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Can you help me find a good home sleep study kit (preferably inexpensive, since my insurance will only pay 80%). It must NOT use a nasal mask or canola. It must include breathing measurements (e.g., chest movement, including something like a chest strap to hold it in place), and possibly a pulse oximeter, to satisfy my doctor. And it must be medically certified (by FDA??).

I have used APAP since 2019. While I initially had severe problems adapting - partly because I was initially fit with a nasal mask, which is completely ineffective for me (wearing a nasal mask, I almost always breath through my mouth), and hurt a lot to wear, and partly because my initial CPAP/APAP machine was defective, and always used maximum pressure. Partly because even after fixing, when it detected an event, it switched to high pressure, which always woke me; I could not get back to sleep without resetting the machine to go back to low pressure. (By the way, I probably didn't get to sleep at all - or only during a few minutes - during my hospital sleep study with a CPAP, again using a nasal mask and very high pressure. But the hospital AI that analyzed my EEG, EKG, oxygen levels, nasal flow, and many other uncomfortable things concluded I did, so their doctor concluded CPAP was worth trying.)

I have now adapted to using a Resmed F20 full face mask and a Resmed Airsense 10 CPAP in APAP mode, set to as low pressure as possible. I still wake when it detects an event, and need to reset it, but that doesn't happen most nights. I also use a Vive (hard foam) cervical collar (neck brace) and a wedge pillow (brand & model unknown; Walmart used to sell it).

I believe my real problem is that when I drop my chin to my neck, that cuts my airflow when breathing in a lot - even if I am awake. I have tried uncertified tests, just using the pillow and neck brace. An uncertified smartphone app says that eliminates my snoring. A (Contec CMS50DA+, but it was sold without prescription, so it might not be certified) pulse oximeter says it keeps my oxygen levels reasonable.

That's not enough. As per state law, I told the Maryland Motor Vehicle Administration when I renewed my license that I was diagnosed with sleep apnea. (Stupid!) Now they require annual doctor certification that I comply with effective treatment, or I lose my driver's license. My doctors says that if I use an (FDA?) certified home sleep study kit, and it gives a good result, that will be enough to convince him.

(It's a shame the Airsense 10 doesn't have a 0 pressure setting, where it just measures breathing. If it did, it would make great home test kit. But maybe Resmed doesn't want people to try alternative solutions.)

https://wesper.co/ has a FDA cleared test.

It measures Respiratory Effort, SPO2, Airflow, Heart Rate, Pressure, Body Position.

It's $180 at https://cpapsupplies.com/home-sleep-test

Ask your doctor whether it's acceptable.

https://mva.maryland.gov/Documents/driv ... elines.pdf

Maryland's guidelines are incredibly lax.
If your AHI from your initial diagnosis is below 20, you're golden.
If it was over 20 then you only need a treated AHI of 19 or less to comply

It feels like your doc is doing a CYA by requiring an HST to certify fitness to drive.

The Statistics screen from OSCAR provides better evidence of compliance.

If you're willing to lug your CPAP to the doc visit, the Sleep Report (with Essentials Plus turned on) from your AutoSet is also better compliance evidence than the one night HST. The compliance data is stored for 365 days if you didn't reset it.

Does your doc have access to the Resmed AirView compliance software? If he does, he should be able to get your data if you provide him with the serial number.

GrumpyHere wrote: ↑

Tue Apr 15, 2025 8:04 pm

https://wesper.co/ has a FDA cleared test.

It measures Respiratory Effort, SPO2, Airflow, Heart Rate, Pressure, Body Position.

Something seems fishy. How can "non-invasive" patches measure all that? Heart rate and body position, sure. Maybe approximate respiratory effort, if one is positioned near diaphragm muscles, which might be hard for people like me who aren't medically trained to do, and the algorithm has size & shape info. Likewise for airflow. But how would they estimate SPO2 & pressure? (Or maybe they measure SPO2 the same dubious way pulse oximeters do?)

GrumpyHere wrote: ↑

Wed Apr 16, 2025 1:26 am

he Statistics screen from OSCAR provides better evidence of compliance...
If you're willing to lug your CPAP to the doc visit, the Sleep Report (with Essentials Plus turned on) from your AutoSet is also better compliance evidence than the one night HST...

The problem is that I am seeking to use an alternative treatment - just using the neck brace and maybe the wedge pillow. Because that would be both cheaper in the long run (due to my share of the cost of CPAP supplies, plus the eventual replacements of the CPAP machine), more socially acceptable in many settings, and much more practical on extended backpacking or other camping trips.

I think the neck brace basically fixes the whole problem. (For me! The doctor says it would not suffice for some people with sleep apnea. He is a surgeon and I guess often deals with more extreme cases.) The pillow probably isn't needed - just somehow made it less likely to go into the chin dip position when I wasn't using a neck brace.

AFAIK, OSCAR isn't medically certified, so a doctor probably can't use it. Plus, it requires the use of the CPAP machine, which would invalidate the claim that I don't need it if I use a neck brace. Of course, OSCAR can also take data from my pulse oximeter, and maybe I could talk him into using that - but I want better data for my own peace of mind. Non-invasive pulse oximeters like that that just send a pulse of light through the skin & back aren't all that reliable, because they have to make assumptions about distance and the optical properties of the skin - from what I understand you need to monitor the blood chemistry to get a really accurate oxygen level. Or at least find a way to calibrate the measurement for various parameters.

I easily meet the CPAP (really APAP) treated criteria the link you provided lists, when wearing the neck brace and using the wedge pillow. I normally have no recorded events - except maybe when waking up to go to the bathroom, which obviously aren't real apnea events, even if the machine and OSCAR record them. But I want to show the APAP part isn't needed.

I made a major mistake reporting my condition to the Maryland MVA. Now I will still probably need to keep being doctor certified. My doctor is in Virginia, so he wouldn't have normally reported anything to Maryland.

And I wish I had figured out the neck brace thing instead of getting those hospital sleep studies done - which were completely meaningless because the extreme discomfort of the conditions of the test basically made sleep difficult or impossible. My doctor says that he believes that home sleep studies are overwhelmingly more reliable than hospital studies, for similar reasons.

camper wrote: ↑

Wed Apr 16, 2025 10:06 pm

respiratory effort
airflow

https://www.sciencedirect.com/science/a ... 1822001887

Surrogate measurements with good enough correlation.

camper wrote: ↑

Wed Apr 16, 2025 10:06 pm

But how would they estimate SPO2 & pressure? (Or maybe they measure SPO2 the same dubious way pulse oximeters do?)

Come with a Checkme pulse oximeter.

Unless you plan to draw blood and do labs, pulse oximeters give you a close enough approximation.

Dunno about the pressure... Not even sure what they are measuring. (blood??? Air???)

camper wrote: ↑

Wed Apr 16, 2025 10:34 pm

The problem is that I am seeking to use an alternative treatment - just using the neck brace and maybe the wedge pillow.

Hmmm you're on a CPAP forum.

In any event, not sure how many sets of adhesives the test kit contains.

However, the subscription kit ($75/mo) comes with 7 sets of adhesives. This will allow you check whether your alternative treatment can actually meet the Maryland criterion.

You can then "upgrade" to a test for $179.

Prior to experimenting with your alternative treatment, you need to be off CPAP for 5 - 14 days to washout the benefits CPAP provides over the past 5 years.

Good luck

GrumpyHere wrote: ↑

Wed Apr 16, 2025 11:43 pm

Hmmm you're on a CPAP forum.

A very useful forum! It and one other forum was the place I found out about pillows and neck collars, as well as different face masks and machines, and I found out how to change the settings on my CPAP machine. Without those things, I could not have successfully used CPAP.

In part because the sleep technician at the hospital wouldn't listen to me when I said the mask she foisted on me hurt too much (and the environment was too noisy, and the attached hardware too cumbersome) for me to sleep, and couldn't possibly work because I sometimes breath through my mouth. (She claimed that if she set the CPAP pressure high enough it would force me to breath through my nose. Also that the mask she used was the latest and best for everyone.) She also ignored my statement that I had been awake essentially the whole night when attached to the CPAP machine - she took the hospital AI's analysis as correct. (My doctor says EEGs and other sleep test criteria are tricky to evaluate, and involve a lot of guesswork, so he doesn't find it surprising that a machine analysis was problematic. But I find it interesting that as early as 2019 a major big city hospital was using hardware with an embedded AI to analyze medical test results.)

Prior to experimenting with your alternative treatment, you need to be off CPAP for 5 - 14 days to washout the benefits CPAP provides over the past 5 years.

Is that a legal requirement, something the MVA doctors might require, or just your suggestion?

The benefit CPAP provided, from my perspective, was that knowing the CPAP name helped me find forums like this where people actually know something.

Someone I know who used CPAP said their sleep technician (at a small town hospital) had been very helpful, and that the small town hospital offered very informative seminars to patients who wanted to try out different things, where patients who had trouble with their masks were given alternate masks to try by mask company representatives. So it's obvious that some sleep technicians and hospitals do a much better job than others.

If I had been helped by people like that, I might never have looked for alternative treatments, because I would have had a much easier task adapting to CPAP.

My current doctor says a lot of people like me with what he calls "mild" cases of sleep apnea find effective alternative treatments of various sorts - e.g., neck pillows, cervical collars, dental appliances, other appliances. (I know one who found she eliminated the problem by going to sleep sitting in a chair, which seems a little like using a wedge pillow. But I wonder if that is bad for her back.) As a surgeon, he probably sees a lot of people with severe cases, including ones that alternative treatments and CPAP itself can't help.

There is some evidence that the effects of CPAP therapy lingers for up to two weeks after cessation.

So a washout period is suggested for more accurate result if retesting.

camper wrote: ↑

Tue Apr 15, 2025 6:08 pm

Can you help me find a good home sleep study kit (preferably inexpensive, since my insurance will only pay 80%). It must NOT use a nasal mask or canola. It must include breathing measurements (e.g., chest movement, including something like a chest strap to hold it in place), and possibly a pulse oximeter, to satisfy my doctor. And it must be medically certified (by FDA??).

The statements that I've put in bold face contradict each other.

To get breathing measurements---i.e. to measure the air going into and out of the lungs, you need either a nasal mask or a canola of some sort. All the rest of your ideas such as a chest belt to measure chest movement and a pulse oximeter do not measure breathing. They may measure the effort to breathe (chest belts) or the efficacy of breathing (the pulse oximeter), but they don't measure breathing itself.

The nasal canola won't work for me because it forces me to breath through my mouth. But if the test could use my chosen CPAP mask, it could work.

There seem to be many types of home sleep test equipment, that measure a variety of different things. Since I am not just trying to justify not using a CPAP, but actually wish to know whether the proposed form of positional therapy is sufficient in of itself for me, I want the test to be accurate and actually measure all the things it should. That complicates the choice a lot.

E.g., the majority of home sleep tests do not measure EEG, breathing, rapid eye movement, or include a video camera. Most measure changes in body position and include a pulse oximeter. The pulse oximeter would show the OSA the hospital tests detected, but would not be sufficient for all possible sleep disorders.

Also, the FDA has warned that pulse oximeters are often inaccurate. My device's nominal accuracy levels - I think 5% - are greater than the difference between my O2 levels, and unhealthy levels. I suspect a more sophisticated device could be more accurate, but would be too expensive for me to buy.

Maybe the decisions of the sleep technician (mentioned earlier), combined with my desperate attempts to get to sleep, biased the hospital sleep tests. (I tried meditation [untrained], slowing my breathing and breathing evenly, for long periods. The hospital AI may have concluded from these that I was asleep, and that I dreamed.) (At home, I do not have difficulty going to sleep, and only remember waking to go to the bathroom - or with a CPAP, resetting it to stop the high pressure mode, which generally wakes me. I never remember dreaming except if I wake out of a dream, which is rare. I don't know if that means I partially wake without remembering, or if I rarely dream.)

Perhaps a hospital sleep test with my preferred CPAP mask, my wedge pillow, my neck brace, my chosen APAP settings, nothing attached to my back or front which forced me to sleep in uncomfortable body positions, and in a room with a less noisy ventilation system, would yield more accurate results than the ones that I had. But I can't really afford that.

My doctor wrote a sleep test prescription for a home sleep test from Snap Diagnostics. Do you know if their kits usually provided in good condition, and are their results fairly trustworthy, relative to other home sleep test companies?

They have two types of testing kit, and can't tell me yet which I will receive, until talking to my insurance company. E.g., their website says the "Snap Diagnostics Sleep Apnea Monitor" can potentially measure respiratory airflow, chest effort, sound (snoring), SpO2, heart rate, and optionally movement & body position. It doesn't include EEG or rapid eye movement, so it probably can't tell whether I dream.

The rep says either kit has a nasal Canola, but that it can be cut, and the sensor can be taped inside my CPAP full face mask, so it gets air from my mouth too - and they include directions on doing that, so they must have run into my issues with nasal Canolas before.

It has an SpO2 sensor (either a ring, which sounds ideal, or something rubber that fits onto my finger - if that looks like it might fall off, as sometimes happens with my Pulse Ox, I will tape it in place. She didn't say if it measures heart rate too, but sleepreviewmag.com/wp-content/uploads/2024/09/Home-Sleep-Testing-Devices-Comparison-2024.pdf says the Snap Diagnostics SAM does.

It has a chest strap and sensor to measure "respiratory effort"; I'm not certain what that means. She said it is not an accelerometer. Perhaps it just measures whether my chest keeps moving in and out?

The website says they measure breathing, but aren't specific. But I notice some of the kits listed at that comparison link don't. I guess that was my biggest concern. I guess I can live with this.

They recommend several days testing (which might allow for doing it with and without my wedge pillow), 6 hours/night, but that will depend on my insurance company.

My hospital sleep tests used much more equipment: "a Viasys SomnoStar Pro computerized system... EEG (C4-A1, C3-A2, O2-A1,O1-A2) with LEOG, REOG and a submental EMG channel. Respirations were measured using an oronasal thermister and nasal pressure cannula, with piezoelectric bands to measure chest and abdominal effort. Oxygen saturations were recorded with a pulse oximeter... a snore microphone, leg EMG and body position sensor." Multiple devices were glued onto each of my head, chest and back. I probably looked like a Borg drone. It's hard to believe anyone can sleep wearing all that.

I'm not sure what to do about the advice from another forum that I should stop using CPAP for 2 weeks to get an accurate assessment of not using it. But my previous tests with a pulse oximeter were done with no such stop, which brings them into question.

regarding washout
https://link.springer.com/article/10.10 ... 014-1086-6

The full article is here
https://repository.uantwerpen.be/docman ... d/9276.pdf

Interesting study. OK, clearly I would need to stop CPAP for 2 weeks to make a valid test.

HOWEVER:

All the certified home sleep test companies I have looked into, including that one my doctor prescribed, get horrible reviews from patients and employees, and they have paid out millions of dollars for federal fraud charges, for overcharging, and sometimes for charging for tests not actually performed. And they mostly don't say what they will charge.

I asked my doctor for other options. He listed another company with the same issues.

He also listed the same company whose main hospital completely messed up my in-lab tests in 2019. Yet they mostly have good reviews by customers and employees, for in-lab tests, so maybe my experience wasn't typical. But the person who answered the phone had such a strong accent I wasn't sure what he was saying, as to what the home test measures and how.

Some sleep doctors claim that mild sleep apnea cases cannot be diagnosed by most home sleep tests - except the type 2 ones that include EEG and maybe rapid eye movement testing, which none of the home tests my doctor has so far offered to prescribe do. E.g.
https://www.portea.com/medical-equipmen ... dx-philips
appears to allow more comfortable positions than my in-lab tests did.

I'm left confused and uncertain. I don't want a limited test that says the cervical collar is enough (which, based on my own pulse ox tests, it probably will), but still leaves me with undiagnosed poor sleep that will cause additional future health problems. (For that matter, I don't know if the CPAP machine makes things better or worse. My impression is my CPAP sill makes it somewhat harder to sleep - but that only includes the arousals I am aware of.)