Wd You Prefer a Sleep Test At An Accredited Facility, or ? ?

In March of 2000, my PCP told me he wanted me to take a Sleep Apnea Test - I couldn't believe I heard correctly. At that time, Sleep Apnea was not well known, & I thought the only people who had Apnea were Ex-Pro Football Players who weighed 300 pounds. He was serious, I was to check with Blue Cross to see if they would pay for the test. My B.C. rep. told me B.C. would pay for one Sleep Apnea Test and one Titration during the lifetime of my coverage.

As instructed, I took my jammies and pillow and checked into the back room of a Rehab Center. A young man told me he was in charge of the sleep tests. He said he was a full-time University student and worked nights doing sleep tests. He looked & acted like the most sleep-deprived person I have encountered. He took me into the next room that was about the size of a broom closet, the night stand was a wooden chair. He sat on the chair & I sat on the lumpy bed while he got me ready for the test. His eyes closed and his head dropped to his chest repeatedly as he was affixing wires and attaching the bands.

I got the results about 3 weeks later. I was diagnosed with Severe Obstructive Sleep Apnea Syndrome, with 99 apneas and hypopneas per hour of sleep accompanied by moderate to severe oxygen desaturations. My PCP made arrangement for a Titration later that month at the same place, with the same guy running the test.

The findings were strikingly different. In this study I had central apneas predominately, including central apneas or hypopneas up to 84 events per hour, with occasional obstructive apneas up to 16 per hour. There was a slight improvement in hypoxemia.

My doctor made arrangements for Sleep Test #3, at a different facility in August of 2001, & special arrangements with Blue Cros to allow the test. . The physical aspects of the lab were a little better than the first sleep center. However, there were two about 30 year old women attendants, and a male trainee. This time the bed was in a room, but it was directly outside their work station. The women competed with each other to see who could entertain the young man with the loudest laugh or clever remark. I called & told them I could not go to sleep because of the loud noise they were making, but it didn't abate. My sleep latency was 3 hours, The sleep structure very disrupted and onset to consolidated sleep was postponed.

I was scheduled to get the report from the Sleep Doctor 9-11-2001. with the confusion of the day, and because my PCP changed specialities, and family problems, I got the portion of the sleep test, I listed in the paragraph above, 8 years after the sleep test.

I eventually gave up on Cpap because of repeated bouts of conjunctivitis. Sleep Masks were not as advanced then, as they are now, & I could not keep the air from blowing into my eyes. Later I had UPPP surgery.

In December of 2008, I saw another doctor for verification or denial of COPD. He was more interested in doing another sleep test. I had started Medicare, & they informed me they would pay for the test if it was done in an Accredited Facility. I asked the doctor, he said it was accredited, but when I came for the test, not to go in the front door, but go the the side entrance, which had a different address.

When I entered I met the technician and his assistant. They showed me to a clean, shabby room, but it had redeaming qualities. They told me it was quiet and it had dark drapes, the outside lights wouldn't bother me. . They got me wired up for the test. If I had been able to stand back and watch them, it would have been like an old 1920 movie of the Keystone Cops, each wired and belted a side, like they were in a comedy race trying to beat the other person. When I got into the bed I discovered The mattress had a deep crack, and I if I moved much, my back became lodged in the separation, and it hurt my back.

In the final report, I was diagnosed with moderate sleep apnea. I wasn't too surprised the ECG led had fallen off during the night, and they had decided not to try to reattach it. Which my new sleep doctor thought was questionable because my heart rate ranged from a low of 16 to a high of 150. There were other questionable decisions apparently made that night. In addition they did not use the new accreditation standards in preparing their report. That sleep lab may be accredited with someplace, but it has never been accredited with the AASM

The doctor from the 12-2008 sleep study kept delaying on his statement that he was going to change sleep apnea machines, and because of the UPPP surgery, I was having complications with CPAP therapy.

In May of this year I met with the Director of a Hospital Sleep Center. He agreed to accept me as a patient His facility is accredited by the American Academy of Sleep Medicine (AASM) He shook his head when reviewing my previous sleep studies. And, gave me a copy of the September 2001 Study. The 2001 Sleep Doctor isn't currently practicing here, but both doctors were on the same System, and my records were still there.

The new sleep doctor scheduled a Cpap Sleep Study in his accredited Lab. I went into a what I would call a first class sleep lab. It was furnished like a very nice hotel, with black-out draperies, nice quality bedding and a comfortable bed. One of the best aspects was Jill, the technician. She said to work in a fully accredited AASM Sleep Lab you had to have commensurate training. She was far more knowledgeable than anyone I have encountered in my four previous sleep studies. She ran numerous checks on the equipment, and came in twice during the night to reattach a wire that had become disconnected. When I get the results in a month, I meet with her, as the technician who ran the test. After she explains it from a technicians point, I meet with my Doctor for his evaluation, and how it will effect me.

To have a sleep study in a nice facility, with carefully trained technicians was a positive experience, and without the frustrations I experienced in four of my five sleep studies.

To locate an AASM accredited sleep center for your State, go to the American Adademy of Sleep Medicine web site, hit the link for the map of the United States, and hit your state for a list of the Accredited centers.

With the new 2009 Medicare regulation regarding Cpap Home Sleep Testing, it is estimated that the larger DME's will enter into this field. Sleep Review Magazine proposes that they can have 10 to 20 patients in an educational class at once, preparing them for a Home Sleep Test and reduce the costs to the DME. DME's are being advised that this is the time to educate insurance carriers, & referring physicians, that they can do Home Sleep Testing at a lower cost than lab testing

Another sleep testing proposal originated in India. The ISN centers have opened from Texas, to Florida and New Jersey. Their sleep centers are outfitted to have the feel of a luxury hotel, with an attached bar sink, and flat screen T.V.'s. To improve time and cost efficiency, ISN employs 20 physicians in India to do all of the scoring. The raw data from all the studies is collected electronically at ISN Headquarters in Iselin, N. J., then sent to India where it is scored by physicians who are certified in India. Their results are checked by another Indian physician who is certified in U.S. The data is sent back to the United States where it is checked by a registered technician. Finally a board-certified sleep physician reviews the results the the patients. Using their system of checks and balances, ISN can turn around a signed interpretation within 72 hours, and the average cost of scoring falls below $20.00 for the sleep test results.

Who knows what health care will look like in a year for now. The best aid a sleep apnea patient may have is a data capable machine, and the softwear.

How do you see in the future of the sleep apnea treatment??

Jan

SaltLakeJan wrote:The best aid a sleep apnea patient may have is a data capable machine, and the softwear.

And this forum!

I've had varying experiences with my (now five) sleep studies, too. If the professional demeanor at the lab is questionable, you can't help but wonder how accurate the results will be.

I have no idea what the future holds for sleep apnea diagnosis and treatment. A push towards real patient education by the entire industry would be a big improvement - from what to expect during and from a sleep study, to the various machines and mask options that are available, to effectively managing your therapy with your sleep doctor. Obviously, some great strides have been made in that regard, and the existence of this forum (and others like it) is proof of that. But the whole industry needs to get on board re: patient involvement.

There's my $.02.

Good golly Miss Molly, SaltLakeJan!!! You must hold the record for encountering incompetent, crappy sleep labs and staff (including doctors)!!!! Your experiences are almost unbelievable that so many such facilities existed yet received referrals from practicing physicians!!!!

My first sleep study was 1996. We aren't a particularly big town, but we did have two hospitals. At least one of them had a sleep lab. I went, not because of the thought of OSA, but simply because I hadn't been sleeping phershtunga for 2 years after a whiplash. The staff was very professional, there were three pulmonologists/critical care doctors and one neurologist all subspecializing in sleep medicine, the rooms were large, clean and comfortable w/private full baths w/showers. There were consultations w/one of the sleep doctors before, between and after the sleep evaluation and titration PSGs.

In 1998 I went back for another sleep evaluation but to an independent sleep lab. That lab was clean, the bed comfortable and the staff pleasant - but - there was not the professionalism and no private bath much less shower - I refused to return to that lab for the titration and went back to the sleep lab at the hospital. Again, clean, pleasant, professional, comfortable. Unfortunately, the local DME supplier my insurance was contracted w/was a real sheister.

In 2006 I went to yet another sleep lab - but the sleep lab manager was the scoring sleep tech from my 1996 and 1998 hospital sleep studies and the sleep pulmonologist was the same one I had had at the hospital in 1996 and 1998. The lab was clean, attractive, comfortable w/friendly staff.

In 2008 I had a bi-level titration at Mayo Clinic and it was all you would expect at Mayo Clinic, attractive, clean, comfortable rooms, tremendous staff - except the sleep doctor. He was a condescending jerk and NOT at all what one would expect at Mayo and certainly NOT of Mayo calibre!!!

The ISN sleep centers sound like they are really approaching the ideal (I could care less about the flat screen TVs, I'd rather have a private bath AND SHOWER).

I have to tell you

SaltLakeJan wrote:... When I get the results in a month, I meet with her, as the technician who ran the test. After she explains it from a technicians point, I meet with my Doctor for his evaluation, and how it will effect me.
...

I ENVY YOU this consult w/the RPSGT!!! THAT I haven't had the good fortune to experience. *sigh*

Hi Bleeping Beauty

BleepingBeauty wrote:SaltLakeJan wrote:
The best aid a sleep apnea patient may have is a data capable machine, and the softwear.

And this forum!

As usual, B.B. you went to the heart of the matter. This Forum - Where would any of us be without the information and support we get from the members. Plus the generous support from our host, Johnny Goodman. I would be interested to know he developed and implimented the idea for this forum. Perhaps some of our veterans know the details.

BleepingBeauty wrote:I have no idea what the future holds for sleep apnea diagnosis and treatment. A push towards real patient education by the entire industry would be a big improvement - But the whole industry needs to get on board re: patient involvement.

The on-going sales of softwear to private owners may be the turning point for the Companies. I had to switch from a data capable machine to Fisher & Paykel 608 for the super humidification. The 608 is top-of-the-line for F&P, but it does not have any softwear. I read in Sleep Magazine that F&P will add softwear to a new model. The softwear isn't cheap, and the added dollar value to the Companies will probably increase their interest in the sales - rather than their desire to accomodate the individual owner.

Jan

I wanted to add something to what B.B. wrote:

BleepingBeauty wrote:I've had varying experiences with my (now five) sleep studies, too. If the professional demeanor at the lab is questionable, you can't help but wonder how accurate the results will be.

My sleep doctor for the 12-2008 sleep test, asked if I was sure the results from my first two tests were both mine. The first test revealed severe obstructive sleep apnea, and the other test taken a month later showing severe central sleep apnea.
He commented they could easily have been from different people.

Jan

i agree that it is amazing how many questionable experiences you have had in your sleep studies- i am not so surprised about the difference between the 1st study with high number of OSA then the second study having lots of centrals- for what i have read it seems that sometimes Centrals are actually caused by CPap therapy, often when they need rather high pressures to deal with the obstructive events, but it then leads to lots of centrals instead- i am not sure what the mechanism is, one article i read suggested that the tendancy for central may have been present in the 1st study but did not show because of the obstructive events kicking in 1st- centrals interested me as they are the major part of my problem and the first machine i trialled actually made things worse not better despite it being a machine aimed at centrals- ir was a respironics, when i swapped to the resmed VPAP that i am still using i got great results instantly and the machine actually felt different to- obviously they algorithms in the 2 machines are very different and i wish i understood all this stuff well enough to work out why the difference- the DME techs i was sealing with said that some people with centrals did better with the respironics while others like me did bettter with the resmed which almost suggests that even with centrals the underlying reason for them may be rather different. mine are put down to neurological damage from MS but at least my results with this machine are fantastic!


i have only had the 2 studies done and both were at the same lab- it was based at a private hospital that i have been in many times, i had expected the usual uncomfortable hospital beds and rather sterile rooms but they had the rooms in the lab set up to look more like a decent hotel room, the beds were electtric adjustable but the type you would have at home rather than the hospital type, it was a king single so it was wider than the usual beds and the mattress was vastly different from a hospital bed- i was summise that it was a latex mattress- what ever it was it was absolute heaven- i dread hospital beds, i have contractures from being in a wheelchair constantly, i also have a rotten lumbar spine- i fractured 3 vertabra last year so much of the time i actually sleep in an electric recliner chair- normal hospital beds are agony!. they had the machines not actually concealed but situated very discretely by the bed to illustrate that the equipment will not make the home bedroom look clinical. they had video cameras and then telemetry set up to feed the results back to their office which was well away from the patient rooms so there was definately no issue with staff disturbing patients from laughing and talking- thats the height of rudeness- i have done night shift for years and some of those i worked with needed a lot of reminding that its not fair to disrupt the patients in the name of staff amusement!! thats just so unprofessional!

i have wondered about the stories i hear about the difference in sleep labs and the theory i have come up with is that it may be related to the fact it is still a rather small specialty that has not been around for a long time- i did some research about sleep techs here in Australia and it seems that there is no formal training for these techs here- not like other paramedical staff whose training may range from certificate courses to 3 year degrees or more- it seems the requirements varey from lab to lab- until there is uniform training and standards you will see huge variations- the web site for the lab i went to had a careers page and it said that the technicians came from a variety of backgrounds but behavioural sciences was common- behavioural science degree is the 1st part of university training that can lead to clinical psychology and i know that i did some psych at university a few years back and one of the intersting parts of the course was the neuropsych and we had a fascinating lecturer whose research specialties was sleep and also spatial awareness. i know our systems are very different but i wonder if there is a clear standard for sleep techs and sleep labs, accreditation implies there is


these days with the IT equipment that is available i am surprised why they do not do more testing in the person own home, that has to be the most accurate. in the same way that the techs were able to monitor us from a distance away even though it was the same building, it would be possible to do this from a persons home- it would mean a higher staff to patient ratio though if they were doing the same monitoring as the tech would have to go to each individual home to wire the patient up and set up the equipment then un do everything in the morning

The tech who did both my husband's sleep study and titration was a fully licensed physician born and trained in India as a specialist in sleep disorders. He has been in the US for 5years, took the required courses needed including a residency and is waiting to be licensed by the State of NJ. He was very knowledgeable with good bedside manner and seemed to know his stuff. The room was very inviting with a great Sleep Number Mattress. Hubby was titrated at 13cms with a FFmask, and after almost a year of experimenting with settings based on that titration and lots of help here, we've settled on 12cms which seems to be getting the desired results. I've read of so many test results that were nowhere near the mark so we were fortunate.

Nobody likes the sleep lab, and the discomfort in getting to sleep leads one to suspect the results. Yet, I think that the suspicion is not justified. The sleep techs and doctors know their equipment is uncomfortable (none of us is the first to complain) , but the results are still valid. Though it might seem that one's personal comfort is paramount in a sleep study, that is just not the case. Comfortable or not, the measurements are sufficient for a diagnosis

In my case the Cpap , once I got used to it, made all the difference in the world. The reason I have it is simply that I was diagnosed in a sleep lab.

Slinky,
Your post really got me thinking. Michigan is a larger State than Utah, but why would your state have 48 Accredited Sleep Centers and Utah have only six. There has to be a reason. What could it be?

I know that Michigan has a larger population, just over !0,003 Million, than Utah which is just under 3,000 Million. I checked 2008 Census statistics for H.S, Graduation, and B.S. Degrees and Medium Annual Income, show Utah slightly ahead of Michigan.
Utah, 87% Graduate from H. S,, 26% of people over 25 have B.S. Degrees, & medium income for 2007, was $55,220.00. Michigan, 83% graduate from H.S., 21% over 25 have B.S. degrees, and 2007 medium income is $47,931.00.

Slinky, it seems if you have sleep apnea, you have a better opportunity for accurate diagnosis if you live in Michigan, rather than Utah. Surely, the proximity of the Mayo Clinic, shouldn't make that much difference.

I became even more curious. I compared the accredited sleep centers in four more Western States. Nevada, has five Accredited S.S.. New Mexico also has Five. The State with the largest population is Arizona, with of 6,500,180 million. They have 13 AMSA sleep centers. One of their S.S. is run by the Mayo Clinic.

I wondered what states with lower medium income figures would have in the way of ASMA Sleep Centers. Kentucky has 36 AMSA Sleep Centers, and the State of Missipppi has 22. Their H.S. Graduation, B.S., and medium income are much lower than the Western States.

Slinky, The Western States I checked, are simply under represented in valid accedited Sleep Centers. Perhaps, that is why out of my five sleep studies, I wound up in such crappy holes in three, and & inconsiderate personnel in the fourth. Then I felt euphoric, by comparison in the fifth & most recent study. Jan

Hi kebsa,

kebsa wrote:i have wondered about the stories i hear about the difference in sleep labs and the theory i have come up with is that it may be related to the fact it is still a rather small specialty that has not been around for a long time- i did some research about sleep techs here in Australia and it seems that there is no formal training for these techs here- not like other paramedical staff whose training may range from certificate courses to 3 year degrees or more- it seems the requirements varey from lab to lab- until there is uniform training and standards you will see huge variations-

When I was researching the difference between the States in the number of Accredited Sleep Sites, I found in many States, including Utah, that in the small sleep centers, many of the technicians get on the job training.

kebsa wrote:i know our systems are very different but i wonder if there is a clear standard for sleep techs and sleep labs, accreditation implies there is

When I was answering Slinky's post I became curious because her State, Michigan had 42 Accredited Sleep Centers, and Utah (with a much smaller population has six Sleep Centers. But some of the central and eastern States had similar populations and had as many as 22 Accredited Sleep Centers. I don't know who decided how many S.S. a State has. But, from my experience, an Sleep Apnea Sleep Study in an accredited S.Center, is different from a hole in the wall, as day is from night.

.Jan

I'd guess that the good healthcare benefits that the UAW had negotiated w/the automobile industry had a lot to do w/the abundance of sleep centers and other medical facilities in Michigan.

In the 80s GM had 7 Steering Gear plants (now Delphi), 3 foundries and at least 2 other plants in Saginaw, Michigan. In addition, Saginaw had a good size Eaton Mfg complex and Wickes Corp. In the 70s just two of the GM foundries employed 7800 UAW workers. Now there is ONE foundry w/400 hourly and 100 salary workers. I don't know how many are still employed at Delphi nor how many Delphi plants are still in use. I do know that plants 1 and 2 are closed. That's just ONE town in Michigan! And Saginaw is NOT a particularly large town. By 2008 Saginaw county had a population of 200,000 and the city of Saginaw some 57,000. Its estimated that Saginaw county has lost some 9,000 people in the last 7 years.

Wow Jan, I agree with Slinky - that's one colourful and probably unique history there! Not to make light of it, but now it's over do you laugh when re-reading it? - does sound like an episode of keystone cops! I can honestly say I feel better now - makes my experience seem rather tame.

My initial sleep study was done at home - here the GP (mine is very versed with this, wonderful woman) can send you out to Resmed, and collect the equipment & instructions to do this at home - makes it cheaper. Like many things, I've found my private cover does not extend to CPAP. When sleep apena was confirmed, I saw a sleep specialist. This doctor charged me $240 for 12 minutes, of which only $110 was refunded on medicare. Gave me little or no information at all. I was disgusted, and after titration never went back, found this forum, and just moved forward. It'll be a cold day in hell before I step foot in his surgery again - this forum is the only sleep specialist I need.

Titration was in a local private hospital, in a very run down and ordinary room. I was informed the techician later had a lot more training - he did not respond to queries for a trial of masks - only one all night, despite being advised he would be regularly changing them. No response on queries since the mask leaked all night. I did not sleep a wink, the bed was shocking - no problem to him clearly at all. The sleep centre I was referred to subsequently for ongoing treatment was less than thrilling also - by law they advised I had to purchase the trial mask, no fitting at any stage. After finding this forum, I went back & demanded they keep swapping masks until I found one I could wear - which as it turns out was the full 3 months trial period. I'd have eliminated a lot of those if they'd have just trialled throughout titration.

Now, I feel I was blessed only having this small negative experience! Maybe you need to apply for directorship of one of the local sleep centres - your experience would mean you'd definitely be a shoe-in for the position, ability- and experience-wise!

Mornin' DoriC,

Every time I read one of your posts, you either have positive or encouraging material to add to the on-line conversation. And after following your posts to Mar, it is nice to get to finally "talk" with you. Your DH is fortunate to have you know how to understand and help him with his therapy. My DH is full capable, athletic man, but he has said if he had been diagnosed with sleep apnea, & I didn't take care of everything, but him wearing the mask . . . he would just blow it off

DoriC wrote:The tech who did both my husband's sleep study and titration was a fully licensed physician born and trained in India as a specialist in sleep disorders. He has been in the US for 5years, took the required courses needed including a residency and is waiting to be licensed by the State of NJ

I agree that you were fortunate in having a fully licensed & trained physician, act as tech for both your DH sleep study & titration. I checked with the AASM and N.J has 22 fully accredited Sleep Centers. It is surprising to me that the Eastern & Midwest States are more progressive and have far more accredited sleep centers than we have in our portion of the Western States. I also read that the more S.C.'s a state has, it puts pressure on the other Sleep Centers to measure-up to the accredited ones.

DoriC wrote:Hubby was titrated at 13cms with a FFmask, and after almost a year of experimenting with settings based on that titration and lots of help here, we've settled on 12cms which seems to be getting the desired results. I've read of so many test results that were nowhere near the mark so we were fortunate.

In addition his titration and the help you got at the forum, gave you the desired pressure results. Congratulations, And I have to give the credit to you - you pursued the exact pressure for him. Great Job Doric

I hope we meet again on the same thread. Jan

Mornin' Jan, thanks for the kind words, it means a lot, but in the end it is my hubby who somehow gained the courage to face this and fight the good fight without complaint. He has been through many illnesses and war injuries so it amazes me that he didn't just say "that's enough". There were times at the beginning when I certainly was ready to do just that.(I still don't like seeing that mask go on). I wish we had known what good changes would be waiting for us 9months down the road. We could only imagine that and keep going by reading the uplifting posts we read here and the good friends we made. Your story had the hair on the back of my head standing up. Your description of the machine sitting on a wooden chair just floored me! I'm sorry you had to go through that. The whole process even in a "hotel" setting is nerve-wracking enough. I'm raising my cup of coffee to all good things in the future for you and for all of us. Dori

georgepds;

Good point about the sleep lab not being comfortable with all the attached wires

georgepds wrote:Nobody likes the sleep lab, and the discomfort in getting to sleep leads one to suspect the results. Yet, I think that the suspicion is not justified. The sleep techs and doctors know their equipment is uncomfortable (none of us is the first to complain) , but the results are still valid.

There isn't another way, currently, to get the results from the tests without being wired -

="georgepds"]Though it might seem that one's personal comfort is paramount in a sleep study, that is just not the case. Comfortable or not, the measurements are sufficient for a diagnosis

Did you get a good pressure reading from your sleep test? Jan