Back in March or so, I had a home sleep study done with the Philips Alice NightOne system. The Phillips system looks very similar to the ResMed setup and I would say records all the same things. The test report looks very similar. Remember that besides nasal flow there is a respiratory effort sensor based on tension in the belt around your chest. That is an indicator of your breathing. And if you have an apnea there should be a reduction in oxygen saturation which is being measured also. So there are three independent measures of breathing flow, effort, and oxygen. I also breathe through my mouth, and now that I have a CPAP I know I open my mouth in my sleep based on leak data.
My sleep test was a horrible experience and I would have sworn that I got close to zero sleep. But, the device monitors data quality and gives a quality signal in the morning that indicated the test was valid. Who can argue with a computer? In any event it came up with an AHI rating of about 34 which puts me just into the severe range. Now that I have a CPAP and frequently analyze my own data using SleepyHead, I can easily see that I do in fact suffer from obstructive apnea, central apnea, hypopnea, and snoring. It takes about 12 cm of pressure to normalize the obstructive apnea and eliminate the snoring. Central apnea is not reduced with pressure, and my hypopnea seems to be mainly an incomplete central apnea cycle, so it is not reduced so much either. I now have no question that the home sleep study report was reasonably accurate for me, but I sure did wonder at the time.
That said your concern about validity and accuracy is a fair one to question them about. Also for sure you should ask for a copy of the sleep study report. It should look like the example shown on page 4 of the product brochure at the link below.
If you post the critical details from your report (AHI, OA, CA, hypopnea), you can get some feedback on what it means, and what implications it might have on a need for a machine, any things to watch out for.
Hi, Thanks for your response and sharing your experience. I did obtain a copy of the test results and they were puzzling based on my experience with the test equipment. The nasal cannula caused me to panic so I took them off before I even fell asleep. After several hours of trying to distract myself enough to be able to put them back on and sleep, I ended up putting them on just at the edge of my nostrils (all I could tolerate). I slept for 2.5 hrs (which I can confirm based on viewing history on my tablet; I was watching a documentary to try and relax :)). I let the lab know that I got minimal sleep, had trouble with the nasal cannula, and am a mouth breather. I also took the pulse oximiter off for a bit because it smelled very strongly of someone's perfume (yuck! must have been a used kit) so I tried to clean it around 1am. The test came back as follows: Recording: 7:22; Monitoring Time: 5:13; Oxygen Saturation evaluation: 7:12. AHI: 7.3 Apneas: 0 Hypopneas: 38 Oxygen Saturation: Baseline-94; Average 94; Lowest-89 The final diagnosis was "Mild Obstructive Sleep Apnea" My concern is that the test is either under or over-stated given the trouble I had with completing it. For example, the test says I was supine for 5:05 hours and non-supine for 7 minutes. That's crazy because I was up walking around during the night and then sitting in a chair for at least 2 hours while I watched a video. I wrote detailed notes on the post-test questionnaire that I returned with the test equipment but the lab came back and said "come get fitted for an APAP." They didn't seem to be concerned about the issues I had raised. If I have to get an APAP then I will but there is a significant out-of-pocket cost for me and I want to make sure these results are even valid before getting equipment that may be insufficient or even unnecessary. Any feedback is appreciated!
Based on the data you provided the diagnosis of "Mild Obstructive Sleep Apnea" would seem about right. The home sleep test is considered suitable for straightforward cases of quite probable sleep apnea in the absence of other cardio pulmonary issues. Your case is not so obvious based on the test. The rating system used for AHI is:
None/Minimal: AHI < 5 per hour
Mild: AHI ≥ 5, but < 15 per hour
Moderate: AHI ≥ 15, but < 30 per hour
Severe: AHI ≥ 30 per hour
Your oxygen desaturation is kind of on the borderline to normal too. See this link for a bit more of an explanation.
In my amateur non medical opinion, the cost no object obvious alternative would be to get a full sleep in the lab test done. That probably will be more invasive than the home sleep test, and if you are paying out of your pocket it can be in the thousands of dollars, depending on your insurance and where you are located. And, at the end of the day the results may come back exactly the same but with more detail.
If that is not feasible then there are three options I can think of:
Where are you located and have you been given prices for an APAP? It may seem rash, but in Canada at least you can get a good APAP for $900 CDN or so. In the US about the same, or perhaps a little more. Also in Canada when you have had a home sleep test the labs at least in our province, will give you a free trial of an APAP to see if you tolerate it. That would be the very best way to go if that is an option. In fact that is what I did. I did the free trial and then took the equipment back because they wanted a ridiculous price for it ($2400), and bought my own from an on line company for the $900.
Hope that helps some. If you can fill in a little more detail on what your options and costs are for a machine, I can probably make a few more suggestions.
Hi, Thanks so much for the detailed response - I really appreciate it. I am in the US Northeast and the price quoted for the APAP was $90 a month for 10 months (rent-to-own), so similar to the price you quoted. The mask, however, was ~$700, which seemed grossly overpriced based on the mask prices I've seen online. This is all out of pocket due to an insurance deductible. It's one of those things where if I felt like the home test was executed perfectly and therefore the results were beyond question, I'd suck it up and pay it. But I remain very dubious about that test so without a less costly "trial period" option I'm disinclined to jump on the APAP train. I should mention too that the doctor/sleep lab/medical equipment provider are all commingled so that the lines between them are very unclear. Case in point, the test results came on the sleep lab/equipment provider's letterhead which included the ResMed manufacturer name, and the results were digitally signed by the doctor who ordered the test. I felt like they had made a decision about getting me "papped" before the test was even administered and have been pretty persistent in getting it set up. So my guard is up with this team. I am not able to purchase equipment online without a prescription. I'm actually not sure if I have been prescribed anything; I have had no interaction with the doctor's office since they ordered the at-home sleep test - all follow-up has been with the sleep lab/equipment provider.
So I am taking this to mean you have no opportunity to do a free trial of the machine? That certainly makes it more difficult.
As for a prescription the way it works in Canada is that your doctor gets the sleep test report. If it indicates apnea and they believe a CPAP is suitable, the doctor just signs it and it becomes a prescription. I would think it is similar in the US, and the doctor involved is obligated to provide you a prescription even if they don't sell you the machine. Kind of like a prescription for a medication.
As for a machine, your issue is essentially hypopnea and not apnea. Not all machines detect and treat hypopnea as well as full obstructive apnea. I think the best auto CPAP on the market is the ResMed AirSense 10 AutoSet. From testing it does treat hypopnea well, and it is good at reporting hypopnea, obstructive apnea, central apnea, snoring, flow limitation, and other variables. It is compatible with SleepyHead so you can take the SD card from the machine and read it with SleepyHead to get your detailed results.
I see that CPAP.com offers a 30 day free return policy. So I guess one could buy the machine, try it, view the results on SleepyHead, and then decide if an APAP is really necessary, and if you can tolerate it.
Here is a link to the machine at CPAP.com. I would suggest the "For Her" version even if you are male. It has an optional extra program that you can try to see if it works better than the standard program. Unlike places in Canada, this outlet does not seem to offer packages. This appears to be just for the machine standard hose, and no mask. Most will want a heated hose for comfort, and that is an extra $40. A basic mask would be the ResMed AirFit P10, and it is $100. It comes with a fit pack which means it includes the small medium and large inserts, and you use the one that fits you the best. But, I would look around. In Canada you can get the machine, heated hose, and mask for about $900 CDN ($660 US). There may be better prices in the US. But perhaps at CPAP.com you are paying extra for the 30 day ability to return and get your money back. In any case here is the link:
Hi, Sorry for the delayed response. No, no option to "try before you buy" but I suppose one could return the device the rental period and discontinue payments. I was kind of uncomfortable with that "auto-debit" situation where you supply a credit card and they just bill you until you say stop. I have been burned by that model before when someone "forgets" to stop the auto-payments. I will surely look into the cpap.com option - thanks for providing that info. It wasn't immediately clear to me if the 30 return was for your money back or a store credit but I will do some research :)
Bear in mind that almost all of the data derived from your sleep study would only be from the time you were asleep, so what you were doing while awake will have little effect on it. I assume they put a sensor in the hair on your head to measure your brain activity. If not the whole thing is a load of garbage. I wouldn't get too caught up in the positional info because the position sensors can be a bit dodgy and they won't have video to correct it with.
I don't believe the at home ResMed device uses EEG. I saw no mention of it in the product datasheet. My Phillips Alice NightOne setup certainly did not. My thoughts are that this test probably did include the time not sleeping and while sitting up. Positional data was probably messed up in the sitting position, and since most people don't have apnea while awake, the overall AHI is probably underestimated.
No, no sensors anywhere save for the pulse oximiter, chest band, and nasal cannula. Very basic setup. Sierra I think you are correct that it included all time from when I powered the test kit on and up until when I turned it off, regardless of actual sleep. It concerns me that the AHI could be underestimated. But also that the results could be skewed in the other direction given that a) I mouth breath and b) I wasn't wearing the nasal cannula properly. If that was meant to measure breathing then I can't see how those results could be valid based on little to no air coming out of my nose :) I just re-listened to a voicemail I had from the equipment provider; they were going to get me nasal pillows which again, is odd given my near 100% mouth breathing (deviated septum). The whole thing is just strange to me - lol!
I did a little more research on prices in the USA for a ResMed AutoSet. I don't know anything about this company but their prices do look better and are more in line with the prices we see in Canada. They seem to have odd ball packages which don't include the three main components which are the machine with carrying case, a heated hose, and a mask. However, their prices when you buy them individually are still not too bad. I don't see anything about a return policy though. In any case here is what I found:
ResMed AirSense 10 AutoSet For Her - $649
ClimateLineAir Tubing - $33
Picking a mask is very hard to do without being able to trial it. And since you didn't like the cannula and mouth breathe, a nasal or nasal pillow mask is very unlikely to be tolerated. I've tried 5 different masks and only tolerated the ResMed P10 nasal pillow. I didn't like the full face ones I tried which were the Mirage Quattro (seemed big and it leaked especially into my eyes), and the ResMed AirFit F20 (also leaked and irritated the bridge of my nose). Of the face masks available from this same vendor I picked out a couple you might want to consider. They both minimize contact with the face, and potentially keep leakage away from the eyes, and put minimal pressure on the nose further up.
Amara Full View (Fitpack) - $149
DreamWear Full Face Mask (Fitpack) - $159
The fitpack packages are the safest bet as it improves your odds of getting the right size, because you can try each one. There is no fitting guide for the DreamWear mask, but there is one for the Amara Full View, so you could go for broke and just order one size which saves about $30. Here is the fitting guide.
I believe wiredgeorge a contributor here uses the Amara Full View, and perhaps could give you some tips on which mask may be the best bet. CPAP.com has these masks as well and include "free" return insurance, but they are more expensive.
In any case the total is going to be in the $800-850 range depending on the mask. Hope that helps some. But, again I know nothing about this company and it would be worth checking that out further before going ahead. They appear to be located in New York.
