Accuracy and Value of Titration Studies?

I agree that a "good" sleep study is very helpful, not only as a starting point, but also to diagnose all of the sleep issues. That said, I believe an autopap with extensive data, such as the S9, is also very helpful. By periodically checking the data one can see trends that indicate something else is going on. Then it is time for medical intervention. I think giving someone a CPAP and never checking on them is wrong. This is what happened with my first Doctor and sleep study. It was only years later when I was exhibiting the daytime symptoms that I went to another Doctor and lab and had a new study and received a new RX. But if you or the Doctor follow the data from an autopap I think you can avoid a sleep study for a period of time unless there is a significant change health, sleep, or effectiveness. Since each sleep study costs me out of pocket over $500 and my insurance company considerably more I think it is makes sense to rely on the APAP until a sleep study is actually needed. My plan is to get a sleep study every 5 years, unless: I see problems in my APAP data, have a significant medical issue develop that can effect my sleep, or, have a medication prescribed that can effect my sleep. What do you think of this plan?

I am not replying to any specific poster with this reply. Instead, perhaps we can use some reasoning to better understand how we as CPAP users can take advantage of a sleep study.

When people start throwing around the idea that essentially note "all studies are useless" or "nothing can be done without a study", it is often helpful to look for analogies to use to compare to a sleep study. So, let me drag out a favorite analogy.

When my car has unusual problems, I could try to fix it myself. Through my own experience, I know that if it's not something simple, I honestly do not know enough about how it works to quickly figure out the issue. So, I go find someone who specializes in car repair. I try to find a mechanic.

So, how would I hunt for a mechanic? I can open the Yellow Pages and find ... hundreds of them listed in most cities. Uhhh... Do I use the "eenie meenie minie moe" approach? Knowing my luck, the outcome is all to predictable: BAD!

Hey, wait! I can hunt for a "certified" mechanic. There we go, I note that fewer of the mechanics are listed as ASE Certified Mechanics. Well, that helps pare down the list. I can also certainly use location to pare down the list further. So, I have some mechanics in my area who are certified. That's a much smaller list. THAT, I can handle.

But I don't just drive the car to the first shop! Nope. I want it done right. It should not be too expensive. But more importantly, I do not want to keep coming back to have the same problem addressed. Even if they cover it under warranty, I don't have the time to waste on repeat visits. You see, I understand that being an ASE certified mechanic does not mean that the mechanic is good.

So, I call the mechanics. I learn a lot from the "feel" of the call. Often it is the intangible stuff - which "supposedly" has nothing to do with being a certified mechanic - that tells me how well I will like the mechanic and the results. Do they answer curteously? Is the answer prompt? Do they offer extra services (such as help me get the car to and from the shop)? Are they willing to get to know me and how I drive? Do they understand my overall preferences in how to maintain a car? (I keep cars a LOOOONG time, so I am pretty particular about how work is done!).

This hand full of calls will get me usually to two shops. I can visit the two. Now that I'm here, I can SEE the shops. And I want to see a fairly clean, well organized shop. Too clean and I suspect they do not have much business. Too messy and I suspect things are out of control.

This process is NOT theoretical! I walked through this process about four different times. I've been in my current area for almost 25 years. And I've stayed with my current mechanic for almost 20 years. I am very happy with them.

And you know what? The same process works when I hunt for a doctor or a sleep lab. And it is just as important.

I *never* blindly go to a doctor, sleep lab or a DME. I do not get the chance to interview a doctor before my visit, but I typically look for reviews of doctors before I visit them. And if the first visit does not go well, I hunt for another. I am fairly tolerant of differing approaches, but expect to be treated with respect. If the doctor is not willing to explain things to me or listen, then I do not return to that doctor. But with the sleep lab and DME, I *always* interview them first. ALWAYS.

And remember my comment that it is the intangible things that often makes the difference when choosing a mechanic? Well, the same is true with the sleep lab and the DME. I can not tell if a mechanic is truly qualified. But I can tell if they appear to have reasonable business practices and have a good approach to customer satisfaction. It matters. Ditto with doctors and sleep labs and DMEs.

This approach has not eliminated all problems. But it certainly helps. And it does not take a rocket scientist to do it.

Okay, I know most regular members of the forum understand this. But I thought it might help newer members or just cruising through. Afterall, my 20 years of dealing with sleep problems has helped me figure out how to work with the system.

John
the problem however is that most of us were so brain fogged by the time we are sent to a sleep lab that those steps will have seemed mush to complicated. I checked this board when looking for information but I gave up trying to understand because of the fog. It was 2 weeks after I started my cpap that the posts here suddenly were understandable.
I was lucky my sleep test and titration were done at home (considered and entry level sleep test) and paid for by our health system. My DME not so much.
I think in the wiki we need a down loadable simple checklist for each step - sleep test, titration, first DME visit. Those should be on the first page in blinking bold links.

Satsleep wrote:... My plan is to get a sleep study every 5 years, unless: I see problems in my APAP data, have a significant medical issue develop that can effect my sleep, or, have a medication prescribed that can effect my sleep. What do you think of this plan? ...

You might not even need it that often! If you data shows things are going well, and you feel well rested, why bother! The most important thing is to actually monitor your therapy. Think of the data on your machine as your blood glucose monitor. It helps you keep track of your therapy to be certain things are where they should be.

But to the point of only using APAP as the diagnostic tool, it would miss ALL of the other sleep issues that people can have. For example, if over 15 years ago all I had was APAP, then the observant sleep tech would have not noticed that I had a LOT of arousals while sleeping with CPAP. He switched me to BiPAP and I slept a lot better. It was VERY clear in the graphs. Currently (not saying it won't happen in the future), APAP has no idea if I have an arousal or not.

That's just one issue. And the list is really extensive. A few of the disorders a sleep lab can help sort out includes:

• Obstructive sleep apnea
• Central sleep apnea
• Complex sleep apnea
• Restless leg syndrome
• Periodic limb movement disorder
• Circadian rhythm sleep disorders
• Delayed sleep phase syndrome
• Advanced sleep phase syndrome
• Non-24-hour sleep-wake syndrome
• Narcolepsy
• REM sleep behaviour disorder
• Sleepwalking (or somnambulism)
• Bruxism (Tooth-grinding)
• Bedwetting or sleep enuresis.
• Sleep talking (or somniloquy)

BlackSpinner wrote:... the problem however is that most of us were so brain fogged by the time we are sent to a sleep lab ...

That's a very good point. I am an exception in that even when very sleep deprived I function fairly coherently. It takes a lot of will-power and I find exhausting, but I can generally function for a short period of time.

BlackSpinner wrote:... I think in the wiki we need a down loadable simple checklist for each step - sleep test, titration, first DME visit. Those should be on the first page in blinking bold links. ...

That is a SPECTACULAR idea! In fact, let's get started on it. Remember, this will take a lot of additional text around this, but it will be a starting point:

How do you know you might need a sleep study?

< list of symptoms would go here > ... use links to other resources

If you are dealing with a Primary Care Physician (PCP) or General Practioner (GP) or Internist, then you might want to ask:

• Will I be referred to a sleep specialist or just the sleep lab?
• If I am referred to a sleep lab, will I be able to get specific questions answered?
• If I do not see a sleep specialist, what happens if I have questions about the conclusions from the sleep study?
• I would like a copy of the sleep lab summary report?
• I would like a copy of any resulting prescription?

If you are referred to a sleep specialist (and your insurance allows you to choose the specialist), you should check:

• Is the doctor a board certified specialist in sleep medicine? (links to resources)
• How long has the doctor been practicing in the area?
• What do other patients in the area think of this doctor? (links to resources)

If you are then referred to a sleep lab ...

Is this along the line of what you were thinking?

JohnBFisher wrote:A few of the disorders a sleep lab can help sort out includes:

• ...
• Bedwetting or sleep enuresis.
• ...

John, I had to laugh at this one! This is one of the few on your list that I actually don't think one needs a sleep study to identify!

SleepingUgly wrote:... This is one of the few on your list that I actually don't think one needs a sleep study to identify! ...

You think there might be some "tell tale" clues?

Ah, you've got to love (and hate) the good old cut and paste!

JohnBFisher wrote:

BlackSpinner wrote:... I think in the wiki we need a down loadable simple checklist for each step - sleep test, titration, first DME visit. Those should be on the first page in blinking bold links. ...

That is a SPECTACULAR idea! In fact, let's get started on it. Remember, this will take a lot of additional text around this, but it will be a starting point:


Is this along the line of what you were thinking?

Yes and maybe one with tick boxes like
Sleep study/titration at lab:
__ Sleeping medication
__ Ears plugs
__ Comfort items
__ Masks used _______________________________________
_______________________________________


That sort of thing too
Really basic basic things

Well some are lucky and can get it done in one night others two or more. Given that if you have a titration then the OSA has been documented. I believe the data that can be collected is very beneficial to the process as you will not get near that much from a cpap, or bpap and it can reveal other health conditions. For many people myself included the sleep study and titration were not the best of nights, but at least we gat a machine and a valid range and then settle in for the journey back to the land of the living.