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home testing as good, and cheaper than sleep lab testing.
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herbm Offline

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Post: #41
RE: home testing as good, and cheaper than sleep lab testing.
But what percentage of people will get a bad pulse ox with no apnea or vice versa?

What percentage of people get a more or less worthless sleep lab result?

What are the relative costs, and how easy is it to get a rough idea -- but must stronger than "do you snore"?

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
09-21-2014 09:11 AM
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bwexler Offline

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Post: #42
RE: home testing as good, and cheaper than sleep lab testing.
Herb I understand.
I seem to have silent but constant AFib. I am sure I have had it for years prior to diagnosis. I have felt it a few times prior to diagnosis but had no idea what it was. I didn't even know if it was internal or external, like the vibration from a passing train. I thought the Toperol XL I was precribed was for controlling the AFib. Recently (after 4 years) I have learned it is primarily to control Blood Pressure. No one has recomended any of the meds you mentioned.
I also learned that the first PCP was known for ordering tests and procedures and referals to pad his insurance billing. He was a prety good dignostician with a very bad bedside manor aimed at scaring the patient into complience.
09-21-2014 10:48 AM
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DocWils Offline

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Post: #43
RE: home testing as good, and cheaper than sleep lab testing.
AFib is relatively common, often not fatal, although sometimes we see results from drugs to control it that actually seems to hasten fatal events (not always, but statistically....). The most common, an early beat, is uncomfortable but not actually really dangerous - more or less one of the heart valves fires a bit earlier than it should, which then triggers the blood to stay in the next chamber a bit longer. That is a highly simplified explanation, not really accurate, but it will suffice for now for your basic understanding. If your GP, after doing an EKG (or ECG, depending on your religion) feels that you need further testing with a cardiologist, then I would advise it - if he doesn't, in about 87% of the cases he will be correct. He will send the tracings to the referring physician, so they will be able to compare it to any testing they will make. Back in the days of dinosaurs, when I learned all this stuff, we had to learn to read various tracings and pretty quickly you begin to spot the patterns that look bad and those that don't. Today, the machines are 1/5th the size and can read the tracings for you, spotting the patterns and making recommendations.
If the AFib lessens under duress, like in a stress test, which it often will, then forget it, it may be just a stiff valve, which is common in around 17% of the population and not at all dangerous. Not comfortable, it may feel like a hammer in your chest sometimes, but not dangerous, either.
09-21-2014 01:06 PM
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DocWils Offline

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Post: #44
RE: home testing as good, and cheaper than sleep lab testing.
herbm -
the percentage of bad PO readings with no apnoea is not high, but it exists and can be a clear pointer to heart problems or other circulatory problems. SA diagnosis without clear desats if rare, but not discounted clinically.

Worthless sleep lab results - well that varies - if you can sleep anywhere, then a sleep lab is fine. If, like me and some others on the forum, you can't sleep in strange bed and only put in little to no sleep, then a home test is you best friend. All proper sleep labs have them, since they are the same ones used for in-lab testing.
I don't know if in the US they are cheaper (it actually costs the same here, but we have a very different medical system and charge different ways that the US does), but I would be the results are more reliable for initial testing. Further testing would only be needed, in-lab, if the results don't point to a clear cause and a clear therapeutic approach (titration, etc).

Getting a rough idea - well.... the problem is not a "rough idea", but getting usable data that can be applied to a diagnosis and therapeutic approach. The "rough idea" is: "I feel like a dog's breakfast when I get up, and I fall asleep in meetings at the office". "I snore like a freight-train", "I get headaches every day", that sort of thing. That is enough to start a testing procedure. A recording PO will not tell you anything more than you need to get tested properly, but feeling like shite will also tell you the same thing.
09-21-2014 01:15 PM
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Whitewabit Offline

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Post: #45
RE: home testing as good, and cheaper than sleep lab testing.
I had 3 sleep study's done in a 2 week period, the first with CPAP results were 3 OBS and 24 Centrals, it was decided I needed one with Bi-PAP the results there were 12 OBS, 1Mixed, and 93 Centrals , oops. So a third study was ordered where the results were 5 OBS, and 9 Centrals with a ASV machine. Much better .. but would wonder if a home study, ( study's) would have had the same results or would I have been treated with a BiPAP that would have raised my very dangerous centrals to a higher level then they were initially ?

I understand that it is much more comfortable to sleep at home with much less wiring on, but in some instances I wonder if the quality of the study just is there for certain sleep disorders. I wonder if I or someone with complex sleep apnea problems would be accurately diagnosed and if they weren't could they suffer great harm? If given the wrong machine under the wrong pressure it would have greatly increased the central apnea's that I was having and many of them were lasting close to a minute. Would that have harmed my heart, I don't know but don't think I would be willing to find out ..

So I think if I could afford the Sleep Lab over the Home study I would chose the Sleep Lab. Luckily I have good insurance, and they negotiated the price on the last sleep lab down to "No Charge", with no charge to me either.
10-07-2014 11:35 PM
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archangle Offline
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Post: #46
RE: home testing as good, and cheaper than sleep lab testing.
(10-07-2014 11:35 PM)Whitewabit Wrote:  I had 3 sleep study's done in a 2 week period, the first with CPAP results were 3 OBS and 24 Centrals, it was decided I needed one with Bi-PAP the results there were 12 OBS, 1Mixed, and 93 Centrals , oops. So a third study was ordered where the results were 5 OBS, and 9 Centrals with a ASV machine. Much better .. but would wonder if a home study, ( study's) would have had the same results or would I have been treated with a BiPAP that would have raised my very dangerous centrals to a higher level then they were initially ?

I understand that it is much more comfortable to sleep at home with much less wiring on, but in some instances I wonder if the quality of the study just is there for certain sleep disorders. I wonder if I or someone with complex sleep apnea problems would be accurately diagnosed and if they weren't could they suffer great harm? If given the wrong machine under the wrong pressure it would have greatly increased the central apnea's that I was having and many of them were lasting close to a minute. Would that have harmed my heart, I don't know but don't think I would be willing to find out ..

So I think if I could afford the Sleep Lab over the Home study I would chose the Sleep Lab. Luckily I have good insurance, and they negotiated the price on the last sleep lab down to "No Charge", with no charge to me either.

Some home sleep tests don't have a chest effort belt and won't detect centrals. Most home sleep tests don't involve CPAP pressure and won't detect pressure induced centrals.

A home sleep test is only half of the test. You need to do further testing and titration with a fully data capable CPAP machine or an in-lab titration and test.

No one should be on CPAP at all without a fully data capable CPAP machine and monitoring at least initially. The data capable machine will indicate whether you're having apneas and will probably be able to tell you whether it's central or obstructive. Even if it fails to distinguish centrals from obstructive, it will indicate that you're still having apneas, and a competent doctor will investigate further.

Remember that the problem with centrals isn't that they're more harmful than obstructives, they're just harder to eliminate.

A fully data capable CPAP machine and monitoring is doubly necessary if you had a home test or a "bad" sleep test where you didn't sleep well or had unclear results.

I think a decent home sleep test, even without a chest effort belt, with a fully data capable CPAP with proper monitoring and followup would probably work as well as our current system over all. The followup would include an in-lab sleep test if needed. Don't forget that a lot of people don't sleep well or at all with in-lab tests. Many patients give up rather than go through a horrid in-lab sleep test.

Get the free SleepyHead software here.
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If it's midnight and a DME tells you it's dark outside, go and check it yourself.
10-08-2014 03:30 AM
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