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[Diagnosis] Home Sleep Study
I completed a home sleep study last week. I have been on CPAP for 15 years. The sleep lab just called and they want me to do a in lab sleep study. Why did I have to do a home study 1st? What is going on here? I feel like a lab rat. The home study showed that I need therapy. Why not just connect me up to an automatic CPAP and we will all just gently drift off to sleep. Is this just another rip off by the medical profession?Oh-jeez[/size][/font]
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Perhaps your condition has evolved from obstructive sleep apnea to complex sleep apnea that would require a more complex machine such as an ASV...
Just putting you on an auto might actually worsen your condition.

However, I do understand you reluctance. And, there are some sleep centers and DMEs who are just interested in maximizing profit.

Perhaps the best tack to take at this time is to ask for a copy of the report from your home study.
If they deny it -- then I'd be skeptical. (Also, watch for language like: "You wouldn't understand it." --- not only is that an insult; it's a arrogance.)

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If you live in the US, just mention HIPPA (pronounced HIP-UH) and they'll hand over your report.

If you have been using it for 15 yrs, a full sleep study is probably a good idea. It will give you a full picture of how your sleep is doing. Not just your sleep apnea, but your entire sleep structure. The home study can only do so much.

If you know how to read your data and know how it all works and all that wonderful stuff, then ask them why not just let you use an APAP for a few weeks.

It is your health. Demand answers.
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What motivated you to do the home study? Do you feel your current therapy isn't as effective as it should be?

As the others have suggested, I would ask for a copy of the home study results. I would also ask them why they feel a followup in lab study should be done. They may have wonderfully appropriate reasons, and if so I would just think they'd like nothing better than to share them with you.

or not.
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(02-23-2015, 03:52 PM)Danny D Wrote: I completed a home sleep study last week. I have been on CPAP for 15 years. The sleep lab just called and they want me to do a in lab sleep study. Why did I have to do a home study 1st? What is going on here? I feel like a lab rat. The home study showed that I need therapy. Why not just connect me up to an automatic CPAP and we will all just gently drift off to sleep. Is this just another rip off by the medical profession?Oh-jeez[/size][/font]

Sometimes I feel like they want to co-pay you to death, then stick it to the insurance companies before they tell you your results.
I'm sure I'm overreacting , they must have seen something to want you in for further assessment .
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It's a tough call, because we do not know the motivation.

I had both studies as well, but I figure the home study was good for an initial diagnosis. I only had the full study after 50 days of APAP at 5-20, which was a bit of a wild ride and only lowered my AHI from ~56 to ~8.5. The full study included titration, which informed the doc as to how to set the range a little better, and then AHI went under 3.

But here is the important part, which is I got SleepyHead, learned what was going on through research (much of it from the fine gurus on this forum), parsed my own data, took control of the therapy myself, tweaked the settings based on that, and brought that down to a 1.7. So I recommend this to you.

Was the motivation to get a payday from a home study and a sleep study both? I have no way of ever knowing. But I would like to think that they had my best interests at heart, and that it was critical to the therapy. I think that often the home study, which is a mere fraction of the cost of a full study, plus has a much better compliance factor (folks are intimidated by the full study, and rightfully so, so many blow it off), can be a good way to go because if it shows you do not have apnea or have mild apnea, they can then treat that without the cost of a full study. But often the home study reveals that they need to dig deeper. They could do that by just doing the full study, but that is a roll of the dice; costly if it turns out not to have been necessary (you won't know without doing it or without the prior home study), and then there is that compliance factor.

So I am on board with having both, as it is the best assurance of the best diagnosis for those of us who have severe OSA or something even more complex and dangerous. And my insurance co seems to think this roll of the dice is a good strategy as well, as they paid for both. If they hadn't, I might not agree quite as much, but I would also not want to save a couple of hundee by not taking the full test and not finding out exactly what the therapy should be, and therefore not getting the exact therapy I need.

Without the full test, the fact that an ASV or a BiPAP or supplemental 02 might be required might not even register with them. These are things you do not want the doc to miss. I used the experience as an opportunity to pick their brains on the subject, with intelligent questions based on my research and the help and advice of folks on this forum, some who have posted here right in this very thread. I never would have discovered the P10 without the recommendation of the sleep tech in charge of my full study, who has 26 years of experience doing this. Every little bit of what they do and know can be valuable info you would otherwise miss.

So this is another reason why I recommend parsing your data and taking control of the therapy; if you know your data well and the machine is telling you there are no instances that signify maybe that you need a full test, then if they are asking for one, you have a very hard question for them to answer as to why, and if they are simply gouging those that are uninformed to pay their sleep clinic bills, trying to slip one past them, this may be a deterrent to them gouging someone who knows what is going on.

Information is power. We know to not let the used car guy sell you the undercoating, and you can use knowing what is going on to prevent that sort of thing from being a waste of your time and money taking a sleep study that you possibly don't need.

But start from the assumption that you do; it's better to be gouged and get the right therapy than to not be gouged and not get the right therapy.

One last thing; the full lab sleep test is a document that holds up in court. What I mean by that is that if it shows you have a certain condition that should be treated, the last thing an insurance co or doctor wants is to be cast in the role of being an entity standing in the way of that. So it compels them to sign off on the therapy. A home study maybe is not as airtight. It might be easier to make a "he said; she said" issue out of something that is not as definitive as a full test. Potential litigation is a powerful motivator, and may be one of the reasons why they seem to want the full test, which is why docs routinely overtest everyone for everything. In their minds, they are erring on the side of caution, an argument that has a certain amount of merit. I would rather be overtested than undertested.
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I agree looking at the home study DETAILED results including any waveform record is exactly what I'd want to see. You have been doing CPAP for 15 years, and I suspect your current machine doesn't produce good detailed data. Your profile shows you currently use 14.5 cm pressure. That is borderline to where you'd benefit from a bilevel machine for exhale pressure relief.

That evaluation may be what they want to do. Insist on knowing exactly what the objectives of any additional testing will be. You don't want a separate sleep study then have to go back for a titration. If the purpose of this test is to titrate and evaluate bilevel therapy, or adaptive servo ventilation, that seems like a reasonable and valuable test. You already know you have sleep apnea. If the stated purpose of the test is to further evaluate your apnea, I'd decline.

If you have great insurance and low deductibles and copay, it's clearly not a problem to get the sleep study. If you have typical insurance, it would be less expensive to ask for the prescription for a data recording auto CPAP or BiPAP that will let you continue your therapy comfortably. A modern machine will generate data that will let you if you have any complex apnea issues that should be investigated. A study will easily cost several times more than that machine. I know from my data I'm effectively treated and don't need to be someone's guinea pig. You will know that too within a month of using a modern machine.
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The medical mafia loves $leep $tudie$.

However, they might be doing the right thing. If the home test shows no apnea, it's a pretty good sign you don't have apnea. Once it shows positive results, it may indicate there's a good case for a full in-lab sleep test. There might be something in your results that needs an in lab $leep te$t, but I suspect a distrust of in home CPAP data is the cause, and, deep down, greed and ignorance are the causes for that.

I think they could probably do 90% of the patients with home sleep tests with a good data capable CPAP machine with a cell modem and proper monitoring. They could do an in-lab $leep te$t if the patient has problems, or they can't get their apnea under control However, that would require the doctor or someone to do some actual work and thinking.
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If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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