Home sleep test vs. sleep study at clinic

[rikkitikkitavi]

I strongly suspect I have sleep apnea: I snore loudly, have been told I wake myself up gasping for breath, don't feel refreshed after waking up, and am extraordinarily tired during the day. 

I'm a woman, 48, 5'5", 170 lbs. The last 20 lbs came on during the pandemic, but the problem has been going on for years, even when I was lighter. I do think my sleep issues have gotten worse with age and weight, however. 

One of the reasons I put off getting a sleep study all these years was the extreme hassle of doing an overnight sleep study at a clinic. But it seems there are at-home sleep tests available now at places like Lofta and Supplier #1.

Our health insurance has a very high deductible, so both the sleep study and the CPAP machine will be something we'll have to pay for out of pocket. The home sleep test kits are usually under $200, which makes them much more affordable. My thinking is that a sleep test kit together with CPAP equipment will be under $1500, which is far less than what we'd pay for the sleep study alone at a clinic, given our deductible, so why not go with the at-home option? 

Considering all this, is there any reason to still prefer doing an overnight sleep study at a clinic? Are the at-home tests much less reliable? 

Many thanks!

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Moderator Action: DME Link Edited to Supplier #1

To maintain our status as an educational organization, links to DME-owned or DME-operated websites and links to pages that sell prescription-required items are prohibited in forum posts. This is stated in the Apnea Board Rules.

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[Sleeprider]

A clinical sleep study is not particularly useful when you are not reimbursed by insurance for any aspect of the diagnostics or equipment by insurance. It is possible to obtain your equipment without any sleep study at all if you're reasonably certain you have sleep disturbed breathing as a result of symptoms you described well in your first sentence. The Lofta test appears to be one of the least expensive options that includes analysis and prescription. If you want to save some money, call on the :ResMed AirSense 10 AutoSet CPAP Machine wit HumidAir Heated Humidifier - $800 (petaluma)" advertised in Craigslist and ask how many hours it has. If the hours are low, and it has never been exposed to smoke, it may be a good solution that will not require any testing or prescription. The Resmed Airsense 10 Autoset is an excellent auto-CPAP that provides full data and we can help you use the free OSCAR software to optimize your therapy.

[rikkitikkitavi]

Thank you, that's super helpful. 

I love that you actually found me a Craiglist listing in my area! My one worry about buying used or from a reseller is the lack of warranty. $800 is a lot of money for something that might be broken. 

But to buy from a retailer I would need a prescription, I guess.

The thing is, my psychiatrist might be happy to write me a prescription himself. He knows how much I've struggled with my sleep for the many years he's treated me, and strongly suspects I have sleep apnea. He said he was happy to refer me to any sleep clinic I wanted, but I think he'd be open to writing me a prescription himself under the circumstances. 

If he agrees to do this, what exactly should the prescription say? Is there a standard format? Also, can he write it on his usual Rx pad. (Starting in 2022, his office has started doing online prescriptions for meds, maybe due to a new rule in CA? I don't know if this applies also to medical devices.)

PS: Very happy to get a reply from @sleeprider. I was already becoming a sleeprider groupie based on their posts and replies here.   

[SarcasticDave94]

Since Sleeprider mentioned AutoSet, you can ask for a script with the following:

. ResMed AirSense 10 AutoSet
. Default 4-20 pressure (optional mention because we at Apnea Board can coach you to set your own pressure set, then your doc isn't pressured into figuring that out, but I'd want it on there)
. Mask, patient choice
. Heated hose
. Humidifier (even though it's integrated on the 10 series it should be mentioned for future insurance coverage)
DAW - Dispense As Written (meaning it must be dispensed as the script is written, no substituted item)

[Sleeprider]

A typical prescription includes a brief description of the device and the HCPCS insurance code which you don't need. As far as a prescription this is typical, and you can get away with less:

For treatment of obstructive sleep apnea diagnostic code 327.23
Auto CPAP Resmed Airsense 10/11 Autoset HCPCS E0601, Minimum pressure 5.0, Maximum pressure 14.0. Patient to self-titrate and adjust as indicated.
Heated humidifier E0562,
CPAP mask interface of patient choice and refill nasal or full-face cushions and supplies as needed
Heated tubing A4604
Filters A7038
Refills as needed no expiration
Water chamber as needed A7046

[Geer1]

If doctor will just give you a prescription you can go that route but I assume most doctors would want a sleep study done. Home version is good for apnea which makee up the the majority of breathing issues. The in clinic version is usually only needed for non breathing related issues (movement disorders as an example). The one breathing issue that can be missed in a home study is UARS as it requires EEG data for a diagnosis.

[Big Guy]

I had a local two night in-lab sleep study done. My insurance covered 100% of it. I have heard that they are very expensive. 

I don't know anything about the in home tests.

[Jerry Sends]

I recently helped a friend buy a Resmed Airsense AUTOSET 10 off Craigslist Seattle.  His low hours machine was $350.

[SarcasticDave94]

If it helps inform what to expect, the latest Titration I had, my new pulmonary PA-C ordered regular BPAP testing, but tech and I had a nice chat and he monitored my CA and addressed them, into the mix some ASV setup. Hence PA-C said I needed back on ASV. That Titration was at Penn State Lemoyne. Total bill to insurance was $4,800.

[rikkitikkitavi]

Thanks so much, everyone!

I had an appointment with my doctor today, and he agreed to write me a prescription for CPAP directly, without having to get a sleep study first. He agreed with me there's a very good chance I have obstructed breathing during sleep—we've talked about my sleep issues for most of the 12 years I've been seeing him—and didn't see why I needed an expensive sleep study to confirm that when I could simply try the treatment and see if it worked.

He ended up writing a prescription that's slightly less detailed than suggested here, mostly in not specifying the particular device, since he thought it would be better to have a more general prescription. So basically it's a prescription for CPAP, with the pressure settings noted (a wide range, to be adjusted by patient); CPAP mask, humidifier and any other supplies necessary; and refills for any of these as needed, with no expiration.

I feel fortunate to have a doctor who's so open to patients taking charge of their own care (this is very rare, especially for psychiatrists) and also to have found this amazing forum.

I'll keep you posted on the rest of my adventures in sleep.

Thanks again.