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My At Home Sleep Study Experience
This is in response to Mike's request in another thread:
Mike said:
My sleep study was done through a private clinic. My family doctor recommended it because I had visited her to discuss the fact that I was too tired to get out of my own way, the noise from my snoring was waking me up, and my weight was spiraling out of control. I told her I need to get this addressed, and the most sensible place to start, is with my sleep. We had actually discussed my snoring about seven years ago when I had just started working shifts and was pregnant with my first child, and I saw an ENT way back then, but for many reasons, follow through never happened. I told her I wanted to be re-referred to the ENT (I was convinced the problem was simply that I needed my tonsils out).
Anyway, she said she expected I have sleep apnea ( I assured her I didn’t, lol), and wanted the ENT to have sleep study results when he saw me (I live in Canada, so it's going to take many months for the ENT appointment).
The clinic where I had my sleep study done is actually the DME as well, and I think the ENT to which my doctor referred me is a partner in the venture - so I guess there could be all kinds of issues of conflict of interest, but I haven't had any issues or concerns.
The clinic will arrange the sleep study without a referral, but they asked for one, and since I already had one, it wasn’t a problem. I visited the clinic and spent about 30-40 minutes with the sleep study coordinator who did my intake, asked me a bunch of questions, showed me the “WatchPAT 200" machine, and I watched a short video about how to use it while she programmed the device. We reviewed what to do with it to make sure I understood, and then I took it home.
It was an extremely easy process, you wear the device on your non-dominant wrist, like a large wristwatch, attach an O2 saturation and heartrate monitor to your fingers, and then there are two sensors that you feed up your sleeve to attach to your chest and at the base of your neck. One measures the decibels of your snoring, the other measures your sleep position. The next morning, I returned the device to the clinic. The sleep study coordinator was planning to send me the results in the mail, and also to my family doctor, but she only sent them to my doctor. It wasn’t an issue, because the next time I was there, I asked for it and was given the printout.
The entire cost for the sleep study was $75.00. I haven’t made the request for re-imbursement to my insurance yet, so I don’t know if that cost is covered. Not a big deal to me.
A few days later, my doctors office called me to come in, and my doc discussed the results with me, that I have moderate sleep apnea. We discussed whether I was open to CPAP therapy, and I told her “absolutely”. She wrote me a prescription for a CPAP machine, and I called the clinic back and made an appointment to get the machine. That only took a couple of days to arrange.
When I met with the therapist, she reviewed my sleep study results in great detail and also discussed my symptoms with me. She spent a lot of time getting to know my individual issues and is very nice to talk to.
The printout of my sleep study data is exactly as pictured and reviewed in the link Judy posted in the other thread:
http://www.centerforsoundsleep.com/blog/?page_id=150
I also asked for and received printouts of the smart card results every time, as well.
Here’s the process I went through:
- 30 day free trial with the CPAP machine
- Once weekly appointments to bring in my smart card and review the data
- The clinic prepared all the paperwork and submitted the pre-determination to my insurance company
Which I have now completed. My insurance covered at 100%, and the follow up is included in the cost of the machine. I go back in another 30 days, then at three months, then at six months. I assume there will be a cost for any further follow up, or I will have to get further approval from my insurance.
What I’m using:
Respironics REMstar Auto M Series with C-Flex
Humidifier
ResMed Swift LT for Her mask
I haven’t needed any alterations to the original set up that we worked out in the office except an adjustment to the C-Flex setting.
So far, my dog has chewed my nasal pillow thingey, and they replaced it, no questions asked. My therapist gave me three nasal pillow thingeys to try, in three different sizes, and she said to bring her back the two that don’t fit, and she will replace them with ones that are my size, so I will have a couple of spares in case the dog gets hungry.
I think I may have gotten a little off track here and there with personal details, but it’s difficult no to. My response to the sleep study result was that I was pretty excited to have a definitive diagnosis, with a clear cut avenue to address the problem. I’ve had a very good experience every step of the way, and remain enthusiatic about the process.
Mike said:
Moe-jo: you're one of the very few patients out there to have been diagnosed by an at-home sleep study. would you mind posting a separate thread on how you made the choice, whether it was your doctor's idea, how much your insurance covered, etc? i think it would be very interesting for folks on the forum to hear more about your experience.
Moe-jo said:I was diagnosed by an at-home sleep study. I wore a little machine called a WatchPAT 200. I haven't seen this mentioned elsewhere in this forum in my reading so far. I thought it was very cool.
My sleep study was done through a private clinic. My family doctor recommended it because I had visited her to discuss the fact that I was too tired to get out of my own way, the noise from my snoring was waking me up, and my weight was spiraling out of control. I told her I need to get this addressed, and the most sensible place to start, is with my sleep. We had actually discussed my snoring about seven years ago when I had just started working shifts and was pregnant with my first child, and I saw an ENT way back then, but for many reasons, follow through never happened. I told her I wanted to be re-referred to the ENT (I was convinced the problem was simply that I needed my tonsils out).
Anyway, she said she expected I have sleep apnea ( I assured her I didn’t, lol), and wanted the ENT to have sleep study results when he saw me (I live in Canada, so it's going to take many months for the ENT appointment).
The clinic where I had my sleep study done is actually the DME as well, and I think the ENT to which my doctor referred me is a partner in the venture - so I guess there could be all kinds of issues of conflict of interest, but I haven't had any issues or concerns.
The clinic will arrange the sleep study without a referral, but they asked for one, and since I already had one, it wasn’t a problem. I visited the clinic and spent about 30-40 minutes with the sleep study coordinator who did my intake, asked me a bunch of questions, showed me the “WatchPAT 200" machine, and I watched a short video about how to use it while she programmed the device. We reviewed what to do with it to make sure I understood, and then I took it home.
It was an extremely easy process, you wear the device on your non-dominant wrist, like a large wristwatch, attach an O2 saturation and heartrate monitor to your fingers, and then there are two sensors that you feed up your sleeve to attach to your chest and at the base of your neck. One measures the decibels of your snoring, the other measures your sleep position. The next morning, I returned the device to the clinic. The sleep study coordinator was planning to send me the results in the mail, and also to my family doctor, but she only sent them to my doctor. It wasn’t an issue, because the next time I was there, I asked for it and was given the printout.
The entire cost for the sleep study was $75.00. I haven’t made the request for re-imbursement to my insurance yet, so I don’t know if that cost is covered. Not a big deal to me.
A few days later, my doctors office called me to come in, and my doc discussed the results with me, that I have moderate sleep apnea. We discussed whether I was open to CPAP therapy, and I told her “absolutely”. She wrote me a prescription for a CPAP machine, and I called the clinic back and made an appointment to get the machine. That only took a couple of days to arrange.
When I met with the therapist, she reviewed my sleep study results in great detail and also discussed my symptoms with me. She spent a lot of time getting to know my individual issues and is very nice to talk to.
The printout of my sleep study data is exactly as pictured and reviewed in the link Judy posted in the other thread:
http://www.centerforsoundsleep.com/blog/?page_id=150
I also asked for and received printouts of the smart card results every time, as well.
Here’s the process I went through:
- 30 day free trial with the CPAP machine
- Once weekly appointments to bring in my smart card and review the data
- The clinic prepared all the paperwork and submitted the pre-determination to my insurance company
Which I have now completed. My insurance covered at 100%, and the follow up is included in the cost of the machine. I go back in another 30 days, then at three months, then at six months. I assume there will be a cost for any further follow up, or I will have to get further approval from my insurance.
What I’m using:
Respironics REMstar Auto M Series with C-Flex
Humidifier
ResMed Swift LT for Her mask
I haven’t needed any alterations to the original set up that we worked out in the office except an adjustment to the C-Flex setting.
So far, my dog has chewed my nasal pillow thingey, and they replaced it, no questions asked. My therapist gave me three nasal pillow thingeys to try, in three different sizes, and she said to bring her back the two that don’t fit, and she will replace them with ones that are my size, so I will have a couple of spares in case the dog gets hungry.
I think I may have gotten a little off track here and there with personal details, but it’s difficult no to. My response to the sleep study result was that I was pretty excited to have a definitive diagnosis, with a clear cut avenue to address the problem. I’ve had a very good experience every step of the way, and remain enthusiatic about the process.
Views: 491
Replies to This Discussion
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Permalink Reply by Judy on
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I would agree w/that, Henning, and that appears to be the way we are heading here in the USA w/Medicare's recent acceptance and approval for payment of an in-home sleep study and 3 months use of CPAP and then the decision of whether CPAP is sufficient or an in-lab PSG is needed. At least that is the way I understand the recent ruling.
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Permalink Reply by RockRpsgt on
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I am not doubting your results Moe-jo. you have every right to be happy with your therapy. I do not think that every pt will have the same results that you have had. it is just to inconsistent of a way to Dx.
Moe-jo said:Part of my assessment letter reads:
"These are called respiratory effort related arousals (RERA's) and are picked up by the WatchPat unit in the Respiratory Disturbance Index (RDI). RDI's greater than 10 events per hour in the presence of a normal AHI constitutes a condition known as Upper Airway Resistance Syndrome (UARS)."
Obviously - I didn't have a normal AHI, nor do I know how the device measured the RDI. My AHI was 20.9. My RDI was 23.7.
I am not adding this information in defense of my test or the process, or the clinic I attended. I am not entering into any debate on the subject, nor, am I offering any opinion, one way or the other. I'm just parroting this for information in case anyone is interested.
Rock, with respect to my sleep journey, I went from referral- to test- to diagnosis and treatment in fewer than four weeks. My AHI went immediately from 20.9 to a consistent number around 2, my large leak number is always 0. I know this is a lifelong process, but so far, I'm pretty happy with the pace. :-)
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Permalink Reply by Darillyn Patterson on
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I'm wondering if I would have benefited from a home test because I found it very difficult to sleep when I was in the sleep study lab at the hospital.
Are test results accurate even if one's sleeping is atypical? In other words, I normally fall asleep without a problem and seldom wake up during the night. That's not the way they saw me sleeping in the lab. As I mentioned, I had one heck of a time sleeping. It seems as though a more true picture of my condition could be obtained by a home test if I was able to sleep the way I normally do. Am I making myself clear, or is this too confusing?
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It is my understanding that UARS can only be diagnosed by using an esophagael balloon in conjuction with a psg. RERAs and flow limitation can be measureed with a home test. However actually defining any other types of events. I do not think so.
Henning said:I don't know how the WatchPAT 200 detects UARS, I simply refer to an earlier article by David E. Lawler, and his Website.
A difference could be that the PSG equipment is set to only counting apneas and Hypopneas from 10 seconds and upwards.
As far as I know the only way to detect UARS by a PSG, is combining with a PES measurement. (Pressure in the Esophageal). This is done by a little balloon in the Esophageal. This is not a procedure used with a normal PSG.
Henning
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It can be seen with these 2 instuments, but not diagnosed. Without an esophagael pressure balloon UARS is a tough Dx to sale to an insurance company. Since this post I have talked to every doc on our staff and they all agree.
Mollete said:Cindy Brown said:
The biggest reason I'm responding is the statement that the WatchPAT 200 can detect UARS that can't be detected in the lab unless there is the application of special gauges. I don't see how one can detect the narrowing of the airway or the increased work of breathing with a snore mic, position sensor, pulse ox and "pat probe". I'm not even sure what the pat probe does.
PAT (peripheral vascular tonometry) measures digital vascular tone. WatchPAT searches for reduction in PAT amplitude, indicating increased digital vasoconstriction. This is an "autonomic arousal" (vs the "cortical arousal" of EEG). It cannot definitively diagnose UARS, it can only indicate high probability. Also, it cannot diferentiate between obstructive, central and/or mixed events (probability is determined by presence or absence of snoring). CompSAS will totally baffle it.
UARS can be effectively diagnosed using nasal presure transducers with respiratory inductance plethysmography.
mollete
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Permalink Reply by Henning on
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I was not aware of plethysmography before this discussion. I have now read a lot about this. It is like the PSG there is the gold standard, so PES is also the gold standard.
But plethysmography is "almost" as accurately as a PES. Moreover, this method is much more comfortable than a balloon mounted in the nose and lowered down into the esophageal.
So I am sympathetic to this approach.
Henning
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jnk it is because the air pressure is measured through a canula in your nose. The thermistor is measuring airflow in both your nose and mouth. You will see a reduction in the nasal pressure signals when a pt breathes through there mouth.
j n k said:Nice chart at bottom of page 453.
http://books.google.com/books?id=ZzlX2zJMbdgC&pg=PA453&lpg=...
Interesting how the pressure sensor shows flattening but the thermistor shows amplitude reduction. Same event. Seems silly to define what the body does by how we choose to measure it. Kinda technical.
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Permalink Reply by Duane McDade on
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I know lets just set up a section at places like Cost-co and Walmart. Where some pimpled faced large adams appled teenager gives you a Sleep Apnea "kit" for you to take home. Then when you bring it back the next day he USB's it into his computer and it spits out a order for the CPAP machine and mask, that the testing equipment computed you need. A auto CPAP set at 4-20 cm/h20. If you need advice or if you have questions you'll be directed to a interactive web site. There's no need for sleep labs or Doctors. This whole thing reminds me of the hospital in the movie Idiocracy (2006) .
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I know. I was just being sarcastic, I'm a sleep technician.
Mollete said:Duane McDade said:I know lets just set up a section at places like Cost-co and Walmart. Where some pimpled faced large adams appled teenager gives you a Sleep Apnea "kit" for you to take home. Then when you bring it back the next day he USB's it into his computer and it spits out a order for the CPAP machine and mask, that the testing equipment computed you need. A auto CPAP set at 4-20 cm/h20. If you need advice or if you have questions you'll be directed to a interactive web site. There's no need for sleep labs or Doctors. This whole thing reminds me of the hospital in the movie Idiocracy (2006) .
If this discussion is is referring to WatchPAT, what is "spit out" is a "Sleep Study Report", not an "order for the CPAP machine and mask". The sleep study itself, xPAP equipment and pressure settings must all still be ordered by a physician.
However, to your point, since the scoring algorithm is completely automated, I suppose "some pimpled faced large adams appled teenager" from "Cost-co and Walmart" could "gives you a Sleep Apnea 'kit' for you to take home" and "USB's it into his computer".
That being said, none of those scenarios offer rationale against the use of PAT in portable testing.
mollete
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you don't need special gages any technician who has a half a clue can hear U.A.R. with the room mic. What do you work for WatchPAT200 or something?
Mollete said:Cindy Brown said:
The biggest reason I'm responding is the statement that the WatchPAT 200 can detect UARS that can't be detected in the lab unless there is the application of special gauges. I don't see how one can detect the narrowing of the airway or the increased work of breathing with a snore mic, position sensor, pulse ox and "pat probe". I'm not even sure what the pat probe does.
PAT (peripheral vascular tonometry) measures digital vascular tone. WatchPAT searches for reduction in PAT amplitude, indicating increased digital vasoconstriction. This is an "autonomic arousal" (vs the "cortical arousal" of EEG). It cannot definitively diagnose UARS, it can only indicate high probability. Also, it cannot diferentiate between obstructive, central and/or mixed events (probability is determined by presence or absence of snoring). CompSAS will totally baffle it.
UARS can be effectively diagnosed using nasal presure transducers with respiratory inductance plethysmography.
mollete
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It reminds me of Obamanomics
Duane McDade said:I know lets just set up a section at places like Cost-co and Walmart. Where some pimpled faced large adams appled teenager gives you a Sleep Apnea "kit" for you to take home. Then when you bring it back the next day he USB's it into his computer and it spits out a order for the CPAP machine and mask, that the testing equipment computed you need. A auto CPAP set at 4-20 cm/h20. If you need advice or if you have questions you'll be directed to a interactive web site. There's no need for sleep labs or Doctors. This whole thing reminds me of the hospital in the movie Idiocracy (2006) .
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And WHY would anyone expect CosCo or Walgreens to kick loose w/a APAP????? I doubt either one would even kick loose w/a fully data capable CPAP w/o a knock-down, dragged-out, bitter battle!
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