Sleep Lab in a Box

[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, that 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):

[lazer]

...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

Aww. You really didn't hurt me other than sending me on a frantic "google" search for : Brain Damage & euphanic breathing.

[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!

No prob!

Course, that 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):

I do hope you'll remember to send this to me on Valentine's Day! At the very least, I will know someone loves me.

[Todzo]

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.

Hi archangle!

What I am proposing here is that we use a remotely monitored (by sophisticated software supplemented by an operator) full PSG in the home.

The PAP units would also be full time monitored - I mean - forever. The changes that occur in a human being never stop. So monitoring must not stop.

Considering how oppressive the medical community is these days (check out the crazy industrial troll activity this thread) I do understand your feeling that they would never seek our best interest. I simply pray that any who would be oppressive in, from, or around our medical care facilities would be like chaff before the wind.

Have a great week archangle!

Todzo

[Uncle_Bob]

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

Thanks!

Have a great weekend!

Mine is a Friday

[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 Christmas season go extremely well!!

Todzo

Aww. You really didn't hurt me other than sending me on a frantic "google" search for : Brain Damage & euphanic breathing.

Hi Lazer!

Certainly I am the more brain damaged of us two I think. The whole thing caused me to look more carefully at my own data. While my AHI is now running and for the 75 days at my new pressure is running less than 2 unstable breathing has now become present. This time it is more subtle to pick up in the data - you have to go to the waveform. Establishing a bit of enhanced expiratory rebreathing space (EERS - see: http://www.ncbi.nlm.nih.gov/pubmed/21206741 ) has made my sleep much more restorative.

Dr. Barry Krakow recently mentioned that the newest PAP technology is "breathing volume aware". I think that my solution of using EERS right now will probably result in less fragmented sleep than even the newest technology. Even Dr. Barry Krakow is not allowed to know what is in the newest boxes, that is proprietary!!! It is one of the reasons I recommend that this be a government sponsored project.

Thanks for the reply!

Todzo

[Todzo]

The boxes would be reusable...

uhh, yeah, like i would want to use a box from a ill, contageous person would you.

The microbiome in my house I am used to. The microbome of the hospital or sleep center is likely to be filled with virus and bacteria my body has no immunity to.

The boxes, of course, will be processed to minimize cross contamination. Since they are small this can be done much more efficiently and completely than in a sleep center as we do things today.

[Todzo]

The person would come in for a couple of weeks of classes to learn how to put on, take off, use, and maintain the equipment. Practice would be done under the supervision of the instructor and/or helpers. At the end of this set of classes he would leave with the suitcase the little box was in....

So your saying turn a one nite PSG into a 2-3 week ordeal

Currently the run to the Sleep Lab or major hospital is quite an ordeal. Many cannot sleep during the studies and have to be given pharmaceutical aids to help them perhaps sleep some.

Often one must drive many miles to reach the lab.

But this system will be designed to work in the persons own home and to be comfortable for them to put on and use themselves. No great time hit to get to and from the sleep lab. No strangers. No strange room. You use it at times convenient to you which will reflect the actual times you normally sleep in your own bed which is where the data will finally be able to reflect how you actually sleep rather than how you try to sleep given the crazy stresses you would have seen in a sleep lab.

No “in lab effect”!

No “first night effect”.

Simply how you sleep.

As well, since several nights are looked at the natural human changes in stress of life, diet, weekly cycle, simply all the normal variance of being human and sleeping every night will be seen in the data. This is apparently something we currently know nothing about. I understand that there are currently some small studies being done in the home. No one has taken the time to find out how we sleep in our own homes. We only know how we sleep in the lab. We have not even done the basic, basic science yet.

So while the current PSG may be “golden” for those who get paid for them - lets stop calling what has no basic science behind it a “standard”. Simply, it is not.

[Todzo]

Basically – take all of the sensors and make them usable by the person in his home. Should take less space than my desktop computer

.....Who want to place leads on the scalp, measure, paste, accuracy etc

I met an old friend at a class reunion this last summer. He works for the telephone company. They have gone through many changes in technology. When the Internet technology started to mature it's incorporation into the telephone industry was hard on a lot of people. Those who made their living servicing the old public branch exchange switching equipment became unnecessary.

My friend was indeed doing that at the time – but - he is a greatly curious fellow who loves technology. While others spent their time worrying about the impending job loss his curiosity drove him into the books on the new technologies. By the time the change was in process he was leading the planning and installation teams. He will always have a job there, happy as a clam.

The iBrain is a startup example of what will come to be. In the future I believe they will be able to “hear” a single neuron fire! The incredibly crude signals gathered by the now in use pads on the head will be replace by advanced printed circuit antenna arrays much better able to discern what is going on in the brain. So what in the past was an ordeal as they pasted wires to your head will become a simple cap with a lot more horsepower.

Technology moves on. Move with it or be blown away.

[GeneS]

I agree that something needs to be done so that the 95% or so of the people with untreated sleep apnea start getting treatment. I did not get into the details of the first post yet and I cannot read the second post because of the color but I think it is good to look at new ideas. Sleep apnea is not new. I have been on cpap for 27 years and feel fortunate but in these 27 years we have not figured how to reach the other 95%. Technology is changing rapidly and I think we should be very close to coming up with a simple diagnostic system that is available at drug stores, discount stores etc. without prescription. Many people may then need to go to a doctor, sleep lab or similar place to have their apnea checked out in more detail but at least they would be aware of sleep apnea and understand that they need to seek treatment. I think we can do better than we are doing now.
GeneS
.

[Todzo]

I agree that something needs to be done so that the 95% or so of the people with untreated sleep apnea start getting treatment. I did not get into the details of the first post yet and I cannot read the second post because of the color but I think it is good to look at new ideas. Sleep apnea is not new. I have been on cpap for 27 years and feel fortunate but in these 27 years we have not figured how to reach the other 95%. Technology is changing rapidly and I think we should be very close to coming up with a simple diagnostic system that is available at drug stores, discount stores etc. without prescription. Many people may then need to go to a doctor, sleep lab or similar place to have their apnea checked out in more detail but at least they would be aware of sleep apnea and understand that they need to seek treatment. I think we can do better than we are doing now.
GeneS
.

Hi GeneS!

There are many looking for OSA markers to make such screening devices so perhaps you will get your wish. I would love to see that!

Some are talking about a study expected out in Feburary telling the cause of OSA. Hopefully it is true and will result in a true cure rather than continued mechanical splinting to reduce the effects of a physiological problem.

Great post!

Todzo

[LSAT]

I agree that something needs to be done so that the 95% or so of the people with untreated sleep apnea start getting treatment. I did not get into the details of the first post yet and I cannot read the second post because of the color but I think it is good to look at new ideas. Sleep apnea is not new. I have been on cpap for 27 years and feel fortunate but in these 27 years we have not figured how to reach the other 95%. Technology is changing rapidly and I think we should be very close to coming up with a simple diagnostic system that is available at drug stores, discount stores etc. without prescription. Many people may then need to go to a doctor, sleep lab or similar place to have their apnea checked out in more detail but at least they would be aware of sleep apnea and understand that they need to seek treatment. I think we can do better than we are doing now.
GeneS
.

Hi GeneS!

There are many looking for OSA markers to make such screening devices so perhaps you will get your wish. I would love to see that!

Some are talking about a study expected out in Feburary telling the cause of OSA. Hopefully it is true and will result in a true cure rather than continued mechanical splinting to reduce the effects of a physiological problem.

Great post!

Todzo

Psychological is directed toward the will or toward the mind specifically in its conative function. [ Source: http://www.chacha.com/question/what-is- ... l-problems ]

I disagree with your statement......I would describe OSA as a mechanical problem that is sometimes corrected by surgery. (or CPAP). I don't believe that it is our mind that is the problem.

[Todzo]

I agree that something needs to be done so that the 95% or so of the people with untreated sleep apnea start getting treatment. I did not get into the details of the first post yet and I cannot read the second post because of the color but I think it is good to look at new ideas. Sleep apnea is not new. I have been on cpap for 27 years and feel fortunate but in these 27 years we have not figured how to reach the other 95%. Technology is changing rapidly and I think we should be very close to coming up with a simple diagnostic system that is available at drug stores, discount stores etc. without prescription. Many people may then need to go to a doctor, sleep lab or similar place to have their apnea checked out in more detail but at least they would be aware of sleep apnea and understand that they need to seek treatment. I think we can do better than we are doing now.
GeneS
.

Hi GeneS!

There are many looking for OSA markers to make such screening devices so perhaps you will get your wish. I would love to see that!

Some are talking about a study expected out in Feburary telling the cause of OSA. Hopefully it is true and will result in a true cure rather than continued mechanical splinting to reduce the effects of a physiological problem.

Great post!

Todzo

Psychological is directed toward the will or toward the mind specifically in its conative function. [ Source: http://www.chacha.com/question/what-is- ... l-problems ]

I disagree with your statement......I would describe OSA as a mechanical problem that is sometimes corrected by surgery. (or CPAP). I don't believe that it is our mind that is the problem.

of a physiological problem

Definition of Physiological - 1. of or relating to physiology 2. characteristic of or appropriate to an organism's healthy or normal functioning

[Todzo]

The sleep testing portion would take several nights to get a base – or – the titration portion would start if the persons OSA was so bad that to wait longer would be medically unwise...

so the patient comes in every day to be looked at for OSA

The Sleep Lab in a Box unit stays in the persons home for the entire PSG. No travel time lost. No taking the time of nurses, doctors, technicians – simply a testing unit in the persons home they use at their convenience.