Is the Sleep Study necessary vs. just buying an APAP m/c?

[dunninla]

I have four physicians (ENT, Allergist, Internist, neurologist) telling me that my chronic sleepiness is likely due to sleep apnea. I snore quite regularly and loudly.

So, the ENT gave me a couple of places for an overnight Sleep Study. I am scheduled for tomorrow night. The cost to me will be about $825 for 1-Night, and $910 for Split-Night. I am paying out of pocket, without Insurance.

Then I got to thinking (this is normally where you would be advised to run from the room). Why not just purchases an APAP machine for about $600, use it, and see if my chonic daytime sleepiness goes away? If I do have sleep Apnea, this will take care of it for under $700. If I don't, it will have cost me $700.

However, doing the Sleep Study costs me $900, plus the APAP machine, or about $1,600. So I'm not sure what value there is in the Sleep Study when I can confirm Sleep Apnea by simply buying the machine now and not doing the overnight Sleep Study.

Your thoughts?

[LSAT]

You will need a prescription for the CPAP. Talk to your doctor and see what he will go along with. You can't just buy a unit and turn it on...you need to know what you are doing or you can hurt yourself. Sleep study is the preferred way to do it.

[SleepingUgly]

You can't diagnose OSA with a CPAP. This seems to me to be due to the fact that no studies have been doing comparing normals to people with OSA on CPAP, rather than that there wouldn't be any findings that would suggest OSA on the data. In theory, if a person had no OSA, they would sit at the lowest pressure of CPAP all night; however, we have no idea if even normals would have pressure changes on CPAP to one degree or another.

I had an empiric trial of CPAP prior to being diagnosed, and I found it very difficult to figure out what my correct pressure is. There are a lot of different permutations, especially if you have Auto-pap ranges, EPR, etc. It's not easy.

That said, if money were an object, it's not impossible to go that route, and your doctor may very well be willing to write you an Rx for it.

[acdodd]

If I had it to do over again I would do just what you said.
Buy a APAP, set the pressure for 5 to 20 and use the machine.
Read the data and then start to narrow down my pressure window.
Check craigslist if your doc will not go along.
That is just my opinion, others will no doubt disagree so make your own choices.

[SleepingUgly]

BTW, a sleep study will rule out other things, not just rule in OSA.

[Todzo]

I have four physicians (ENT, Allergist, Internist, neurologist) telling me that my chronic sleepiness is likely due to sleep apnea. I snore quite regularly and loudly.

So, the ENT gave me a couple of places for an overnight Sleep Study. I am scheduled for tomorrow night. The cost to me will be about $825 for 1-Night, and $910 for Split-Night. I am paying out of pocket, without Insurance.

Then I got to thinking (this is normally where you would be advised to run from the room). Why not just purchases an APAP machine for about $600, use it, and see if my chonic daytime sleepiness goes away? If I do have sleep Apnea, this will take care of it for under $700. If I don't, it will have cost me $700.

However, doing the Sleep Study costs me $900, plus the APAP machine, or about $1,600. So I'm not sure what value there is in the Sleep Study when I can confirm Sleep Apnea by simply buying the machine now and not doing the overnight Sleep Study.

Your thoughts?

Hi dunninla!

The cheapest path, I think, in our current world is get an in home sleep test (box in mailbox, use box - internet results to docs - return box - perhaps $400) and then your idea of purchase an Auto-PAP for titration as well as use.

I think things are changing and need to change in this industry. Currently it is grossly inefficient!

But if you have it and do not treat it - you die.

I hope you find a good way!!

Todzo

[soundersfootballclub]

I'm assuming you are in overall good health since you saw 4 different docs and they couldn't find anything wrong. That's exactly what I would do knowing what I know now. Not to mention a sleep study is pure torture and I will never do one again. Look on craigslist you can probably find a new APAP machine at a bargain basement price.

[MidnightOwl]

People have done this successfully. I also recall at least one reference to a published study where doctors did this. You might try to find that and see what health conditions disqualified a patient for this approach.

[dunninla]

OK, thanks for the replies.

The cautionary part of me has turned out to be more influential than the part that hates waste and inefficiency, so I'm going ahead with the sleep study tonight.

I am in very good health overall. BP, body mass, cholesterol, etc. I've had some vertigo 18 months ago, and a residual feeling of mild constant dizziness since that time, so all the Doctors I've seen have been for diagnosing those symptoms --- rule out cancer, tumor, something wrong in the brain, etc. and after all those doctors, the two health issues remaining are that I don't have BPPV but likely did last year, and now probably have residual BPPV (inner ear calcium carbonate crystals that cause dizziness), and daytime sleepiness. Thus, Epley and Cawthorne exercises for the dizziness, and now a Sleep Study for the daytime sleepiness.

If I have OSA from the study tonight, then I'll come back with a lot of questions about APAP m/c, which type of mask, and whether CPAP is superior to a TAP-3 dental device assuming only ONE device is going to be used ... are there any studies on this that are published that I could read?

[kteague]

While treating OSA without a formal study has been proven by some on here to be doable, if the money permits, a formal sleep study does provide deeper insights for those whose apnea is not just the garden variety. Doesn't affect everyone, but if you are one of the ones, it will matter very much to you. One thing to consider before buying a machine when you haven't had a diagnostic or titration study is that if you buy one and it turns out to not be the best delivery method for your particular problems, you can't just take it back. For instance, certain types of machine are recommended for higher pressures, complex sleep apnea, UARS or central sleep apnea. A sleep study will also monitor the heart, brain waves, oxygen levels, and limb movements. May be overkill for most, but to get all those things looked at in one night seemed a comfort to me. Not so many "what ifs" floating around in my head.

I agree with your cautionary side, since apparently it didn't predict impending doom by spending the money for the study. Let us know how it goes.

[deltadave]

The cheapest path, I think, in our current world is get an in home sleep test (box in mailbox, use box - internet results to docs - return box - perhaps $400) and then your idea of purchase an Auto-PAP for titration as well as use.

I think things are changing and need to change in this industry. Currently it is grossly inefficient!

As it turns out, DinLA has underlying sleep architecture issues that would not have been uncovered by Type III or IV HST.

Overall, your advice is generally poor and and reflects your lack of knowledge.

[Todzo]

The cheapest path, I think, in our current world is get an in home sleep test (box in mailbox, use box - internet results to docs - return box - perhaps $400) and then your idea of purchase an Auto-PAP for titration as well as use.

I think things are changing and need to change in this industry. Currently it is grossly inefficient!

As it turns out, DinLA has underlying sleep architecture issues that would not have been uncovered by Type III or IV HST.

Overall, your advice is generally poor and and reflects your lack of knowledge.

thank you for the encouragement I am constantly working on that

[archangle]

You can't diagnose OSA with a CPAP.

I will disagree, with some caveats.

There are lots of details, but basically, a "CPAP trial" may show that you DO have apnea, but you might have apnea and not have it show up on a CPAP trial.

The in-lab PSG does give you MUCH better info. If you sleep enough. If you sleep the same way in the sleep lab as you do at home. If you don't blow it off due to cost, effort, and inconvenience.

The PSG will find conditions a CPAP won't.

If you do get an in-lab test, be sure the doctor gives you a sleeping pill to take in case you can't get to sleep in the strange environment. You'd rather take the test unaffected by drugs, but a sleep test without sleep is useless.

Many insurance plans won't pay for CPAP without a formal sleep test. (Doesn't matter for the OP in this thread.)

[SleepingUgly]

You can't diagnose OSA with a CPAP.

I will disagree, with some caveats.

There are lots of details, but basically, a "CPAP trial" may show that you DO have apnea, but you might have apnea and not have it show up on a CPAP trial.

I would be interested to see any studies that exist that show what normals look like on CPAP. It's only by comparison to norms that one could even begin to diagnose deviations from the norm. I went round and round about this with my then-doctor when I was on an empiric trial of CPAP prior to my OSA diagnosis.

In theory, if someone has flagrant/severe OSA, it ought to show something on CPAP. But that's IN THEORY and in practice I've never seen one article comparing those with OSA and those without on CPAP. Who knows how someone with mild OSA or USA would look compared to normals. I keep trying to recruit normal spouses for a study of this, but so far no one has signed up for my study. Any takers?

[purple]

Go for the split study. If you do one night to diagnose, you would need a second night to do the titration. Sounds to me more like it is the first part of the night would be to determine the exact nature of your sleep problem. If it is uncomplicated OSA, then the second part of the night, the Titration, will determine the exact numbers you need to have to get good sleep. A lot of folks do not, for whatever reason do not get a successful titration, which is why some get poor sleep, and come to this board all angry with the medical community.