Dual Tests

[reds fan]

I was scheduled to do a dual study where for the first part they would monitor me without a mask and the second half of the study then would monitor me with a mask. The Tech woke me up at the wake up time which was 7:00 am and I asked him why I wasn't given the mask for the second half of the study. He explained to me that by the time I reached my deep sleep there was no time to run the second part of the study which included the mask because we had to be done by 7 am. I guess my problem with this is I didn't show up for my study till 11:00 PM and really didn't get to sleep till 12:30 or so. Had I known there would possibly be a time issue I would have shown up much earlier so both study's could have been done. Instead I missed doing the second study by a half hour. Now they want me to show up to do a second study which who knows what my insurance will say. Something just doesn't seem right.

Any input is welcome.

[Emilia]

My sleep study tech told me they only need you to sleep about 2 hours to get the data needed; however, if you didn't cycle through properly to a deep/REM sleep until late into the night, that is a problem. I slept for 5 hours and only 2% of that was in REM sleep. I go back tomorrow night for part 2/titration. I am sure your doc will be sending you back as well

[cobra4x4]

This is quite common, They start you off in what would be considered your normal sleeping state and monitor your vitals, body positioning, breathing, O2 levels etc etc. Once they have determined you have OSA (In my case after only 2hrs) if there is time left then they will do a split study which is where they then put you on a cpap machine and titrate the pressure needed to keep your airway open while you sleep (This usually requires the patient to enter REM sleep as more apneas happen during REM sleep). Some patients take longer to diagnose therefore a second study for titration is required.

Some sleep labs require the patient to go in for a second titration study (that way they get paid for 2 visits instead of 1). It all depends on who does the testing and what country you live in, they all have different rules to follow. I lucked out in that my study was done in the hospital instead of a sleep lab or home study.

[elena88]

There is another option, they can send you home with an apap to do a one week titration at home, so you dont have to go thru
another sleep study..

That is what happened to me, I slept an hour, got the diagnosis, but no time for a titration.

This is a machine you rent, so its not as expensive as a sleep study. No one even mentioned a second sleep study for me, they
just sent me home with the apap.

I would not suggest going that route unless you were already on this board, and you are..

[LoQ]

(that way they get paid for 2 visits instead of 1).

Or, even if your oxygen stays below 88% for 30 consecutive minutes during the night test, they declare that the problem isn't yet apparent and that you still need an MSLT the following day, and then finally agree that you need to do a titration study. That way, they can charge you for 3 visits instead of 1.

[Reds Fan]

I guess these responses tell me pretty much what I assumed and that is they are trying to get my insurance company to pay for two sleep studies as opposed to one. Which will affect my rates and also inconveniences me by having to go back in and get hooked like a lab rat with wires.

[LoQ]

I guess these responses tell me pretty much what I assumed and that is they are trying to get my insurance company to pay for two sleep studies as opposed to one. Which will affect my rates and also inconveniences me by having to go back in and get hooked like a lab rat with wires.

Or, if you have a large deductible, and they can figure out how to split these three tests over two years by telling you in December for the third test that "everyone in the lab suddenly got sick today" so that you have to reschedule for January, they can not only rope in your insurance company multiple times, they can max out my, I mean your, really high deductible twice in just a couple of months.


If I had it to do over again, I think I'd just get an auto off of craigslist and do it myself. A whole lot cheaper that way.

[LoQ]

OK, I'm going to make a serious suggestion instead of just snarky remarks about sleep labs. Why don't you call your doctor or call around to some doctors and see if there is one that will let you do an at home study, I think someone suggested this? I just had an at-home study, and the DME actually loaned me a machine at no charge, although I suppose it is possible they billed insurance for it.

[Redsfan35]

OK, I'm going to make a serious suggestion instead of just snarky remarks about sleep labs. Why don't you call your doctor or call around to some doctors and see if there is one that will let you do an at home study, I think someone suggested this? I just had an at-home study, and the DME actually loaned me a machine at no charge, although I suppose it is possible they billed insurance for it.

Do they have masks for the home study's?? My wife did a home study but she didnt have a mask.What they are wanting to do the second time is readjust the pressure to where it should be. My situation is I have been on a CPAP for 6 plus months but due to a operation on my nose to allow more air flow and recent weight loss they are wanting to reevaluate what the pressure should be.

This also brings up another instance where I brought in the current CPAP machine to the doctor. They read the card and they stated that the pressure is exactly what it should be. I think it was under 1 is what they said although I am not sure what that means. So if the card on the current machine I am using says my pressure is where it should be, why are they having another sleep study other than to milk the insurance company?

[LoQ]

I already have a mask because I am on CPAP therapy. The DME did ask me, however, if I had "supplies" and asked if I had a mask, hose, etc. I'm not sure what they would have done if I had said "no."

I cannot answer your questions about the doctor's comments about your machine. It would help if you could specify the make and model of that machine. I could speculate that they were checking to see if it was set for your previous prescription, and checking to see if your machine is calibrated correctly, and all of that turned out to be good. So then the machine doesn't need correction, suggesting that if you are not getting good therapy, you might need a different setting. Hence, the study. It doesn't sound like, in that case, an attempt to just get more money from insurance.

[montana user]

I guess these responses tell me pretty much what I assumed and that is they are trying to get my insurance company to pay for two sleep studies as opposed to one. Which will affect my rates and also inconveniences me by having to go back in and get hooked like a lab rat with wires.

This may be the case, but if I can play devils advocate here. To do a split-night study we need 15 breathing events an hour, and two hours of continued sleep. We have until 2 am to decide to try the mask or not. It takes a good 4 plus hours to do a GOOD titration. After 2 am, theres not alot of time. My experience in the lab is that most people do fine the first part of the study. I have had people sleep so good, I scratch my head and wonder why they are here? then about 3 am, deep sleep or roll to their back...there it is! Apnea and tons of it!! Well now its past 2 am, so nothing I can do. I believe this is what happened on your study.

Now had you showed up earlier, could you have fallen asleep sooner? I get this alot with people. They don't go to bed till midnight, but they want this done in one night so they come in at 10. Then they toss and turn and can't sleep...until midnight. so they did not accomplish anything. Even with a sleeping pill they still struggled. Ok thats my side, I can not guarantee that the lab you visited ran into that issue or if they truly just wanted you back again. Good luck with this new journey you are on!! CPAP has helped me sooo much!!!

[cobra4x4]

Here where I come from the hospital makes you go in for 9pm ,hooked up and ready by 9:50pm. Lights go out at 10pm precisely and the testing begins, they wake you at 6am precisely and your on your way before 7am after filling out a quick questionaire about your experience.

If your late for your appointment too bad, you get re-scheduled many many months later.

They don't fool around here

[Redsfan35]

Here where I come from the hospital makes you go in for 9pm ,hooked up and ready by 9:50pm. Lights go out at 10pm precisely and the testing begins, they wake you at 6am precisely and your on your way before 7am after filling out a quick questionaire about your experience.

If your late for your appointment too bad, you get re-scheduled many many months later.

They don't fool around here

I would have gladly shown up early had I known there would be a time limit on this. The Tech told me I missed having the second part of the study done by a half hour. I just wish they would have told me that there was only a certain amount of time that this study had to be done. Instead I have to go have another study and they get paid even more now.

[montana user]

another problem we run into is when we wake you up at say 2 am, try the different masks on, let you get used to it, then strap it on..your WIDE awake. I lose alot of patients who want to just go home now that they are awake. So Its a hard call on these split nights. But yes someone should have explained the possibility of a split-night to you!

[Slinky]

Well now, you were going for a sleep study. I would anticipate this to mean that you expected to sleep and were expected to sleep. Since the intention was to evaluate your sleep and determine if you needed CPAP and if you did to find what pressure you needed just how much time did you anticipate you would need to sleep?? WHY didn't you go in until 11PM if you COULD have gone in earlier??

I do NOT see the sleep lab to blame here, nor do I see this sleep lab deserving of the comments as if they were just gold diggers trying to make an extra buck.

Medicare and most insurance won't even pay for a split-night study unless certain criteria are met, number of hours slept, severity of desaturations, number of apneas, etc. w/enough time left in the night to properly titrate. Most sleep techs put in 12 hour nights. After the patients leave in the morning the techs still have to clean all equipment used, most have to also change bedding, etc., etc.