Sleep study -- worth it?

Hello all! I have a dilemma and would appreciate advice.
I have received a preliminary diagnosis of sleep apnea and asked to do a sleep study. I have health insurance, but it's one of those high-deductible plans, so I have to pay the first $3000 of my medical costs. The hospital has told me that each night of sleep study costs around $2000. It seems crazy to me to pay $2000-$3000 to find out whether I need to buy a CPAP machine costing maybe $1000, but from what I'm seeing, this is what I'm supposed to do.

Based on my symptoms and the nighttime experiences of myself and my wife I am quite sure I have sleep apnea, so my question is, why not just skip the sleep study and buy the machine? Either the machine works for me or it doesn't. If it does, great. If it doesn't, then as far as I can tell, there isn't really an effective alternative treatment anyway. So what am I really missing by skipping the study?

Thanks!

Mark

I'm sorry that you have such a high deductible, but if you can possibly swing it, then my answer is Yes, absolutely it is worth it. The sleep study, called psg for polysomnogram, is first used to determine that yes you indeed do have sleep apnea, and also what Type of sleep apnea you have. The second study, if needed, is to decide what Pressure you need for your apnea. Too low and you will still have apneic events, too high and you could induce dangerous central apneas. So yes, it is not just used to diagnose. The sleep studies are important to decide how to proceed with your OSA therapy.

It is my personal belief that diagnostic studies are mostly done for the purpose of getting insurance to pay for the machine, so if that is not going to happen, skipping the diagnostic study would make sense to me.

However, it is also my personal belief that in-lab-titration sleep studies are very valuable for seeing how a patient reacts to pressure and for screening for other sleep difficulties. To me, they are worth the money.

That being said, if your primary doc is willing to scribble an Rx for CPAP, and you were to buy a full-data APAP out of pocket online, I have a feeling you would get a lot of help in this forum figuring out the best pressure and settings for you. Your wife would be in a position to watch for limb movements, and your machine would tell you if you seemed to be having centrals, so I have a hard time seeing how that approach could go all that wrong if it saves big bucks for you. I would probably opt for the ResMed S9 AutoSet with humidifier and a full-face mask. But hey, that's just me.

Then again, that is nothing more than the opinion of one guy on the Internet--me. And I'm not always sure that I know what I'm talking about. That's why I try not to listen to me when I talk, in case I don't agree with what I'm saying.

Personally, I would want my primary-care doc very much on board with that approach. He would be aware if I had any likely contraindications for trying PAP therapy.

Hello Mark and welcome! There are those who buy a machine that reports data that helps them arrive at an effective pressure to treat obstructive sleep apnea. Data is pretty much a must, and having an auto titrating machine makes the process even more streamlined. There are some pieces you will be forfeiting by not getting a formal sleep study and titration in the lab, like identifying the presence and significance of central sleep apnea, complex sleep apnea, UARS, limb movements, and reporting of oxygen levels, brain function regarding sleep stages, cardiac observation, need for a bi-level machine, and any sensitivity to high pressures resulting in centrals. You can buy or have a doctor order a recording pulse oximeter to establish a before baseline oxygen for a night and then correlate with machine data. You wouldn't be the first to do it, and for those with garden variety OSA (I think the majority by far) and no other influencing illnesses (like lung disease, neuromuscular disease, etc.), you'd probably do just fine. Problem is, those who have an extinuating circumstances may not know that in advance. Not sure if you were quoted the billing rates for the insured. Private pay or uninsured may be a different rate. Also, some places do a split night study, the first half the night is diagnostic and the rest of the night is titration on a machine if merited. You might want a quote on that too. It may be there are bits and pieces of this you want to do, particularly in machine shopping. Best wishes on whatever you decide.

kteague wrote:Hello Mark and welcome! There are those who buy a machine that reports data that helps them arrive at an effective pressure to treat obstructive sleep apnea. Data is pretty much a must, and having an auto titrating machine makes the process even more streamlined. There are some pieces you will be forfeiting by not getting a formal sleep study and titration in the lab, like identifying the presence and significance of central sleep apnea, complex sleep apnea, UARS, limb movements, and reporting of oxygen levels, brain function regarding sleep stages, cardiac observation, need for a bi-level machine, and any sensitivity to high pressures resulting in centrals. You can buy or have a doctor order a recording pulse oximeter to establish a before baseline oxygen for a night and then correlate with machine data. You wouldn't be the first to do it, and for those with garden variety OSA (I think the majority by far) and no other influencing illnesses (like lung disease, neuromuscular disease, etc.), you'd probably do just fine. Problem is, those who have an extinuating circumstances may not know that in advance. Not sure if you were quoted the billing rates for the insured. Private pay or uninsured may be a different rate. Also, some places do a split night study, the first half the night is diagnostic and the rest of the night is titration on a machine if merited. You might want a quote on that too. It may be there are bits and pieces of this you want to do, particularly in machine shopping. Best wishes on whatever you decide.

Mark, I like her answer better than mine. I always do.

Thank you all for the great advice!

My doctor is not willing to sign a prescription without the sleep study, which I totally understand. I'm not so sure I buy the need for gatekeeping in this case, but it is what it is. So I called around as suggested, and found a place actually closer to me that is less than half the cost WITHOUT insurance that the original place is WITH the insurance (I did check that I was getting the after-insurance price on the original place, and they confirmed they had "verified my benefits."). How does that happen? I grew up in the UK, and even though I've been here over 20 years, I still can't make head or tails of health costs here

But hey, I get to do the study, and they've already quoted me a price for the CPAP machine if I need one. I'm going in tomorrow, so I'll probably be posting back newbie questions in a few days

Mark

Even with a high deductible, your insurance will knock the cost of the sleep study down to the contracted rate, which is a lot less than the full price quoted. You would only need to pay the contracted rate. Same for the machine.

Make sure your study is a split-night study, with the second half used for titration.

But hey, I get to do the study, and they've already quoted me a price for the CPAP machine if I need one.

Danger, danger, Will Robinson!!!!! [this is an old TV show reference, if you are totally confused at this point].

Beware a sleep lab that supplies the equipment. This is a set up that has a high potential of having you walk out of this place in the morning with the cheapest machine and no data, but they will pocket a handy profit in the meanwhile.

Do your homework BEFORE you set foot in this place--you did a good job finding a less expensive sleep lab, so I know you can do a good job here, too. Take a look at my bog link below for "What you need to know BEFORE you meet your DME", since this sleep lab is purporting to act as your DME as well. Call your insurance company and find out how they reimburse for CPAP machines and whether they make a distincition between data capable and not data capable, CPAP or auto machines. Most DO not make the distinction and will pay the DME one set fee no matter what machine you get. So you should, theoretically, be able to get the best bells and whistles machine you want, but be prepared to fight this sleep lab/DME since their profits will be reduced if you demand a more expensive machine.

Janknitz wrote:

But hey, I get to do the study, and they've already quoted me a price for the CPAP machine if I need one.

Danger, danger, Will Robinson!!!!! [this is an old TV show reference, if you are totally confused at this point].

Beware a sleep lab that supplies the equipment. This is a set up that has a high potential of having you walk out of this place in the morning with the cheapest machine and no data, but they will pocket a handy profit in the meanwhile.

Do your homework BEFORE you set foot in this place--you did a good job finding a less expensive sleep lab, so I know you can do a good job here, too. Take a look at my bog link below for "What you need to know BEFORE you meet your DME", since this sleep lab is purporting to act as your DME as well. Call your insurance company and find out how they reimburse for CPAP machines and whether they make a distincition between data capable and not data capable, CPAP or auto machines. Most DO not make the distinction and will pay the DME one set fee no matter what machine you get. So you should, theoretically, be able to get the best bells and whistles machine you want, but be prepared to fight this sleep lab/DME since their profits will be reduced if you demand a more expensive machine.

I'm wishing I'd seen this advice earlier. I went to a sleep lab last week that acts as the DME. My doctor made the arrangement, so I never understood there was an option of where to go, much less the intricacies of dealing with a combined sleep clinic/DME.

Janknitz, would you mind commenting on my thread at viewtopic/t63376/Trying-to-upgrade-machine.html ? Thanks.

Options:
You can have an overnight oximetry test at your own home with the equipment from --- I guess a clinic somewhere, or a DME rents it. This will fully verify that you seem to have sleep apnea. If you are more sure you do have some form of sleep problem, then omit this as it is only another waste of money.

Like the someone said, "Talk with the Sleep Study clinic as to adjusting their prices . . ." and like someone else said, "Do it all in one night, half the night for diagnosis and the second four hours for titration." Which will reduce the expense.

You can find a teaching hospital, such as one that has a Medical School that trains new docs. They are often receptive to doing reduced rates for even a working person with insurance as it is real cash as opposed to the charity rates or fully free they often do. Plus. Keep in mind, the rates set by clinics and doctors are usually only paid by those with no insurance. Insurance usually negotiates a lower rate for things as part of doing insurance with these agencies. So hospitals and clinics are easily receptive to giving you a similar deal for cash, or even your promise to pay over time.

I am beginning to feel a lot of folks who do sleep apnea treatment had really bad experiences with their Sleep Centers which did their study and diagnosis. I had a great experience through a Sleep Clinic at a Teaching hospital (and quality at teaching hospitals can be extremely variable,) and can not imagine trying to emulate what the Sleep Clinic did for me on my own. I think you would have some very useless frustrating nights with an auto titrating machine. Just trying to learn which mask will really work for you, and how to get it to seal down is frustrating. Notice the number of threads here on people who have trouble with masks. Having a good sleep center to help you select a mask, and helping you learn how to get that mask to be comfortable and stayed sealed can be a big help. My sleep center gave me extra meetings with sleep techs for free just to do those things. My DME was also open to sending someone over to my place for the purpose of choosing another mask, another size or just how to get it adjusted to my satisfaction without more charge. Still the big thing the Sleep Clinic should do is determine the exact nature of your issue, and exactly what the settings on your machine should be.

Yes, if one needs treatment for Sleep problems, it this is really worth the effort. Even if one has to make payments. People with sleep problems will far more quickly die from heart attacks and strokes. and Yes, I am trying to scare you. The stats reveal that treatment makes a big difference. Even better is the improvement to the quality of one's life. Wow, treatment for Sleep Apnea is a life changing technology for me. It is like coming back to life again. I would bet that not getting treatment can also improve your job performance, which can lead to more pay, rather than being that dopey looking person the boss is thinking should be the first person laid off.

Hi mpalvin, I'm glad you found us before you go much further. I'm one of those that had an awful experience in the sleep lab. I didn't sleep well...inconsiderate people talking right outside the door kept waking me up. I was too nice, didn't complain and made the mistake of signing the damn "exit interview" form in the morning. My night was so messed up that they said I didn't have OSA but "sleep maintenance insomnia". With all the talking and doors slamming I'm not surprised! Two home studies said I had OSA, (AHI =13.4 and 14.4) and my fully data-capable APAP gives me data that agrees with the home studies. Happily, my good Dr believed the home studys...not the sleep lab...and I have a machine....and I have my life back!
Some things I hope you can do:
Go see the lab before you make an appointment. Stand in a test room by the bed, close the door, close your eyes and listen carefully to your surroundings. How noisy is it??
Very Important: Ask the techs what is on the other side of the walls around the test room. Are those areas used at night?!
Check the test room's air flow... does it hit the bed hard? Can you tolerate it? If you are a light sleeper ask your Dr for something Rx to help you sleep during the test. He/she will know what to prescribe that will not interfere with your sleeping patterns.
MedOneMedical in Sandy, UT sends out equipment for home sleep studies. You can find them on line and I had good luck with them.
I've read other posts where Dr sent person home for a study with an APAP for three weeks or more. Got their Rx for OSA from that. There are alternatives....it's just what the Dr feels comfortable with...OR how hard patient pushes Dr. That's a fine balance.
Good Luck and keep us posted here on your progress and the outcome.
Cindy

jnk wrote:

Mark, I like her answer better than mine. I always do.

I just got a chance to read yours that posted while I was typing and had to chuckle at this cause I'm sitting here thinking, gee, if I'd know JNK had it covered I coulda kept mine.

Wow! Thanks, everyone!
I'm getting answers to questions I didn't even know to ask!
Thanks to you guys, I'm going in well armed, knowing what to expect, what machine to ask for, and even not to be afraid of asking for something to help me sleep, which I would never have thought of. If only I could be this well-informed on everything else

The sleep center I've ended up with does do one-night tests, based on "circumstances" -- presumably whether the problems manifest well enough during the first half of the night. I think the facility will be OK since I had a friend do a study there a few years ago, and she didn't mention any issues. I do have problems getting to sleep, so it's good to know that an at-home test might be an option if the study doesn't turn up anything.

Thanks a million!

Mark

Mark,
Consider a home sleep study. Here is a link that might help you. They are far less expensive than center studies and you will be more comfortable. I'm a dentist in Alvin Texas. Stop by if you want to chat;)

Yours,
Chris Hoffpauir DDS
Winning Smiles Family Dentistry
General Dentist
281-756-9990

Mark hasn't posted here in three years, doc.