How accurate are the home sleep studies and are they really necessary?

I was sent home with a box on my chest, a strap around the chest and another 1 lower. I also had a pulsox for my finger. I don't know what model it was, but I know it was $400. I got a unbelievable AH score of 121 with my O2 level dropping to 68% at some point in the night. How is that even possible? Twice per minute? Seems like a glitch.

Then I took the in-house sleep study for another $700, while wearing a mask. They didn't really give scores out, they just said "Yeah, you have severe apnea". They barely discussed anything, until I called and insisted on talking to the sleep Dr. I guess my GP was supposed to go over things with me, but he doesn't seem like he knows much about apnea, so everything was vague.

I'm 43, in decent shape, 6 foot, 200 pounds and I have a score that is something on the order of 4 times what is considered severe? It seems illogical. I should probably add that I live at 8500 altitude, so low O2 is kind of par for the course here.

There is no doubt I have it, but this whole ordeal seems sketchy as hell. Since my deductible is 6000 a year, I'm paying for everything out of pocket. I feel like I could have saved myself $1100, just in tests. When every person you have slept near alarmingly tells you that you choke and stop breathing constantly, it didn't take those tests to diagnose. I could have just tried my dad's old machine for a night and read the results for free. I feel like everyone could do this themselves. The whole sleep study bullshit feels like a racket.

Anyway, I've been compliant for about 10 days now. My average AHI is 10 over those nights. Except 2 days ago it went to AHI 47.7, but that was probably a glitch as well. I didn't sleep well that night and I have a feeling the machine was recording me away from the machine or messing with the mask or something along those lines.

I got the SD card now, so I'm going to run it through the SleepyHead app and see if that shows me anything. I do feel a lot better. No headaches in the morning and my chest doesn't hurt all the time. I can't say I sleep better, but I feel better in the morning. I get up and adjust something with the equipment about 5 times a night, bathroom, snack, but I think when I am sleeping, it's better sleep. If I can get used to the mask so that it doesn't wake me, I think things will be good. Last night I dreamed I was caught in a fishing net, drowning. My hose and mask was all tangled and maybe I was caught.

Sorry for the long post, but I wanted to introduce myself. I've been reading your messages for a week and this is a very helpful group. Thanks for being here.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

I was sent home with a box on my chest, a strap around the chest and another 1 lower. I also had a pulsox for my finger. I don't know what model it was, but I know it was $400. I got a unbelievable AH score of 121 with my O2 level dropping to 68% at some point in the night. How is that even possible? Twice per minute? Seems like a glitch.

It's certainly not the highest AHI I've heard about. Yes, twice per minute, and more.

68% is getting near the spontaneous death zone for oxygen deprivation.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

Then I took the in-house sleep study for another $700, while wearing a mask. They didn't really give scores out, they just said "Yeah, you have severe apnea". They barely discussed anything, until I called and insisted on talking to the sleep Dr. I guess my GP was supposed to go over things with me, but he doesn't seem like he knows much about apnea, so everything was vague.

One doesn't get 'scores' in a titration session.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

I'm 43, in decent shape, 6 foot, 200 pounds and I have a score that is something on the order of 4 times what is considered severe? It seems illogical.

Why? nothing illogical about it.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

There is no doubt I have it, but this whole ordeal seems sketchy as hell. Since my deductible is 6000 a year, I'm paying for everything out of pocket. I feel like I could have saved myself $1100, just in tests. When every person you have slept near alarmingly tells you that you choke and stop breathing constantly, it didn't take those tests to diagnose. I could have just tried my dad's old machine for a night and read the results for free. I feel like everyone could do this themselves. The whole sleep study bullshit feels like a racket.

I frequently suggest that people just buy a used autoset, and see if it helps.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

Anyway, I've been compliant for about 10 days now. My average AHI is 10 over those nights. Except 2 days ago it went to AHI 47.7, but that was probably a glitch as well. I didn't sleep well that night and I have a feeling the machine was recording me away from the machine or messing with the mask or something along those lines.

"compliance" is only for the insurance company. If you'r AHI is 10, that's really crap, and your machine isn't adjusted for your needs. Writing off everything that's not good as a 'glitch' is foolish.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

I got the SD card now, so I'm going to run it through the SleepyHead app and see if that shows me anything. I do feel a lot better. No headaches in the morning and my chest doesn't hurt all the time. I can't say I sleep better, but I feel better in the morning.

If you're feeling better, then you're sleeping better, qed.

If the machine you show in your profile is correct ....Airsense 10 CPAP....Sleepyhead will not do you any good. Usable data is not available with that model. Check and see what it says in the lower RH corner of the machine.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

The whole sleep study bullshit feels like a racket.

A racket is exactly what I told my wife about the formalized process. Could certainly be streamlined at least. Here's how it went for me:

• Referral from PCP
  Consultation ($$)
  Diagnostic sleep study($$$$)
  Consultation ($$)
  Titration study ($$$$)
  Consultation (<-- first time I saw the "sleep doctor") ($$$)
  Get machine

I've got a high-ish deductible HSA, so it was all out of pocket for me as well. My wife diagnosed me years ago. I researched taking off on this CPAP venture on my own, with no doctors involved. Decided I had no idea about any of it and went the formal route. If I had signed up here and started asking the right questions, I could have saved a bunch of money.

DUG wrote: ↑

Tue Aug 21, 2018 3:36 pm

Sorry for the long post, but I wanted to introduce myself. I've been reading your messages for a week and this is a very helpful group. Thanks for being here.

Welcome! I'm not going to be giving out any advice, but get those sleepyhead charts up so I can continue my education by watching the advice you get in this thread. Do keep using this thread, so the folks helping you have the whole picture handy. Please read the sticky at the top of the thread list, if you haven't already.

Am wondering if your machine is correct in your profile. You most likely have the Airsense 10 Autoset. You have to scroll down to the "R"'s (resmed) to find it. I did the same thing when I signed up. See you around...

It really is ridiculous how the whole thing is setup, considering how the medical community loves to emphasize how many untreated people with OSA are out there. The extent of the artificial barriers to entry placed around CPAP are absurd relative to the actual risk of using a CPAP.

There is the requirement for a prescription to purchase, the restriction on all sales without a license, providers and DMEs price-gouging insurance companies, who are passing those costs along in-kind to patients, who often have high deductibles and and the expectation of 20% co-insurance and yet can still end up receiving a Dreamstation or an Autoset with the default factory settings. Poor settings and follow-up care encourage poor compliance rates. And then the manufacturers of the device do everything they can to suppress the secondary market so that patients have less alternatives to the insurance scheme, and so non-compliant users have few options to recover any of their costs on perfectly functioning machines.

It was very straightforward for me to self-treat using the resources here and elsewhere on the net. I have the data and the results to prove it worked efficiently. It worked faster than I would have even gotten the device through a prescription provider. I probably still would not have the sleep study completed based on how long the wait was just to get the first consultation appointment.

To answer directly the question in the thread title . . .

How accurate are the home sleep studies and are they really necessary?

. . . Home sleep studies are a money-saving method used for docs to prove to payers that someone should be allowed to try PAP therapy. They are very good in that they are accurate enough for that specific purpose when it is completely obvious to a doc at a glance that a person has moderate-to-severe OSA and the doc only needs something objective to prove it to payers.

The limitation of home sleep studies is that they are profoundly unable to prove someone is NOT a candidate for getting benefit from PAP. So anyone who shows negative findings with a home sleep test must go ahead and get a lab polysomnography diagnostic test anyway in order to get truly definitive negative results or more subtle positive results that home tests are incapable of providing.

Alright, I changed the bio equipment. I have the sleepyhead program up and running, although I don't know what I'm looking for. Does anyone want to lend a hand to decipher it?

Do I take screenshots or is there an upload protocol to post it?

When I say I sleep better, I mean, depending on how you look at it.

I do feel better in the morning, but I'm up all night, or about every couple three hours.
Without CPAP, I didn't wake up during the night, but headaches and chest pain wasn't fun either.
Given the choice, I still prefer CPAP overall. I think my problem at this point is just getting more accustomed to the mask. It's only been maybe 2 weeks.

How to post images of the reports and the format to start with.
viewtopic/t158560/How-to-post-images-for-review.html
You can get everything we need to start with in one image. If we need something else we will ask.

To understand what you are seeing there is a little tutorial at the top of the Announcements section...lots of reading but just take it in small steps...start with the basics first. Leaks, pressure and events. Get a handle on those things and you really don't need to understand all those other graphs all that much.

DUG wrote: ↑

Wed Aug 22, 2018 7:38 am

Without CPAP, I didn't wake up during the night, but headaches and chest pain wasn't fun either.

But your brain did, as your body was constantly choking for oxygen and in panic mode all night long - you just don't remember it because they weren't conscious arousals.

I think I got it this time. Should I start a new thread to keep things clean?

Any special reason you are waking so often?
Mask comfort/fit/leak or just something new on your face thing?

Do you ever spend much time on your back? At 2:30 you had a significant pressure needs increase...usually that's either REM sleep or sleeping on your back. With your fragmented sleep it's really hard to judge sleep cycle probability here. Need longer blocks of sleep to estimate sleep cycles.

I think you would benefit from a higher starting minimum pressure...not sure just how much but I think 7 or 8 cm would be a better starting point. Often when the minimum pressure is more optimally set the machine won't need to increase the pressure as much.

I really don't know why I wake so often. I think I just need to get used to the mask. When the pressure gets too high, it wakes me up or I get wrapped up and it wakes me. When I wake up, the air is on high, blowing my exhale back in, almost. I haven't tried the EPR setting. I read online that EPR doesn't really do much, for most users.

I always fall asleep on my back and I try to stay on my back or on my right side, because the tube goes right and also that's my normal side to turn on before CPAP started.

I was dreaming last night. I don't really dream, unless it's a bad thing and I rarely remember them. Last night's dream started off nice, family at a fun park, real nice. Then there was an emergency and everyone had to get out of the park. I had been holding my wifes cell phone in my pocket, so we couldn't call each other and there were people everywhere. So, in the end, it was a bad dream again, and I woke up afraid I couldn't find her and the kids, but the first half was cool. Generally, I don't have good parts. Most of the time, I don't dream at all.

I raised my min pressure from 5 to 6 last night. I'll put it on 7 or 8 tonight.

I like EPR myself. Others don't. It's a personal preference thing but you won't even feel its effects until you get up around 7 or 8 starting pressure. For me it makes the breathing feel more natural and not so much "work".

Give it a try while awake at the various settings and see what it feels like to you.

And yes...sometimes we just wake up because the brain wants to say "hey, dude, do you know there is an alien on your face blowing air up your nose"...
Took me about 3 months before the brain quit doing that. I wasn't having problems with leaks or fit or comfort..just would wake up briefly for no reason and feel the mask on my face and say "oh yeah"..."that thing" and go back to sleep. Eventually the brain comes to terms with its new best friend.

jnk... wrote: ↑

Tue Aug 21, 2018 5:53 pm

To answer directly the question in the thread title . . .

How accurate are the home sleep studies and are they really necessary?

. . . Home sleep studies are a money-saving method used for docs to prove to payers that someone should be allowed to try PAP therapy. They are very good in that they are accurate enough for that specific purpose when it is completely obvious to a doc at a glance that a person has moderate-to-severe OSA and the doc only needs something objective to prove it to payers.

If they send people home and it tests positive, they send you to the real sleep study. In the off chance that it doesn't show positive, they also send you to the real sleep study. Brilliant!

It seems to me that Apnea is a lot like alcoholism in that if you think you have it, you probably do, or you would never have thought about it.

Either way, they add $400 to the total and add a referral and a consultation fee in there.

That alien analogy is spot on. My mask is nice enough. Doesn't leak much at all. It hurts the bridge of my nose a little, but I'm developing something similar to a callous. After a while, it will be fine.

I think after a month or so, the alien in my subconscious will go away, or perhaps it will erupt from my chest and that will be that.

I'll try out the EPR settings tonight.