Questioning Home Sleep Study/Scheduled Overnight

[moonslice]

Hi. My ENT sent me to a sleep specialist because I told him that my husband complains about my snoring. After talking with the sleep specialist we decided to do the home sleep study. That night, I know I was awake until 4 am (really, I was), but I had to return the equipment by 9 am, so not much sleep. I set alarm for 8 am.

Imagine my surprise when they called me with the results and said that I had stopped breathing 110 times while asleep, 13 times per hour, 16.8 times while on back, and my oxygen dropped to 84%.

The math doesn't add up to me. I would have had to have had much more sleep than I did. I think they got my machine mixed up with someone else's or it malfunctioned. They want me to do an overnight sleep study with the CPAP machine.

I'm an insomniac, and it's unpredictable. Some nights I can fall asleep, others not. Many nights I wake up throughout the night. My insurance does over 90 percent of the sleep study, which costs $4k. I went ahead and scheduled it, but I can't help wondering if I should cancel it and talk with the doctor before doing the overnight study. It's for July 11.

There are a couple of reasons I went ahead and scheduled it: If I wait for a doctor's appointment and then schedule a study after that, it's going to get close to a scheduled vacation. I want to get this resolved before vacation. If not, I'll worry! The second reason is that recently I remember waking up gasping for air, and having this thought in my head that, "oh, yeah, I do this a lot at night."

When I talked with the doc at my first visit, I didn't mention the gasping because I didn't think I did it. It was almost like I recovered the memories. Weird.

So, am I doing the right thing my going ahead and doing the overnight study? I'm really nervous about being able to fall asleep.

I'm female, 42 years old. Normal BMI.

[avi123]

Even if you sleep for one hour it is enough for them to decide if you suffer from OSA. When I did my several sleep studies in clinics in the past I took a small dose of 5 mg Zolpidem (generic Ambien) tablet. But this Rx delays REMs.

[jnk...]

. . . am I doing the right thing my going ahead and doing the overnight study?

If you can afford your part of it, do it. It might reveal some especially valuable information for you and your team.

I'm really nervous about being able to fall asleep.

Discuss that with the sleep doc. The two of you may decide on a strategy that will put your mind at ease about that. It may involve making sure you are especially sleepy that night or having a pill available to use just in case. Sometimes just knowing the pill is there if needed is enough to let you fall asleep without it.

If you end up getting to try PAP, the testing was all a success, regardless of what happened on the way to that.

Sounds like you will soon be getting an opportunity to find out if PAP will make your life a lot better! I know it has mine.

[moonslice]

Thanks for the replies.

If I'm understanding this correctly, the CPAP machine is not typically used during a first sleep study, but is being used for me because of my home sleep study results. Is this correct?

Regarding the sleeping pills, I've had a prescription for Ambien in the past but was terrified to use it because of the sleep walking side effect. Though sleep walking isn't normally a problem for me, I have encountered in it the past along with night terrors. I might dream that something is happening, and then get up and act out the dream. I'm afraid Ambien will make it worse. I also talked with the sleep doctor about the night terrors, but he decided that they happen so infrequently that the chances of capturing one during the study would be very slim. Hopefully I don't get up in my sleep and trip over all these wires.

Since we only discussed the home sleep study in the office, I feel a bit lost now. I wonder if I'm supposed to have special instructions. Guess I should call them back... I'm still having trouble processing this new diagnosis of sleep apnea. And if I do have to sleep with a machine, I'm hoping it's something that you can travel with easily. Eek. And hopefully my cats won't attack it in my sleep.

[palerider]

Thanks for the replies.

If I'm understanding this correctly, the CPAP machine is not typically used during a first sleep study, but is being used for me because of my home sleep study results. Is this correct?

you never use a machine during a sleep study, because the point is to see how you breath on your own.

when a machine is used, it's called a titration study, the point of which is to determine how much pressure it takes to keep your airway open so you can breath.

Is it annoying or uncomfortable to use?

cpap is often what you make of it... sure, it's less convenient than just flopping into bed and going to sleep, but if you look at it as something that'll make your life better, (and let your husband sleep instead of keeping him up with your noise) it'll go a whole hell of a lot better than if you look at it like some huge unnatural pain in the ass that you hate.

attitude can make a big difference.

[jnk...]

For me, CPAP represented the end of the annoyance and discomfort of being unable to breathe while asleep.

There are two types of in-lab/in-center sleep studies--diagnostic and titration. Your at-home study has already taken care of the diagnosis, so the titration should determine how you respond to PAP and should make sure no other sleep difficulties are unmasked once the basic airway problem has been solved.

[avi123]

Thanks for the replies.

If I'm understanding this correctly, the CPAP machine is not typically used during a first sleep study, but is being used for me because of my home sleep study results. Is this correct?

Regarding the sleeping pills, I've had a prescription for Ambien in the past but was terrified to use it because of the sleep walking side effect. Though sleep walking isn't normally a problem for me, I have encountered in it the past along with night terrors. I might dream that something is happening, and then get up and act out the dream. I'm afraid Ambien will make it worse. I also talked with the sleep doctor about the night terrors, but he decided that they happen so infrequently that the chances of capturing one during the study would be very slim. Hopefully I don't get up in my sleep and trip over all these wires.



Since we only discussed the home sleep study in the office, I feel a bit lost now. I wonder if I'm supposed to have special instructions. Guess I should call them back... I'm still having trouble processing this new diagnosis of sleep apnea. And if I do have to sleep with a machine, I'm hoping it's something that you can travel with easily. Eek. And hopefully my cats won't attack it in my sleep.

Don't take a sleeping pill unless your doctor says that you should!

[mummmz]

You will have some special instructions for the titration study. Mine were things like eat a light supper before reporting for the sleep study, either wear or bring comfortable clothes to sleep in, and don't take evening meds-bring them with you. Specifically ask the doctor ahead of time if you should take the Ambien or not. You might want to wake up early the morning before the study so you get sleepy earlier. They will put goop in your hair to hold the electrodes in place. I got it out when I got home my washing with regular shampoo and using a comb to loosen it. You'll have electrodes and belts on your chest and legs. If you start to get out of bed the tech will talk to you to see what you need. If an electrode comes off they can come in to reapply it. They watch and listen to you sleep. I forgot to bring a pair of socks and my feet were cold all night so you might want to have some just in case. You can bring your own pillow if you want. Try out several masks to find one that is comfortable. I just accepted what they gave me and later found out the titration study is where you should be fitted for the best mask.

My two dogs could care less about my machine or mask. It is quieter than the air conditioner so they don't hear it. It will probably take a little time to get used to wearing a mask but don't give up on it. I was waking up gasping for air and I don't think I am any more. Gasping like that is a symptom of Congestive Heart Failure. Mine is very mild at this point but leaving my apnea untreated made me gasp even more.

Good luck with the titration.
Dani

[jnk...]

. . . I've had a prescription for Ambien in the past but was terrified to use it because of the sleep walking side effect. . . . Hopefully I don't get up in my sleep and trip over all these wires. . . . I'm hoping it's something that you can travel with easily. Eek. And hopefully my cats won't attack it in my sleep.

Someone will be monitoring you during the sleep study, so don't worry about Ambien use or tripping. It's all kinda cool. Kinda like a safe abduction by aliens who want to learn about your sleep.

Travel with CPAP is easy.

As for cats, hey, they are what they are. They will only attack the machine if they sense you would find that especially irritating. (So don't show fear. They can sense fear. ) Your cats will likely appreciate your quieter sleep, I believe.

[palerider]

I'm hoping it's something that you can travel with easily. Eek.

Travel with CPAP is easy.

no matter what Airmony would like you to believe.

[Janknitz]

If you are skeptical about the home sleep study because the numbers don't add up considering the number of hours you know that you slept, you can request a "split study". The first half they will just monitor you without CPAP, and then do the titration the second half of the night. If your apnea is really all that bad, they won't have to do the first part for long before they decide to do the titration.

Talk to your doctor about this possibility.

If nothing else, it will rule out any problems with the home study data and help you deal with denial if that's part of the reason you are not accepting of the home study results (not saying that it is, but it might be).

[palerider]

If you are skeptical about the home sleep study because the numbers don't add up considering the number of hours you know that you slept, you can request a "split study". The first half they will just monitor you without CPAP, and then do the titration the second half of the night. If your apnea is really all that bad, they won't have to do the first part for long before they decide to do the titration.

Talk to your doctor about this possibility.

If nothing else, it will rule out any problems with the home study data and help you deal with denial if that's part of the reason you are not accepting of the home study results (not saying that it is, but it might be).

more likely the numbers don't 'add up' because they're incomplete, and the hours recorded as slept aren't the same as someone remembers while drifting in and out of sleep...

I'd take as many hours as possible for titration and forget the split study part of it, (or just buy an auto machine and skip the titration completely)

[moonslice]

Thanks again everyone. This is all interesting and informative. Maybe I am in denial, but I'm pretty certain that I just laid there not sleeping until 4 am. I felt miserable that day for lack of sleep.

The person who called to give me the results didn't call it a Titration. She just said second overnight with CPAP, but she didn't have much of a bedside manner and seemed annoyed with my questions.

I had assumed it would be diagnostic as well, but looks like I'm wrong. Maybe they are planning to do the split study. I didn't really read up on any of this in anticipation of the results because I was convinced that this was just another test ordered by an overcareful doctor. It's funny because I'm somewhat of a hypochondriac, yet whenever I am diagnosed with something it's a shock and something I never suspected.

I'm guessing the doctor won't be there when I report at 8:30pm on Monday, so I should try to get the questions answered tomorrow, or postpone the test.

[zoocrewphoto]

Thanks again everyone. This is all interesting and informative. Maybe I am in denial, but I'm pretty certain that I just laid there not sleeping until 4 am. I felt miserable that day for lack of sleep.

The person who called to give me the results didn't call it a Titration. She just said second overnight with CPAP, but she didn't have much of a bedside manner and seemed annoyed with my questions.

I had assumed it would be diagnostic as well, but looks like I'm wrong. Maybe they are planning to do the split study. I didn't really read up on any of this in anticipation of the results because I was convinced that this was just another test ordered by an overcareful doctor. It's funny because I'm somewhat of a hypochondriac, yet whenever I am diagnosed with something it's a shock and something I never suspected.

I'm guessing the doctor won't be there when I report at 8:30pm on Monday, so I should try to get the questions answered tomorrow, or postpone the test.

Some insurance companies require a positive home test before doing a lab version of the diagnostic test. Some do a home test and go straight to titration. So, it could be either way. It is a reasonable question to ask. I would also ask about ambien. I am a severe night owl, and I did not sleep well in hotels before cpap, so I was afraid I would not sleep. My doctor prescribed one ambien, and told me to wait until the tech told me to take it. I figured it would be safe since I was in a hospital, so if I did have a bad reaction, I would be observed. I slept really well, and my study was spot on.

As for feeling like you didn't sleep, it is often a mistaken perception of time. For example, I had restless leg syndrome the other night, and I felt like I didn't sleep for the first 5 hours. But I can't remember all of the tv I watched either, so I probably drifted in and out, and I just don't remember it.

I also have a history of falling asleep upright while watching tv. I don't remember sleeping, but I snort myself awake, so clearly, I had to have fallen asleep.

[mummmz]

They could have counted apneas during some of the time you weren't (or thought you weren't) sleeping. Ask for a copy of the report so you can read it yourself. Get a copy of the second study as well so you can compare. Your home sleep study counts as your first study without the CPAP. She probably just used the term sleep study with CPAP as the layman's term for titration. She was probably up all night performing a study so she might have been tired. Give the doctor a call ahead of time to ask about using Ambien. Don't use it as a reason to postpone, lol.

Good luck,
Dani