The So-Called "Sleep Test"

[Tabbycat]

I spent $1000 for a split-night test at what I later learned was a CPAP mill. (Insurance price would have been $5000.). In this test they spend the first half monitoring you, and then "if needed", spend the second half hooking you up to CPAP and manually titrating.

The doc told me to get up early the day of to be "as tired as possible". Of course I'd find it uncomrtable to sleep in a strange room hooked up to 100 wires while techs watch me, so I had to take drugs to sleep -- maybe more than usual.

It's no doubt already obvious tomembers of this board that there are a number of problems with this approach. The whole "be as tired as possible" tactic, as well as the drugs nedded to combat the discomfort, will bias the results by worsening any apneas. The manual titration would be laughable if it weren't such a waste of my money. I was paying $500 for a tech to do what my S9 Autoset does for free every night, and more accurately. Their equipment was old -- no exhale pressure relief (how nice for a stressed-out first-timer) and it could handle only single integers for pressure (my S9 does increments of 0.2).

Here's how I imagine a legitimate, comprehensive sleep test would be pitched:

"Let's hook you up to a sleep polygraph and watch you sleep the whole night. We'll try to make it as unintrusive as possible, maybe even at your home. Try to do everything as you normally do. We'll watch and record your sleep cycles through an entire night. Then you and I will review the results and see what we can learn."

That's not even close to what I got, is it?

The "data" portion of the test -- the only portion with any value, IMO -- lasted TWO HOURS. That's it. How are you ever going to learn about my sleep cycles, or their depth, in two measly hours?

What I got was really an overpriced "CPAP Suitability Test". Doesn't the fact that they decided on a split test beforehand mean the decision had been already made to focus on apneas? As I've learned recently, breathing is important but it is NOT everything when it comes to sleep quality. In fact, I've done home tests with an SPO2 monitor showing that CPAP can worsen my O2 levels. But that's a discussion for another day.

I'd love to a full-night polysomnography at my house, for a full night -- without being as tired as possible or drugged or uncomfortable. Don't know how that will happen -- home sleep tests have a long way to go. But I think it wiuld give a much more useful picture of my sleep quality.

[DeepBreathing]

Yeah, I agree with you about the split test or even the overnight in-hospital titration test. I don't know about the rest of the world, but my experience went like this:

1. Rock up at the hospital after dinner with a Ipad and a good, boring book (I suggest Les Miserables by Victor Hugo ). Run a series of baseline tests (lung capacity, ecg, etc) before being hooked up to all the wires and tubes then tucked up in bed. Played with the Ipad, read the book, slept fitfully for the night.

2. In the morning I was told I had very severe apnea (AHI=62) with 50% centrals. I was handed an S9 Autoset there and then, given instructions how to use it and an appointment made to come back early the next week.

3. I then came back every week for 7 weeks, bringing the SD card and Sleepyhead printouts to discuss with the therapist. They started me with the Autoset set wide open, then narrowed the range based on a week's data, then tweaked the settings each week to get the AHI down. This process normally takes four weeks but because of my centrals, and the fact that ASV machines are so expensive here they tried as much as possible to treat me with CPAP and APAP. In the end I got the ResMed VPAP Adapt and all was well.

This whole process cost me $360 out of pocket plus the cost of the machine which was just on $4,000. I got an extra $500 back on the machine from my medical insurance - pretty pathetic really. You see the absence of a titration study - as you said, the Autoset effectively does a titration every night.

There are new developments in home studies discussed in another thread - apparently the insurance companies are jacking up about the cost of in-hospital studies and looking for alternatives. Colin Sullivan (the inventor of CPAP) is working on a new non-invasive under-sheet mat with sensors to replicate a lot of the functions of a polysomnograph. It could be a game-changer.

[Tabbycat]

DeepBreathing,

Sounds like you got a much better test than I did.

I got no baseline tests that I recall. And you got the whole night.
No one handed me an AutoSet -- instrad got a nice brick, the Escape (a whole $100 less).
They didn't carry the AutoSet or even allow its name to be mentioned. Can't interfere with that $2500 manual titration industry.

[Ghost1958]

Will agree that in lab titration tests are pretty much useless. Itll tell if you have SA or not or centrals but they cant get your pressure right in one night. I had a home test and lab titration.

Could have just dont the home test and figured the pressure range with the PRS1 Auto myself since the pressure they came up with was wrong anyway.

With Auto machines being what they are patients with OSA though maybe not central apnea would be better served with a home test given an auto machine and shown this forum or one like it.

[PaytonA]

There are sleep tests and there are sleep tests.... When I was getting set up for my initial sleep test, I was told that the first half would be measurement and observation and then, if needed, I would be titrated for a CPAP. When I got to the facility, the tech told me that the first half would be measurement and observation and then they would hook me up to a CPAP for titration. No "if needed" mentioned. I got POd and told the doctor who referred me to this group that I thought they were just pushing their equipment. He told me that the medical group that he was part of did not use the same outfit to get the equipment from. That made me feel a little better.

My sleep test was at night (thankfully) and was in a facility where a lot of care had been taken to make it as much like sleeping in a normal bedroom as possible. The environment also seemed carefully controlled. I had absolutely no problem getting to sleep even with all of the wires connected to me but then it was normal for me to have no trouble falling asleep.

The titration and resulting prescription was right on the money as I found out later. I was given an auto bilevel machine because my prescription was for bilevel and my doc insisted on the auto. My prescription was straight bilevel. I was given an auto bilevel machine that was set up as a straight bilevel machine. Later I decided to try the auto mode. The machine chose pressures lower than my prescription consistently. My AHI went up at the lower pressures, so I went back to straight bilevel.

There are some good sleep labs but it also helps if the patient is able to fall asleep easily.

Best Regards,

PaytonA

[quiescence at last]

Hi all. I am a little off topic, perhaps, but is there something other than low oxygen level that we need to prevent? I monitor my O2 during machine-sleep and is stays well above the 88% danger level. Regardless of how many events, if my O2 level shows to be fine, isn't the treatment level appropriate?

Thanks.

[PaytonA]

Low O2 levels are not the only danger from sleep apnea. The lack of restorative sleep that is a result of sleep apnea can be the cause for a plethora of other problems-some of them potentially fatal like falling asleep behind the wheel. So.....no good oxygen levels are only part of the equation.

Best Regards,

PaytonA

[archangle]

Low O2 levels are not the only danger from sleep apnea. The lack of restorative sleep that is a result of sleep apnea can be the cause for a plethora of other problems-some of them potentially fatal like falling asleep behind the wheel. So.....no good oxygen levels are only part of the equation.

Best Regards,

PaytonA

When you stop breathing, almost everyone will "wake up," at least partially, and start breathing before they completely strangle to death. Many people don't wake up enough to remember it, but it disturbs their sleep.

Some people wake up before their O2 level drops enough to measure, but there can be an increase in blood pressure and heart rate. There is stress, both in terms of neurological stress, and stress hormones. These are all "physical" effects, along with the harm done by the lack of proper sleep.

It's not just low O2 and sleepiness that will kill you with apnea.

[quiescence at last]

Thanks for the info. I'll read up.

[vcottom]

I took my Sleep Test in a Sleep Lab of a major hospital here in the mid-west. They wanted me there at 12 midnight, and I would be there until 9:00 AM. It was freaking below zero when I left home for the 15 minute journey to the test center! I entered the basement level test center, and told to put these pajamas on. Go over here to get wired up, 52 connections I believe, crawl into a bed made or lumpy rocks, that smelled like it had been used by "ladies of the night" for years, and go to sleep. After 20 minutes or so they come into the room, woke me and put an ill-fitting CPAP mask on my face, and turned it on, and nearly blew my ear drums out. I complained, and was ignored. They took the mask off, and told me I was done. I changed clothes, and was back home by 3AM. That was not a scientific method to test, anything! I determined the whole activity was a insurance fraud being paid by the Veterans Administration (YOU!) But went along and played their game.
It's been 14 months now, the SSD card has never been read, and when I went in for my annual lung cancer checkup, the doctor said he did not prescribed the BPAP box; tp this day I have not found out who prescribed this rather expensive medical device.
I learned how to adjust it, and how the system works, and over about a month was getting "good" numbers, and was able to sleep with it. Doc tells me they never see my oxygen numbers like mine in his office, 99% to 100%.

What I can't figure out is why I have to make a near-diarrhea run to the bathroom upon waking nearly every morning. Just one time, a major release of gas, with little solids, and lot's of liquid. One time, and I good to go for the day. If I don't but the BPAP on, I don't have the diarrhea! Can you all think on that for a bit?