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Sleep Study - How many Nights?

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brons7 +0 points · almost 3 years ago Original Poster

When I did my sleep study about 10 years ago to determine if I have obstructive sleep apnea and need a CPAP, I only had to go in one night and during that night, they did everything including monitoring and recording my brain activity, eye movements, heart rate, blood pressure, oxygen levels, body movement, etc.. Basically everything needed to not only for the diagnosis but also to capture the correct measurements to get the CPAP machine set up which I was prescribed and got a few weeks later.

My wife went in for a sleep study about 2-3 months ago. They connected her to the machines using the electrodes, finger monitors, microphone, etc. The the whole shebang, but not to a CPAP machine, unlike what they had done with me. Long story short, she gets a call a few weeks ago from the doctor telling her that she does indeed need a CPAP machine and that she needs to go do another sleep study to get the measurements for the machine. So she went in another night, same hookups, but this time they had her use a CPAP machine also.

During my sleep study, they started me up without the machine, and a few hours later woke me and had me start using a CPAP machine

Now, we have received two bills from the sleep study clinic for $1,500 for each of the nights ($3K total). Is it normal now a days to have to go in twice for sleep study? I tried to find this online but could not get any good results back.

Thanks in advance for your feedback.

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Sierra +0 points · almost 3 years ago Sleep Patron

I don't know what standard practice is in the US. In Canada now it typically a one night sleep study done at home. Then they prescribe an auto CPAP. With an auto machine you can set it up for a wide range, although if they are experienced they will know approximately where to set it. The new machines transmit the data wirelessly to the provider and they can do the finer adjustments wirelessly as well. No need for another return visit. The other thing that happens in Canada is that you do the one night sleep study, which typically includes a 2 week trial of a CPAP. This is all free. However, then either you or your insurance company have to buy a machine. Some buy the machine from the clinic, but if you don't have insurance then it is typically much cheaper to buy a machine on line and set it up yourself. That said the practice may vary somewhat by province. I believe Ontario pays 75% of the cost with their government healthcare.

In Canada the two night study in the clinic used to be used. I suspect to cut costs, that is seldom done anymore.

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snuzyQ +0 points · almost 3 years ago Sleep Commentator

Oh wow...I'm so sorry, but it appears your sleep clinic has figured out a way to make a buck.

I would try playing nice. Call 'em (preferably the top dog there) and explain your situation. Tell them you were expecting your wife's initial study to include the trial on CPAP once they had noted her apneas and that you were prepared to pay for one study - not two. Then, if it were me, I would flop around like a wounded bird and tell 'em I can only afford $1500 for the whole shebang and I have budgeted my funds to also provide for the treatment and there is nothing left over after that. Then see how it goes. Don't back down. Most medical providers will hem and haw a bit and then find "specials" and this and that to reduce the cost. Three thousand dollars for a sleep study is ridiculous. Don't let them get away with it.

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wiredgeorge +0 points · almost 3 years ago Sleep Enthusiast

It is considered normal practice for a patient to undergo a sleep study. When the study is complete and the decision is made to us PAP therapy, a second visit called titration study is done to set up the parameters of a machine. Mode of operation, pressures, ramp setting, etc. Sometimes it isn't done this way but it is very common it is. This method of setting up a machine has a much higher chance of a successful prescription than the home study route based on patient comments here on this forum. I went this route and my insurance paid the whole thing... was Humana HMO at the time and they are notoriously cheap and will pay for the least possible. The sleep clinic had to be "in network".

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Nightmare +0 points · almost 3 years ago

My new guy experience. I had two home tests to recommend my PSG sleepover. ~6 AHI and my cardiologist sleep doctor prescribed a CPAP ResMed 10 Air Sense. At my 30 day follow up my AHI is ~15 and he realized, volunteered immediately, Central SA. Yes! So now I’m waiting about two weeks for titration PSG and an ASV.

I’m 70 and am working towards an Athletic Heart Syndrome diagnosis. At my follow up OV work up, my HR was 45 BPM with a normal BP despite rushing around.

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SleepyMommy703 +0 points · almost 3 years ago Sleep Commentator

A separate 2 night study is standard where I go. That's how mine was done. Only after they diagnosed the sleep apnea through the first test did they order an overnight study with a CPAP.

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sleeptech +0 points · almost 3 years ago Sleep Enthusiast

Sometimes it is possible to perform diagnosis and treatment in one night and sometimes it takes 2. There are a bunch of perfectly legitimate reasons why it is not always possible to do both in one night, so it is no surprise that you were done in one night and your wife in 2. I'm not a huge fan of the one night study and the prescribe auto thing because it encourages laziness on behalf of all the people involved. I've met hundreds of patients who have wasted years of their time and thousands of dollars because they were handled this way and as soon as they got their auto CPAP no one could be bothered helping them. Also, in Australia and auto CPAP is 2 - 3 times the price of a fixed pressure machine (don't ask why, it just is). The one study and auto method of handling patients is a favourite of physicians who just want to pump through as many patients as possible with minimum effort and maximum financial reward. I think that it's only appropriate to verify if a treatment is actually working. Also, sleep studies are available for free here, which makes a difference. Anyway, taking 2 nights to do the whole thing is quite standard and probably just a sign of the people managing your wife's treatment being thorough.

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snuzyQ +0 points · almost 3 years ago Sleep Commentator

Thank you, sleeptech...your posts are so helpful!

My own study was done overnight at home, with the "wristwatch" method. I had to return the "wristwatch" by 8:00 am the next morning at a pulmonary clinic, 30 miles away - in commute traffic ala SF East Bay Area here in California. This was no easy feat. Within a week, I was assigned a date at another clinic to get a machine and mask for a 2 week titration at home. After the 2-week titration, I returned the machine and mask to the clinic and an appointment was made to pick up a new machine and mask of my choice at a Durable Medical Equipment supply close to my home. A respiratory therapist there fitted me for the mask and calibrated my new machine via my doctor's prescription. And that was it. Thus, the insurance plan was able to minimize costs and get the job done in a reasonable length of time. Unreasonable to me, though, because my sleep was suffering so much - severe OSA.

The "wristwatch" method, I know, is not the best sleep study one can have...it leaves out so much useful information. It is only diagnostic for obstructive sleep apnea. You have to struggle through quite a length of time before you become eligible for the in-clinic study, which is 55 miles away from my home. I, fortunately didn't need one. I think most patients wouldn't need one. It's just unfortunate, in my insurance plan, for the slightly more than few who do.

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redwood +0 points · almost 3 years ago

I was told that in order to get a titration study done on your first visit, you had to reach certain parameters within a couple of hours or you had to return for a second sleep study for the titration phase.

I had the privilege (?) of 4 sleep studies in 8 mos. due to a multitude of reasons that were not my doing. Thank goodness, insurance has picked up the tab on all of them.

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sleeptech +0 points · almost 3 years ago Sleep Enthusiast

That is more or less correct but the parameters vary from one lab to the next. Also, different labs have different policies. Some will always split and some will never split, regardless of what happens. Where I work we try to do whatever is in the best interests of the patient.

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waterlady1200 +0 points · almost 3 years ago

That makes no sense. Get a referral to a real sleep doctor and not just a plain pulmonologist or other non specific doctor.

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snuzyQ +0 points · almost 3 years ago Sleep Commentator

Hi waterlady1200:

I wish I had had a choice. I'm in an Exclusive Provider Organization (EPO) . I could go outside my plan, of course, but the total expense would be on me and I'm just not that wealthy. First we go to our primary care provider and are referred for the at-home sleep study (no choices there). The results are analyzed and sent back to the primary care provider. If you have OSA, then you are referred to a pulmonologist (most of us never even see this person) and are taken care of by the pulmonologist's underlings - the respiratory therapists, who set us up for the 2-week titration (CPAP trial).

We do the titration. We report back in. The respiratory therapists review the sleep data, make treatment pressure recommendations which are then briefly reviewed by the pulmonologist for signature. Thus the treatment recommendations become a prescription. We dither about with the respiratory therapists over what mask to wear. Then, still without ever seeing the pulmonologist, we are packed off to the DME provider to pick up our spankin' new machines and masks. The respiratory therapists show us how to use our new machines and off we go into the great beyond of making CPAP work for us. "Call if you have a problem", they say. Right. Thank God for the forum. I'd have been so lost without it!

This is airport-runway-medicine. They line you up, give the lift-off command, and then you fly the thing with help from "Houston". "Houston...I've got a problem...". It's super-cost-efficient.

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