They didn't take advantage of you when they didn't do the second (daytime) test. What the lab did when they canceled the second test is part of a "differential diagnosis" process. A differential diagnosis is when a doctor (or team of doctors) is trying to decide which of several conditions/diseases is most likely the real cause for a patient's reported symptoms. In order to figure out which of the suspected conditions/diseases the real cause, the medical team runs tests in a specific order. If a particular test turns up positive, then any subsequent test is NOT run: The underlying disease has been identified and you start treating it.Snoopchic wrote:I think I just feel taken advantage of since they didn't do the other test. If I knew the results, and they were severe, I wouldn't feel that way.
Since the doc who ordered the sleep test originally scheduled you for a (potential) two part sleep test, it sounds like the doc thought you might have narcolepsy: The second (daytime) test is designed to diagnose narcolepsy. But narcolepsy, OSA, and a host of other sleep disorders all share many of the same symptoms, and among those common symptoms are excessive daytime sleepiness, excessive daytime napping, and the inability to get good, restorative sleep at night. So before a doc is going to diagnose anybody with narcolepsy, s/he needs to rule out other things like OSA, periodic limb movement disorder (PLMD), and a host of other sleep disorders that occur during the regular, night time sleep period. Hence if a doc suspects that a patient might have narcolepsy, the first thing that has to be done is the overnight sleep test, which is used to diagnose OSA, PLMD, and a whole slew of other sleep disorders. If any night time sleep disorder is found, there's no point in doing the test for narcolepsy: Until the newly discovered night time sleep disorder is properly treated, the daytime test (for narcolepsy) has a high chance of being what's called a "false positive"---i.e. the excessive daytime sleepiness caused by the night time sleep disorder can be severe enough to make it look like the patient has narcolepsy even though the patient does not actually have narcolepsy.
In other words, narcolepsy can only properly be diagnosed if the night time sleep is normal. Hence, the protocol for the second test to take place is that there is no evidence of night time sleep problems that could lead to the daytime symptoms that suggest narcolepsy. And your night time test turned up evidence of OSA. And that means your OSA has to be treated before a diagnostic test for narcolepsy can be run.
It seems to be common practice to run the titration test as soon as possible after the diagnostic test turns something up. And then schedule a follow up either after the titration test or even a few weeks after PAP therapy has begun. I suspect the reason it is usually done this way is that most sleep docs want to get their OSA patients onto CPAP as soon as possible: There's the real hope that if patients start CPAP as soon as possible, then they'll start feeling better that much sooner. And the body will start repairing the damage done by years of untreated OSA that much sooner....I just hate that he doesn't want me to come to the apt until after they do the CPAP test with shoving stuff on my face If I knew everything first, I would feel like I could work with it. If he won't fax my results Monday, I feel like I will have to post pone the test. I need to know there is a true reason. I just don't trust anyone to just say it. I have to see it for myself. You guys have helped so much today! Thank you
But I agree with you: It's not really fair to the patient to do it that way---the patient should be able to see the full results of their diagnostic test and ask the doc some questions before the titration test is set up. The one good thing I will say about my first sleep doc is that he did schedule an appointment between my diagnostic test and my titration test to go over my sleep study reports. But I didn't know enough then to force him to give me my own copy of the results that day. (I was also numb with finding out that my apnea was "moderate" rather than "mild".) And he didn't really give me much of a chance to ask many questions and I left that appointment with more unanswered questions than answered questions. And the doc tried to get me to sign a form allowing him to send my yet to be written script to the DME next door to his office. I knew enough to NOT sign that paper, and I'm glad I told him that I wanted to shop around for a DME of my choice and that I'd let his office know after the titration was done and I'd found a DME where they could send the script. He agreed to that, but he sure wasn't happy about it.
The fact that I had a consultation with the sleep doc after the diagnostic test and before the titration test did delay my titration test by a good two weeks. And the fact that I insisted on finding a DME that I wanted to work with delayed my starting CPAP for another 4 weeks after the titration study. That bugged the heck out of the sleep doc: His office was calling me on a daily basis asking me why I just wouldn't let them send the script to the place next door, which I knew would set me up with a brick. (I knew that because I'd called them and asked what kind of machine they'd set me up with.) It got so bad that hubby finally told them that if they didn't quit calling that I would find a different sleep doctor to prescribe my equipment. All told, I got my equipment 55 days after my diagnostic sleep study. That's considered a pretty significant delay, but I figured at the time that I'd been sleeping with the OSA for at least 3-5 years and it hadn't killed me yet and I wanted to make sure that I got the right equipment in order to maximize my chances of becoming a fully compliant full time CPAPer for the rest of my life.
