WHY NOT USE OXIMETER FOR HOME STUDY?

[packer]

question- why not simply use recording oximeter for first step in
detection of sleep problems?

if DR. or patient thinks you snore too much or have any of
the other symptoms of apnea-

why not just sleep a few nights while recording oxygen levels?

if O2 gets low then we can do sleep study

same with present users of CPAP- why not rent or own a oximeter and
every once in a while sleep with it and double check the levels?

I am a little over a year compliant- check my AHI all the time- but am just thinking it would be good to actually check the O2 level

perhaps this has all been discussed but I havent noticed it much packer

[RipVW]

I'm sure some of our wiser old timers will jump in here, but I think you're right. Since the recording oximeter measures blood oxygen saturation, one may check for any drops in oxygen saturation (the damaging effect of untreated or unresponsive apnea events). A great device to double-check CPAP therapy efficacy (I check mine periodically), seems like the perfect initial screening test to determine whether or not one should proceed with a sleep study.

[Bearded_One]

Home sleep studies are coming. Proposed US Medicare and UK criteria include home sleep studies as a diagnostic method -- they won't require laboratory sleep studies. These two groups are very influential in medical care in the US and the UK.


The proposed UK criteria is at
http://www.nice.org.uk/nicemedia/pdf/CP ... tation.pdf

"2.2 Moderate to severe OSAHS can be diagnosed from patient history
and a sleep study using oximetry or other monitoring devices
carried out in the person’s home. In some cases, further studies
that monitor additional physiological variables in a sleep laboratory
or at home may be required, especially when alternative diagnoses
are being considered."


Article about US Medicare is at
http://www.post-gazette.com/pg/08009/847751-114.stm
Wednesday, January 09, 2008

"Medicare currently covers sleep apnea treatment -- the most common is the CPAP, a mask that covers the nose and mouth, increasing air pressure in the throat during the night -- only for those diagnosed in a sleep lab.

But last month it proposed to cover treatment for seniors diagnosed with home tests. A final decision is expected in March."

[RipVW]

That's great news for all! Hoping these proposals are adopted!!

[Wulfman]

question- why not simply use recording oximeter for first step in
detection of sleep problems?

if DR. or patient thinks you snore too much or have any of
the other symptoms of apnea-

why not just sleep a few nights while recording oxygen levels?

if O2 gets low then we can do sleep study

same with present users of CPAP- why not rent or own a oximeter and
every once in a while sleep with it and double check the levels?

I am a little over a year compliant- check my AHI all the time- but am just thinking it would be good to actually check the O2 level

perhaps this has all been discussed but I havent noticed it much packer

It's been done. Sometimes at the insistence of the patients. If you look up the forum member "NightHawkeye" and his history, that's how he finally convinced his doctors that he actually had sleep apnea after they "poo-pooed" him for some time.

One of the problems with using that method alone is that SOME people don't desaturate enough to validate that method alone.

Another "problem" is that this method doesn't generate the sizeable fees charged by the sleep labs. Pulse-oximetry is basically "Free"......sleep labs generate "income".

Many sleep docs will order a pulse-oximetry for a patient after they've been on their therapy for a month or two, to see how well it's working.....(since they don't believe in the reports from the CPAPs that collect data)

Den

[Treesap]

That's great news for all! Hoping these proposals are adopted!!

No kidding. Sleep studies are majorly expensive. My 20% was $600. When the pulmonologist told me I needed a second one for titration, I said NO!!! I can't afford it, and it was the worst night of sleep I ever had.

Rosie O'Donnell has sleep apnea. She tested herself at home. But then she probably pays cash and doesn't have to deal with the stupid insurance companies. It must be nice to be wealthy.

[betty303]

I kept pushing my doctor for a test to find out if I had sleep apnea, and when I found out it cost $4000, I asked for a home study first. She had me try a free overnight oximeter test and then put me on 2L right away.

That convinced me to have the sleep study and I now use O2 with my machine.

I travel now and then and am getting ready for a trip that will keep me away from home between 1-2 months. To my distress, I discovered that Medicare will NOT COVER O2 when I am away from home, as my previous insurance did. Neither will supplemental (if Medicare doesn't cover it, they won't cover it.)

This is unbelievable to me (I called Medicare and my supplemental, and had a long talk with the owner of my DME to check for sure) that you can't stay away from home overnight and have O2 covered. I can't move my DME for the period I am gone (has to be over 6 months) and Medicare will still pay $198/mo for the concentrator that will sit in my home while I am away.

My DME used to reimburse $5 per night for time away (usually 1/2 - 1/3 the cost) - out of the goodness of his heart, he said...but has quit that practice because he can't afford it. He said that technically, the regulations read that if you don't have a home that is so large that the hose will not reach from the O2 source to all rooms in your house - that is the only way you qualify for portable O2 to even leave your house to go shopping or to the movie. (he said this is mostly ignored, however)

Amazing law makers we have setting these policies. I guess once you are 65, you are not expected to have a life that includes any overnight travel or even to go outside of your home, if that home is too small.

[Mile High Sleeper]

A forum member and I are now using an overnight recording pulse ox generously loaned to us by another forum member. I've already used it with two relatives who don't have SA and hope to loan it to a couple more undiagnosed relatives and friend on therapy. I find it useful to double-check the results of my therapy once a year or so. If you need supplemental oxygen at night, I'd definitely recommend having your own pulse ox.

I think there was a post by rested gal with the idea of how cool it would be to share a community pulse ox, since most of us need it infrequently.

Unfortuately, it's not a magic bullet, as Den indicated. I had very severe OSA but my O2 wasn't that bad, because my heart was working so hard, incurring damage now healed, to keep the O2 levels up. So by itself, I think a pulse ox is unreliable to detect SA. The proposed home tests will hopefully measure more than a pulse ox does, as Kaiser has done for some time. Seems to me a home study would be great as a screening device leading to a sleep study for those who can afford it, or great teamed with a subsequent APAP for those who can't afford a sleep study.

A sleep study may be unwelcome in term of comfort and money and give questionable titrations, but it's still the gold standard of diagnosis. If we didn't have access to sleep studies and only had home titrations, we would probably be complaining about that. As I look back, my baseline study was very helpful. My second titration study was useless. (I had good insurance then, past tense.) When I look at my therapy now, I wish I had affordable access to a sleep lab like Dr. Krakow's, that seems to really know what it's doing, because of the intricacies of treating SA in some people.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, APAP

[Guest]

I had a sleep study about 8 years ago that was a total bust. I only slept something like 1 hour and was told all was normal. (yeah, right).
So when my new Internist recommended I have one for fibromyalgia symptoms, I just plain refused. But I suggested an oximeter test at home, and he agreed. Unfortunately, it showed desaturations, and I had to still have the sleep study test again. Fortunately, I was allowed to take xanax.
I think it makes sense to use them at home, before anything more is decided. Plus, I'm sure they are more reliable than some sleep studies, where we are so out of our element, and many of us didn't even sleep.

[RipVW]

I had very severe OSA but my O2 wasn't that bad, because my heart was working so hard, incurring damage now healed, to keep the O2 levels up. So by itself, I think a pulse ox is unreliable to detect SA.

If one's heart had to overwork to keep blood oxygen saturation up, wouldn't one's pulse rate be significantly elevated as well? If so, would that not be another indicator that one should proceed with further diagnostic tests?

[Bearded_One]

Medicare isn't saying that you can't get the equipment or O2 that you want for traveling, they are just saying that they won't pay for it.

I have an issue with Medicare covering portable devices based upon the size of one's house. I find it a bit odd that Medicare won't pay for portable O2 equipmet, because the VA will.

[betty303]

Right - as long as I can get a script sent to a O2 supply place where I am traveling, Medicare is not even involved, knows nothing, and I am responsible for the bill.

But for something that is so vital for treatment, I am flabberghasted that I can't get it covered if I travel - which I need to do for my work. I can get other things covered by Medicare, no matter where I go in the States. And why should they pay the DME for equipment that is not being used - especially for long periods of time, when the patient - who is suppose to be who Medicare is serving - gets penalized.

Rant, Rant, Rant.....Sigh

[split_city]

I'm not 100% sure, but I think one of our PhD students/sleep specialists actually conducted a study to see whether pulse oximetry was a suitable and accurate method for assessment of OSA. I would need to find out whether this is true.

[NickD25]

Here in Canada, that's actually the first test I was given to determine if I had sleep apnea. I'm surprised to see that it's not given more in the US. I really though it was standard procedure. Heck, I prefer this to any sleep study unless they put me in a hotel suite and no I'm not even kidding. My sleep study was more an awake study to finally get the piece of paper for a prescription.