Sleep Lab in a Box

[KSMike]

Seems to me that Todzo has come to the same conclusions that I did, over 10 years ago. The whole premise of sleeping in a strange bed, in front of strangers, with potentially different air conditions, etc., invalidates a portion of whatever results are obtained. I will not be convinced that in-home sleep studies are not only possible, but would yield far more accurate results, and probably with less cost to whoever is paying for it.

Having said that, I don't understand why the first "to-do" is to get government sponsorship. Why is that everyone's first inclination for every idea that comes along? I also don't think it would take weeks of classes to show the patient how to do it. The part played by humans in a sleep study never seemed like rocket science to me. Want to doom the project? Start by getting "government sponsorship."

[Todzo]

Hey Todzo!

Can you do me a BIG favor?

Just pick ONE day out of the week where you're not an asshole?

Thanks!

Have a great weekend!

Delta Dave,

Come on now, you know that name calling has no place on this board.

You're better than that.

49er

Hi 49er!

For those that may wonder I am working on a post I will probably call "The Todzo Incident".

What I know from the past is that I do not see well at times, come to the wrong conclusion - but - am unable to see that for some time.

So, I am giving it a bit of time - so - I can see clearly - so - my very likely and very public apology to Lazer and thanks to SleepingUgly can be truely sincere.

from what i have read delta's posts are full of verbal and other abuse but i do not see clearly i request that others would check this out and report

thanks all

todzo

[ems]

The posts on this forum lately have been so far out of the box that I can't see the end of the box.

[Todzo]

The posts on this forum lately have been so far out of the box that I can't see the end of the box.

In years past i hurt my family during this Christmass season deep regret

people with obstructive sleep apnea have problems which seem to cause them to fail in relationships home and work

what i have experianced is that i see things improperly - react - perhaps are corrected - but - still see things improperly

i think they call it concrete thinking

i have noted that others with obstructive sleep apnea do this as well

i am having diffaculty with unstable breathing in spite of about half the pressure of last year probably from memories of an attack upon my person and a seasonal affective disorder

i think that the obstructive sleep apnea damaged parts of my brain are now stressed and i know my cpap treatment is not going well

i know this affects the very places in my brain i need to be to work through relationships

the holiday season is hard on many of us

may we cut one another some slack

[Todzo]

Seems to me that Todzo has come to the same conclusions that I did, over 10 years ago. The whole premise of sleeping in a strange bed, in front of strangers, with potentially different air conditions, etc., invalidates a portion of whatever results are obtained. I will not be convinced that in-home sleep studies are not only possible, but would yield far more accurate results, and probably with less cost to whoever is paying for it.

Having said that, I don't understand why the first "to-do" is to get government sponsorship. Why is that everyone's first inclination for every idea that comes along? I also don't think it would take weeks of classes to show the patient how to do it. The part played by humans in a sleep study never seemed like rocket science to me. Want to doom the project? Start by getting "government sponsorship."

Hi KSMike!

I thought of government sposorship for two reasons:

1. The initial development and production of the technology to do this will cost millions (will save billions but will cost millions).
2. The industry is all tied up in patents, corporate secerecy, just plain greed. We need to brush that away quickly. It takes a heavy hand.

Yes we need to eliminate the "lab effect" but we also need to deal with the fact we do not sleep the same every night. I am suspicious that there are many whose sleep apnea is currently expressing itself once a month. Then it will proceed to once a week ... Titration needs to deal with the time it takes to get used to pressure as well as the fact that if the therapy works the body will heal so pressure will need to follow the change. The body and the persons life will never stop changing. Monitoring must be continuous - titration ongoing.

Thank you for the on topic response!

Have a great week!

Todzo

[deltadave]

And, that's an awful avatar!

You're right!

What was I thinking!?

Where's my Christmas spirit!?

Avatar changed.

[Todzo]

Seems to me that Todzo has come to the same conclusions that I did, over 10 years ago. The whole premise of sleeping in a strange bed, in front of strangers, with potentially different air conditions, etc., invalidates a portion of whatever results are obtained. I will not be convinced that in-home sleep studies are not only possible, but would yield far more accurate results, and probably with less cost to whoever is paying for it.

Having said that, I don't understand why the first "to-do" is to get government sponsorship. Why is that everyone's first inclination for every idea that comes along? I also don't think it would take weeks of classes to show the patient how to do it. The part played by humans in a sleep study never seemed like rocket science to me. Want to doom the project? Start by getting "government sponsorship."

Hi KSMike!

I thought of government sposorship for two reasons:

1. The initial development and production of the technology to do this will cost millions (will save billions but will cost millions).
2. The industry is all tied up in patents, corporate secerecy, just plain greed. We need to brush that away quickly. It takes a heavy hand.

Yes we need to eliminate the "lab effect" but we also need to deal with the fact we do not sleep the same every night. I am suspicious that there are many whose sleep apnea is currently expressing itself once a month. Then it will proceed to once a week ... Titration needs to deal with the time it takes to get used to pressure as well as the fact that if the therapy works the body will heal so pressure will need to follow the change. The body and the persons life will never stop changing. Monitoring must be continuous - titration ongoing.

Thank you for the on topic response!

Have a great week!

Todzo

Actually I do not care who builds this as long as it gets built soon.

For that matter if we develop a treatment that is useful to the 80% I believe this will work for (with 100% use and good heatlh benafits) then the 18 million or so who need it will flock to it. As it is a 20% chance of perhaps some success at one year will not justify the extreme expense for most people.

As well treating 18 million people will create a lot of jobs, not to mention save a lot of jobs, and save a lot of relationships, and save a lot of lives.

[lazer]

...my very likely and very public apology to Lazer and thanks to SleepingUgly can be truely sincere.

Thank you.

[Todzo]

...my very likely and very public apology to Lazer and thanks to SleepingUgly can be truely sincere.

Thank you.

I very much regret hurting you Lazer.

Historically during winter parts of my brain do kind of shut down. Hopefully I can actually "see" how wrong I was - well - by March?

Appreciate you greatly regardless Lazer.

May your relationships this Christmass season go extremely well!!

Todzo

[ems]

And, that's an awful avatar!

You're right!

What was I thinking!?

Where's my Christmas spirit!?

Avatar changed.

Now that's more like it. Thank you!

[stage0]

Back to the original posts.....in my EXPERIENCE...ppl just want to decieve to get something for nothing. IE. wnat to become diagnosed with OSA to get some sort of benefit. These home testing units are very much influenced by the person taking it home. I have evern heard of some holding their breaths to induce desats; giving the unit toa healthy person to avoid diagnosis of OSA and taking the pulse-of off thru the nite thus voiding the test altogether. ALLLLL the technical advances will not overcome the will of the patient to influece the test to their advantage. As to the person that is used to sleeping at home and being forced to sleep in a clinic...i have found very few that have a problem with it. Most undagnosed OSA ppl are soo tired to care.

[Todzo]

Back to the original posts.....in my EXPERIENCE...ppl just want to decieve to get something for nothing. IE. wnat to become diagnosed with OSA to get some sort of benefit. These home testing units are very much influenced by the person taking it home. I have evern heard of some holding their breaths to induce desats; giving the unit toa healthy person to avoid diagnosis of OSA and taking the pulse-of off thru the nite thus voiding the test altogether. ALLLLL the technical advances will not overcome the will of the patient to influece the test to their advantage. As to the person that is used to sleeping at home and being forced to sleep in a clinic...i have found very few that have a problem with it. Most undagnosed OSA ppl are soo tired to care.

The FULL POLYSOMNOGRAM IN THE HOME testing units will be run for SEVERAL NIGHTS.

I do not believe that anyone can fake an EEG!

People are not coming for diagnosis because there currently is no long term effective treatment offered. They may not specifically know the numbers but they are watching a friend who is going through the process or has gone through the process of trying to use PAP. They are watching the person struggle in our oppresive medical system - still be sick - not be helped - be oppressed. So they know better than to do what will not work and would cause pain.

The current ways of doing things do not work and need to be replaced soon.

[Todzo]

Lab is the gold standard ad very acurate. also, i am a honest 3rd party in evaluation

The Polysomnogram. They still do it the old fashioned way. They have you travel, often great distance, to spend the night in front of strangers in a lab.

I remember an ad for a competitor to the iPhone. The little joke was the guy was saving place in the long line to get the latest - for his parents.

The technology to bring the entire Polysomnogram into the home has been around for a long time.

The thing is if I take an animal who sleeps in an under ground den to a lab and then call his observed sleep there "normal" my fellow researchers will cry fowl.

But when the doctors take a normal human being out of his comfortable home and place him in a lab - the medical researchers will call “Golden Standard”.

I cry fowl!!

I think that it is ridiculous to think that someone would seek a diagnosis of obstructive sleep apnea

[archangle]

There are already a lot of people working on home sleep tests.

Some of them I consider to be almost quackery. Either the manufacturer looking to make a quick buck, or a scam for the insurance companies to come up with an excuse to not pay for a real test.

I'd say the jury is still out on some of them, but they show great promise.

Some are pretty darn impressive already.

However, as little faith as I have in the medical mafia, I'll say that none of them can hold a candle to a well run, in lab PSG test.

Unfortunately, in-lab PSGs have big problems.

1. Tests where the patient doesn't sleep.
   
   I think every sleep test should have a sleeping pill available in case the patient can't sleep. Yes, you'd like to get results without a sleep aid, but a test with no sleep is worse than a test with a sleep aid. Then the patient is our $xxx and is probably not willing to waste time and money testing for sleep apnea in the future.
   
   Unfortunately, a lot of doctors are too pigheaded to see this and prescribe a bill "just in case."
2. Patient sleeps but sleeps differently in the lab than at home.
3. Noisy labs, incompetent, surly sleep techs, etc.

I suspect that the overall outcome would be better if the standard "sleep test" was an APAP machine with a modem, and a quick nightly interpretation of the results for a few weeks along with a conversation with the patient followed by adjusting the settings up or down until you can get a pressure. Start with a low pressure, see if the patient shows apneas, then tinker with the pressure until you find a good setting.

I'll bet a considerable percentage of the apneacs would be properly detected and treated this way.

Even better would be a real time remotely monitored in home sleep test with just a remote controlled APAP and maybe a two way intercom for a few nights.

If you can't figure things out that way, then consider a more detailed home or in-lab sleep test.

Of course, you can botch up the home sleep test the same way we currently botch up a lot of in lab PSG sleep tests as well.

One thing is for sure, getting the best outcome for the patient is not going to be high on the priority list of the people in charge.

[deltadave]

And, that's an awful avatar!

You're right!

What was I thinking!?

Where's my Christmas spirit!?

Avatar changed.

Now that's more like it. Thank you!

No prob!

Course, this one's only good till Epiphany at most, then I'll need a new theme.

How about this (playing on the Valentine's Day thing):