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home testing as good, and cheaper than sleep lab testing.
#21
Hey Doc!!! Long time no read. It's great to see you here. How have you been?
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#22
(09-17-2014, 08:28 PM)DocWils Wrote: Home test kits depends on what each hospital has on offer, but many, if not most, will have a small device that fits around your neck to take EKG readings from sensors attached to various parts of your abdomen, a pulse oxymeter, two chest bands that measure breathing patterns, and a nasal cannula to measure how much O2 is taken in and expelled. to add an EEG to the mix is only should there be a suspect Central Apnoea problem, which would be the next step should home testing not be considered sufficient. With the exception of the Neural net used in EEG testing and cameras to view sleeping habits, everything else used in standard lab tests is portable.

I think that there are a lot of much less capable home sleep tests being offered in the US, in addition to the more thorough ones like you mention. There may be higher standards in Europe.

Some appear to be just an airflow sensor device on the nose. Some have pulseox. Some have variable capabilities where device X may have inputs for various sensors, not all of which are used for every patient.

There's also a Watch-pat (?) that sounds interesting about determining a bunch of stuff from just a wrist sensor. I'm very skeptical about the reliability of the results in determining sleep apnea, especially false negatives.

I think a lot of places may over rely on overnight pulseox, which is useful, but probably has a lot of false negatives as well.

Some home test are also for tests for drivers, which can probably be beaten by staying awake if they don't have an EEG sensor of some kind. I suspect some of this is a deliberate dodge for phony legal purposes.

I agree, good to hear from you again, Doc.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#23
I was diagnosed with a home test ordered by my GP. It could tell if I had centrals, o2 levels, breathing or not breathing. From there it was one night in the sleep lab to get my pressures. Check centrals body movements etc etc. medicare paid for all of that less the standard 20 or 40 deductibles. Now on the 30 60 90 day period and in 13 months of they pay 80 and i pay 20 percent the machine is mine.

Wife gets her home test Friday night. She had a sleep lab test years ago and i know she had it bad then but she could not go into any level of real sleep in the lab. Snooze a few minutes and wake up so the test showed nothing at all. I expect Friday will be much different here at home with her doing the usual snoring, stopping breathing, coming up gasping for air all night long.
Than goodness they do home tests or she would never get diagnosed.
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#24
(09-17-2014, 10:07 PM)Ghost1958 Wrote: I was diagnosed with a home test ordered by my GP. It could tell if I had centrals, o2 levels, breathing or not breathing. From there it was one night in the sleep lab to get my pressures. Check centrals body movements etc etc.

Sounds good.

Do you remember any details on the home test? Name, chest belt, EEG leads, probe on the nose, pulseox, large c-clamp around your head?
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#25
In my case, it was a skull cap type of overnight home test...nasal cannula to measure breathing rate, internal gyro for sleep position, pulse oxymeter (I think it was forehead mounted, if not it was taped on the ear). Once the initial screening came back a hit, they did a titration study using an Autoset to get the pressure.
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#26
Sorry, r-g, if I have been quiet for a while - the life of a teaching doc is a busy one, to say the least, so I have only quickly scanned many subjects and saw people beating me to the comments with good responses, meaning I didn't need to say anything, and I had little new to share, either. Since having moved to the Airfit P10 I had little to report except for the increase in CA events, which I still don't know the cause of (although I suspect it is CO2 gathering in the larger chamber of the P10 and being rebreathed, meaning the vents don't do as good a job of clearing the exhaust as the Swift models), but I am keeping my weight off, despite managing to have a two week vacation in London were I ate out every night (Jaimie Oliver's Covent Garden Restaurant, be there or be rectangular, and Carluccio's for great Italian. The Savoy Grill, Claridge's, the Dorchester, ahhhhhh culinary joy!), yet my overall pressure has dropped nearly 40% on the CPAP. Not bad, eh?

Archangle, you are right, testing standards vary from place to place, but hospital sleep labs in the US should have the same portable gear we have here - most of them are based on the Holter recording devices, which are multi purpose monitors that are exceedingly common in the Medical industry and sleep labs get them from the same manufacturers - in fact, since sleep labs need Holter devices too, generally they get the ones that will do the most anyway. Private testing facilities on the other hand may be a bit spottier and less thorough, and less well equipped, so I would guess that it would partly depend on where you went to get the gear for the home test. University hospitals and teaching hospitals are always the best equipped in the US and follow "industry" standards for testing devices rather than buy the cheapest they can get away with, since the trainees need to be checked out on the types of gear they should most often encounter; so my advice is always to go there for the necessary testing equipment.

Thanks for the kind welcome back, guys.

Let me mention something here that correctly should be in a new subject, but is interesting and has some bearing on our common affliction - new guidelines for M.D.s are that we do more of our consulting standing up, and the patient, too. The reason is that recent research has indicated that sitting is very bad for you in a way we never imagined - it shortens the Telomeres, the protective caps on our genes that may affect both our life span and our susceptibility to disease, including weight influenced Apnoea. Sedentary people tested showed shortened and frayed Telomeres in comparison to to those who are active and on their feet all day, and the act of changing the activity pattern seems to have an effect on this.
I mention this because a) it is brand new, and b) to encourage you all to get as much on your feet as you possibly can - if you have a desk job, see if you can get a variable height desk or an upright station to work at regularly, and don't be couch potatoes. You will drop a few, and feel better, and thanks to this new research, may well lower your risk of chronic diseases considerably. It is off topic, I know, but I just wanted to mention it anyway. Mods are more than welcome to move this to another part of the forum.
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#27
(09-18-2014, 05:24 PM)DocWils Wrote: Archangle, you are right, testing standards vary from place to place, but hospital sleep labs in the US should have the same portable gear we have here ...

I'm a skeptical cuss. Someone commented once that skeptics are right more often, but the gullible people are happier.

I get the impression that there's a great deal of dumbing down and cheapening the standards of medical testing and treatment in the US.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#28
Quote:Gee whiz, after my cheapo pulse ox home test, I KNEW what the Sleep Study for thousands of dollars in the lab was going to show


after having used an ox test beforehand, do you bother to use one now and if so, why, or rather, why not if you don't?
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#29
(09-18-2014, 06:02 PM)archangle Wrote:
(09-18-2014, 05:24 PM)DocWils Wrote: Archangle, you are right, testing standards vary from place to place, but hospital sleep labs in the US should have the same portable gear we have here ...

I'm a skeptical cuss. Someone commented once that skeptics are right more often, but the gullible people are happier.

I get the impression that there's a great deal of dumbing down and cheapening the standards of medical testing and treatment in the US.

Probity forbids me from commenting directly on that Wink, however, within the teaching hospital system in the US, in order to maintain their licenses, there are standards that have to be met one way or another, so at least there, the dumbing down is at a minimum compared to HMO and private hospitals. And some teaching hospitals, like Johns Hopkins, are still rated amongst the best in the world, and many of us go there for a semester or two to train (and I get students from there as well, all very good, if somewhat overwhelmed by our more deliberate, methodical and quiet approach after the hectic bustle of US hospitals, which are like war zones compared to ours - they get very nervous here for a while, and then very quiet and I have to work to get them out of their shell). Local and regional hospitals in the US tend to be a bit more variable but still have to meet state licensing requirements, and private hospitals and HMOs can be very uncertain in standard, which is why I was very vocally opposed to the attempt to introduce HMOs here ( I won, too - we had a plebiscite in which I was very involved, and the people rejected it by a large margin). I think your best bet is still to try to get to a teaching hospital over a private one, but I will be respectful enough not to comment on any dumbing down of medicine in the US. I will say that when it is good, it is near the top of the world standards, and when it is not, it can be dismal, but that is as much a problem of the daft insurance system you have in the US as anything else - the actual medical standards and licensing is as strict as here, minus the requirement of writing a doctoral dissertation in order to get the actual title of Doctor (we actually distinguish between an Arzt and a Doktor, although most everyone who goes into practice will have gotten both titles - better to say the first is what you get for finishing medical school and passing the exams, sort of). It is just as tough to get your FACP (or FACS) in the US as your FMH here, and the continuing educational requirement to maintain your license to practice is as demanding and as tough in the US as here.


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#30
(09-18-2014, 10:20 PM)ShelaghDB Wrote:
Quote:Gee whiz, after my cheapo pulse ox home test, I KNEW what the Sleep Study for thousands of dollars in the lab was going to show


after having used an ox test beforehand, do you bother to use one now and if so, why, or rather, why not if you don't?

While a pulse oxymeter can be a great way to first gauge if there is something to look at, it gives no information other than you are desaturating - how and why are not disclosed by the device - for that you need a far more thorough test, so it is only of use to eliminate the possibility that you have Apnoea, not to confirm it and determine type, cause and therapeutic approach.

In short - no desats = no Apnoea, look at other causes of your problem; desats = maybe Apnoea, certainly something that needs to be looked into further.
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