

Is this typical? I have my sleep study in a few months and was planning on using my own mask.

[JohnBFisher]

I recently had another study, and brought my mask just in case they didn't have one. The tech wouldn't let me use it because it compromised the data.

Is this typical? I have my sleep study in a few months and was planning on using my own mask.

Nope. It depends on the sleep lab. But some labs will let you use your mask, others no. Mine let me use my mask. They just insisted that the mask be adjusted to eliminate any leaks. Regarless of the policy, they want to be certain you breathe well, don't have excessive leaks. Some solve the situation by requiring you use a newer mask. Others assume you are happy with your mask and will sleep better with it, as long as it doesn't leak. Call and ask the sleep lab before the night of the sleep study.

[Catnapper]

To answer your question about why the tech appeared to be poorly trained, my daughter had a terrible experience with a tech. The first thing he told her when he met her was "This is going to be the worst night of your life!" He soon appeared at her bedside with a huge wad of tobacco in his mouth. When she challenged him about it, he said he would have had to wash his hands if he removed it and he didn't want to. (Wouldn't you want to hear a health professional tell you that?!?!) He asked her not to tell on him because he really needed the job and had just started 2 weeks before. As her study was over, he told her she did not have sleep apnea. He messed up what was to be a split night study because he misinterpreted her AHI. Two days later the lab called her telling her she had such severe apnea that she needed to come back that very night for further titration because she was in imminent danger of dying. That is the kind of thing that can make you panic. Needless to say, she went to another lab for the titration.

When I went to arrange for my titration for bi-level about a year and a half after my first titration, the man I befriended (office manager and tech both) set my appointment, but then changed it because he said he would rather do it himself because the original appointment had a newbie on the job. Apparently if I had not made friends with him, the newbie would have done it and possibly missed something important. He told me that he himself did not have certification, but had been doing studies for several months, less than a year.

I was led to believe that a computer read the study and produced a report.

Catnapper - Joanie

[montana user]

We use the Resmed M series. They are not the typical CPAP machines as we can make them do all 3 settings(CPAP,Bi-level, SV). The software we use is called PC direct. This is wired to the CPAP machines so we can change all settings needed on the computor and do not have to go in the pt. room to make adjustments. As far as software that collect the data, there are numerous ones. Alice 5, Somnologic, Sandman, to just name a few. They all record the exact same data, but each program has a few functions that are different. ( the way you type your tech notes, to the way the program starts). ...

Giggle! Forgive me, Montana! Please. BUT - while I'm delighted that you've chosen the Resmed S8 Elite II w/EPR as your personal CPAP - Resmed does NOT make M Series devices, Respironics does. I'm really rather curious as to why the majority of sleep labs seem to use Respironics devices for their titrations.

I've read and been told that the conversion charts between the Respironics and the Resmeds aren't really all that reliable and accurate. Has that been your
experience? Have you had patients titrated on the Respironics who were provided w/a Resmed and needed a pressure adjustment due to this?

YES you are correct!! This is what I get for trying to answere quickly before proof reading my post! We use a machine called OmniLab from Respiraonics.

As far as the difference between Respironics and Resmed- we have a pressure check machine that anyone can bring in there machine and make sure that if its set to 7cmH2O it is pushing 7cmH2O. We test all kinds of machines and I honeslty have not seen one that was not blowing the pressure it was suppose to. (with exception to a bad machine that was blowing 5 instead of the 12, but it was very old and needed replaced)

[montana user]

Why is the leak rate in the lab so insanely high? I recently had another study, and brought my mask just in case they didn't have one. The tech wouldn't let me use it because it compromised the data. So I tried on another FF mask, but couldn't stand it. She finally let me try mine. But she made me pull it wayyy toooo tight. I have a very, very low leak at home, nor do I ever feel anything. So I felt no leak anywhere in the lab, but she said the leak rate was 50 (just 50, no units) and basically begged me to put on the other mask again. So I did, again way too tight and uncomfortable. She said it was much better and the leak went down to 20.

So what's the deal here? I know how to put on my mask nice and comfy and have no leaks.

I can not see any reason not to use your mask. I actually love it when they bring there own mask in for two reasons. 1. Its adjusted to them and they are comfortable with it. 2. I don't have to clean and disinfect one in the morning . We watch the leak rate very closley. It is measured in l/min. An average acceptable leak is around 32 l/min. Now as I raise the pressure from my computor the leak rate increases slightly. We still like to have a leak rate around 35, but sometimes depending on the mask( different masks allow a different leak rate) I get a leak of 40-50. As long as I can't feel a leak and the patient doesn't complain of a leak, we continue the study.

I think a huge problem is, there is no 1 standard for a sleep lab. Just like plumbers-one might like PVC pipes, the one likes copper pipes. As long as the job gets done and done right no one is the wiser of which pipe was used. So the sleep lab is the same. We all probabaly do things a little different, but were all hoping for the same outcome. I don't considere myself an expert sleep tech. but I do try to educate the people coming in so they will understand why I am putting the wires here and there, and why I am using this mask and not this one. I think that goes a long way with people.

[montana user]

We use the Resmed M series. They are not the typical CPAP machines as we can make them do all 3 settings(CPAP,Bi-level, SV). The software we use is called PC direct. This is wired to the CPAP machines so we can change all settings needed on the computor and do not have to go in the pt. room to make adjustments. As far as software that collect the data, there are numerous ones. Alice 5, Somnologic, Sandman, to just name a few. They all record the exact same data, but each program has a few functions that are different. ( the way you type your tech notes, to the way the program starts).

What makes you think your tech had no accreditations? We also like to hear what other techs are doing "wrong" so we can measure ourselves against them.

I was curious about what particular model has ALL of those modes......and can be remotely manipulated. (I notice Slinky picked up on the brand/model "typo". ......I think I knew which one you were talking about)

The person who monitored my sleep study basically told me that her "normal" job was at the local hospital, but she was helping out or filling in till they found somebody permanently. I gathered that they showed her what needed to be done and how to run the equipment and she did it. The actual sleep study was then shipped to the main facility in Billings where it was interpreted by someone there. The reason I know that is because I (and my insurance) got a bill from that person for reading my sleep study. "Odd" thing was that my local sleep doctor ALSO tried to charge for reading the sleep study. I'm not sure if his bill actually got paid......my insurance refused to pay it, but I'm not sure whether I actually did, because this was during the time when my deductible was getting used up and it was difficult to figure out who paid what. In any case, I was (and still am) pissed about being charged twice for the same thing. And I DID call the local office and pitched a bitch about it back then.

I am not up to par on insurance and billing, but it does seem odd they tried to bill you twice. The company I work with charges one fee. They score the study, then give it to a accredited sleep doctor to look at and diagnose, then they send it back to me. So I get it all done for one price. Was your doctor actually charging to read the study, or billing you for the time to talk to you about the study? Thats the only thing I can think of that remotely makes sense.

[josef]

[
I am not up to par on insurance and billing, but it does seem odd they tried to bill you twice. The company I work with charges one fee. They score the study, then give it to a accredited sleep doctor to look at and diagnose, then they send it back to me. So I get it all done for one price. Was your doctor actually charging to read the study, or billing you for the time to talk to you about the study? Thats the only thing I can think of that remotely makes sense.

I had wrote you earlier about how my split night turned into 2 nights. As you will see below, there are 2 seperate charges for the sleep study and 2 totally seperate charges by a Doctor Kumar who is not a sleep Doctor but read my sleep study. I never once saw this Doctor Kumar. I assure you that all 4 bills were paid by me and my insurance company for a prescription pressure of 16cm h2o which I have never been able to use. Biggest waste of money I've ever made. Just read my earlier post to you.

09/30/08 to 09/30/08 DOUGLAS
10/06/46 Medical Completed 3,115.00
Details CITIZENS MEDICAL CENTER $ 1,962.45 $ 218.05
09/30/08 to 09/30/08 DOUGLAS
10/06/46 Medical Completed 425.00
Details BANGARVSWAMY KUMAR $ 196.09 $ 21.79
09/23/08 to 09/23/08 DOUGLAS
10/06/46 Medical Completed 375.00
Details BANGARVSWAMY KUMAR $ 182.51 $ 20.28
09/23/08 to 09/23/08 DOUGLAS
10/06/46 Medical Completed 2,966.00
Details CITIZENS MEDICAL CENTER $ 1,868.58 $ 207.62