RE: Saw my sleep doc today...changes
The process for PSG and APAP are different. The APAP does not have any of the sensors that the PSG has, but the PSG does not have the sensor that the APAP uses. All processes estimate by educated guessing, and neither can actually identify any sleep event directly. So there is always guesswork going on here, and therefore always inaccuracy.
How accurate does it need to be? Only accurate enough not to skew results that would hurt the diagnosis changing the prescription.
The APAP may be less accurate than the PSG, but it is just a matter of degree. Both are good tools, and both should be part of everyone's therapy.
Many in the industry, which is a profit center for many of these doctors, are threatened by the fact that the PSG is not the be-all anymore. If the studies show that the APAP is nearly as accurate, just really how important is the $3700 sleep study, which is 95% profit? Some docs react by being in denial; some react by circling the wagons and adopting bunker mentality. But neither of those mesh with the Hippocratic Oath in any way.
The data in my sleep study is based on about 2 hours of me being in great pain from the soft mattress, and being disoriented and very uncomfortable not sleeping in my own bed. Factors like this detract greatly from the information being all that empirical or thorough, or even all that helpful. On the other hand, in the last year alone I have 2800 hours of hard data from me being comfortable in my exact sleeping environment, from my APAP. And I used this data to fine tune and cut my AHI in half from where it was when following the doc's recommendations on pressure.
With that in mind, is the data from the APAP worse than the data from the PSG? Maybe its actually better, since there is so much of it (1400 times more than from the PSG) and since my sleep environment preserves the empirical nature of that data.
The reported inaccuracy? Claiming a slightly lower AHI when AHI is high is not an issue, because we already know it is too high and must be engineered to come down through therapy. Claiming a slightly higher AHI when AHI is low is also not an issue, because we have a low AHI already, and a slight increase in reporting it does not set off any alarm bells. So the inaccuracy is essentially meaningless.
Sleep disturbance events are not precise and identifiable; each is a matter of degree, and many times an "event" is actually a morphing of one kind of event and another. There is no black and white, only shades of grey. So accuracy is not ever going to be precise. Whether thinking I have $250,000 currently in my IRA is not really any less important than knowing it is actually $250,000.02; accuracy is often over-rated and distracting from what is really important anyway
And if you have 2800 hours of data like I do, you can peruse it at your leisure, and even parse it to the nth degree. Get out the microscope and look at it and interpret it as thoroughly as you want to. Using what you find to change your AHI from a 3 to a 1.5 is not an insignificant goal, because it means being strangled in your sleep 12 fewer times every night. And that is something I could not have accomplished with a CPAP, which also would likely yield an even higher AHI because it does absolutely nothing to treat or prevent SA other than blow constantly like a hair dryer. An APAP is essential for this sort of fine-tuning or augmentation of the therapy, whether the doc likes it or not.
The two hours of data from my PSG were probably looked at for about 45 seconds, by a doctor in the system who is basically forced to see patients on a conveyor belt; they are always trying to beat the clock, so they do the bare minimum. Because that is the system we have. But being able to breathe while asleep is quite literally a matter of life and death, and a matter of life extension for those relieved of the suffering. The advantages of an APAP over a CPAP measured in how much longer one will preserve my health more than the other, could mean more days, weeks, months, and years. Even decades. How much is even just one more day on earth worth compared to the difference in the costs of these technologies?
So a sleep doc resisting APAP is questionable at best, and probably never really in the patient's best interests as much as it might be in the interests of supporting the status quo before this disrupter technology of APAP came along. But it is nearly 2016, so they need to get with the program.
I think manufacturers should abandon CPAP altogether, since there is nothing that a CPAP can do that an APAP can't do, and plenty that an APAP can do that a CPAP can't even pretend to do.
(This post was last modified: 10-09-2015 05:31 PM by TyroneShoes.)