My wife will be having her own sleep study next week

[tonycog]

When I had my first sleep study done, I knew nothing and had never seen this forum. Now I've read enough to know how much I didn't know.

My wife will be getting a sleep study next week. There is a strong likelihood that she will be diagnosed with OSA. My sleep issues don't primarily involve OSA; I have Cheyne-Stokes respirations, so I don't know much about typical OSA and I have some questions about how to proceed. Here are the circumstances:

We have already told our doctor that since our insurance deductible resets on January 1 he will need to have everything finished by December 31 - sleep study, follow-up appointment,etc. He told us (and it is the way he treated me this summer) that the "standard of care" is to have a second sleep study about 1 month into CPAP use for titration. We told him that we could not have a second sleep study if it came after December 31. He told us that he will do what needs to be done to work with us, acknowledging that sleep studies are expensive. My titration sleep study was billed at $3348 plus about $800 for the doctor's follow-up.

Is a 2nd sleep study/titration the typical "standard of care"? I have a friend with OSA who sees a different sleep doctor - in the same building, just down the hall from mine. His doc does not believe in ordering a second sleep study. Based on what my friend told me, it looks like he uses card data and patient discussion about how things are going to set pressures. How necessary is the second sleep study, assuming typical OSA?

What should she/we know before she goes in for the sleep study? Anything we should ask about? Any advice will be appreciated.

Many thanks,
Tony

[cflame1]

no... 1 month later isn't... it's probably his policy however.

a couple of weeks is usually what it ends up being... unless it's a split night study. If it's a split night then it could all be over in one night.

[KatieW]

I had a split study. My sleep doc had said that if they could verify OSA during the 1st 4 hours, then they would wake me up, and do the 2nd half as a titration. Before I went to sleep, the tech tried different masks on me, and had it ready it put on.

That worked well for me. I don't know how common this practice is. But I'm sure it's cheaper.

[roster]

Will the first sleep study be a full night of diagnosis or a split night with diagnosis and then CPAP pressure titration?

If she gets a CPAP after the first study, she should get a data-capable machine and titrate at home. If she is successful at this, then cancel the second study.

Here is a check list of questions that must be answered by the doctor from the first study.

Things To Ask About Your Polysomnogram (PSG) and Titration Study

1. Did I have any central apneas? How many?

2. Were there any comorbidities? What were they?

3. Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?

3. Did I exhibit Positional Sleep Apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)

4. Is there anything else unusual about the results?

5. How will I know my therapy is preventing apneas?

6. I am determined to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. This will allow me to call your office with specific questions if I have problems with the therapy. Will you help me with the appropriate prescription?

In addition to the questions:

1. Get a copy of your PSG. It is your legal right to have one.

2. Get a copy of your CPAP prescription.

3. Make sure the prescription calls for a humidifier with the machine.

[bailachel]

I was supposed to have a split study but didn't sleep enough the first night to get to the titration part of the study. They had me come back the very next night to do the titration.

[tonycog]

Will the first sleep study be a full night of diagnosis or a split night with diagnosis and then CPAP pressure titration?

If she gets a CPAP after the first study, she should get a data-capable machine and titrate at home. If she is successful at this, then cancel the second study.

Here is a check list of questions that must be answered by the doctor from the first study.

Rooster
Thanks for the list of questions. Those are exactly the type of things that I had hoped to find.

As for the sleep lab's plans, I don't know. When I had my PSG, the tech told me I would have qualified for a split study had I slept more during the first half of the night. By 2 AM, due to the amazing comfort of the wires, I had only managed about 60 minutes of official sleep, so I didn't meet their criteria for a split study despite the fact that the tech told me that she had already seen plenty of events. I mention my experience because this tells me that this sleep lab routinely does split studies when their criteria are met. I'll be sure we ask about a split study while they are wiring my wife up.

I already know about the need for a data-capable machine, thanks to this group. I'll start another topic about specific machines to choose from.

Can you tell me more about titrating at home? I know nothing about machines other than the fancy Bi-PAP AutoSV that my Cheyne-Stokes requires. I guess I got to go straight to the Cadillac of machines, at least price-wise. It's the only one I've ever used - or even read much about for that matter.

Thanks,
Tony

[kdiverson]

If your concerned about not sleeping enough the first four hours to qualify for a split study, ask for an ambian. they offered one to me, and i declined, ended up haveing to return for a second night. the ambian will insure that you sleep enough for a split study.

[Jaylee]

My insurance would not cover a split study, they wanted at least 6 hours of testing. So I had to go back about 3 weeks later. It would have been longer, but someone cancelled their appointment and I was able to get back in sooner.

[Sleeprider]

I was relatively intolerant to the sleep study which found I had severe sleep apnea; however I did not actually sleep for many hours. Rather than schedule a second titration study, my primary physician simply prescribed APAP. I have since shared data results and it is clear from that what the titration should be. The most economical thing your doctor can do is to prescribe an Auto-titration machine and be involved in reviewing the data. Even if you have to pay for the card-reader and software (send me a PM and I'll explain something), you will save on future sleep studies, and be able to demonstrate the efficacy of your wife's treatment as well as compliance. I think most physicians are surprised at what the patient can produce in terms of records and data that can help them to coach the therapy, and keep their patient engaged in a successful outcome. If you need examples of the types of data possible, you could probably use your own machine data, or members here would probably provide you with some examples of data-reports.

[plr66]

I can't think of any reason for delaying the second sleep study (titration)--if it indeed cannot be done as a split study night--other than scheduling capacity. Mine was done 2 nights after the first study; and I met shortly thereafter with the sleep doc for the "interpretation" and Rx.