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Home Study or PSG?
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jdip Offline

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Post: #1
Question Home Study or PSG?
Hi all,

I've been wanting to go for a sleep study (extreme fatigue all day every day for as long as I can remember, even though I get plenty of sleep) and am not sure whether to go for the Home Test ($500) or do the full PSG.

I've done some reading online and saw that the Home Test is useful for diagnosing sleep apnea but not any other sleep disorders. Would you recommend doing the Home Test? $1500 for the PSG is a bit steep, but might be worth it if I can get reasons why I always feel so tired, but if the Home Test can diagnose sleep apnea just as well I'd rather save the $1000...

I'd really appreciate it if anyone could offer me some advice. My quality of life is very miserable right now because of the chronic fatigue. Thanks and have a nice day.
10-21-2014 02:38 PM
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zonk Offline

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Post: #2
RE: Home Study or PSG?
Hi jdip and welcome to the forum

I had my sleep study in the sleep lab, sleep studies are covered by Medicare in Australia

Sleep lab reports are more comprehensive but for most people home studies is more than enough

I would go with the home test and educate myself about the treatment which include getting an auto-data-capable machine and mask choices, mask choice is essential for effective treatment

There are many machines around and everyone has a favorite, I happen to like "ResMed S9 AutoSet"
[Image: s9-autoset-models.jpg]

Best of luck
10-21-2014 02:53 PM
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jdip Offline

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Post: #3
RE: Home Study or PSG?
(10-21-2014 02:53 PM)zonk Wrote:  Hi jdip and welcome to the forum

I had my sleep study in the sleep lab, sleep studies are covered by Medicare in Australia

Sleep lab reports are more comprehensive but for most people home studies is more than enough

I would go with the home test and educate myself about the treatment which include getting an auto-data-capable machine and mask choices, mask choice is essential for effective treatment

There are many machines around and everyone has a favorite, I happen to like "ResMed S9 AutoSet"

Best of luck

Thank you very much zonk!

I'm in Canada so healthcare also covers the sleep study. However, the sleep labs at hospitals (where it would be free) have waitlists of 3-4 months, which I don't want to wait for so I'm looking at private places instead.

In Australia did you need to get a referral from your GP to get the study done? Most places here require it, but a place I called said that they can do it without
one. Their home test is $375 now as opposed to ~$500 at most places. I'm not sure if those are red flags to stay away from that place or not.

The S9 AutoSet looks like a popular one. Does the "Auto" mean that it takes care of the titration and sets your air flow automatically?
10-21-2014 03:22 PM
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trish6hundred Offline

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Post: #4
RE: Home Study or PSG?
Hi jdip,
WELCOME! to the forum.!
Good luck to you on your sleep testing decision and hang in there for more answers to your questions.

trish6hundred
10-21-2014 04:02 PM
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jdip Offline

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Post: #5
RE: Home Study or PSG?
Thanks for the warm welcome. You all seem like a very pleasant bunch!
10-21-2014 05:04 PM
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becker44a Offline

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Post: #6
RE: Home Study or PSG?
(10-21-2014 03:22 PM)jdip Wrote:  . . .
The S9 AutoSet looks like a popular one. Does the "Auto" mean that it takes care of the titration and sets your air flow automatically?

Hi jdip,
Welcome to the forum - many of us have found great answers here.

The ResMed S9 Autoset is a fully-data-capable machine, and can function as a fixed-pressure CPAP or as an Auto-titrating (APAP) device. Many RT's (the lower-grade bunch) often just turn the machine over to patients set for the full range (4 - 20 cmH2O), and such a wide range can make a user uncomfortable. A number of people have simply purchased an S9 Autoset, loaded some software, and started off in a self-directed quest for effective treatment. Some have no insurance, or for a variety of reasons need to go outside the official structure. For these folks, the S9 Autoset provides all the data needed to be successful in this.

Of course, if practical, it is good to get a sleep study, have a titration, and get a reasonable starting point. But very often, even with that, the "Sleep Medicine establishment" will write a CPAP script, hand you off to a DME (Durable Medical Equipment provider), who will peddle you the cheapest brick machine they can get away with, send you out the door with little more than showing you where the power button is, and look for the next patient.

So even if you go the official route, you may find yourself largely on your own anyway.

Some recommendations:

1) Review the machines carefully, and decide what you want. Be SURE the machine is fully data-capable. Note that some of the model names are confusing. The ResMed S9 Autoset is a great choice. ResMed has also recently released the Airsense A10 series, but if I were to go buy a 2nd machine today, I would still buy an S9 Autoset, as I don't feel there is enough user experience to recommend the A10 over the S9. The Philips-Respironics machines are also good, but I'm prejudiced in favor of the ResMed units. I also don't like that the PR machines have no means for a user to set the clock, so correlating the sleep times to actual time-of-day can be more complicated than necessary.

A useful wiki article on this:
http://www.apneaboard.com/wiki/index.php...ne_Choices

2) Get an APAP machine, if possible. Any APAP can operate as a fixed-pressure CPAP, as well as an auto-adjusting APAP, so it is like 2 machines in one.

3) In the USA, to get an APAP unit, the prescription must be written with a range of pressures. If you use the private place you mentioned, make sure they can provide such a prescription, or will send your report to someone who can.

4) Educate yourself, as you have already started to do. Advocate for yourself, as no one else will be as interested in your treatment as you. Listen to the medical people, but decide for yourself. There are plenty of people in the Sleep Medicine establishment who are arrogant, opinionated, and won't listen at all to you. There are also some at the other end of the scale. The trick is to find one you can work with.

5) Keep reading here, and keep us informed as to what is going on with you. We will do our best to answer your questions.

Hope this helps you.

Good luck on your journey.

A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
10-21-2014 10:48 PM
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Ghost1958 Offline

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Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

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Post: #7
RE: Home Study or PSG?
I had the home study here in the U.S. It could diagnose Sleep Apnea, distinguish centrals from obstructives, and O2 desat levels. Other than pressure and sleeping position it covered the same things as the sleep lab I was titrated at afterwards.

I probably could have went with just that had my GP write a script based on that study and punched in some pressures. With the PRS1 560 auto it would have figured out its best baseline pressure on its own every thirty hours, and reading data I could have set the max pressure on my own. Did complance thru my GP for medicare and that would have been that.

All depends on how you want to go and how insurance works where you are how you go about it. But in my case the pressures my sleep lab study set were pretty wide and the machine corrected its own baseline pressure on its own.
10-21-2014 11:06 PM
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DocWils Offline

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Post: #8
RE: Home Study or PSG?
If you believe that your sleep disorder is caused by Apnoea, then a home kit will do the trick for a basic study. However, if your sleep disorder is from anything else, then a sleep lab visit is unfortunately required. The negative to the sleep lab is that many people do not sleep well in that environment, so sometimes the useful data is more limited than a home study, unless the problem is neurological from the start. Sometime a home test will indicate that lab study will be necessary anyway, but often the problem is "simple" Apnoea, and for that a home test will suffice.

Simple test - do you snore loudly, and have odd breathing stops during the snore or just after, perhaps followed either by a gasp or an overloud snore? That would indicate SA and a home test will do the trick.
Are you overweight and is your neck near or greater than 40 cm? Again, SA is probably the culprit.
Do you have to get up frequently to pee? Again, this is often Apnoea related, as you are already in a wakened state, so the urge to urinate is greater, and many apnoea sufferers report that once on CPAP, they sleep through the night.

If none of the above apply, then it may be neurological in order and a lab test will be required, however, it may be wise to start with a home test, and if the results are negative, then take the time to schedule a free test at the hospital (if you are in Ontario, OHIP will expedite the time if your GP puts a rush on it, believing you to be in danger somehow - just a hint. This does not work in Quebec, unless you have some pull somewhere, or your GP is also on staff at a hospital or has privileges at one, nor in western Canada, for some reason. If you are in the Atlantic Provinces, well, good luck.... Also, although you did not say where you are, if you are in Montreal, the Jewish General will take you far faster than any of the other hospitals if your GP has consulting privileges there).

Please be aware that while many of your southern neighbours like Australia's RESMED machines, Philips makes machines that are very good, robust and of equal quality to RESMED's offerings. For those, you want a System One Autoset with A-Flex or C-flex, and they are very good machines - preferred, in fact, in Europe over the Resmed, although Resmed masks are very very popular here. Masks are independent of the machine type or make, so you can mix and match without worry - try to find the type that is comfortable for you - if you are not a mouth breather, nasal pillows and the RESMED P10 might be your delight for a mask. There are many discussions of mask types on the forum, and if you go one area up, to the Home page, you will find an area with reviews of many, if not most of the machines and masks available.
(This post was last modified: 10-22-2014 02:51 AM by DocWils.)
10-22-2014 02:48 AM
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jdip Offline

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Post: #9
RE: Home Study or PSG?
Wow, so much detailed feedback! Thank you all for taking the time to humor me.

(10-21-2014 10:48 PM)becker44a Wrote:  Hi jdip,
Welcome to the forum - many of us have found great answers here.

The ResMed S9 Autoset is a fully-data-capable machine, and can function as a fixed-pressure CPAP or as an Auto-titrating (APAP) device. Many RT's (the lower-grade bunch) often just turn the machine over to patients set for the full range (4 - 20 cmH2O), and such a wide range can make a user uncomfortable. A number of people have simply purchased an S9 Autoset, loaded some software, and started off in a self-directed quest for effective treatment. Some have no insurance, or for a variety of reasons need to go outside the official structure. For these folks, the S9 Autoset provides all the data needed to be successful in this.

Of course, if practical, it is good to get a sleep study, have a titration, and get a reasonable starting point. But very often, even with that, the "Sleep Medicine establishment" will write a CPAP script, hand you off to a DME (Durable Medical Equipment provider), who will peddle you the cheapest brick machine they can get away with, send you out the door with little more than showing you where the power button is, and look for the next patient.

So even if you go the official route, you may find yourself largely on your own anyway.

Some recommendations:

1) Review the machines carefully, and decide what you want. Be SURE the machine is fully data-capable. Note that some of the model names are confusing. The ResMed S9 Autoset is a great choice. ResMed has also recently released the Airsense A10 series, but if I were to go buy a 2nd machine today, I would still buy an S9 Autoset, as I don't feel there is enough user experience to recommend the A10 over the S9. The Philips-Respironics machines are also good, but I'm prejudiced in favor of the ResMed units. I also don't like that the PR machines have no means for a user to set the clock, so correlating the sleep times to actual time-of-day can be more complicated than necessary.

A useful wiki article on this:

2) Get an APAP machine, if possible. Any APAP can operate as a fixed-pressure CPAP, as well as an auto-adjusting APAP, so it is like 2 machines in one.

3) In the USA, to get an APAP unit, the prescription must be written with a range of pressures. If you use the private place you mentioned, make sure they can provide such a prescription, or will send your report to someone who can.

4) Educate yourself, as you have already started to do. Advocate for yourself, as no one else will be as interested in your treatment as you. Listen to the medical people, but decide for yourself. There are plenty of people in the Sleep Medicine establishment who are arrogant, opinionated, and won't listen at all to you. There are also some at the other end of the scale. The trick is to find one you can work with.

5) Keep reading here, and keep us informed as to what is going on with you. We will do our best to answer your questions.

Hope this helps you.

Good luck on your journey.

Those were some excellent tips you gave me. I really appreciate it. If it turns out I need a machine, I'll look into getting an APAP. I definitely would like to get one that is fully data capable. I'm a bit of a data nut and I'd like to see that everything is working as it should be.

I don't know if the sleep clinics here do the whole DME referral thing. Maybe the public ones at the hospitals do, but from what I've seen, most of the private ones sell equipment themselves. This kind of concerns me a bit. If they diagnose as well as sell equipment, they could easily be very aggressive in diagnosing sleep apnea in order to make more sales on equipment. I guess I might just have to trust that they are not being unethical in their practice.


(10-21-2014 11:06 PM)Ghost1958 Wrote:  I had the home study here in the U.S. It could diagnose Sleep Apnea, distinguish centrals from obstructives, and O2 desat levels. Other than pressure and sleeping position it covered the same things as the sleep lab I was titrated at afterwards.

I probably could have went with just that had my GP write a script based on that study and punched in some pressures. With the PRS1 560 auto it would have figured out its best baseline pressure on its own every thirty hours, and reading data I could have set the max pressure on my own. Did complance thru my GP for medicare and that would have been that.

All depends on how you want to go and how insurance works where you are how you go about it. But in my case the pressures my sleep lab study set were pretty wide and the machine corrected its own baseline pressure on its own.

I'll have to check what their home tests actually measure. I've heard some also include EEG which seems like a good thing. So if I got an auto machine would I not need to do a titration, since the machine would figure it out on its own? I was talking with a sleep tech online and he said that doing a titration is superior, especially with higher pressures because the techs can sometimes see things that the machine cannot.

(10-22-2014 02:48 AM)DocWils Wrote:  If you believe that your sleep disorder is caused by Apnoea, then a home kit will do the trick for a basic study. However, if your sleep disorder is from anything else, then a sleep lab visit is unfortunately required. The negative to the sleep lab is that many people do not sleep well in that environment, so sometimes the useful data is more limited than a home study, unless the problem is neurological from the start. Sometime a home test will indicate that lab study will be necessary anyway, but often the problem is "simple" Apnoea, and for that a home test will suffice.

Simple test - do you snore loudly, and have odd breathing stops during the snore or just after, perhaps followed either by a gasp or an overloud snore? That would indicate SA and a home test will do the trick.
Are you overweight and is your neck near or greater than 40 cm? Again, SA is probably the culprit.
Do you have to get up frequently to pee? Again, this is often Apnoea related, as you are already in a wakened state, so the urge to urinate is greater, and many apnoea sufferers report that once on CPAP, they sleep through the night.

If none of the above apply, then it may be neurological in order and a lab test will be required, however, it may be wise to start with a home test, and if the results are negative, then take the time to schedule a free test at the hospital (if you are in Ontario, OHIP will expedite the time if your GP puts a rush on it, believing you to be in danger somehow - just a hint. This does not work in Quebec, unless you have some pull somewhere, or your GP is also on staff at a hospital or has privileges at one, nor in western Canada, for some reason. If you are in the Atlantic Provinces, well, good luck.... Also, although you did not say where you are, if you are in Montreal, the Jewish General will take you far faster than any of the other hospitals if your GP has consulting privileges there).

Please be aware that while many of your southern neighbours like Australia's RESMED machines, Philips makes machines that are very good, robust and of equal quality to RESMED's offerings. For those, you want a System One Autoset with A-Flex or C-flex, and they are very good machines - preferred, in fact, in Europe over the Resmed, although Resmed masks are very very popular here. Masks are independent of the machine type or make, so you can mix and match without worry - try to find the type that is comfortable for you - if you are not a mouth breather, nasal pillows and the RESMED P10 might be your delight for a mask. There are many discussions of mask types on the forum, and if you go one area up, to the Home page, you will find an area with reviews of many, if not most of the machines and masks available.

I'm definitely not a high-probability person for sleep apnea physically - I'm slim, don't snore, am not aware of any gasping at night (I sleep alone, don't have anyone to notice it if I am doing it). But I do wake up during the night intermittently for no reason and go through phases where I need to go to the bathroom very often (which is not the case at the moment). I'm just so excruciatingly tired all of the time and want to know why. I constantly feel severely sleep deprived, even though I get plenty (too much) of sleep every day. I've slept an average of 10 hours a day for the past 2 weeks. It feels like if I get any less I won't be able to function, and I'm still constantly exhausted throughout the day.

You sure know a lot about the system in Canada! Did you used to live here? I'm in Montreal, but I don't have a family doctor. If I saw a GP now it would either be one from university or at a clinic nearby, so it might be unlikely that they have connections at the Jewish General. But I'll ask.

Thanks for the suggestion on the Philips machines. It seems like everyone is always talking about the Resmed ones, so I'll be sure to also take a look at the Philips ones if I end up needing a machine.
(This post was last modified: 10-23-2014 10:01 PM by jdip.)
10-23-2014 09:51 PM
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Doc J Offline

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Post: #10
RE: Home Study or PSG?
To get and idea what's going on you could video record your self sleeping. Low light maybe something over your eyes and more light. A few hours will show you a lot, if you are stopping breathing it will be obvious and a little scary. I used my digital camera with a big card and it still shut off in 25 minutes. But that was plenty because within 5 minutes I choked out every 30 seconds, which is exactly what a sleep study showed.
So it may not show everything but may give you some info to base your decision on. Hope you get it figured out because as many of us on the hose know life is rough and dangerous without any sleep.

Good Luck!

Doc J (despite my nickname I am not a doctor)

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10-23-2014 10:10 PM
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