Certified home sleep test kit that doesn't have nasal canola?

[camper2]

Can you help me find a good home sleep study kit (preferably inexpensive, since my insurance will only pay 80%). It must NOT use a nasal mask or canola. It must include breathing measurements (e.g., chest movement, including something like a chest strap to hold it in place), and possibly a pulse oximeter, to satisfy my doctor. And it must be medically certified (by FDA??).

I have used APAP since 2019. While I initially had severe problems adapting - partly because I was initially fit with a nasal mask, which is completely ineffective for me (wearing a nasal mask, I almost always breath through my mouth), and hurt a lot to wear, and partly because my initial CPAP/APAP machine was defective, and always used maximum pressure. Even after fixing, when it detected an event, it switched to high pressure, which always woke me; I could not get back to sleep without resetting the machine to go back to low pressure. (By the way, I probably didn't get to sleep at all - or only during a few minutes - during my hospital sleep study with a CPAP, again using a nasal mask and very high pressure. But the hospital AI that analyzed my EEG, EKG, oxygen levels, nasal flow, and many other uncomfortable things concluded I did, so their doctor concluded CPAP was worth trying.)

I have now adapted to using a Resmed F20 full face mask and a Resmed Airsense 10 CPAP in APAP mode, set to as low pressure as possible. I still wake when it detects an event, and need to reset it, but that doesn't happen most nights. I also use a Vive (hard foam) cervical collar (neck brace) and a wedge pillow (brand & model unknown; Walmart used to sell it).

I believe my real problem is that when I drop my chin to my neck, that cuts my airflow when breathing in a lot - even if I am awake. I have tried uncertified tests, just using the pillow and neck brace. An uncertified smartphone app says that eliminates my snoring. A (Contec CMS50DA+, but it was sold without prescription, so it might not be certified) pulse oximeter says it keeps my oxygen levels reasonable.

That's not enough. As per state law, I told the Maryland Motor Vehicle Administration when I renewed my license that I was diagnosed with sleep apnea. (Stupid!) Now they require annual doctor certification that I comply with effective treatment, or I lose my driver's license. My doctors says that if I use an (FDA?) certified home sleep study kit, and it gives a good result, that will be enough to convince him.

(It's a shame the Airsense 10 doesn't have a 0 pressure setting, where it just measures breathing. If it did, it would make great home test kit. But maybe Resmed doesn't want people to try alternative solutions.)

[SarcasticDave94]

I'm not really sure what you're trying to accomplish with another test. You have a ResMed probably the AutoSet. You just need to get it set to effectively treat you.

You state you had a sleep test, but also say you used a mask in that test. That's going up be the Titration to attempt to determine settings for the CPAP.

If you want help setting the CPAP up, you'll need to post OSCAR charts. If you want to satisfy your DOT, usage of your ResMed into OSCAR charts can produce a report that should be acceptable. But you'd need to prove it's effective, needing settings that's helping. Again, that takes seeing your OSCAR charts.

Minimum pressure that you're indicating means something isn't quite right, because most need some pressure to work right.

If you need a test with results, home tests like Lofta might suffice, but again you already proved you need CPAP at one time.

[camper2]

(post deleted)

[camper2]

With CPAP (actually APAP), together with the neck brace and wedge pillow, I do comply.

I'm trying to show that I don't need the CPAP, that the neck brace is sufficient.

So results that use the CPAP won't do for my purpose. (Too bad the CPAP machine doesn't have a 0 pressure setting, so it could be used as a home sleep test!)

The original hospital sleep tests were meaningless, because the extreme discomfort of the tests made it essentially impossible for me to get to sleep. My doctor says a lot of his patients say that too. He favors home sleep tests. (Also, the hospital sleep tests said I was asleep and dreaming some of the time I know I was awake.)

If I had realized that a simple neck brace was all I probably needed, I would never have gotten those hospital sleep tests. In retrospect, I had seen sources that said that one should try multiple sleep positions. But I took that to mean on the back, on the stomach, and on the side, all of which I tried. None of those stopped my snoring, or eliminated the problem that I needed more hours of sleep than most people. (I didn't know yet that my type 2 diabetes was consistent with sleep apnea. Plus a family history of diabetes and high blood pressure.) It didn't occur to me yet that I needed to keep my chin from touching my neck.

I was initially completely unsuccessful with CPAP, for several reasons. But I finally recorded my snoring, and figured out the only way for me to reproduce that sound (when awake) was to let my chin touch my neck, which more or less cuts off the airflow. It's just taken me a long time to get around to trying to test my theory that the neck brace is all that matters, for me personally. I.E., that CPAP is irrelevant, or slightly counterproductive, in my particular case. I've tested it already as best I can without proper equipment - just using a pulse oximeter + OSCAR, and an uncertified app that showed I don't snore with the neck brace. But I want better data to be sure, for my own peace of mind.

Plus I need to assure the doctor, using a certified test, so he can certify me to the MVA.

(Note: my doctor says a neck brace would not be a sufficient treatment for some sleep apnea patients. So people, don't get the idea that it is sufficient without confirming data, like I am trying to get. And if your case is severe enough you might die without CPAP or APAP, you probably shouldn't try it.)

[SarcasticDave94]

Just my thoughts, if you've told DOT you have Apnea, which I'm thinking you did, they're not going to accept you self treating with collar only. You'll need CPAP therapy as one of few acceptable therapies active with results. I might be mistaken, but this historical information can't be undone except by medical intervention statement that you medically do not need CPAP. This will include doctor recommendation and test results showing CPAP isn't medically necessary.

Otherwise you need to use CPAP with proven positive therapy results.

[camper2]

Understood.

Which is why I am involving my ENT doctor.

And I will probably still need periodic certifications from him or another doctor.

They only way to do my mistake telling the MVA would be to move to a different state, preferably one with no sleep apnea reporting requirements.

But I like Maryland. I have reasonably close access to a lot of outdoor recreational activities I enjoy.

[camper2]

There seem to be many types of home sleep test equipment, that measure a variety of different things. Since I am not just trying to justify not using a CPAP, but actually wish to know whether the proposed form of positional therapy is sufficient in of itself for me, I want the test to be accurate and actually measure all the things it should. That complicates the choice a lot.

E.g., the majority of home sleep tests do not measure EEG, breathing, rapid eye movement, or include a video camera. Most measure changes in body position and include a pulse oximeter. The pulse oximeter would show the OSA the hospital tests detected, but would not be sufficient for all possible sleep disorders.

Also, the FDA has warned that pulse oximeters are often inaccurate. My device's nominal accuracy levels - I think 5% - are greater than the difference between my O2 levels, and unhealthy levels. I suspect a more sophisticated device could be more accurate, but would be too expensive for me to buy.

Maybe the decisions of the sleep technician (mentioned earlier), combined with my desperate attempts to get to sleep, biased the hospital sleep tests. (I tried meditation [untrained], slowing my breathing and breathing evenly, for long periods. The hospital AI may have concluded from these that I was asleep, and that I dreamed.) (At home, I do not have difficulty going to sleep, and only remember waking to go to the bathroom - or with a CPAP, resetting it to stop the high pressure mode, which generally wakes me. I never remember dreaming except if I wake out of a dream, which is rare. I don't know if that means I partially wake without remembering, or if I rarely dream.)

Perhaps a hospital sleep test with my preferred CPAP mask, my wedge pillow, my neck brace, my chosen APAP settings, nothing attached to my back or front which forced me to sleep in uncomfortable body positions, and in a room with a less noisy ventilation system, would yield more accurate results than the ones that I had. But I can't really afford that.

[camper2]

My doctor wrote a sleep test prescription for a home sleep test from Snap Diagnostics. Do you know if their kits usually provided in good condition, and are their results fairly trustworthy, relative to other home sleep test companies?

They have two types of testing kit, and can't tell me yet which I will receive, until talking to my insurance company. E.g., their website says the "Snap Diagnostics Sleep Apnea Monitor" can potentially measure respiratory airflow, chest effort, sound (snoring), SpO2, heart rate, and optionally movement & body position. It doesn't include EEG or rapid eye movement, so it probably can't tell whether I dream.

The rep says either kit has a nasal Canola, but that it can be cut, and the sensor can be taped inside my CPAP full face mask, so it gets air from my mouth too - and they include directions on doing that, so they must have run into my issues with nasal Canolas before.

It has an SpO2 sensor (either a ring, which sounds ideal, or something rubber that fits onto my finger - if that looks like it might fall off, as sometimes happens with my Pulse Ox, I will tape it in place. She didn't say if it measures heart rate too, but sleepreviewmag.com/wp-content/uploads/2024/09/Home-Sleep-Testing-Devices-Comparison-2024.pdf says the Snap Diagnostics SAM does.

It has a chest strap and sensor to measure "respiritory effort"; I'm not certain what that means. She said it is not an accelerometer. Perhaps it just measures whether my chest keeps moving in and out?

The website says they measure breathing, but aren't specific. But I notice some of the kits listed at that comparison link don't. I guess that was my biggest concern. I guess I can live with this.

They recommend several days testing (which might allow for doing it with and without my wedge pillow), 6 hours/night, but that will depend on my insurance company.

My hospital sleep tests used much more equipment: "a Viasys SomnoStar Pro computerized system... EEG (C4-A1, C3-A2, O2-A1,O1-A2) with LEOG, REOG and a submental EMG channel. Respirations were measured using an oronasal thermister and nasal pressure cannula, with piezoelectric bands to measure chest and abdominal effort. Oxygen saturations were recorded with a pulse oximeter... a snore microphone, leg EMG and body position sensor." Multiple devices were glued onto each of my head, chest and back. I probably looked like a Borg drone. It's hard to believe anyone can sleep wearing all that.

I'm not sure what to do about the advice that I should stop using CPAP for 2 weeks to get an accurate assessment of not using it. My previous tests with a pulse oximeter were done with no such stop, which brings them into question.

[SarcasticDave94]

The chest effort belt will determine literally if there's breathing effort or not. No effort detected while in an Apnea indicates a Central Apnea. While Apnea with effort indicate Obstructive Apnea.

I know of no home test that will include EEG.

The nasal cannula are there to measure airflow. How exactly are you going to incorporate the cannula into the test with the CPAP mask? Just place them in the mask in some way?