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Home Sleep Testing
#1
There are options for home sleep testing that goes beyond the capability of just sending you home with a pulse oximeter or an APAP. Multi channel recorders are available for home use, overnight, which will do just about everything but EEG. The devices are user friendly and could save a pile of money. At some point a lab sleep test might be necessary, but that might be only for a very few. The Star Dust II is one such device capable of 5 channel recording but there appear to be more sophisticated devices available. StarDust II information can be found here. Also see attached. It appears that there has been very little discussion of this option on the forum. I know in my community this approach towards home sleep study has become common place. Really, there is no other option when wait list for lab sleep tests (public health) extent to a year or more. But, on the other hand, why waste money on a lab test?


Attached Files
.pdf   Home_Sleep_Testing_HelpfulHints.pdf (Size: 90.14 KB / Downloads: 296)
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#2
[copied from the old forum]
SuperSuper re-posted the complete article and wrote: this article is from 2008, wonder if there's been any updates since then?
..................................................................................................
Medicare to cover sleep apena testing at home
Procedure is less costly and allows patients to skip spending night in lab

WASHINGTON — Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.

A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea — letting people snooze in their own beds instead of spending the night in a sleep laboratory.

It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.

"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," says Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.

Today, Medicare pays for sleep apnea treatment — called CPAP, a mask that blows air through the nose while sleeping — only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. The public may comment on the proposal until next week; final approval is expected in March.

While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.

Sleep apnea doesn't just deprive family members of their own zzzz's. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.

Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.

Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.

Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways, and apnea in the family.

Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring — or until daytime sleepiness gets so bad they can't function.

Only then comes the test debate.

There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.

But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles' drive.

Only tests for apnea, not other disorders
For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and a doctor checks the recordings later.

A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, says Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change.

"You have this good feeling that everything was taken care of, when in fact it wasn't," he says.

"It certainly is possible to diagnose severe apnea at home," adds Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"

Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.

Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients — but should be administered by sleep specialists.

Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.

Lack of support for some
In fact, Medicare concluded a sleep-lab test isn't perfect, either — and thus proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.

That's important, because about half of apnea patients prescribed CPAP struggle to use it, says Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent. What he calls tricks of the trade — trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils — early could keep more of them in care.

Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.

Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.

"There's a different level of comfort being at home," Miles says of the testing.
http://www.msnbc.msn.com/id/22542232/#.T9RVr7UUOZA
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#3
(06-10-2012, 03:16 AM)zonk Wrote: wonder if there's been any updates since then?
Thanks, zonk! The article did not come up with my input of search terms. Interesting read: in 2008, it was highly predictive of the current practice, 4 years latter.

I think what has changed is that multi-channel monitor home sleep studies followed by APAP trials (cellular modem connected) are the standard, here in BC and, I assume, in many other regions. This is both money saving and pragmatic, presents less barriers to diagnosis and equally effective. The future is here!

The criticism of home sleep studies, in the article is: "A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, says Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change." True, that the lack of EEG readout is a shortcoming of information, but that is largely irrelevant to diagnosis or titrating pressure. For example, I had three lab sleep studies with nary any REM sleep. But, nothing can be done about that and titration has to proceed anyways. So, Dr. Gravelyn's objecting argument is rather spurious.

In most ways the pro and cons of apnea diagnosis by home testing parallel those arguments about in-home titration with APAP.

OK, the question is how much has the medical practice gravitated towards home sleep testing in other countries? Is the "future" happening in the US, for example, or is the medical establishment still preserving it's interest in expensive lab studies?


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#4
If home testings is found to be reliable and cheaper, it will win.

However, once it wins, it will increase in price.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#5
Just as an FYI...

Here's a copied discussion from our Apnea Board Linkedin group on the issue of Home Sleep Studies and their future role:

http://www.apneaboard.com/forums/Thread-...-Diagnosis

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#6
(06-10-2012, 04:26 PM)SuperSleeper Wrote: Just as an FYI...
Here's a copied discussion from our Apnea Board Linkedin group on the issue of Home Sleep Studies and their future role:

Thanks, SuperSleeper. It is informative but frustrating to read, as I suspect protecting turf is what most of the anxiety is all about. The most cogent comment is as follows:

IDS Wrote:Hi there, my name is Stacie Felice and I work for [company name removed]. We are a diagnostic testing facility specializing in Overnight Pulse-oximetry testing and Home Sleep Testing.

A lot of people are "afraid" of home sleep testing as they see it REPLACING sleep labs. That is not the case at all. Home Sleep Testing (HST) is used for diagnosing OSA ONLY. For any other sleep related issues, the sleep lab will always be required.

The pool of potential OSA patients out there is MASSIVE. There is no way sleep labs can manage that many patients.

There are also A LOT of older patients out there who cannot or will not travel to a sleep lab, this form of testing is ideal for them. We have also encountered a lot of patients who would have to travel long distances to a sleep lab where they could incur hotel costs and what not for spouses, etc. As someone mentioned above, HST does have its place.

And yes, Gavino, your doctor would have to order a Home Sleep Test for you just as any other medical test. Once ordered, we would call to schedule your HST. We would ship it to you the same day and you would receive it in 2-3 business days. You would test with it the night you receive it and mail it back the next day in a pre-paid envelope.

Once we receive it, one of our board certified sleep doctors will interpret the test results. When we receive the results back from him, the results are immediately faxed to your physician.

It's as easy as that. =)

I'm a little puzzled by the comment that only OSA is being screened, since I believe some multi-channel recorders do identify CA. In any case, a trial period with a full data APAP would pick up on that.

Some writers are concerned about lack of follow-up and support for CPAP usage. Seems to be a red-herring. The absence of patient support has nothing to do with home sleep studies.

There is some concern that in one jurisdiction sleep labs have closed for lack of referrals. How could that be a problem, if they are no longer needed or wanted?
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#7
(06-10-2012, 05:25 PM)HeadGear Wrote: Thanks, SuperSleeper. It is informative but frustrating to read, as I suspect protecting turf is what most of the anxiety is all about.

Yep, probably right. Many of the folks who participate on the Linkedin group discussions are DMEs, Respiratory Therapists, sleep lab workers and a few doctors. So whatever is said there tends to have a particular bias towards the health care professionals' view of things, just like here we have a bias towards the patients' views.

As far as follow-up and support, with my old brick and mortar DME, I hardly received any of that from them. Heck back when I lost my insurance and started buying my supplies from Supplier #1 on our Supplier List, I got more good information from them over the phone than I ever got from my local DME.

Smile
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#8
The 2008 article posted by Zonk mentioned a sleep study cost of $1,500. Less than four years later, the one I had not long ago at a hospital's sleep lab carried a price tag of $2,300.
Regarding follow up and support, my experience with my DME pretty much echoes the situation reported by SuperSleeper--not much of either. They're nice and friendly, and I like the RT I've been communicating with lately. However, the vast majority of real help, education and support has come from right here on this board, something other members have also reported. The most recent case in point for me is the tip from Zimlich re: a way to get rid of leaks with our favorite Respironics FitLife masks. Zimlich suggested using silicone ear plugs rolled into a pencil thin, long rope and placing it on the forehead portion of the mask's seal. It sounded crazy, but I tried it a few nights ago for the first time, and it works! I remind myself that I learned this trick from a fellow board member, and not from a RT or even the RT dept. supervisor at my DME. No doubt, that's at least partly because they don't have first-hand experience dealing with the machines and masks that we do.

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#9
(06-10-2012, 04:26 PM)SuperSleeper Wrote: Here's a copied discussion from our Apnea Board Linkedin group ...

Where is this Linkedin group? Would they allow a mere user to read what they say?
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#10
(06-10-2012, 08:41 PM)JJJ Wrote:
(06-10-2012, 04:26 PM)SuperSleeper Wrote: Here's a copied discussion from our Apnea Board Linkedin group ...

Where is this Linkedin group? Would they allow a mere user to read what they say?


Here's our Linkedin Main Page:

http://www.linkedin.com/in/apneaboard

The Linkedin Apnea Board discussion group is here:

http://www.linkedin.com/groups/Apnea-Board-4199728

The group attracts medical professionals, primarily... and it's not very active. But yep, feel free to join the group - the more the merrier!

Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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