If you are seeing a sleep specialist, pulmonologist, etc and you guys are talking about having a sleep study done, and they tell you that they want to have you do a home sleep study rather than a lab sleep study, SLAP THEM ACROSS THE FACE AND FIND ANOTHER SPECIALIST !!!
but seriously yes try and have the lab study done because lab sleep studies are superior diagnostically in many different ways. Home sleep studies are so incredibly limited and questionable in what they can show, they Are just about worthless. The sleep disorders are really complex already, the BEST thing you can do for yourself if possible is the lab sleep study overnight in the hospital or whatnot .
That gives you your best shot diagnostically
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.
You are most definitely wrong and you probably are actually misdiagnosed as the home sleep study has such a limited scope.
It only measures breathing (and even THAT has been inaccurate in some patients in these tests) IT DOESNT RECORD SLEEP!! Many results from home sleep studies have been PROVEN to be inconclusive and show false negatives again and again.
Home sleep study isn’t for everyone, a specialist from Cleveland clinic said that for the bulk of patients with sleep disorders this test is absolutely inappropriate.
The reality is lab study and home study may be both uncomfortable to some like you, but to use that as an excuse is laughable as the patient is giving himself or herself the best possible shot at understanding what is wrong by doing the lab study.
LAB polysomnography shows highly accurate data unlike home study, it has sensors for respiratory effort, cardiac data, ACTUAL SLEEP TIME, Eye leg and other movements, brain waves EEG, probes, pressure transducers, the benefit of the technician being there to aid you and change anything if needed, etc
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?
No you don’t get more data from a cpap than a one night in lab polysomnography actually it’s foolish to even compare the two. Cpap doesn’t check your brain waves, respiratory effort, eye leg muscle movement etc etc
I understand about price but many people have options and can get help with that, regardless all I’m getting to is the fact is it’s superior to a home study. You calling it torture makes you seem pretty weak. Nothing close to torture. Hope people realize that.
If a patient has a second in lab follow up sleep study using a machine it’s not just to find a “magic pressure”. No specialist or tech will ever say something like that. It has all the benefits of the first lab diagnostically obviously and they can see what machine will benefit the patient, pressures to start the patient off of course, tolerance, respiratory signs, etc. to set a patient up for success
You said, “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”
That right there is a dangerous statement and that would be sending people closer and closer to their death. You can talk to many specialists themselves or do the research, only a small number of people would really benefit doing that. It’s already known The huge majority of sleep disorder and apnea patients will need the lab sleep study diagnostically to get proper treatment and help. The limited home study will do JACK nothing for them. Except maybe Provide misleading conclusions.
So many people could do wht you said and also have A. b. C. D. And e. That are not even being dealt with and under the rug. So not good.
You seem to bring up the cost and healthcare again but I’m only speaking on what will benefit the patient Diagnostically. Each patient has different options they can take with insurance or whatnot.
Regardless , the lab is superior in helping a sleep disorder patient.
Sierra,
ok boomer.
I am not trying to sell you anything. This is for other patients who will see this. You aren’t worth convincing. I’m a sleep disorders patient in my 20s.
Home sleep studies won’t truly help the majority of patients.
The arguments you’ve given yourself have been extremely terrible. Im going off research and words of medical professionals and specialists. You go off money and your own opinions projecting on others. Thank god you don’t work in medical field and you just crap post on this forum otherwise you’d be really doing disservice to patients and hurting them
So I’ll conclude with this, sorry about you and your wife. Good luck boomer.
As for others who read this, please try and get a lab study done to help find out what’s going on with you diagnostically and to help your sleep struggles. You don’t want anything hiding Under a rug for years misdiagnosed!
Peace
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.
One thing though, put satisfaction aside,
Because fact is home testing only checks for 1 type of sleep disorder, and even that can be botched or misleading
In lab sleep study checks WELL over 90 different types of sleep disorders, with a lot more understanding and info given the ekg eeg resp effort etc etc
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.
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.
Well this is a fun thread and less tactful that is normally tolerated.
Sorry SleepDent but despite my respect for your beliefs, I'm fully behind Sierra in this one.
Yes, on a bunch of technicalities and rare improbabilities, there are some good arguments for doing a sleep study in a clinic.
In a perfect world I'd like to be under 24/7 surveillance by every specialist known to modern science ......... just to be sure! :)
BUT in the real world of complex issues, limited resources and conflicting domains Sierra's arguments make sense.
Most patients are still alive and not yet dependent on CPAP when they initiate enquiries regarding Apnea and, presumably, they are under separate medical supervision for any other illnesses, the APNEA in itself is not usually life-threatening at this stage so I think the implied peril might be a bit overstated.
The APNEA investigation process can take months to implement effective treatment, during which time the patient should be following up on any medical issues with someone who is actually qualified to deal with them.
Anything that simplifies the APNEA process and facilitates it for a wider range of potential sufferers warrants fair consideration
Anyone who implies that cost doesn't matter must surely be delusional or overselling something.
As I understand it the home study equipment is improving and presumably will continue to improve. Generally it does what it is supposed to do.
The Home Sleep Study was only ever used as a general indicator which should also be true of Sleep Clinic results. Abnormal studies in abnormal circumstances can never be a true indicator of normal responses. Nothing to do with APNEA, IMO, is an exact science.
I too did a home sleep study and for me it was effective and convenient and as to Sleep Clinics, I know of many who have expressed bitter disappointment and disdain or similar negative views regarding their experiences there.
Unfortunately I don't have Sierra's faith in the machine to diagnose and treat APNEA but surely the sleep industry must believe in the machines or they shouldn't be selling them.
Arguments and squabbles over technicalities and territory are fun, but it's the results that matter.
My crystal ball is broken regarding the future of APNEA treatment but, in the past, a Home Sleep Study and the supervised application of a CPAP machine delivered the fastest, most convenient and least expensive results.
From my first mention of APNEA to my doctor, to being issued with a CPAP machine, was about a week and cost me $80 plus a small contribution to help offset the cost of the machine. (We have a health system in Australia that still works, despite constant pressure to adopt American Health policy methods of privatisation, price fixing and market manipulation.)
If it had been much more trouble or more expensive I would not have bothered.
projections and baseless claims.
Home study: 1 kind of sleep disorder assessed (and even that’s proven to be sketchy accuracy)
Lab study: WELL over 90 disorders (majority of sleep disorder diagnosed patients factually do not benefit at all from home study)
I’m pretty sure sleep dent is a medical professional.
Im definitely not and I’m glad you aren’t and I’m glad Sierra isn’t, cuz you’d be killing people!!!!
I’ll take sleep dent advice over you!!!! Anyday of the week!!!
Yes SlowBro, SleepDent is a professional and much appreciated in this forum.
Now that we are all agreed, can we skip straight to the hors d'oeuvres?
Then you can list the well over 90 possible disorders that I might have. :)
If you want You can research in lab sleep study and see the countless indicators and sleep disorders it may confront and detect but I would advise you to see your specialist
( I’m nothing close to a professional just a patient who wanna help others to not waste time with BS home study, they suffer ENOUGH with complex sleep issues and their bodies deserve the best shot they can get)
and you can get a in lab study done and then you can see what you may have , little buddy :)
I think there may be some misunderstanding as to what a home sleep study test is intended to accomplish. Basically it is a three step process. You are first given an Sleep Apnea Assessment Screening Test. If the results are positive for sleep apnea, and there are no other cardio vascular and other health complications, then a home sleep study test is ordered. The purpose of the test is to determine whether or not you have sleep apnea that needs treatment (AHI > 5 in most North American jurisdictions, but the UK NHS uses AHI > 15). The third segment of this process is to do a trial test of 2-3 weeks with an automatic CPAP machine to determine if a CPAP is suitable for treatment by examining the data collected by the APAP machine. The home sleep study is not intended to diagnose all the possible reasons why one might not be sleeping well, or any other medical condition. It is only intended to diagnose sleep apnea. If you have it, and the machine works, then one has a choice of buying a machine or having your insurance company buy one for you.
In other words it is only intended to diagnose sleep apnea, nothing else.
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
Yes, my situation may have been a little different than typical. I was not in my opinion having sleep issues. I slept very well albeit with some snoring. I got cornered by my doctor into taking the screening test and failed. I very reluctantly went for the home sleep study, and really wanted to be found to not have sleep apnea. My wife was already using a CPAP and having to sleep with that contraption was the very last thing I wanted. Despite my wishes I failed the HST with an AHI of 37 or so. And here I am.
Short story is that I did not want to be diagnosed with anything. I do have to admit that I now sleep better and don't disturb my wife with snoring.
And as an aside a HST can identify central apnea events, or at least the Phillips Alice NightOne can. It measures breathing effort and air flow as well as oxygen levels, and body position. No air flow + No breathing effort = Central apnea event. Oxygen desaturation events can be also compared to apnea events for verification.
Facilitate treatment for OSA, taking a big risk in sweeping other issues under the rug.
Many times the specialist will just order the home sleep study as if it’s some kind of convenient better replacement of the lab studies with patients, I know others who this happened to and it happened to me. It was completely unclear limited results. Proof of this was my lab studies showing some major issues. And if I did not question the specialist I don’t think lab would have been done and things would be hidden under the rug.
It’s just home sleep studies can be inaccurate and underestimate the severity of the patients condition. doesn’t objectively measure sleep time or sleep duration.
It doesn’t completely rule out even apnea.lab test is superior to home test in detecting sleep apnea
There are differing opinions on whether HST overestimate or underestimate AHI. One study I read found that a HST underestimated sleep apnea frequency. To me that study makes sense. A home sleep study divides the number of events by the time in bed (TIB). A lab study divides the same number of event by time sleeping. A smaller denominator makes for a higher AHI.
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
Insurance companies prefer the home sleep studies, the sleep lab would love to have you take the sleep study with them.
Hi Sleepea
I'm not sure that the insurance companies would care about the cost in the long run because once they have had enough time and leverage to get a slice of the cash flow they can't help but benefit by escalating overall health costs.
Yes they will make issues about costs politically and for publicity reasons and to encourage people to raise the level of their coverage but in the long run they win either way.
It seems to me that the more expensive health costs become in America the more power and money there is to distribute amongst the key players.
Insurance is, after all, just a numbers game. The larger the numbers the more security and the greater the profit.
Yes, I am sure the insurance companies like the cost of a home sleep study, which in my area of Canada is zero. What is a little more puzzling is the cost of the APAP machine if that is the outcome. On the surface of it, it seems the insurance companies (within their allowance limits) willingly pay $2400 or so for a machine. However, they are sold for about $800 on line. It seems hard to grasp why they would pay so much over the real price. Perhaps what we as the client see as the price paid by the insurance company is not the same as the actual money that changes hands behind the scenes. Perhaps we are getting a $2400 "benefit", that the insurance company really pays $800 or less for it.
Big gremlin
Of course you disagree JUST BECAUSE!!
you think this is a game!!!!
I and other patients have almost died!!! Sleep dent is a MEDICAL PROFESSIONlAL! And agreed!!
You are just a contrarian! I’m gonna listen to the medical professional over a quack like you.
Your mindset hurts people. Patients are being damaged! Hurt! Passing away due to negligence
You’re just trying to be cute they are checking things like Brain waves eye movements REM, heart, patterns of breathing, Blood oxygen, body positioning,chest and abdominal movement limb movement snoring , noises, etc etc
do you UNDERSTAND HOW MUCH THIS COVERS!?? DUH!!!
This is my last post.
Well SlowBro, what can I say?
Us "boomers" are pretty much impervious to insults and yes, I believe that life is the real game, and other games are practice sessions for life. They are all important in their own way so where is the great divide? Why can't life be fun?
In my world the same applies to serious subjects and humour. Some of the most serious lessons in life are often accompanied or softened by humour. They are both communication tools and not necessarily incompatible.
I've not come across the word contrarian before, and it does apply to my role in this forum, (example) so that's something new that I've learned.
I'm sorry if you had a bad experience, but I make no apologies for my existence on this planet, or in this forum.
I like to watch and listen and learn (thanks for the info on lab tests btw) and occasionally express a point of view.
I try to avoid dishing out advice, except by deduction or implication, but I do like to question.
Shouldn't a good argument or observation benefit from reasonable scrutiny and welcome a healthy debate?
Your point was made, your points were valid and accepted, but there are other factors to consider too and we don't have to be in possession of a doctorate to have experiences or comprehension or a valid point of view.
Professionals do have a vast array of knowledge and data, much of which is based on input from patients, so a patients point of view must have some merit too, at least in a cumulative sense.
For me, asking questions, provoking responses and gathering the broadest range of viewpoints, (yes even yours) is how I make sense of a complicated and confusing world.
Others navigate through life by different criteria. That's fine.
It's the variety (yes even the insults) that makes life interesting.
So don't let my questionable attitude deter you from participating. :)
