Home sleep apnea test - how long is a “night?”

[Zandor435]

Wondering if anyone has had experience with this before. 

What is the typical minimum amount of time necessary on a home sleep test to diagnose sleep apnea?

  I have sleep apnea myself but I was diagnosed in a lab. My father has to do a home sleep test because of other complicating factors regarding his cancer treatment.

 The instructions  say he has to sleep two nights with the home device on and without any cpap machine.

The issue is that he does not sleep without the cpap (we have him using an older cpap bc it allows him some extended sleep).  Hence I don’t want him to have to be off the cpap for any longer than necessary. 

I have read that as little as 2 hours of home sleep test data can be sufficient to officially diagnose sleep apnea. 

Is there a standard time necessary for this? Or is it completely up to the physician usually?

I appreciate anyone else’s thoughts.  Thanks

[Sleeprider]

If your dad was previously diagnosed with sleep apnea, why is this test necessary? Who says so?
Is there any way to obtain the original diagnostic study? Have you tried?
Can you explain the "complicating factors" for doing a clinical PSG without compromising your dad's privacy? Those may be sufficient cause to use an alternative diagnostic method. Also, what machine is he using now and does it produce data?

I know I would do just about anything to avoid sleeping without PAP therapy for even one night, so your concern is understandable. A home sleep study varies greatly in quality, and most will underestimate AHI because they have no means of determining when you are asleep, so the apnea is divided by the entire time of the test rather than excluding awake hours. The tests also do poorly identifying complications like flow limitations, central apnea and even oxygen desaturations.

This is the CMS decision memo for Medicare CPAP coverage. https://www.cms.gov/medicare-coverage-da...?NCAId=204 If you have any documentation from a previous study, you can avoid another study.

[Gideon]

I had to redo sleep study for Medicare, or so they told me.  I agreed to a split study with a BiPAP device.  They gave me credit for 2 hours of sleep instead of the actual 118 minutes then woke me up saying they needed 2 hours of sleep to diagnose me.  I had an AHI of 77 quite an improvement on my 90 something 10 years prior.  I too do NOT sleep without CPAP.

Based on that I feel the requirement is 2 hours OF SLEEP when in a sleep lab.

[Gideon]

I like the idea of getting data from the DreamStation to help demonstrate need.

[Zandor435]

He is undiagnosed. My mom and I both have had our own battles the sleep apnea and hence noticed his breathing and other symptoms. The doc has seen vid and confirms he likely has osa. Still they need to officially diagnose him.

My mom has an old resmes. It’s a brick. Only tells us how long the machine has been on. It starts at 4 and ramps to 9. He is able to get some sleep on the machine so I think that certainly confirms our assumption that he does have osa.

He also has some new anxiety over His sleep troubles (I’m very familiar with this part personally).

So my question is mostly one of “what is the shortest amount of time he can be on the home test and it be “valid”?

A friend of mine is a sleep clinician and she said 2 hours is typical for diagnosis.

I was just asking here to hear if anyone had other experiences.

Thanks for the comments.

[Sleeprider]

A couple hours of sleep time is minimal, and more is better. I don't think two nights is necessary, but is a kind of insurance policy to ensure data is collected to justify a diagnosis.

The option of continuing self-financing of equipment is something to consider. Medicare will require a 13 month rental of the equipment, and depending on the copay for rental, a purchase may be better. There are great deals on modern machines like the Resmed Airsense 10 Autoset on sites like Craigslist, Letgo, Facebook Marketplace and Offerup. Supplier #33 will sell a brand new Autoset for under $600 shipped. This is a full data machine that can be used to fully optimize his therapy, and without the hassles that come with testing, dispensing and copays, follow-up, and biannual appointments to document use and efficacy. Just sayin'

[mesenteria]

Ideally, the length of time it takes for the patient to fall asleep, and then to cascade, or to climb through, several stages, but particularly to reach REM, is minimum.  For some, most, it's about 90 minutes early in the sleep cycle.  Later that night, in the wee hours, we dream more frequently...generally.  But each stage has its own flavor with the body, and we need to see what the apnea 'looks like' in order to generate a useful set of parameters for PAP therapy of one kind or another.  It seems the experts hope for two solid hours because almost anyone who can actually stay asleep will probably reach REM...but only if significant apnea does not prevent it.

[Zandor435]

Sleepridwr- self financing.  Yes. Thanks for the suggestion. That is a possibility for sure.

Unfortunately my dad is older and not capable of self treatment. So this is really all about getting a clinician or doctor to manage his treatment with the right pressure setting she etc.  

I probably could set up a newer machine and in the future walk them through it, but my dad will likely benefit greatly from some authority figure telling him what needs to happen.  He will be much more compliant when a doc gives him marching orders.  

Thanks again for suggestions.  This board is one of the biggest lifelines out there.  Thank you guys.

[Sleeprider]

Sleepridwr- self financing.  Yes. Thanks for the suggestion. That is a possibility for sure.

Unfortunately my dad is older and not capable of self treatment. So this is really all about getting a clinician or doctor to manage his treatment with the right pressure setting she etc.  

I probably could set up a newer machine and in the future walk them through it, but my dad will likely benefit greatly from some authority figure telling him what needs to happen.  He will be much more compliant when a doc gives him marching orders.  

Thanks again for suggestions.  This board is one of the biggest lifelines out there.  Thank you guys.

The machine I am suggesting, the Resmed Airsense 10 Autoset is capable of being set to a wide range of pressure and quickly intercepting obstructive events. It also provides a bilevel like exhale pressure relief that is comfortable and can help target specific problems.  Basically what I'm saying is that with a single night of trial data, I could give you a suite of settings that would not likely need changed. What that means is, if you or a family member can start him out for a day or two, you're basically done. After that you can monitor his therapy using MyAir software to see what is going on from anywhere in the country.

It's a comforting idea that you can rely on local doctors and a DME to monitor dad's therapy, but the reality is, the DME will make no changes to settings without a doctor's prescription, and very few doctors will do anything without clinical data; most do not "believe" in the machine data. The process is awkward, slow and expensive. You can manage this, and it's much easier than you may think.