Sierra

That seems high as was pointed out the maximum number of 10 second events would 360 per hour. However I have heard of diagnosis AHI's over 100. It can be obstructive apnea, or it can be central apnea including a special condition called Cheyne Stokes Respiration. This is basically when the control system regulating breathing goes unstable, and it results in back to back CA events. There can be many causes including heart failure or use of drugs such as opioids. This is one example of a situation where one would want to have a full in lab sleep study, as well as an investigation of other potential cardiovascular issues.

Central apnea can be made worse by CPAP treatment. Here is one example of pretty bad Central Apnea while using an APAP. The green highlighted areas are flagged as potential Cheyne Stokes Respiration (CSR).

My experience is in Canada and how sleep apnea is treated varies from jurisdiction to jurisdiction. Ontario our largest province, will allow home sleep study tests, if you pay for it yourself, or your insurance company pays. However, the government also pay for 75% of a CPAP machine, but do not accept a home sleep study. They force you to do a lab sleep study (and may even pay for it), before they will pay their part of a CPAP machine. I would suggest they are way behind the times, and are paying for it with massive debt in the province.

The province where I am, is a little more advanced than that. They allow GP doctors to order a sleep test from a private lab which uses home sleep studies, and do not charge anything for it. They give you the equipment for free (with a credit card scan to back it up). If you test positive, they also do a free trial of a CPAP machine (typically an APAP) of two to three weeks. At the end of the trial if the machine works then they want you to pay -- typically $2400 for an APAP. You can take it or leave it. Those with a generous insurance plan generally take it. Those without a plan, like me, buy their machine on line at about $800, and set it up themselves. If they are astute enough they get the settings from the trial machine and also monitor their progress with SleepyHead. The government sits back (in a country that is supposed to have free health care) and thinks this is great. It costs them nothing. They finally are stepping up and setting standards for those doing the testing and doing the diagnosis with the results. It was overdue. While I believe my home sleep test was credible, as the machine (Phillips NightOne) does it all, I was not at all impressed with the sleep technician.

So what do the full blown sleep clinics think of this? Not much. They are going out of business. They are of course lobbying that in lab sleep clinics are essential and necessary to diagnose sleep apnea. My observation is that they are losing. Times are a changing.

It is an interesting article but my observation is that sleep apnea treatment is driven by medicare and insurance companies. Changes seem unlikely to occur unless they change their standards for diagnosis. Most will not even recognize RDI as a valid measure to prescribe CPAP equipment.

It is unfortunate that you had a bad experience with sleep testing. A survey done by MyApnea found that 60% of people that used the home testing process were satisfied, compared to 71% who did the in lab testing. So, it is not a sure thing even with in lab testing.

Home Testing vs In Lab Sleep Tests

The original poster uses SleepyHead. With that software, one has a pretty good idea when CA events are occurring especially when the machine is in Auto mode. I put the machine in Auto to narrow in on the best pressure and then switch to CPAP for fine tuning. Your points have some merit though and it may be time to switch back to Auto mode and see if there is something to be learned.

Opening your mouth and letting air out can be fairly easy to spot on SleepyHead as well. They start quite suddenly and have flat tops on the leakage graph, and end quite suddenly, often when you wake up...

You sound like a used care salesman trying to sell me a car, and if I don't buy it from you it will be a lemon. Sorry, but your arguments are not convincing. I don't buy it. And, not the car either.

Central apnea is more likely to be caused by a higher pressure, not a lower pressure. It is best to do everything you can to keep pressure as low as possible. Turning Flex off on a DreamStation or EPR right off on a ResMed when sleeping often can reduce required pressure by a couple of cm, for example.

My doctor prefers bisoprolol to metoprolol for a beta blocker. He says that it has a much more uniform effect during the 24 hours of the day instead of peaking in effect a few hours after taking it. Metoprolol is often taken twice a day to minimize the peaking effect. I was initially prescribed 5 mg of bisoprolol to be taken once a day. I still split the pill and took half a pill twice a day. Then I did a bit of a test and stopped taking the evening half of the pill. It seemed to reduce the CA frequency and did not significantly increase my BP, or pulse rate. I also take 8 mg of perindopril, an ACE inhibitor, daily for BP. My doctor agreed to the change, so now I only take 2.5 mg of the bisoprolol once a day first thing in the morning. My thinking is that any peak it may have will be during the day, and not at night when I am sleeping and susceptible to CA events. I exercise at a gym in the late morning and can see the impact bisoprolol has on my heart rate if I forget to take it. Even at 2.5 mg a day it does limit heart rate during exercise.

You may find this article on complex sleep apnea of interest.

Complex Sleep Apnea

I have complex sleep apnea and while the home sleep study gave me an AHI of 37 and may have underestimated the central apnea a bit, the consequences are the same. The next step is to get an Auto CPAP and find out how you do by monitoring the data from the trial Auto CPAP over a couple of weeks. You get much more data from the CPAP than you do from a one night study.

This said, there may be some cases of sleep disorders which are more than obstructive and central apnea that need a better study. With the soaring cost of healthcare, I think it makes sense to take it one step at a time. A home sleep study is very inexpensive compared to a full blown lab test. And like it or not, many people are very reluctant to go to a lab to undergo the torture of a full sleep study. If the home study and Auto CPAP does not provide relief then it may make sense to spend the money on a lab test.

My view is that the traditional, labour intensive, and expensive route of diagnosing apnea is going the way of the dodo bird. That is when a full lab test is done just to get a diagnosis. Then when you get a diagnosis of apnea then another full in lab titration study is done to fine the magic pressure you need to set a fixed pressure CPAP. Once that is prescribed and things don't work out then further studies may be done.

It is much more efficient and less expensive to do the home sleep study first, and if positive for obstructive apnea, then prescribe an Auto CPAP and go straight into a home trial. When the data is analyzed (which can be done remotely), adjustments can be made at little to no cost. And at some point it may be best to change the Auto CPAP into fixed CPAP mode. When you consider that an Auto CPAP is less than $100 more expensive than a fixed pressure CPAP, it is well worth it to avoid all the very expensive in lab testing just to determine the magic pressure needed for a fixed pressure CPAP.

Both myself and my wife were diagnosed with home sleep study equipment and have no regrets. I monitor both of us using SleepyHead and neither of us have not been back to a sleep clinic since we got our machines. She still runs her machine in Auto with a narrow band between min and max pressure, while I converted to fixed CPAP mode. While she was diagnosed with a very high AHI in the 80's, she averages under 1 for AHI now on the APAP. I was diagnosed in the 30's but have complex apnea (central and obstructive) and average between 2-3 for AHI.

Based on our experience, I would not hesitate recommending a home sleep study, and also believe it is one of the ways our health care system can be made more cost effective. The business of dispensing and reading the results from home sleep studies does need to be carefully regulated to ensure appropriately trained staff and doctors are used.

Just my thoughts, based on actual experience.

You may find this article in the Blog section of this website of interest:

Should Sleep Tests Happen at Home or in the Lab?

I was diagnosed with a home sleep study, and I have no regrets or issues with the process. In fact, if I only had a choice of doing an in lab study, I would have probably refused doing it. I found the study in my own home uncomfortable and invasive enough. If I was forced to sleep in a lab with an audience and TV camera on me, I'm sure I would not have slept one minute during the night. My view is that home sleep studies opens up the door to getting many more people who are having sleep issues, actually diagnosed and treated.

On some further thought, you may want to try wearing a simple chin strap to try and keep your mouth closed while sleeping.