Why is Stanford considered so good?

[archangle]

Re: AutoPAP vs. Sleep study.

A good PSG (Polysomnogram) can see a LOT of conditions an AutoCPAP can not see. Some of these need a different course of treatment from what the APAP will do. The APAP may see and adjust your pressure for some things that the PSG will evaluate better and ignore.

On the other hand, the APAP titration can be done at your house, in your bed, in comfort, over several nights if necessary, etc. You may have trouble sleeping in the lab or sleep differently.

Unless money is too tight, I think all new apneacs should get a good lab sleep test.



Re: Good lab vs. Bad Lab

I have no idea how good Stanford sleep lab is. However, there are some astoundingly bad sleep labs out there. Think a sleepy "retrained" overnight convenience store clerk running the test, and a "sleep specialist" who may not even be in the US, banging out as many evaluations as he can as fast as he can to make the maximum money for his employer.

A well run sleep lab PSG does get a lot of very good info on your sleep.

It's worth trying to find a good lab. Unfortunately, it's really hard to find out who's good.

[Bright Choice]

Well, davelikesbeer, since you seem to be a Honda (or even Hyundai) kind of guy, how 'bout you rent out your place so we BMW owners can have a place to crash while we're getting our not-so-easy-to-diagnose-and-treat problems taken care of at the BMW shop?

P.S. I drive a Honda, so I'm not so sure I like this analogy.
P.P.S. If you've never been to a Honda shop, you don't know how bad it can be.
P.P.P.S. I think the docs can tell the difference between a Honda-kind-of-patient and a BMW-kind-of-patient. The Honda kind comes in with no list of questions and lets the doctor leave the room in 5 minutes. The BMW-kind-of-patient (still hating this analogy...) comes in with a list of questions that makes the doctor feel like he just got grilled for his boards by the time he barely escapes the room in an hour and a half.

Great analogy SU - there are not too many "Hondas" on board here, at least not after they have driven into this shop a number of times.

[asleep@thewheel]

The difference of 20 extra minutes in driving made on my life and that of my families can not be properly calculated into a monetary value.

For a year I went to UCSF in San Francisco since it was closer to my home where I was correctly diagnosed with OSA at 76 AHI and put on CPAP at 7 through a DME of their choosing by the head of their lab. Needless to say with an AHI that high the recommended pressure by their most knowledgeable of doctors was not going to suffice. To make a long story short, I was miserable for a year, switched from a nasal mask, to incorporating dental devices, to trying different meds for my high cholesterol and fibromyalgia due to a bilateral disk herniation in my neck at C-6, C-7. The head allergist at UCSF who administered all the typical skin and blood allergy tests came back with all negative results and so on.

Thank God or whoever is running this universe that I made and appointment down at Stanford where my life was aimed in the proper direction. No More imporper meds, correct allergy diagnosis and solutions with an allergist that is informed with the correlation of OSA and allergies. My pressure was slowly and incrementally pushed up to 14-17 over a few months on APAP with a full face mask. The correct diagnosis was made by a man who pioneered everything there is to know and more just by visually examining my airway not by testing. His experience and know how determined what pressure I would need to thrive and survive at. MMA was the only surgical option if I couldn't tolerate my APAP therapy. Eventually with his suggestion I made my way over to a Stanford psychotherapist who explained that 35 plus years of sleep and oxygen deprivation leads to severe anxiety issues in my case and that prozac not ativan or zanex are the only proper medical solutions while my brain tries to undo all of the sleep fragmentation. Those other medicines contain muscle relaxants which in the OSA world do not go hand in hand.

Best of luck if you want to put your life and that of your families in second rate medical care. What price can you put on that?

Sweet Dreams,
asleep at the wheel.

[VVV]

For the titration, could I not have simply used my APAP to determine the required pressure?

If you have garden variety obstructive sleep apnea and some good knowledge of CPAP, you can titrate yourself with an APAP.

I don't like the idea of the APAP titrating a person. The person needs to do the titrating using the functions of an APAP.

You can even do it with a straight CPAP.

It is best to have the software and I would not do it without the software.

I titrated myself with an APAP and software. The "BMW" shop could not get it done properly. I showed the sleep doc printouts of some nights using the prescribed settings and some nights using the self-titrated settings. He told me to keep at it and I think the lab heard about it.

Heck, I have spent several nights in sleep labs and you just don't sleep like you do at home. I think many can get better treatment if they titrate themselves at home.

Of course there is a mystique about big-name medical schools and "German-engineered cars". We need to keep them under the same critical eye we use for Hyundais.

[SleepingUgly]

The "BMW" shop could not get it done properly.

Why not?

[VVV]

The "BMW" shop could not get it done properly.

Why not?

Huh?

Surely you don't expect me to have the answer to that. (Although I did already throw out one reason.)

[archangle]

Once again, I have no knowledge of how good Stanford is.

It's important to realize that a university clinic can run the gamut from the absolute gold standard for treatment to the absolute pit of incompetence. In one city I lived in, the university was pretty good, but the university hospital was the absolute pits. I can't tell you how many people I heard horror stories from. I met a nurse who worked there and she had it written on her drivers license to never take her to the university hospital if she had an accident.

[Otter]

For the titration, could I not have simply used my APAP to determine the required pressure?.

Probably. IMO, lab titration is often inferior to home titration with APAP and a reasonably intelligent user or a well informed doctor who will take the time to look at more than 95% pressure on more than one visit. Most people just aren't in the lab long enough, and it doesn't address the environmental variables of home at all.

Of course, PSG is a great diagnostic tool, and you have something more exotic or complicated than simple OSA, a sleep lab could be very useful.

[SleepingUgly]

In my experience, unless your outcome variable is just an AHI < 5 and not something like "less EDS", it is not easy to titrate yourself. Too many potential permutations without at least a starting guesstimate.

[Otter]

In my experience, unless your outcome variable is just an AHI < 5 and not something like "less EDS", it is not easy to titrate yourself. Too many potential permutations without at least a starting guesstimate.

I found it easy. It probably depends on how complex your apnea is. Mine isn't, so I didn't have any trouble. I suppose it helped that I was actually conscious of OSA as I tried to fall asleep. Bumping the pressure up every time I stopped breathing at the edge of sleep got me close on the first night. But letting APAP do its thing would have worked too. My AHI is now usually under 1, gets up to 2 or so on a bad night. No centrals to speak of. I think it would reasonable to let people who present with simple OSA to try titrating at home with APAP, and then if they still have trouble, go to the lab to figure out what's going on.

Getting the mask to seal reliably was much harder.