Why is Stanford considered so good?

Stanford happens to be fairly local to me, so I did my sleep studies there, but I'm wondering what's so great about the Stanford Sleep Clinic. Is it the 36 connectors they stuck all around my head and body? Is it the very comfortable beds? Are the doctors much better than others?

Going into my diagnostic sleep study, I already knew I had obstructive sleep apnea. In this case, I just needed the paperwork for my insurance company.

For the titration, could I not have simply used my APAP to determine the required pressure?

Now, I know there can be bad doctors and clinics anywhere, and those should be avoided. But it seems Stanford is like a BMW, whereas a Honda would be more than adequate.

davelikesbeer wrote:For the titration, could I not have simply used my APAP to determine the required pressure?

Don't know about Stanford clinic but the answer to this is simply "No". The APAP won't really be able to titrate that accurately unless you have a point of reference. You don't want to open the range from 1-20cm, that's not a going to get you very far. Your study will give you a starting point (Say 10cm) and you can set your APAP from 10-13 or similar.

Alshain wrote:

davelikesbeer wrote:For the titration, could I not have simply used my APAP to determine the required pressure?

Don't know about Stanford clinic but the answer to this is simply "No". The APAP won't really be able to titrate that accurately unless you have a point of reference. You don't want to open the range from 1-20cm, that's not a going to get you very far. Your study will give you a starting point (Say 10cm) and you can set your APAP from 10-13 or similar.

I was titrated with my APAP, not at the sleep lab. They leave the pressure at 4 to 20 and then see what your 95% pressure is running at for a period of time. Heck, it may be more accurate than a few hours in the sleep lab.

I think the sleep study does more than just confirm that you have apnea and how bad it is. Are there other sleep issues? Issues with REM? Issues with leg movements? Are there other things going on with your breathing? Are the apneas central or obstructive? Etc.

Well, it is possible, but I wouldn't recommend it anyway. Casting that wide a net can cause additional problems. Frequent shifting of the pressure can wake you up making the situation worse and then the APAP won't titrate properly anyway. Sometimes the APAP will attempt to titrate before you even fall asleep, and when it is left unrestricted, you can get a lot of bad information. The human element helps to filter those out. They are looking at more than just your breathing, they also can see if you're EEG/EOG indicates that you are asleep when it occurred.

As for the other stuff, (RLS, Oxygen, etc) yes they do that too but they do that in the sleep study also, so they should already have an idea of what is going on there. Doing that during the titration study is most likely for confirmation, and because your already there so, why not?

davelikesbeer, at the Honda shop they may tell you that beer is not good for sleep apnea. At the BMW shop they will cite 15 randomized controlled studies assessing alcohol's exact impact on OSA, sleep architecture, and CAP, and they will have authored the studies they cite.

davelikesbeer wrote: Now, I know there can be bad doctors and clinics anywhere, and those should be avoided. But it seems Stanford is like a BMW, whereas a Honda would be more than adequate.

BMW as in Big Money Waster?

SleepingUgly wrote:davelikesbeer, at the Honda shop they may tell you that beer is not good for sleep apnea. At the BMW shop they will cite 15 randomized controlled studies assessing alcohol's exact impact on OSA, sleep architecture, and CAP, and they will have authored the studies they cite.

Nice.

Here's the thing. I had the option of going to not-Stanford earlier, or waiting for an availability at Stanford. As I said, I'm local, so no travel plans needed to be made. Since Stanford was the best, I opted to wait which cost me three months. These are three (more realistically two) months I could have been on CPAP. In retrospect, I think it would have been better to go elsewhere earlier.

Having been there, I can assure you they don't cite any studies. During the sleep study, you meet the doctor for all of two minutes. In the age of the internet, and Google Scholar, it's quite easy to find studies on my own.

Also, when I'm getting my car fixed, I don't need to know the history of gasoline additives, I just need to know my fuel injector is clogged and what that does to the engine performance.

Well, davelikesbeer, since you seem to be a Honda (or even Hyundai) kind of guy, how 'bout you rent out your place so we BMW owners can have a place to crash while we're getting our not-so-easy-to-diagnose-and-treat problems taken care of at the BMW shop?

P.S. I drive a Honda, so I'm not so sure I like this analogy.
P.P.S. If you've never been to a Honda shop, you don't know how bad it can be.
P.P.P.S. I think the docs can tell the difference between a Honda-kind-of-patient and a BMW-kind-of-patient. The Honda kind comes in with no list of questions and lets the doctor leave the room in 5 minutes. The BMW-kind-of-patient (still hating this analogy...) comes in with a list of questions that makes the doctor feel like he just got grilled for his boards by the time he barely escapes the room in an hour and a half.

SleepingUgly wrote:Well, davelikesbeer, since you seem to be a Honda (or even Hyundai) kind of guy, how 'bout you rent out your place so we BMW owners can have a place to crash while we're getting our not-so-easy-to-diagnose-and-treat problems taken care of at the BMW shop?

P.S. I drive a Honda, so I'm not so sure I like this analogy.
P.P.S. If you've never been to a Honda shop, you don't know how bad it can be.
P.P.P.S. I think the docs can tell the difference between a Honda-kind-of-patient and a BMW-kind-of-patient. The Honda kind comes in with no list of questions and lets the doctor leave the room in 5 minutes. The BMW-kind-of-patient (still hating this analogy...) comes in with a list of questions that makes the doctor feel like he just got grilled for his boards by the time he barely escapes the room in an hour and a half.

I use this analogy often, but it fits. With every product type there usually is cheap crap and high end expensive stuff. In between there is a range of products that gives you higher quality for your money. With cars, that's Honda. The increased cost of the car, IMHO, is outweighed greatly by the increased quality. However, once you get into the higher end, the incremental cost (for me) is not outweighed by the increase in quality. Believe me, I love driving BMWs. However, my increased pleasure is not worth the additional cost.

And no, I haven't been to a Honda shop... because I have a Honda.

I like this analogy so much that I thought it would make a good basis for a good review website. I thought of it when I was shopping for new kitchen appliances. I didn't want cheap crap, nor did I want to break the bank. I told my friend I wanted "the Honda of kitchen appliances". And since then I find myself thinking that way about alot of purchases. What's good? What's bad? Where is the inflection point where cost outweighs benefit for the average consumer?

Okay, enough with the analogy!

I definitely see your point about the doctor's ability to answer questions that the no so average patient may ask. And most definitely see your point wrt patients with not-so-easy-to-diagnose-and-treat problems.

Why would you need a place to crash? Don't you sleep in the sleep clinic? Also, if you have so much extra cash that you can go to a luxury clinic, why not stay at a nearby hotel?

Dave.

Are you under the impression that a sleep study at Stanford costs more than a sleep study at some other clinic? I do not think so.

Are you unhappy with the results you got from Stanford? Or are you just unhappy that you waited 2 more months than you had to wait to get in somewhere else where you THINK the outcome would have been the same? Maybe for you the outcome would have been the same. Maybe not. (Let's let the BMW part of the analogy go, as I don't think either one of us drives one...) It seems to me that you bought a Honda and now you're wondering if another car would have been just as good and cost you less. But isn't part of the reason that one buys a Honda so that you don't have to wonder whether you got quality and reliability? If you'd gone to another lab, you might have wondered if they caught everything and if they did it right (i.e., reliability). Stick around here long enough and you'll see what I mean. In any event, I doubt you paid any more for your sleep study than you would have down the road, and two months is nothing for piece of mind. Consider yourself lucky that you didn't waste a couple decades of your life at the crap clinics.

SleepingUgly wrote:Are you under the impression that a sleep study at Stanford costs more than a sleep study at some other clinic? I do not think so.

Are you unhappy with the results you got from Stanford? Or are you just unhappy that you waited 2 more months than you had to wait to get in somewhere else where you THINK the outcome would have been the same? Maybe for you the outcome would have been the same. Maybe not. (Let's let the BMW part of the analogy go, as I don't think either one of us drives one...) It seems to me that you bought a Honda and now you're wondering if another car would have been just as good and cost you less. But isn't part of the reason that one buys a Honda so that you don't have to wonder whether you got quality and reliability? If you'd gone to another lab, you might have wondered if they caught everything and if they did it right (i.e., reliability). Stick around here long enough and you'll see what I mean. In any event, I doubt you paid any more for your sleep study than you would have down the road, and two months is nothing for piece of mind. Consider yourself lucky that you didn't waste a couple decades of your life at the crap clinics.

I am in no way putting down Stanford. I do consider myself lucky not going to lemon clinics. And I consider myself foolish for not addressing issues I'd been having sooner.(I was originally diagnosed in 2002, and had UPPP in 2003. The symptoms slowly returned years later.)

I'm happy with the results I got from the sleep clinic. In fact, they told me (and my regular doctor) what we were already 95% sure of. So basically, no surprises there. I have no doubt that most sleep clinics would have been able give me the same results. However, I do not feel that I am a hard to diagnose patient.

Before going to the sleep clinic, I did compare cost between the clinic my primary care physician referred me to and Stanford (which the doctor at my office referred me to). Stanford was a little more out-of-pocket, but not a huge difference. Not sure what would have been the out-of-pocket w/o insurance for either. The reason I selected Stanford was because of their reputation and I didn't like the customer service of the clinic my PCP referred me to. When I called them, they just didn't seem to care. And if I'm honest, that was the primary reason I went with Stanford.

Now that I have hindsight and am a lot better informed, I can say that I'm very certain that I would have gotten the same (expected) results from the other clinic and probably should have chosen it so I could have gotten on CPAP earlier.

I think there is a very real downside to telling people you need to go to the best. There are lots of people suffering from the life threatening affects of sleep apnea. And of those, I'm sure any barrier to getting diagnosed and treated is too much to deal with. You read often on this forum that some people (usually partners) are just in denial about it and don't want to deal with it. Giving them the impression that going to some place other than the best-of-the-best clinics is just wasting their time, can do them harm by making them not consider the clinic just down the street that will in all likelihood get them the treatment they need.

I am currently facing the decision of if I should go back to Stanford for followup visits. I'm more inclined to think this matters more than the actual study. I have the weigh the benefits of having well qualified doctors versus the inconvenience of sharing the data with my primary care physician. If I choose a sleep doctor in the same organization as my PCP, then all my information will be in the same computer database (I really wish there were a single central database where all physicians I deal with could access it).

The vast majority of people who come here are on CPAP already, or have been diagnosed with SDB through a sleep study. Of those who come here undiagnosed, they have a strong suspicion that SDB is their problem, in which case people encourage them to get a sleep study (and no one tells them where) or to auto-titrate themselves if they can't get a sleep study. Of the even fewer who have been misdiagnosed repeatedly as having no SDB but still come here suspecting they do, they would benefit from being told to go to a place like Stanford (although they rarely are told so), as what do they need yet another false negative study for?

The reason we are discussing whether Stanford is the BMW of sleep clinics, which might discourage people from going to the Honda of sleep clinics, is because YOU brought up the subject and named Stanford in your subject title!

Good luck with your follow-up care, wherever you choose to get it. I hope it will be smooth sailing for you, in which case you'll hardly need a sleep doc at all. If you do find you aren't satisfied with your therapy, lucky for you, I hear there's a little clinic down the road from you where Obstructive Sleep Apnea Syndrome was first described in the 1970's...

I don't think you need to go to the best sleep clinic unless your a special case, but you do need to go to a good one. Go to a Toyota

Hondas are not cheap crap, lol. Kia, definately. Hyundai, maybe. Toyota, all things considered despite their troubles, probably not. Honda, no way. BMW = Pay thousands of dollars for a hood ornament.

My take on the issue is basically this:

The Stanford-places of the world attract the better of the best in the world.
The doctors that populate places such as that are usually at or near the pinnacle of their peer groups.
Do we always need doctors of that quality? No not particularly.
BUT and this is, to me, the BIG issue -- IF something arises during the routine treatment that DOES require a specialist of some sort I'd much rather be at a place where they have the best possible resources immediately at hand to call into play.

Could you nave gone to non-Standford and gotten good treatment -- very likely.
In your case would you have been better off in going to non-Stanford and getting into a treatment regime sooner rather than waiting -- probably.
In the case of a lot of folks on this board would they get BETTER treatment at a Stanford place than they do at their non-Stanford places -- most assuredly.

If we all knew back then what we all know now would we all have made different decisions regarding our treatment -- absolutely -- the least of which for most of us would have been to go SOONER.

Thing is you chose to wait -- okay -- so go forward now -- if you get hung up in looking backwards all you do is take your eyes off the direction you really ought to be looking. Go forward -- you made your decision and you've arrived at the here and now -- what should be important is what is the NEXT step -- not whether the last step was right or not.

Alshain wrote:I don't think you need to go to the best sleep clinic unless your a special case, but you do need to go to a good one. Go to a Toyota

Hondas are not cheap crap, lol. Kia, definately. Hyundai, maybe. Toyota, all things considered despite their troubles, probably not. Honda, no way. BMW = Pay thousands of dollars for a hood ornament.

I agree. I think Honda is good quality for the price paid. As I do of Toyota. I think BMW is probably better quality and certainly better performance...but the additional price is not worth it IMHO.