Full Data machines vs Sleep Studies

[bonjour]

First let me say that I feel that Sleep Studies are VERY important when one is initially being evaluated. They can identify central apneas far better than any APAP or other full data machine. They can also ID which phase of sleep you are having problems with and other problems with sleep such as RLS.

From a health insurance point of view, it's cheaper!!! by easily a 10 to one margin. All you need is for one out of ten users to not have to get a sleep study and the insurance companies have broken even. This means that you take the data card to the DME to be read and printed and take the DETAILED reports to your Dr. for evaluation. This detailed data may even indicate the need for a sleep study or a change in treatment (e.g. the onset of centrals), that would make the patient healthier overall and further decrease the cost to the insurance companies.

I view the detailed data similar to the way I view my blood sugar tests, yes I'm also a diabetic, as a way to alter what I do so that I may have a better, healthier life.

Fred

[Hawthorne]

I have had a PSG, a titration and a retitration. All were terrible. I didn't sleep long enough or have enough REM to come to any pressure setting conclusions except that I had ordinary OSA and no other apparent sleep issues (i.e - centrals, RLS, etc).

Now that I have an auto data capable machine, the software and reader, I don't intend to ever go for another sleep study. I will make my own adjustments and evaluate results of the adjustments.

ONLY if I can't get myself back on track will I consider another "in lab" sleep study. I would lean toward an "in home" study on another kind of machine or more involved home sleep studies that may be available in the future.

I do agree, however, that an in lab sleep study, before starting cpap to see what may be going on in your sleep is a must.

[DreamDiver]

My last insurance company was so bad at paying, my sleep doctor's office dropped them right after my last sleep lab. They also didn't tell me before my next office visit two days later. I was pretty put out.

There is one generalized full-data machine I know of that can measure central apneas: The Sandman Auto HC.

Anyone suspected of sleep apnea should be given an at-home oximeter first just to measure 02 sats first. Upon-waking blood pressure should be compared with normal day-time blood pressure. Candidates should be required to take a class on how to read 02 sat levels and interpret blood pressure. It's not that difficult to understand. If you can read a thermometer, you can read an automated pressure cuff and 02 sats.

If 02 sats are obviously too low and upon-waking blood-pressure is too high, candidates should take home a sandman auto hc or an equivalent machine to home-titrate. They should be required to take a class on how to use the software and how to detect leaks in their masks.

If candidates are of the small percentage that need bi-pap or even smaller percentage that need an even more specific machine for centrals, that's when they should go in for a sleep lab to discover exactly what type of machine they really need.

If this were diabetes, we wouldn't be messing around this culture of results-interpretation secrecy. This is not rocket science. Everyone breathes. Machine diagnosis at home in a familiar environment over multiple nights is probably more accurate than diagnosis in a lab over one or two nights in an unfamiliar environment with wires hanging all over.

They don't put in new machines for every patient every time you go to the sleep lab. Nor do they throw away masks. There is no reason why such machines couldn't simply be in a library of loaner machines with your general practitioner's office until you know what you need for your specific requirements.

[pamlt]

Since being diagnosed with sleep apnea, I have been reading everything I can find. All I read says how dangerous it is. I am thinking if it is so dangerous why aren't we (patients) given more information and training on how to record and understand our own daily stats. After all, our lives are at stake. All machines should come with software and read out on a daily basis or at least weekly. As patients we should have the right to know how we are doing. It is just like a diabetic who checks their sugar levels every day and some who have had to learn to give themselves shots usually only given by a medical person.
How do we go about changing the rules and laws concerning sleep studies, DMEs and insurance companies?



ResMed VPAP III
Simplicity Nasal Mask
Humidifier
Pressure 16/11

[millich]

Fred,

Thank you for posting this. It made me feel much more comfortable with the fact that my doc is recommending that I, a newbie, be sent home with an auto-PAP following a sleep study where the lowest AHI obtained was 11.7. I was worried about whether I should have had another sleep study to determine a fixed pressure. You made me feel alot more comfortable that auto-PAP is an acceptable way for a newbie - with no central apneas - to go.

Thanks!

[jdm2857]

There is one generalized full-data machine I know of that can measure central apneas: The Sandman Auto HC.

Do you know how it does that? The sleep labs uses the belts around the chest and abdomen to measure breathing effort to separate obstructive vs. central apneas.

I thought that all of the xPAPs used a formula to guesstimate centrals.

[sepool]

I believe that I've read that the Sandman can detect the sound of heartbeats through the open airway, with no breathing - thus, it isn't an obstructive apnea. So it must be a central.

[Rustyolddude]

Respironics has a nifty little OSA diagnostic device http://alicepdx.respironics.com/

While a xPAP machine might be a helpful low cost diagnostic tool in liue of full study it might be a little tough taking someone initially undiagnosted and slapping a mask & oximeter on them and telling them to sleep for a few nights & report back. For follow-up sleep studys for persons already on xPAP therapy, it would be a good low cost alternative for insurance companies. Give a patient an auto machine, oximeter & let them log a week or two worth of data, the Doc. could re-prescribe based on the optimum titrated pressure.

[DreamDiver]

I believe that I've read that the Sandman can detect the sound of heartbeats through the open airway, with no breathing - thus, it isn't an obstructive apnea. So it must be a central.

Yes, it's actually quite clever!

I've been reading Michio Kaku's Physics of the Impossible.
In my own father's lifetime, we've gone from horse and carriage to maglev high-speed trains.
When he was in college after the Korean War, his physics profs told him he would never see lasers in his lifetime. Now we can't seem to live without them, whether for our aeroplane landing guidance, dvd players or SpO2 meters.

Surely we're only steps from acquiring Dr. McCoy's medical tricorder next.

[jdm2857]

That is creative thinking.

The machine can actually detect the heartbeat signal coming up the trachea, through the upper airway, the mask and a six foot hose. Impressive.

ResMed has a home diagnostic device called the ApneaLink. http://www.resmed.com/us/products/apnea ... c=patients

I got my sleep study via a research study but had to be screened first using one.

I believe that Medicare will now pay for CPAP machines on the basis of some home sleep studies (the ApneaLink would have to have it's optional oximeter to qualify) and no PSG. Actually, they would probably have to prescribe an APAP, at least at first, for titration. Could be a big cost saver. Patients who don't do well could have a PSG later to look for centrals and other more complex problems.