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SLEEP STUDIES

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Generally, a sleep study is a term to describe any test for diagnosing and/or treating sleep problems.

These include the portable or home sleep test (HSAT), the nocturnal polysomnogram (NPSG), the split night study, the PAP titration, and daytime studies that include the Maintenance of Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT).

What are the main sleep tests or studies?

There is more than one kind of sleep test. You cannot assume that the one your doctor orders for you will be the same one ordered for a friend or relative. Often, it’s the patient’s insurance carrier which has a shaping influence over sleep testing protocols, as well.

Home Sleep Apnea Test

A home sleep test (HSAT) is typically prescribed when your doctor suspects you might have a sleep breathing disorder. You will be sent home to sleep that night with a kit composed of various sensors, which usually include:

  • a belt to measure respiratory “effort”
  • a finger probe to measure heart rate and blood oxygen levels
  • a cannula sensor used to measure airflow

When you pick up the test, your doctor or sleep technologist should show you how everything is attached and how the test is turned on and off. There should also be written and/or video instructions contained with the test kit, in case you forget.

The HSAT is often required by insurance payers to screen patients for the likelihood of sleep apnea before they come in for an overnight test as the HSAT is considerably less expensive.

The test is fairly simple and mostly accurate enough for the purposes of detecting the presence of sleep disordered breathing.

It is also, for some patients, a more desirable option as it is conducted in the privacy and comfort of the patient’s home.

In October 2017, the curator of SHC will post a video demonstrating how to perform a home sleep test to show just how easy it is. Stay tuned!

Generally you return your HSAT hardware on the morning after the test and follow up within a week with your sleep physician to discuss results.

An HSAT may not work the first time, and you may be asked to do the test again. You will not be charged for any tests in the case of a hardware failure.

Results

Sometimes the results of an HSAT will indicate that you need to go in for an overnight sleep study in the sleep clinic because the results were either:

a/inconclusive, but strongly suggestive of a sleep disorder

b/conclusive (a sleep disorder is or isn’t present)

Inconclusive testing means there’s a likelihood that additional tests may be needed to uncover a different sleep problem, or the results were borderline for a sleep breathing disorder.

Conclusive outcomes may still require further studies to identify appropriate therapy settings before treatment can be started.

If you are diagnosed with sleep apnea based on an HSAT, you will meet with a durable medical equipment (DME) provider to receive your sleep apnea treatment. This is usually an automatic positive airway pressure (Auto-PAP) machine which comes with a preset pressure range.

When HSAT test results are negative for sleep disordered breathing, this doesn’t necessarily mean the patient doesn’t have a sleep disorder. Many other sleep disorders besides sleep apnea can cause excessive daytime sleepiness or sleeplessness at night, so a followup study in a lab setting may still be required.

Nocturnal polysomnogram

A nocturnal polysomnogram (or NPSG) is a diagnostic test conducted in a sleep laboratory which measures physiological data occurring in patients while they sleep.

The data come from various kinds of sensors attached to different parts of the body: the scalp, the chin, the brow and cheek, the throat, the nose and mouth, the legs, the chest, and the abdomen.

About the sensors

  • Sensors on the scalp measure changes in brain wave (EEG) architecture, which show changes in sleep stages. These can also capture unusual brainwave activity that might be related to seizure disorders or epilepsy.
  • Chin sensors (EMG) indicate when patients are awake, tense, lightly asleep, or in REM sleep.
  • Brow and cheek sensors record different kinds of eye movements (EOG) during both sleep and wake stages.
  • The throat sensor records snoring activity.
  • The nose and mouth sensors measure incoming and outgoing airflow.
  • Leg sensors (EMG) indicate muscle activity in the limbs that can be caused by arousals, movement disorders, and other physiological disturbances.
  • Electrode patches on the chest record ECG patterns (heart rhythms), and belts around the chest and waist show evidence of respiratory effort (or lack thereof), which helps to identify breathing disorders of sleep.
  • An additional device, the pulse oximeter, is clipped to the patient’s fingertip; this device measures both the heart rate and the amount of oxygen saturating the blood, which lets the interpreting physician know just how much (or how little) oxygen a patient is circulating while they sleep.

Once the patient is hooked up to these sensors, they are asked to sleep in a technologically equipped bedroom and monitored via video and audio equipment for the night.

The laboratory technologist collects data which, when scored and interpreted by a sleep physician, can provide answers to explain certain kinds of health concerns, such as excessive daytime sleepiness, morning headaches, low blood oxygen at night, or high blood pressure.

Generally these tests are administered during the evening. However, some patients who work overnight shifts may be scheduled for attended polysomnograhy during the day, when they typically sleep.

Split night study

This test is performed for some patients for whom a diagnosis of Obstructive Sleep Apnea (OSA) or upper airway resistance is highly likely. This is often determined by a pulmonologist who specializes in heart and lung disorders.

A split night study starts out like the NPSG; the patient is prepared in the same way and the same signals are attended during the test. However, respiratory events are a chief focus of observation in this test.

Respiratory events are moments during sleep when the airway is partially or completely obstructed for at least ten seconds, or when arousals occur due to airway resistance, such as in the case of heavy snoring.

Respiratory events in a split night study are tallied over the first third of the test and, if the patient has experienced enough to meet lab protocol, they are given positive airway pressure (PAP) therapy to help eliminate these events.

PAP Titration

This study involves the use of a positive airway pressure device and mask to identify the best therapeutic measurement of air pressure for people with OSA.

Positive airway pressure is essentially delivery of very light puffs of air to the patient’s upper airway in order to assist the patient in completing inhalation and exhalation, both which may be obstructed due to confirmed issues of blockage in the upper airway.

The patient is acclimated to the mask by wearing it before the titration using very light pressure. Then they are hooked up like they would be in an NPSG. However, in the case of a PAP titration, they start their study using PAP therapy.

As they sleep, the technologist remotely and digitally adjusts the therapeutic level of positive pressure feeding through the device and mask, as well as humidity and pressure support for exhalation, until they determine the pressure which most benefits the patient is the most comfortable for them.

Maintenance of Sleep Latency Test

This test helps to identify hypersomnia condition, such as Idiopathic Hypersomnia, Narcolepsy with or without Cataplexy, and Klein-Levin Syndrome (“Sleeping Beauty” disorder).

The MSLT is usually performed on patients on the morning following an NPSG. These are people who are known to be excessively sleepy during the day but who have been determined not to have sleep apnea.

Some of their overnight sensors are removed while others are left on for up to 5 tests performed about 2 hours apart during the day. These nap periods allow the technologist to record their brain wave patterns at those times, which can reveal conditions of hypersomnia.

Maintenance of Wakefulness Test

This test is often used for commercial truck drivers, airline pilots, bus drivers, and other operators of public or commercial vehicles or industrial equipment—anyone who may be at risk for falling asleep at the wheel or while operating machinery.

For these workers, the risk of drowsy driving is too great to ignore any problems with untreated sleep disorders, especially sleep apnea, which can be more common among this population.

A patient undergoes an MWT by being hooked up to specific set of sensors, then sitting in a dark room for a certain period of time during the day. This objectively determines how well they can stay awake in low stimulus conditions.

Will insurance cover my sleep study?

Generally, sleep studies are considered medically necessary because they are critical to identifying underlying sleep disorders, especially those related to disordered breathing.

Fortunately, most sleep disorders are treatable and therapies are also generally covered by most insurance companies.

Different insurance companies cover different kinds of tests and durable medical equipment (DME) related to sleep testing, so it’s best to consult your insurance company to see what they will reimburse. (Your doctor should also be able to help you with this.)

You will likely need to be referred for a test and might need to have your studies and equipment pre-approved by your insurance company before taking a test. Often a doctor’s choices for treatment will be limited by what your insurance is willing to reimburse.

It is advised that all patients look at their insurer’s policies regarding failed or incomplete tests. Generally, patients aren’t charged for tests that have failed mechanically.

If you decide in the middle of a test that you no longer want to participate

If a patient leaves a study in progress, this is considered “against medical advice” (AMA). You will need to sign a form (called an AMA) stating you understand you are leaving against medical advice.

Your insurance company may or may not reimburse in this case, and you could be held responsible for paymentpartially or completelyfor this expensive test.

How do I prepare for a sleep study before I get to the lab?

Usually the lab will give you specific instructions, so please consult them first. In their absence, here are some general guidelines.

To Do List for a Sleep Study

  • Shower
  • Come in with clean, dry hair
  • Remove makeup
  • Eat your evening meal 2 or more hours before coming to the lab
  • Remove dark nail polish, if possible, as it might interfere with function of the finger probe
  • Avoid alcoholic or caffeinated beverages or foods 5 or more hours before coming to the lab
  • Prepare to be told you cannot smoke at least 30 minutes before your study starts (which includes vaping)
  • Take your usual medications, but do not take any sleep aids until you’ve alerted your technologist to the fact you are taking them; it is important to start your study awake!
  • Manage your diabetes medications as usual
  • Expect to start your sleep study with all electronics—including the TV, cellphone, and radio—turned off, even if it’s normal for you to have these on at bedtime

Packing List for a Sleep Study

  • Clothes to sleep in (do not bring lingerie); pajamas, nightshirts, t-shirts, and shorts are all acceptable. Nude sleeping is not permitted in the sleep lab and hospital gowns may or may not be available
  • Slippers to walk in, and a robe; some labs will set up patients in their rooms, while others will set them up in separate locations inside the lab where other patients might see them
  • Comfort items like a favorite pillow, blanket, or stuffed animal
  • Your evening medications (note: technologists are not permitted to administer medications). These could include your usual prescriptions as well as over-the-counter pain relievers, decongestants, nose sprays, antacids, heartburn medications, and the like
  • A white noise machine, if this is helpful for you (some labs have these available)
  • Your usual personal care items like shampoo, conditioner, soap, toothpaste, toothbrush, deodorant, etc. Though many sleep labs are set up to resemble hotel rooms, they are still medical facilities and do not always provide these personal care items
  • If you are diabetic, having some snacks on hand is okay if that will help you regulate your blood sugar through the night
  • Most labs have overhead or standing fans to help keep rooms cool for patients who need them

List of Things NOT TO DO OR PACK for my sleep study

  • Anything with a strong fragrance; most labs are fragrance-free environments
  • Fast food or other carry-out food items that have a strong aroma
  • Pets (service animals are an exception)
  • Loved ones may come with you to the lab to help you get comfortable, but they cannot typically stay the night unless they are pre-approved as caregivers; patients under the age of 18 must be accompanied by a parent or guardian who will be expected to stay overnight
  • Electronics like laptops, cell phones, and handheld gaming devices; if you do bring them with you, please be prepared to turn them off completely stash them for the night. Electronics can cause problems with sleep onset as well as disrupt electrical signal data collection
  • Alarm clocks; you will be woken by the technologist in the morning upon completion of the study
  • Jewelry can interfere with electrical signal data collection and is best left at home

What medications can I take before my sleep study?

Unless advised differently by your physician, take your normal medications.

If you have sleeping pills, hold off taking them until you have had a discussion with your technologist, as they will direct you to the proper time to take them.

If you have problems with heartburn or pain or congestion, you will be allowed to take medications for these as necessary to help you get to sleep comfortably.

However, the lab will not necessarily have these on hand, and sleep technologists are not nurses, so they cannot legally dispense medication of any kind, even aspirin or antacids, so please make sure and bring your favorites in case you need them.

How will the technologist prepare me for a sleep study once I’m at the lab?

Depending upon the nature of your visit, the technologist will prepare you for your study in various ways.

Typically, preparation will include application of scalp and body sensors and trying out several kinds of PAP masks to find the one that fits you best and is most comfortable for you, in the event you will need it.

The technologist is also a sleep educator who is trained to answer all your questions about the test, so feel free to ask questions of them or express any fears or concerns you may have.

At “Lights Out,” the study begins, and your sleep technologist will work with you to perform calibrations. These include little exercises you complete at their instruction, such as blinking your eyes or pointing your toes, so they can capture a digital record of the baseline measurements related to each of the sensors you have attached to your scalp and body.

Each patient displays different variations on these signals (size, shape, speed), so these calibrations come in very handy for the scoring technologist and physician later when they prepare to score and interpret your study after you’ve gone home.

Why do the technologists have to audio and video record my study?

Often the sensors attached to the patient show unusual signals. Using video and audio feeds live helps the technologist to determine whether the unusual signals are due to sensor malfunction or to symptoms caused by sleep disorders or harmless patient movements.

Some kinds of sleep disorders, those involving unusual movement or vocalization, require audio-visual records to confirm diagnostically.

Audio-video streaming also helps the sleep technologist and patient to best communicate with each other as they are in separate spaces for most of the test.

Physicians who have questions about certain aspects of the study may call up both the audio and video recordings to see what happened in those moments during the study, long after the study has been completed.

Finally, because of the somewhat intimate nature of the sleep test, an audio-video recording offers both the patient and the technologist legal protection against any misunderstandings which might occur while the technologist is in the room with the patient at night.

Conversations and activities are recorded in order to provide some objective data when such disagreements arise in these rare occasions.

Audio

Snoring, catathrenia, and sleep talking can be confirmed through audio feed.

Video

Generally, the image of the patient, which is black and white, is kept in a small window inside the upper corner of the computer monitor screen in the lab. The technologist will refer to it to examine and corroborate patterns coming from the signals without having to disturb the patient.

Body position, an important part of data collection, can be confirmed via video feed. So can unusual movements that may indicate rare sleep disorders.

What happens if I have trouble sleeping during my sleep study? Won’t it ruin my test?

Most patients are expected to be a little on edge at first; this is normal. Your best approach is to try to sleep as well as you can and try not to worry about your sleep quality or quantity. The vast majority of sleep study patients do, in fact, sleep enough during a study to provide meaningful results.

It may help to know that the technologist runs the study in such a way as to account for so-called “first night effect,” which impacts nervous patients who can’t sleep initially. Very rarely does anxiety at the beginning of the night impact the overall efficacy of the test.

What are the technologists doing while I’m asleep?

They are not sleeping! They are, in fact, extremely busy, especially if they have multiple patients. They:

  • monitor the data collected by the signals attached to your scalp and body
  • write regular reports and tag specific data inside the study as it happens so the scoring technologist and physician can interpret the study later
  • adjust PAP pressures and settings or oxygen settings, as needed
  • fix or replace any sensors that might have fallen off or might otherwise not be working properly in order to collect the clearest data
  • assist you with getting to the bathroom in the middle of the night
  • help you with comfort issues (more pillows, cooling fans, noise machines)
  • update medical records related to your study
  • prepare your followup paperwork

What time will I get up? 

Generally speaking, patients are woken up by the technologist between 5 and 6am.

Following “Lights On,” they will calibrate your signals, unhook you from all the sensors, go over your followup paperwork with you, and offer any assistance you need in getting ready in the morning.

This usually takes less than 30 minutes, after which you are free to clean up.

Some labs offer breakfast foods; hospital-based labs often hand out coupons for free breakfast in the cafeteria.

Please don’t linger

The technologist you have worked with at the beginning of your study will most likely be the same technologist who will unhook you.

At the end of your test, they will be busy cleaning and sterilizing equipment, assembling packets of information for you to take home, updating medical records, and preparing your data for scoring by another tech. In some labs, they are also tasked with changing linens and towels and restocking the bedrooms and bathrooms.

Sleep lab techs generally work 12-13 hours overnight, then go home, sleep during the day, and return to work the next night.

As a courtesy, it is helpful as a patient to not linger after your study is completed and you have cleaned up.

If you are waiting for a ride, it is better to do so in the waiting room so the technologist can complete their shift. They are unable to leave until their patients have vacated the lab or someone else has arrived to relieve them, which may or may not correspond with the end of their shift.

How soon will I find out my sleep study results?

Most labs will get back to you within 2 weeks. Your sleep technologist should give you information about the process following your study before you leave the lab.

Note: Technologists are not physicians and are, therefore, not qualified to diagnose patients. The technologist cannot discuss your test results the following morning, as a typical test includes about 800 pages of raw data that still require scoring before the physician can interpret the results.

If you have any concerns, your technologist can take notes which can be forwarded on to your physician with your study.

Will I have to have more than one sleep study?

It depends upon what your particular sleep issues are. Some sleep disorders are adequately diagnosed after a single study, while other sleep disorders require different tests on different nights and sometimes even during the day to get at the root cause of the problems.

There is no typical procedure; each test for each patient is determined by their unique needs.

 

5 Comments on SLEEP STUDIES

  1. I believe that sleep medicine is so ineffective because the basic science has not been done. Indeed to this day we have no idea how people sleep in their own home in their own bed night after night.

    Why Sleep Testing Fails to Work in Real Life:

    My daughter put it well; “It is all about the setting”.

    There are many noted problems with the sleep testing process:

    False negatives! False positives! First night effect!

    “The worst night of sleep I have ever attempted”! “I had to come back for a second try”! “This is my third test in as many months”!

    The problem with the in lab polysomnogram (sleep test) is very basic and very simple and simply a deal breaker. The setting is wrong.

    The problem is that we do not normally sleep in a lab. Our “native sleeping environment” is in our own home in our own bed. Due to the differences and stresses of the “in lab” rather than the “in home” experience the data taken in the lab is very very likely different than what we would find if we measured sleep in our own beds in our own homes.

    There is no data I can find to show that the current in lab sleep test tracks with how we sleep in real life. It appears that there is no proof of external validity. The results of the test only represent how you slept in that lab on that night. How you actually sleep in your own home night after night is still unknown.

    Our “in lab” experience is very very different from our in bed normal night at home experience. To expand upon this a bit some of the issues are:

    We are in this lab at great expense which causes us stress!!!

    To get and be there we experienced different before bed procedures and lighting than we normally!

    We were placed in a different bed than we normally sleep in.

    The room we are trying to sleep in has very different temperature profiles than what we experience at home in our own bed.

    The room and building we are trying to sleep in has different sounds than we hear while sleeping in our own bed in our own home.

    We are all wired up!!!

    We are aware of the fact that we are under direct observation all night which can cause stress!!!

    Our future livelihood may be greatly affected by the results!!!!!!

    With all of the differences and stresses involved we may well be given drugs to help us try to sleep!!!!!!!!

    So when will it be that sleep medicine addresses this issue? Would it help to at least stop calling the current test “the golden standard” perhaps?

    We really do need to develop the equipment and procedures to move the sleep test into the home and find out how we actually sleep night after night. We simply do.

  2. Thanks for writing.

    I cannot speak for the major organizational bodies that govern sleep medicine, but I can tell you this: as imperfect as the overnight PSG “gold standard” is, it is still the best option we have for uncovering hidden sleep disorders.

    I speak not only a sleep technologist and educator, but as a patient (prior to my work in sleep health); what they uncovered during my lab visits has been wholly life-altering in the best possible way. Sleep medicine can and does save lives.

    The imperfections of the sleep laboratory environment certainly present a challenge, but there isn't a lab out there which doesn't acknowledge these challenges and make concessions for them.

    Worth noting: much of what a lab can or can't do is not dictated by doctors but by insurance companies and Medicare. Certain criteria need to be met before certain therapies can be introduced; patients are required to “fail” certain therapies before advancing to therapies that techs and docs see as the obvious first line approach.

    To be fair, reliable science has, in fact, been invested into overnight polysomnography for diagnostic testing and therapeutic application. I have seen excellent snapshots of patient sleep architecture in the lab first hand and would guess that 95 percent of my own patients were able to endure the procedure well enough to get solid, clean data.

    Do they sleep differently than they do at home? Of course. But please note that, even at home, a person will not sleep the same way every night, so the variables aren't perhaps as extreme when you compare them. The human body is consistent if only in its inconsistency.

    Also, if a lab were to set up a study in the home, the patient would still know they were being monitored and would still be “wired” in order to collect data. These potentially uncomfortable realities can’t be escaped no matter where you conduct the test.

    And there will be patients who are anxious about lab diagnostics and therapies, but this can be said about patients getting MRIs or colonoscopy or simple blood draws, too. My guess is there will not be a perfect scenario for sleep testing, at least not in the foreseeable future.

    On the other hand, I like the idea of at-home studies because they would afford the lab the opportunity to observe and report the conditions of the patient’s sleep environment.

    Many problems with sleep can be boiled down to poor sleep hygiene and habits; however, lab techs and doctors have very little opportunity observe these environments and habits. Instead, they must take their patient’s word for it on self-administered. Unfortunately, patients will lie about symptoms or behaviors if they think it will get them into (or out of) trouble by revealing this information. So an in-home study could be great for confirming a lab tech’s or doctor’s suspicions.

    Running at-home studies have been attempted in the past, actually. There was an impractical aspect to them that drove tests into the lab. You need proper conditions for recording and a technologist in attendance as the equipment is expensive and requires constant monitoring. In the past, they used analog (paper) recording technology, which didn't travel well. Today’s digital technology has its own bugs to work out, even in a stable lab environment where nothing is transported. At any rate, I imagine an attended home sleep test would cost even more to administer because of these challenges, and that's not a solution anyone wants to entertain.

    Perhaps telemedicine will be where new at-home studies evolve. I hope so, I think more people would welcome a sleep study if they could do it in their own home. Until more money can be put into sleep disorder research, however, this is all we'll have.

    This is a challenge far beyond the scope of SHC; it really is a challenge for healthcare consumers to demand better. Frankly, I hope that day comes, as well.

  3. Here is a post from Dave Schaar, a sleep technologist who performed home studies “back in the day,” for a different experienced perspective.

    Dave Schaar: “Firstly, when considering OSA, which is approx 95% of sleep diagnosis, it doesn't really matter.

    “As stated above, it may not be perfect, but most patients with OSA will demonstrate it.

    “It isn't a comfortable test for sure, but it isn't the nightmare most people who have a negative experience say it is.

    “When doing the exact same tests in home, which is how I started in 1998, it certainly is more comfortable, but keep in mind these patients had a stranger set up and awake the entire night in their home. That was disconcerting to some.

    “There is a measure of restlessness in either environment. First night syndrome is always a factor. If you can visit the lab first, and especially in your case where you went back, you should have some level of relaxation even in lab. If not on the third attempt, I'm afraid you may go un-diagnosed.

    “We were driven to the in hospital sleep lab by insurance companies who had sleep physicians on their respective boards who would not qualify us for preferred status. They were threatened by us running around the country side stealing their sleep studies.”

  4. What prompted me to write about the problems with the sleep study is simply that sleep medicine is so ineffective. We are looking at their “best shot” “golden standard” sleep study. So what about the “golden standard” continuous positive airway pressure (CPAP)?

    How usable is CPAP? A recent study outlines the sorry reality[1]:

    …Epidemiological data show that on average 25% of OSA patients do not accept CPAP treatment and, of those who undertake the therapy, only 30-60% can be considered adherent [8]. An acceptable adherence to therapy is usually considered a minimum of 4 hours/night for at least 70% of the nights of therapy [9]…

    So bottom line, between 85% and 55% of people find CPAP simply UNUSABLE.

    Most people find CPAP unusable long term.

    After looking at many studies regarding what they call “compliance” or “adherence” the numbers above look to me to be what I have read elsewhere when objective long term data is used. Yes I really do believe that it could be as low as 22% of people being actually able to use CPAP long term!

    So whatever is causing the problems they need solving and I mean way past yesterday!!

    To use a testing methodology which is simply understood to change the characteristics of what is measured is simply very bad science. And I very much believe the use of this bad science is a large part of what has led to the current very sad and very bad results.

    FWIW my vision of a valid true sleep study does not include a technologist present in the house as that would change the results of that study.

    [1] Usefulness of reinforcing interventions on continuous positive airway pressure compliance
    Lo Bue et al. BMC Pulmonary Medicine 2014, 14:78

    [2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman “Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets”, American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004.
    doi: 10.1164/rccm.201303-0448OC

    [3] X. S. Zhou , J. A. Rowley , F. Demirovic , M. P. Diamond , M. S. Badr
    Effect of testosterone on the apneic threshold in women during NREM sleep
    Journal of Applied Physiology Published 1 January 2003 Vol. 94 no. 1, 101-107

    [8] Catcheside PG: Predictors of continuous positive airway pressure adherence.
    F1000 Med Rep 2010, 2:70. doi:10.3410/M2-70.

    [9] Weaver TE, Grunstein RR: Adherence to continuous positive airway pressure therapy the challenge to effective treatment.
    Proc Am Thorac Soc 2008, 5:173–178.

  5. Patient compliance with CPAP is often correlated with patient education. Those who are better educated as to the purpose of using CPAP (and the risks that they take in not using it) tend to do much better than those who do not.

    There ARE numerous other options for treatment for sleep apnea as outlined at this link here:

    http://sleepyheadcentral.blogspot.com/2015/02/alternatives-therapies-for-sleep-apnea.html

    You seem to misunderstand what the “gold standard” refers to here. This is a term used widely in healthcare when discussing treatment options, not only in sleep medicine but elsewhere. The term is meant to point at what has been found to be the most effective treatment for a particular diagnosis. That doesn't mean it is going to work for everybody or that it is perfect; it only means that this is the best solution that suits most patients.

    Also, please keep in mind that a sleep study not only assists in diagnosing and treating sleep apnea, but it also documents many other (over 80) kinds of sleep disorders, including Periodic Leg Movement Disorder, parasomnias, epilepsy-related disorders, hypersomnias, upper airway resistant syndrome, circadian rhythm issues, and much much more; not all sleep disorder diagnoses are going to lead to CPAP as a therapy (not even close). Each of these different sleep disorders has a separate “gold standard” that has nothing to do with CPAP.

    Also keep in mind that sometimes patients will have combinations of both apnea and other disorders.

    Finally, it's important to note that sleep medicine is still a very young profession. We didn't even have a treatment for sleep apnea other than tracheostomy until the early 1980s. That's a very short time to develop treatments but they have come a long way in that period of time. Machines are more quiet, masks are more comfortable and smaller and technologies are smarter.

    An in-home sleep study without an attending technologist already happens, it's called an HST (home sleep test) and it is a somewhat crude and inaccurate test for determining whether a patient may have a sleep breathing disorder. It has many flaws and is only good for ruling in/out patients and does not come close to measuring severity of apnea with any accuracy.

    Finally, the purpose of an attended test is primarily to make sure the test is not tampered with. Patients who do not want the test to begin with can do all manner of things to tamper with it for an inconclusive result. The presence of an attending tech is to keep the test as objective and pure in its data collection as possible.

    I'm sorry you feel that not enough is being done to treat apnea and that your opinion is that because some fail CPAP, that it is a 100% failure. I would love you to meet the people for whom CPAP has been a lifesaver and hear their stories. I'll see if I can find some of them to comment.

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