Replies to This Discussion

Permalink Reply by RockRpsgt on August 27, 2010 at 6:53am

I do not know much about the different machines. I have only seen a few. The lab that I am currently contracting with uses the stardust 4 channel by Respironics. It is ok as a pre-screener. I would not take the results to the bank though.

I do see a huge conflict of interest in the example that you posted. There are laws against sleep labs favoring one DME over another. Does not seem right that the DMEs can do it. I know that your store has Rpsgts, but I do not believe that there is a requirement for any sleep education in a DME office. I do not see how this practice will remain. This also puts the pt at a huge disadvantage as they will be going through an HST and then through self titration. I believe that this practice will put more PAP units in the closet.

I am also seeing a very bad trend with the HST. I am getting patients who have gone through an overnight oximeter test, HST, and then come in for a PSG. I asked my doctors about this and was told that the only thing an HST confirms is the need for a PSG. The insurance companies may be in control, but the docs are still going to cover their ass. Just one more test the pts are going to have to go through.

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Permalink Reply by Mark Andrew Hixson on August 27, 2010 at 12:25pm

I appreciate your response I just don't see how this can be stopped.... Check out the ARES machine when you get a chance, i'm curious to see what you think of it. I know alot of docs who don't take these as pre-screener's but the real deal....There is a debate as to how effective it is without a belt as well..
http://www.watermarkmedical.com/


Rock Hinkle said:

I do not know much about the different machines. I have only seen a few. The lab that I am currently contracting with uses the stardust 4 channel by Respironics. It is ok as a pre-screener. I would not take the results to the bank though.

I do see a huge conflict of interest in the example that you posted. There are laws against sleep labs favoring one DME over another. Does not seem right that the DMEs can do it. I know that your store has Rpsgts, but I do not believe that there is a requirement for any sleep education in a DME office. I do not see how this practice will remain. This also puts the pt at a huge disadvantage as they will be going through an HST and then through self titration. I believe that this practice will put more PAP units in the closet.

I am also seeing a very bad trend with the HST. I am getting patients who have gone through an overnight oximeter test, HST, and then come in for a PSG. I asked my doctors about this and was told that the only thing an HST confirms is the need for a PSG. The insurance companies may be in control, but the docs are still going to cover their ass. Just one more test the pts are going to have to go through.

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Permalink Reply by Christy Ritz on August 28, 2010 at 2:47pm

Sleep disorders cause profound metabolic changes to the body. And hormones control a lot of our sleep patterns and are affected by sleep disorders. In my opinion much of the future for diagnosis of sleep problems lies in a combination of blood work, monitoring hormone levels and clinical symptoms . I look forward to the day when we look back at these sleep labs and home tests with all the wires and attachments (not to mention the camera) and view these tests as crude and silly.

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Permalink Reply by gordon on August 28, 2010 at 4:10pm

In 2006, I went to my Kaiser Permanente sleep class where I had insurance. After several classes on how to use the machine, we took it home and went back for the results and Rx. They only gave one night.
DME was not covered (I guess the reward for being self-employed and paying $8K/yr premiums) so they sent me to their
preferred sleep lab, where they sent a machine home with me to make sure the Rx was correct. It was, and they fitted me with the equipment I still use today, Remstar Plus w/ Swift Mirage nasal pillows, which was the most popular at the time.
This was all a good experience for me, although since I was paying myself, I could have kept the test machine more than one night until I got a good 7 hrs sleep, I think they wanted. I managed in the 1st night though.
I think it's great to use a test machine at home. I didn't know they require an in-patient for that still.

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Permalink Reply by Gary West on August 28, 2010 at 6:03pm

I am self employed, & do not have insurance. In doing some research it seemed That I had sleep Apnea.

I decided to go into a doctor, after talking to a local CPAP supplier, they gave me a name of a doctor that had given precripctions.

I went into the doctor he said that since my wife was with me I did not have to do a sleep study, he asked her some questions looked at me and I must have looked very tired, he said he could tell I had not been sleeping very well.

I told him that I could not afford a couple of sleep studies at $2000.00 each.
The doctor prescribed a APAP

I avoided the $4000.00 sleep study to get a CPAP.

My CPAP supplier loaned me the APAP & headset (For Free) for 3 weeks to do the in home sleep study.

My CPAP supplier recommended the F & P ICON CPAP and said it is new but would be available when I am done with the three week study.

So far I have had three nights with the APAP, The first two have been life changing, the last one, I did not sleep at all Ugh!!, but I am sure it will get much better

Westgl

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Permalink Reply by Mark Andrew Hixson on August 28, 2010 at 10:14pm

Wow! To be honest i don't think i've ever heard of a doctor doing something like that... I've been at this a long time and i can assure you that is not a common practice....or maybe it is and i am just in the dark.... From my perspective that doesn't sound very clinically sound considering their really are alot of labs that will work with you on a self pay basis and the doctor should know this in my opinon In all reality and alot of the techs would agree your doc shouldn't just ask you do you snore and if you say yes "ok well you have sleep apnea....But that being said, I completly understand where you are coming from. It can be very expensive, this is one of the reasons that i brought up this home sleep testing because when "Obama care" starts deductibles are supposed to sky rockett and i think that is why private payers are looking at the HST option.. Matter of fact there is a big movement in family practice dr's and internal medicine dr's in support of HST because they don't want to loose their patients and if they are the one's managing their sleep diagnosis they get alot of more visits out of the patients..... The ICON Auto machine is supposed to be a good machine and it will be out in a few weeks , I almost feel weird plugging my business again but the reality is that is what i do and i'm obsessed and passionate about my work.. I've said it before and i'll say it again i will work with any member of sleepguide when it comes to price to get you taken care of.. Here is a link to the icon auto that you can order in a few weeks..
http://1800cpap.com/fisher-paykel-icon-auto-cpap-machine.aspx And here is a link to an auto machine that is available now and in many people's opinion the best machine on the market....http://1800cpap.com/resmed-s9-autoset-cpap-machine-with-h5i-heated-... Good Luck to you... If you need any advice or help with anything feel free to get on my website and ask our doctor any questions. He is a board certified Sleep Doc..

Gary West said:

I am self employed, & do not have insurance. In doing some research it seemed That I had sleep Apnea.

I decided to go into a doctor, after talking to a local CPAP supplier, they gave me a name of a doctor that had given precripctions.

I went into the doctor he said that since my wife was with me I did not have to do a sleep study, he asked her some questions looked at me and I must have looked very tired, he said he could tell I had not been sleeping very well.

I told him that I could not afford a couple of sleep studies at $2000.00 each.
The doctor prescribed a APAP

I avoided the $4000.00 sleep study to get a CPAP.

My CPAP supplier loaned me the APAP & headset (For Free) for 3 weeks to do the in home sleep study.

My CPAP supplier recommended the F & P ICON CPAP and said it is new but would be available when I am done with the three week study.

So far I have had three nights with the APAP, The first two have been life changing, the last one, I did not sleep at all Ugh!!, but I am sure it will get much better

Westgl

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Permalink Reply by Christy Ritz on August 29, 2010 at 3:26pm

My CPAP supplier loaned me the APAP & headset (For Free) for 3 weeks to do the in home sleep study.

Gary-

I am curious about your test and would like more information about it. My ENT (I had been seeing him for a year and had all the classic sleep apnea symptoms except large neck an not over weight) sent me to a lab for a test and it came back negative for sleep apnea because I could not stay down long enough for a positive result but my ENT arranged for me to get an ResMed Auto 25 device and according to the data output the machine is responding to apnea events but my insurance won't recognize the results and neither will other doctors,I have been to USC and UCLA with my machine's output (2 years worth). They all want sleep lab studies. My treated AHI ranges between 3.7 and 5.6.

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Permalink Reply by Banyon on August 29, 2010 at 6:34pm

Gary West,

Do you have access to the data every morning to see how many apneas, hypopneas, and snores you had and the amount of mask leak? I like what your doctor is doing for you.

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Permalink Reply by Mark Douglas on August 30, 2010 at 9:53pm

Well keep in mind, in England 80% of the patients getting CPAP don't even get a sleep study. Home or otherwise.

At least, that was the jist of an article I copied into this goup a few weeks back. They get a overnight oximeter test -- and an extensive questionaire you fill out. Twenty percent of them get a sleep study of some kind -- apparently on the basis of that questionaire.

I think a lot more people would get tested if it was very low cost, and easy, at home.

Sure a complete sleep study is the way to go if you have the time, money, insurance.

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Permalink Reply by Kath Hope www.hope2Sleep.co.uk on August 31, 2010 at 6:35am

Mark, could you point me to this article you're referring to please? I have hundreds of customers in the UK and I've yet to hear of one who only had the oximeter test, so I'm wondering who wrote the article. To clarify, here in the UK we fill in the Epworth Sleepiness Scale and are then sent to a Specialist for a sleep test. I would say that around 60% of us have the Home Study test though, due to lack of Sleep Centres. I would guess that those who only have the oximeter test are those who get a private test done from an on-line company, by-passing their GP's and they buy an APAP from these companies. Things do need to change over here!

Mark Douglas said:

Well keep in mind, in England 80% of the patients getting CPAP don't even get a sleep study. Home or otherwise.

At least, that was the jist of an article I copied into this goup a few weeks back. They get a overnight oximeter test -- and an extensive questionaire you fill out. Twenty percent of them get a sleep study of some kind -- apparently on the basis of that questionaire.

I think a lot more people would get tested if it was very low cost, and easy, at home.

Sure a complete sleep study is the way to go if you have the time, money, insurance.

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Permalink Reply by Brian Smith on August 31, 2010 at 1:29pm

I've had two complete in-hospital polysomnographs at London hospitals. Both were conducted in what could best be described as laboratory environments where the nursing traffic, equipment noise and flashing lights and strangeness of the surroundings made sleep almost impossible.

I also had a home study where the oximeter gizmo only worked for one evening out of the three. According to the technician (we don't see doctors in the UK for sleeping problems) who reviewed the results, he had all the information he needed to titrate my machine.

From a patient/user point of view, I would have to say the home study is a far more reliable diagnostic method than the in-hospital approach. How much information do they need after all? The hospital based studies I had involved multiple electrodes attached to my head and chest and other sensors attached to fingers, chest and so on. The results had to go off to another expert to be deciphered.

Basing their investigations on at-home studies, I believe the technicians get enough info to prescribe a suitable machine and pressure level. Following that, if compliance is good but outcomes are still poor, then a further study is probably justified. But I imagine most OSA sufferers will get the treatment regimen they need and not trouble their doctors/technicians again between the standard follow-ups.

I would like to stray off-post and query the usefulness of the Epworth Sleepiness Scale questionnaire. I don't think it's at all effective and I would be interested in other peoples' views. It takes no account of circumstances, personality or history. It's single advantage is that it is simple and probably easily understood by everyone.

But I don't think it is fit for purpose. What do other people think?

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Permalink Reply by 99 on August 31, 2010 at 1:41pm

you are absoulutly correct for OSA however a poly whats its name find other thing that you were not looking for and may save your life

Brian Smith said:

I've had two complete in-hospital polysomnographs at London hospitals. Both were conducted in what could best be described as laboratory environments where the nursing traffic, equipment noise and flashing lights and strangeness of the surroundings made sleep almost impossible.

I also had a home study where the oximeter gizmo only worked for one evening out of the three. According to the technician (we don't see doctors in the UK for sleeping problems) who reviewed the results, he had all the information he needed to titrate my machine.

From a patient/user point of view, I would have to say the home study is a far more reliable diagnostic method than the in-hospital approach. How much information do they need after all? The hospital based studies I had involved multiple electrodes attached to my head and chest and other sensors attached to fingers, chest and so on. The results had to go off to another expert to be deciphered.

Basing their investigations on at-home studies, I believe the technicians get enough info to prescribe a suitable machine and pressure level. Following that, if compliance is good but outcomes are still poor, then a further study is probably justified. But I imagine most OSA sufferers will get the treatment regimen they need and not trouble their doctors/technicians again between the standard follow-ups.

I would like to stray off-post and query the usefulness of the Epworth Sleepiness Scale questionnaire. I don't think it's at all effective and I would be interested in other peoples' views. It takes no account of circumstances, personality or history. It's single advantage is that it is simple and probably easily understood by everyone.

But I don't think it is fit for purpose. What do other people think?

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