I understand SloBrow's anxiety about the HST vs. the lab test. There is no doubt in my mind that more diagnostic mistakes are being made now vs. when everybody got the lab tests. Actually, the sleep physicians are between a rock and a hard place. I am working in the sleep field and I can tell you that INITIALLY the physicians fiercely tried to resist the trend away from lab based sleep tests. And it was not all about money either. But they got worn down and pummelled from all sides. The patients put pressure on them to do the HSTs for convenience sake and to save money. The insurance companies started to disallow payment for the lab based tests to save money. So the physicians sort of just gave up and went with the flow. And, on average, things are getting by well enough with more HSTs. But, as SlowBro says, are there a proportion of patients being hurt by it, some seriously? Without a doubt. So, buyer beware, patients must be proactive about protecting their own health and seeing that they are getting the best care. Dr. Luisi
Yes, most HSTs are sophisticated enough to pick up central apnea events. Dr. Luisi
Very, very well said. I would largely agree that a first class HST is sufficient to facilitate treatment for obstructive sleep apnea. And that is just what it was designed to do. I think that the point SlowBro is trying to make is that most patients don't make the appointment with the doctor for sleep apnea, they make the appointment because they are not sleeping well. And there are about 90 other reasons in addition to OSA that they may not be sleeping well. So, if the issue is clearly suspected OSA, an HST is a reasonable diagnostic response. But if there are any of the other 90 reasons suspected in addition to or instead of OSA, the full lab test is the reasonable diagnostic response. I really think that we are all in substantial agreement here, but we are arguing over semantics. Dr. Luisi
Good news. I have been able to continue development of the no leak face mask from the prototype stage to a simplified production ready stage. To date, we have had to take between one half hour to an hour to assemble each one and therefore had to price it at $450 dollars installed on your CPAP machine. With the simplified assembly, we can now install one on your machine for $280. If we actually go into production, I would anticipate a price of somewhere near $150, which is competitive with a high-end conventional mask. Dr. Luisi
Well, I think that I am going to split the difference on this dispute. As a health care professional in the sleep field, I am asked to base treatment decisions based upon the data from both types of studies. There is no question that you get a more complete picture from the actual in-lab sleep study. I am always glad to see an actual in lab test because it makes my job easier. Having said that, I find that a good quality HST usually is sufficient to screen for OSA and CSA, if only barely so. I would not underestimate the value of having a sleep technician present in the room to observe you all night. The biggest issue is that they can tell if you are ACTUALLY asleep which is always speculative with an HST. As the original poster said, there are a number of other sleep disorders that become evident in a lab test, so that the diagnostic data is much richer. However, in defense of Sierra's position, a lot of patients find a lab-based test either too much to cope with or too expensive and would simply fail to address their problems if not for the more simplified HST route. In that sense, the HST is a boon. Probably, the whole question will be moot soon because the insurance companies, which are always out to save money at the patient's expense, are increasingly unwilling to pay for the lab test anyway. But make no mistake about it, if you patients want the VERY BEST for yourself diagnostically, the lab test is still IT. Arthur B. Luisi, Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.
Another more comfortable approach is to get a nasal pillow mask supported by the teeth, rather than being secured by straps. With a tooth-borne device you have more stability and the pillows seal well with much lighter pressure against the nostrils. See: MyTap-Pap device at www.Tapintosleep.com. Available without a prescription on CPAP.com, ApriaDirect, and other internet sites. Dr. Arthur B. Luisi, Jr., The Naples Center For Dental Sleep Medicine.
There has been a lot of discussion on the forum about mouth taping to eliminate the air leakage through the mouth caused by CPAP. I am not going to discuss the validity of the concept other than to say that: 1. The price is certainly right. 2. It does seem to be a bit of a hit or miss approach depending on the skill of the patient and how active his lips and facial muscles are during the night. 3. Even with the lightest and least allergenic tape you could find, I wouldn't think that the comfort would be superb, although you patients could correct me if I am wrong. Certainly having tape over your lips long term couldn't be that good for the health of your skin. What I am working on what seems to be a far better approach and it is proving to be so clinically. I have a very soft, comfortable, thin, hypoallergenic, silicone-like clear seal that goes right inside the lips. The air from the CPAP machine seals it tight inside the lips and there is no leakage even it your mouth and facial muscles move around. It is gentle to your skin, lasts about 3 months before replacement and costs between $12-$35 dollars to replace. I do believe that this could be the ultimate solution. The product is made by Airway Management, Dallas, Texas, but this is the first time that it has been used in this way. Only time will tell. Arthur B. Luisi, Jr., D.M.D. . The Naples Center For Dental Sleep Medicine.
I am a dentist working in dental sleep medicine. Actually, there is very little to do. They will just take upper and lower impressions and a special bite record. The only thing that I can think of is to brush and floss carefully to make his mouth super clean and free of plaque. That way you will get the sharpest and best impressions. Arthur B. Luisi, Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.
No. That would be about normal.
You really do have a complex and vexing situation. In terms of nasal patency, you already have that covered and have already done every procedure that a person would reasonably want to have done. So the question remains, if you possibly have UARS, what is causing the increased breathing resistance, if not your nose? A possibility is that you just have an unusually small diameter trachea and other breathing tubes leading into the lungs. An ENT could determine that, but I am not sure that I would want to get into that because I think that those endoscopic procedures could be problematic. You might get a consult just to discuss the issue. I would not recommend boil and bite oral appliances to anyone, mostly because they do not work well and do tend to do some damage to your teeth and mouth. The horror stories as to OAs messing up the bite are definitely over-rated. In my practice, it has not been that much of an issue if you use a morning realigner and a good quality appliance properly fitted. In life, lots of things are trade-offs. Which would you hate more, to go through life always feeling lousy and tired, or getting a little tooth movement. Your life-- your choice. I would focus your attention on one appliance in particular, the Luco Hybrid appliance. It is not very well known, but excellent for comfort, low potential for tooth movement, and restoring EXCELLENT levels of oxygenation. It is really good for UARS. See: www.lucohybridosa.com. Dr. Luisi