Question about at home test for sleep apnea

So I've been using CPAP for nearly 7 months now and I've finally convinced my husband to get tested for sleep apnea. I've suspected he has it for YEARS but up until now he's refused to consider it. We talked to our doctor today and he informed us that things have changed with our insurance since I did my sleep study earlier this year and he's pretty sure my husband will have to do the at home test instead of the test at the sleep lab like I had.

Can anyone tell me how good these at home tests are?

Thank you!

They are fine for run of the mill OSA. IMHO, much easier to tolerate because (at least the one I had consisted of two probes on my fingers. That's it. I got to sleep in my own bed in my own sleeping conditions, on my own schedule. So it was all good. If you suspect your husband has more complex issues like PLMD, restless legs, or central apnea, then a home test may not suffice.

Here's a brief description of the classes (types) of HSTs: http://yoursleep.aasmnet.org/Topic.aspx?id=75

Sharrykb wrote:So I've been using CPAP for nearly 7 months now and I've finally convinced my husband to get tested for sleep apnea. I've suspected he has it for YEARS but up until now he's refused to consider it. We talked to our doctor today and he informed us that things have changed with our insurance since I did my sleep study earlier this year and he's pretty sure my husband will have to do the at home test instead of the test at the sleep lab like I had.

Can anyone tell me how good these at home tests are?

Thank you!

Hi Sharrykb,

I had a home study test 3 years ago and I feel it under-reported the severity of my apnea due to being instructed to keep the machine running even when I woke up. As a result, it falsely computed the AHI index by assuming I was asleep when I wasn't.

But if your husband plans to pursue pap therapy no matter what, I guess it really doesn't matter. However, if he is interested in pursuing other options in which accurate reporting of the severity of the apnea is important such as for dental appliances, it does matter. Additionally, a low AHI could be reported making him wrongly think that all he has to do is sleep on his side to eliminate the apnea. So my advice would be to ask about the instructions for keeping the unit running or turned off if your husband wakes up during the test.

Other than those considerations, as previously mentioned, it should do the job in diagnosing OSA. Other issues need a full scale sleep study.

Best of luck to him.

49er

Are we asking the right question?

So you get a sleep study whether home or at the sleep lab.

That's not enough to prescribe cpap pressures. Then what?

Do you then go on an autopap machine or go to the sleep lab to have the second night of the sleep study pressure measurements performed?

JimP wrote:Are we asking the right question?

So you get a sleep study whether home or at the sleep lab.

That's not enough to prescribe cpap pressures. Then what?

Do you then go on an autopap machine or go to the sleep lab to have the second night of the sleep study pressure measurements performed?

Jim P,

After my HTS, I was prescribed an autopap machine. My then sleep doctor estimated that I needed a range of 9-20 which wasn't totally far off at the time. Unfortunately, she had no interest in reviewing my data even though I printed out copies from sleepyhead.

At the time, I didn't have health insurance so I don't know if a followup titration would have been paid for. You're asking good questions.

49er

I did a home sleep study. Its not a complex or a big hassle. Just wear the thing and turn it back in. I was honestly expecting them to really help me set the machine up.....pressure settings and the works......well the way mine went was this. They called me in for first appointment.... talked to me...and sent me home with the home sleep device and told me to bring it back the next day. Next appointment a few days later....talked to me a few and said I had sleep apnea 55 times and hour average I think they said. They said that was fairly severe. Then the recommended I purchases a auto cpap and they would set it between 5-15 and after a month they would review data and adjust. I pushed them further about helping me with settings....and with the very limited knowledge I had it seemed obvious to me I knew near as much as they did about that lol. I'm thinking I already pretty well knew I had sleep apnea and already have a auto machine (bought it used from friend and supplies off of amazon lol and had been getting positive results just setting it wide range).....so other than me spending several hundred dollars for a perscription for a cpap and supplies when needed....I really gained...well not much. Glad I went, in a way, to get it formally diagnosed and the percriptions.....but the main reason I went was to get some pro advice on pressure settings based on study. Turns out that was kinda a bust....with a little research and help some these fine forums....I think I can do a better and faster job than the folks I was dealing with on that end of things. Lot less hassle and cheaper too. But a "real" sleep study they said would cost around 5 grand....so it was a no brainer for me really. Your mileage may vary. Just my experence.toto

Franky,

At that time, what pressures were you successful using?

As for cost of sleep studies, what the sleep lab charges and what the insurance companies pay are vastly different. My two nights, based on what the sleep lab billed came to $8,400. Insurance paid something like $1,500. I didn't have to pay anything. I do think I'll have to pay something for the machine but I've not heard about that yet.

I'd be curious to find out what is charged for those without insurance. Do the sleep labs charge about what the insurance actually pays. I think its called usual and customary.

JimP wrote:Franky,

At that time, what pressures were you successful using?

As for cost of sleep studies, what the sleep lab charges and what the insurance companies pay are vastly different. My two nights, based on what the sleep lab billed came to $8,400. Insurance paid something like $1,500. I didn't have to pay anything. I do think I'll have to pay something for the machine but I've not heard about that yet.

I'd be curious to find out what is charged for those without insurance. Do the sleep labs charge about what the insurance actually pays. I think its called usual and customary.

Well on my first appointment I brought my auto cpap with me to the office lol to show them. And said I was ready to get started after our talk. They set it to 5-15 ( I had to show them how to get into the settings to change pressure lol)...that same day.....same exact pressure as the said after study lol. ANd HECK I was already doing that same pressure for a week prior to even seeing them at all lol. Its was helping but I didn't think I was getting all I could out of it and wanted some pro help. They said well after a month we will review it and change the setting abit. Ya...well...heck I got to looking around online and found sleepyhead program and this help forum and got to thinking (thats were I get in trouble sometimes.....thinking) I can do this myself. They talked like set it were you feel best...blah blah.... COme back in a month, drive over 60 miles to get here and pay us again.....my bumhole. .Heck I think I'll go it alone awhile and try to learn it myself.....and I think I'm making steady progress on my own with the good help I've received right here.

JimP wrote:Are we asking the right question?

So you get a sleep study whether home or at the sleep lab.

That's not enough to prescribe cpap pressures. Then what?

Do you then go on an autopap machine or go to the sleep lab to have the second night of the sleep study pressure measurements performed?

JimP,

Those are very good questions. However, since I am not a complete newbie to sleep apnea/CPAP, I'm not as worried about this because:

1. We have a good doctor who will send him for a titration study if at all possible.
2. Our doctor had no problem with assisting me in getting the auto fully data capable machine that I asked for.
3. I have SleepyHead that will help us determine how effective the prescribed numbers are.
4. I have this forum of wonderful people who are extremely knowledgeable about CPAP treatment that I know will assist us if we have any questions about his treatment.

So I'm really not that worried about that part of this process. My concerns are really about home study vs. sleep lab study. Since the insurance requires him to start with a home study I guess that's what we have to do.

Well, as was said in an earlier post, the big differences apart from a titration 2nd night would be whether the HST can diagnose e.g. PLMD, UARS, etc. etc. (unless it can - you'd have to ask), but if you don't think those are relevant then I wouldn't worry about it.

Julie wrote:Well, as was said in an earlier post, the big differences apart from a titration 2nd night would be whether the HST can diagnose e.g. PLMD, UARS, etc. etc. (unless it can - you'd have to ask), but if you don't think those are relevant then I wouldn't worry about it.

I don't *think* those are issues but I'm not a doctor so I don't know. I suspect garden variety OSA as that's what his symptoms seem like to me and also because that's what his dad and maternal grandmother have.

I will definitely ask more questions about what kind of home study it will be and what it can and can't tell us. He has to go back to the doctor next week to follow up on another health issue so I will try to get more information then as to what kind of test he is ordering.

Sharrykb wrote:

Julie wrote:Well, as was said in an earlier post, the big differences apart from a titration 2nd night would be whether the HST can diagnose e.g. PLMD, UARS, etc. etc. (unless it can - you'd have to ask), but if you don't think those are relevant then I wouldn't worry about it.

I don't *think* those are issues but I'm not a doctor so I don't know. I suspect garden variety OSA as that's what his symptoms seem like to me and also because that's what his dad and maternal grandmother have.

I will definitely ask more questions about what kind of home study it will be and what it can and can't tell us. He has to go back to the doctor next week to follow up on another health issue so I will try to get more information then as to what kind of test he is ordering.

Hi Sharry - I also had an in home sleep apnea test, and got a recommended titration of 7. I did some research before I did the in home testing, and found some info that said sometimes, milder apnea is not detected with in home tests. I'm not sure if this is true with all in home tests; just relaying info I found because I, too, was curious about the effectiveness of home vs. lab studies.

I would say that the only drawback to in home tests as far as titration, is that there is no 'second test' to see if the recommended rate works for the user. I average an 8.5 titration rate; I found 7 to be too low for me.

Hope your husband gets better sleep soon

I've told this story before, so if you've heard it already just scroll on by!

Several years ago the hospital auxiliary at my community hospital bought an ApneaLink and donated it to the hospital. They use it for free apnea screenings. The only consumables for a test are the plastic tubing & some tape, and the tech who supervises the cardiac rehab room handles the logistics of passing it out and collecting it and running the reports. In my case, I was pretty sure that my ugly daytime sleepiness wasn't apnea -- my husband swears up and down that I don't snore and he's never noticed me stop breathing, and I've got my dad, brother, and two of my brother's kids who act a lot like we all have narcolepsy. (Nobody but me has ever been diagnosed, but we refer to the <family-name> Sleep Gene. This Thanksgiving's task is to badger my dad and brother and niece and nephew to get tested for apnea. Or, better, badger my mom and sister-in-law!)

A couple of years ago my PA tried to get me to use the ApneaLink -- it's free after all! -- but I thought it would be a waste of time. This spring, though, my endocrinologist convinced me that I should get tested, and for narcolepsy, since my thyroid levels are now rock-solid normal and have been for a couple of years. So I took the ApneaLink home. And, drumroll, it showed an AHI of 8 with a minimum desat of 79%. The AHI of 8 should have been more like 11 -- I was only asleep for about 6 hours of the 8 hours that the machine was running. But the most important part of the test is the oxygen sensor, and 79% did it's job and got me into the sleep lab for a sleep study.

The main thing that the sleep lab did for me was that it established my total AHI because that test knows whether you are sleeping or awake, and broke it down into side/back AHI, rem/nrem AHI, and established quite clearly that I don't have narcolepsy. (Narcolepsy is when you spend basically 100% of sleep in REM -- I only spent only 18%). You can't do that in a home test because they only measure breathing and oxygen levels, and an APAP might not even have an O2 sensor. The home tests don't measure respiratory effort, so they can't tell the difference between central apneas (which are a brain problem) and obstructive apneas (which are a breathing problem) -- centrals and obstructives require different treatments. A cpap machine can make an educated guess about centrals, but tends to flag false centrals that would never be flagged in a lab study because the eeg knows that you are not asleep.

All in all, though, cheap home test followed by APAP and then checking the data should be ok. But somebody MUST pay attention to your APAP data for this to work. Just checking hours of use and AHI won't alert them if the patient has something more complicated going on than plain old vanilla obstructive sleep apnea.

JimP wrote:So you get a sleep study whether home or at the sleep lab.

That's not enough to prescribe cpap pressures. Then what?

Do you then go on an autopap machine or go to the sleep lab to have the second night of the sleep study pressure measurements performed?

yes, in many cases an autopap is going to give you a better titration, at home, in your normal sleeping conditions than you're going to get in a few non-prepresentative hours in an unfamiliar setting, in a possibly uncomfortable bed, with all the distractions and stress that are inherent in a sleep lab.

I've seen *MANY* people that come in here and end up finding that their "professional prescribed pressure" is wrong, either too high, or too low, sometimes dangerously... or you get a decent titration and somewhere between the doctor and the DME that sets things up, they put in the wrong settings... which happened recently to one of our members wife, and she suffered for it. (her study said 11, the dme set her machine for 8-10)