Validity of Sleep Study

I'm new to the forum and was hoping someone could give me the benefit of their experience. I recently had a sleep study done. It's been 10 years since my last one. I was informed by the office girl at the sleep center that I now DON'T have OSA anymore. The Dr. who read my report decided that I could use an orthodontic device. I'm somewhat dubious and wanted to see if you folks think this is an optimal study. I'm also basing this opinion on information another board member suggested.

2007 study I was asleep 6.4 hours. 2017 was 6.1 hours so, roughly comparable.
2007 I had 46 Apnea Arousals (ALL while I was on my back) 2017 No Apnea Arousals and 1 Hypopnea Arousal out of 4 (3 of which were in supine position.
2007 Total Rem 90.5 Min (21.7%) 2017 Total Rem 58.5 (16.0%)
2007 Sleep Efficiency 89.2 2017 Sleep Efficiency 78.3

My main concern is that I don't feel enough time was spent on my back to allow Apneas to occur. In the 2007 study, out of 58 respiratory events, 57 were while I was supine. In the 2017 study, out of 365 minutes of sleep I spent 22 minutes on my back out of 365 minutes. Obviously, I did not experience REM sleep during that time. So, my question is; is this a study that, based upon a history of OSA while supine,that failed to adequately test the sleep subject in that position sufficiently to formulate an opinion of any real value? I have a few herniated disks and never go to sleep on my back (but often wake up there) and, quite frankly, once they requested the supine position, I don't recall sleeping at all. After 40 minutes the lady monitoring came in and told me I could roll on one side if I wanted to so, I assumed their attempts to get me to sleep with my back pain were unsuccessful. Does anyone know of any members who have had this problem and were able to contest the results successfully?

And, of course the real issue is that without an OSA diagnosis, Medicare won't pay for a machine and supplies will be full price.
Any answers or opinions would be welcome. Thank you all. I've enjoyed browsing the forum. Sometimes it's just a comfort to know that others share your problems.

Well, I'll be very cynical here - does the MD have some interest in the dental office/lab that supplies ortho devices?

What about trying a home study now? Or else change MD's... Can you afford another lab study?

Mohustle wrote: I was informed by the office girl at the sleep center that I now DON'T have OSA anymore. The Dr. who read my report decided that I could use an orthodontic device.

Why would they say you could use an orthodontic device if you do not have OSA? Did they say that to pacify you? To pad someone's pocket? If you don't qualify for CPAP payment, I'd think a dental device would be an out of pocket expense too.

Mohustle wrote:Mohustle

You don't say whether you have been using CPAP the last ten years. Have you?

What are the reasons you went for another study? (Normally, we find out in the first diagnostic study that we have sleep apnea, and we never have another study because CPAP is rarely cured.)

kteague wrote:Why would they say you could use an orthodontic device if you do not have OSA?

lol Yes, it doesn't make sense unless the doctor is sadistic.

Julie wrote:Well, I'll be very cynical here - does the MD have some interest in the dental office/lab that supplies ortho devices?

... 'cause kickbacks on oral devices are lucrative.

Postby Julie on Tue Sep 05, 2017 3:28 am

Well, I'll be very cynical here - does the MD have some interest in the dental office/lab that supplies ortho devices?

I really don't know if there is a financial interest there or not. I just assumed that they contracted with a physician to interpret their sleep studies.

Postby Julie on Tue Sep 05, 2017 3:28 am

What about trying a home study now? Or else change MD's... Can you afford another lab study?

I never knew there was such a thing as a home study. Both that I have had were at "sleep centers". In both studies I had, the sleep centers had their own interpretive physicians that they used; I had no say in who reviewed the sleep study results.

Actually, with my several phone calls to the center after I saw the recommendations and requested my own copy of the study they did say that I could do a "follow-up" study. While I didn't think about it earlier, perhaps this is an attempt on their part to confirm the original study because, if I definitely don't have OSA there would be no reason to do another. As to affordability, the first study cost me $0. My Medicare Advantage Plan is a good one (State of Texas retiree) and probably the second test would be covered as well if they can demonstrate a need.

Postby kteague on Tue Sep 05, 2017 11:49 am
Why would they say you could use an orthodontic device if you do not have OSA? Did they say that to pacify you? To pad someone's pocket? If you don't qualify for CPAP payment, I'd think a dental device would be an out of pocket expense too.]

Thanks kteague. You answered a previous post of mine and I was hoping to hear from you as you ask the questions that get right to the heart of the matter. I presumed that I had a condition that was not as serious as full-blown OSA but did require a lesser degree of intervention. The doc, in his recommendations said I had "Upper Airway Resistance Syndrome suggested by an elevated arousal index at 10, snoring and associated with fatigue". I was paying more attention to the numbers and, unfortunately, did nothing more than skim the physicians recommendations. I noted that the Mandibular Repositioning Appliance needed to be fitted by a qualified dental practitioner and freaked out when I realized once my 10 year old machine gave up the ghost, I wouldn't be able to get another. I didn't note until now (thanks to your question and the ensuing search for information) that after the page break under recommendations in the physicians report was the line " CPAP titration vs Mandibular Repositioning Appliance, according to patients preference". This sounds to me like justification to ask for a prescription for another machine if the need arises.

Apparently, the secretary/receptionist who contacted me was misinformed, right? When I spoke to her, I asked if I would be covered by my insurance once my old machine stopped working and she said "No". She also told me I did not have OSA but, apparently I have been diagnosed with a condition that can be treated with a CPAP which, I presume would be covered by my insurance. I will take this study to a local respiratory center where I've been buying supplies and see if they can get full payment based upon this study. Also, I believe that, armed with this study, I should be able to have my PCP write a prescription if necessary. If indeed that is so, I'm sorry to have wasted the time of all you kind people who responded. And, if anyone sees any holes in my logic, please post your concerns. If my take on the situation based upon that one line in the "Recommendations" section is erroneous, I will repost with answers to the other questions posted.

I can't really respond to the financial/insce. issues here (Canadian) but would strongly advise against the 'device'. If you really have UARS (do a forum search here - lots of info) then a C- or Apap would be useful. Get more info before deciding.

You need to check with your Medicare Advantage Plan to see if they cover cpap for UARS diagnosis.
Just because a doctor write a RX for something doesn't mean that it is going to be covered (paid for) by Medicare or the Medicare Advantage system.

Postby Pugsy on Wed Sep 06, 2017 6:11 am

You need to check with your Medicare Advantage Plan to see if they cover cpap for UARS diagnosis.
Just because a doctor write a RX for something doesn't mean that it is going to be covered (paid for) by Medicare or the Medicare Advantage system.

I agree. The respiratory center folks are very helpful considering the small amount of money I spend with them. Unfortunately, I live in a flyspeck of a town and they are only here on Tuesdays and Fridays so, it will be a couple of days before I can enlist their aid in researching. However, if I can get the RX, I could get online and order a bargain model for considerably less if worst comes to worst. I haven't done a lot of research myself on my condition (after all, CPAP therapy worked for me for 10 years so, why bother) but I get the general feeling that purchasing from a respiratory company is 2-3X more that online companies.

Another member suggested Craig's List as a viable alternative. He was right; they are out there for sale. For the above mentioned reason (rural area) and the fact that I'm 1 hour from one large city and 1 1/2 hours from another, my chances of snagging a deal are minimal. Last weekend I found a Resmed Aircurve 10 with low hours and all the accessories in San Antonio for $175. Seller said it was gone in less than 2 hours. I'm afraid that'll be the case for most of what I find.

So yes, I'll definitely check to see if Medicare/Insurance will cover the expense should my antique (Resmed Tango) go belly up.

If you can't get Medicare on board for a new machine...check back with me. I might know a source for a new or used machine that wouldn't break the bank.