Anyone have experience w/in-home sleep studies?
Question:
Dan wrote: > SS-Well, call me cynical, but my personal opinion is they like the lab > tests because they can CHARGE a helluva lot more. Especially if they > have all the equipment sitting there. Even if > newer/smaller/faster/better approaches have come about (as they are > likely to do with testing that’s as computer/electronic in nature as > somnography) the drs who have a big investment in the older approach > are going to want to stick with it (even if all those 3 grand a pop > overnighters paid it off long ago… ) The US in general is very > "procedure oriented" when it comes to health care compared to other > countries. Interesting that despite all out "high tech", we rank 37th > globally in life expectancy, right between Costa Rica & Slovenia. > Obviously something’s wrong ;-( Anyway, do you recall if the > test/apparatus you used had a particular name?
It is true statistically. The return, statistically, may be much lower for a lab test relative to a home test. In the great majority of cases the additional expense is not going to be cost effective. For the majority an AutoPAP for a week at home will result in a perfectly good prescription or non-prescription. In a measurable number of cases the prescription (or non-prescription) may not be optimal, complete, or even a benefit. What is your preference? I pay for health insurance. If I have a (covered) choice between a comprehensive lab test or home test I’m going to opt for the lab test. I figure there will be trained personel conducting the test that can ensure the proper environment, equipment setup and operation, subjective observations, parameter tuning to focus more on certain areas that might warrant it, optional procedures, etc. Excluding the cost, I don’t think anyone can argue that a lab test will be more comprehensive, more thorough, and just plain "better". It all depends if you are looking at it from your personal perspective or statistically. I think that in the US the mindset is more of you get what you can afford whereas the rest of the world has more of a socialized health care outlook. -Quick
Response:
On Mon, 20 Dec 2004 16:59:12 -0500, Dan wrote: >Interesting that despite all out "high tech", we rank 37th >globally in life expectancy, right between Costa Rica & Slovenia. >Obviously something’s wrong ;-(
If you look, we do have a fairly high murder rate.
Response:
In my Kaiser area they use the "Star Dust" by Respironics "Dan" <prograd…@hotmail.com> wrote in message
news:32p0h4F3qt9n8U2@individual.net… – Hide quoted text — Show quoted text -> Barb-Do you recall the name of the test or equipment you used? > Dan > Berkeley_Barb wrote: > > Hi Dan > > I am lucky enough to belong to Kaiser and they provided a test that was > > taken at home. I had to take it twice, because one thing didn’t work, > > but we finally got it done. It was painless and I feel, very good. If > > you have a HMO maybe they would do the test. > > Good luck > > Berkeley Barb > > Dan wrote: > >>I think I may have a sleep related problem, and had an initial > >>consultation with a sleep center in the area, which (not > > surprisingly) > >>recommended their in-center sleep study. Around $2-3,000, as I > > recall. > >> At the time (about a year ago) I did not have insurance (I do now) > > so > >>the cost put me off, but even more of a concern is the fact that I > > have > >>ZERO doubt I would not be able to sleep 2 winks in the setting they > >>showed me. I often have enough trouble falling asleep in a very nice > >>hotel room with my wife when we travel, let alone all wired up in a > > lab. > >> When I told them this & asked what they do in such cases, they > > replied > >>that after about 6 miserable hours of tossing & turning, they would > > call > >>the dr. at home & get authorization to give sleep medication. I’m no > >>expert, but it seems to me this might well skew the data. Also, to > > my > >>question "And if I DON’T sleep, do I still have to PAY???" They of > >>course replied "yes". It occurred to me that SOMEONE must have put > >>software on a laptop one could take home which would record at least > > the > >>majority of data required to come up with some findings, conclusions > >>which it would seem would be more representative than what you’d get > >>under the artificial & stressful atmosphere of a lab, especially if > >>you’re drugged. Even if they wanted to "observe" you, I’m sure this > >>could be done at home with modern digital video technology. And I’m > >>sure most of us have the brains to be able to stick on the requisite > >>test leads etc. as instructed by the doctor & staff while sitting on > > the > >>edge of our beds at home. I guess they figure it’d be harder to get > >>people to pony up 3 grand for this. I did a brief search & did find > > at > >>least one place that offers a home test, called "Sleep Quest", the > >>portion of their web site dealing with at-home testing is > >>http://store.yahoo.com/sleepquest/testsection.html The have a rig > > that > >>fits entirely on the patient’s left arm, and is said to "measure > >>peripheral arterial tone (PAT). (Peripheral arterial tone accurately > >>identifies respiratory events during sleep). In addition to the PAT > >>Signal, the Watch_PAT100 records oxygen saturation, pulse rate, > > movement > >>(actigraphy) and sleep/wake states". $495.00, including a report for > >>your doctor. Before I look any further, I thought I see if any of > > the > >>knowledgable people on this NG have had any experience with home > > testing > >>in general and "Sleep Quest" in particular. > >>TIA > >>Dan
Response:
- Hide quoted text — Show quoted text -Andy Hall wrote: > On 22 Dec 2004 22:41:07 GMT, jakewr…@aol.com (JakeWrite) wrote: >>>> I think I may have a sleep related problem, and had an initial >>>> consultation with a sleep center in the area, which (not >>>> surprisingly) recommended their in-center sleep study >> Yep, not surprising at all, since there is no substitute for a >> full-blown PSG test in an accredited sleep lab. > That depends on the condition for which the diagnosis is being made. > Portable testing is completely suitable for a lot of patients where > uncomplicated OSA is suspected especially if the patient is going to > have difficulty in an artificial lab environment. > This is not to say that there are not situations where a lab PSG does > not make the most sense, but it isn’t always necessary to throw the > whole gamut of science in where a simple diagnosis is being sought.
Right, but how do you know that until you have a full-blown PSG? Much of your argument is after the fact. "uncomplicated OSA is suspected". Even though it may be an informed suspicion it is still a suspicion. Even if a simple test confirms an uncomplicated suspicion it does not eliminate other disorders that may be present. What you propose is probably the most cost effective approach from a provider’s point of view. The majority of patients would probably not be referred for further diagnosis. Many of those would probably end up with completely adequate treatment. Others’ overall condition would be improved but not as much as it could be and additional disorders would go undiagnosed. We have/had a saying over here "Close enough for government work". -Quick
Response:
Dan <prograd…@hotmail.com> wrote: >I completely agree! This dr made a big deal of how they give you a >continental breakfast in the morning, after which you hang around till >about 11 when they have you take a nap for another test. I’d be even >LESS likely to sleep during THAT portion!
Then you’ll probably pass the Multiple Sleep Latency Test (MSLT). 
>Jeez, I’m sounding like a real boozer here, in >fact I generally have maybe 2-3 glasses of red wine a night with dinner.
That shouldn’t affect anything either way, the alcohol should be gone after three hours. > I’ll definately keep the Ambien in mind.
Please do, it got me through two titrations. Tom – Hide quoted text — Show quoted text ->Dan >Tom Devlin wrote: >> Dan <prograd…@hotmail.com> wrote: >>>Thanks Rob, I have used Ambien a time or 2, it does perform as >>>advertised. I know I’d need SOMETHING & I doubt they’d let me bring in >>>a couple bottles of 2 buck chuck 
>> I’ve always thought that someone who usually has a couple of drinks in >> the evening should be allowed to do the same at a sleep test. Isn’t >> the whole idea to re-create your normal sleeping environment? >> Anyway… My sleep doctors both prescribed Ambien when I mentioned >> that I had trouble sleeping in strange locations. Just make sure that >> the folks at the sleep lab know about the prescription, they get >> positively _frosty_ about "unapproved" sleep meds. >> Tom
Response:
On 22 Dec 2004 22:41:07 GMT, jakewr…@aol.com (JakeWrite) wrote: >>> I think I may have a sleep related problem, and had an initial >>> consultation with a sleep center in the area, which (not surprisingly) >>> recommended their in-center sleep study >Yep, not surprising at all, since there is no substitute for a full-blown PSG >test in an accredited sleep lab.
That depends on the condition for which the diagnosis is being made. Portable testing is completely suitable for a lot of patients where uncomplicated OSA is suspected especially if the patient is going to have difficulty in an artificial lab environment. This is not to say that there are not situations where a lab PSG does not make the most sense, but it isn’t always necessary to throw the whole gamut of science in where a simple diagnosis is being sought. >>to me that SOMEONE must have put >>> software on a laptop one could take home which would record at least the >>> majority of data required to come up with some findings, conclusions >>> which it would seem would be more representative than what you’d get >That would be nice, yes.
It’s perfectly possible and already in use. For example http://www.medcare.com/products/diagnostic/embletta/ >>And I’m >>> sure most of us have the brains to be able to stick on the requisite >>> test leads etc. as instructed by the doctor & staff while sitting on the >>> edge of our beds at home. >Probably not. The leads are placed in very specific areas, which may need to be >shaved down and then glued. It’s a pain in the ass (I speak as someone who’s >had four studies), and I’m sure I’d fluck it up if left to my own devices.
It depends on the instrumentation being used. There are various sensors that can be used for diagnosis of certain sleep disorders that do not require EEG electrodes etc. – Hide quoted text — Show quoted text ->> I guess they figure it’d be harder to get >>> people to pony up 3 grand for this. >Your cynicism is going to interfere with you getting help. Trust me on this >one. >> I did a brief search & did find at >>> least one place that offers a home test, called "Sleep Quest", the >>> portion of their web site dealing with at-home testing is >>> http://store.yahoo.com/sleepquest/testsection.html The have a rig that >>> fits entirely on the patient’s left arm, and is said to "measure >>> peripheral arterial tone (PAT). (Peripheral arterial tone accurately >>> identifies respiratory events during sleep). In addition to the PAT >>> Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement >>> (actigraphy) and sleep/wake states". $495.00, including a report for >>> your doctor. Before I look any further, I thought I see if any of the >>> knowledgable people on this NG have had any experience with home testing >>> in general and "Sleep Quest" in particular. >I took the Sleep Quest PAT test in late 2003 due to my dissatisfaction with my >sleep physician and the stuttered nature of my sleep during in-clinic PSGs. I >was hoping for a "cleaner" result. >The equipment was non-invasive, just as advertised. Two finger clips measure >the peripheral arterial tone and oxygen levels in your blood. >The biggest problem with PAT is that it’s a very simplistic, generalized >overview of sleep disorder. It did record 197 respiratory disturbances during >the night, so it supported the results of the PSG, but could not be nearly as >comprehensive.
It really depends on the diagnoses being sought and the instrumentation used. A few years ago, the typical home study machine was just a recording oximeter and not too much more. Now they measure respiratory parameters, movement, position etc. etc. with improvements all the time. This isn’t intended to replace a lab study, but is suitable for certain SDB diagnosis applications. >It cannot titrate you, give details regarding the length and severity of the >breathing cessations, record snoring events, record leg movement, record time >spent in various sleep states, or observe your body/habits during the night.
If an autotitrating machine is used, then titration isn’t necessary anyway. Most of the other factors you mention can be measured by portable equipment. >In other words: it’s like having tooth pain and having a dentist treat you >based on a superficial examination…no x-rays, no probing, no pictures, no >questions about pain/problems, etc. >My advice to you is to TRY having the PSG done, because it will provide the >greatest amount of information in the most professional manner possible. If you >are concerned about not being able to fall asleep, then sleep for only 4-6 >hours the evening before. Force yourself to get up early and perform your >regular duties. >Failing that, take on a labor-intensive job that takes up the afternoon. Do >something to provoke greater than usual fatigue that will likely override any >mental obstacles you have going in.
If a variety of sleep disorders are suspected by the doctor, then a PSG probably does make sense. If he suspects simple OSA, then there is no reason not to use a home study approach. If there is OSA, then that needs to be treated anyway. Then if there are other sleep disorders after that, they can be made subject to further tests if necessary. >Be relaxed in the knowledge that if you can’t sleep, you can always resort to >the PAT…though there’s still the matter of getting titrated if you indeed >have apnea.
This is not required if an autotitrating flow generator is used. >You should probably accept that an in-clinic evaluation is going to happen at >some point. Some outfits offer an in-home study, but you’re probably going to >be just as uncomfortable at home with a strange dude in the adjacent room as >you will be in the clinic.
Could be, but perhaps less clinical…… — .andy To email, substitute .nospam with .gl
Response:
Don’t recall. you could call the Clnical Monitoring Center (Cupertino, CA) at 408 523 3461. Tech’s name was Henry Luu.
Response:
>> I think I may have a sleep related problem, and had an initial >> consultation with a sleep center in the area, which (not surprisingly) >> recommended their in-center sleep study
Yep, not surprising at all, since there is no substitute for a full-blown PSG test in an accredited sleep lab. >> the cost put me off, but even more of a concern is the fact that I have >> ZERO doubt I would not be able to sleep 2 winks in the setting they >> showed me.
I can sympathize – my problem wasn’t so much the surroundings as the fact that I felt like I HAD to get to sleep, otherwise I’d never have a solution to my problem. And, as anyone knows, having anxiety about sleep is the best way to never get any. I didn’t sleep well, but I did sleep…enough for them to diagnose sleep apnea. (And that does not appear to be my only problem, but that’s another novel.) >> expert, but it seems to me this might well skew the data. Also, to my >> question "And if I DON’T sleep, do I still have to PAY???" They of >> course replied "yes".
Of course. The time and expense isn’t negated just because you didn’t sleep. If the findings weren’t sufficient, they should be able to schedule another test at no additional expense, though. >to me that SOMEONE must have put >> software on a laptop one could take home which would record at least the >> majority of data required to come up with some findings, conclusions >> which it would seem would be more representative than what you’d get
That would be nice, yes. >> under the artificial & stressful atmosphere of a lab, especially if >> you’re drugged. Even if they wanted to "observe" you, I’m sure this >> could be done at home with modern digital video technology. And I’m
It comes down to practicality. Theoretically, a surgeon COULD take out your spleen in your own bed, but it would come at great effort, expense, stress, etc. >And I’m >> sure most of us have the brains to be able to stick on the requisite >> test leads etc. as instructed by the doctor & staff while sitting on the >> edge of our beds at home.
Probably not. The leads are placed in very specific areas, which may need to be shaved down and then glued. It’s a pain in the ass (I speak as someone who’s had four studies), and I’m sure I’d fluck it up if left to my own devices. > I guess they figure it’d be harder to get >> people to pony up 3 grand for this.
Your cynicism is going to interfere with you getting help. Trust me on this one. > I did a brief search & did find at >> least one place that offers a home test, called "Sleep Quest", the >> portion of their web site dealing with at-home testing is >> http://store.yahoo.com/sleepquest/testsection.html The have a rig that >> fits entirely on the patient’s left arm, and is said to "measure >> peripheral arterial tone (PAT). (Peripheral arterial tone accurately >> identifies respiratory events during sleep). In addition to the PAT >> Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement >> (actigraphy) and sleep/wake states". $495.00, including a report for >> your doctor. Before I look any further, I thought I see if any of the >> knowledgable people on this NG have had any experience with home testing >> in general and "Sleep Quest" in particular.
I took the Sleep Quest PAT test in late 2003 due to my dissatisfaction with my sleep physician and the stuttered nature of my sleep during in-clinic PSGs. I was hoping for a "cleaner" result. The equipment was non-invasive, just as advertised. Two finger clips measure the peripheral arterial tone and oxygen levels in your blood. The biggest problem with PAT is that it’s a very simplistic, generalized overview of sleep disorder. It did record 197 respiratory disturbances during the night, so it supported the results of the PSG, but could not be nearly as comprehensive. It cannot titrate you, give details regarding the length and severity of the breathing cessations, record snoring events, record leg movement, record time spent in various sleep states, or observe your body/habits during the night. In other words: it’s like having tooth pain and having a dentist treat you based on a superficial examination…no x-rays, no probing, no pictures, no questions about pain/problems, etc. My advice to you is to TRY having the PSG done, because it will provide the greatest amount of information in the most professional manner possible. If you are concerned about not being able to fall asleep, then sleep for only 4-6 hours the evening before. Force yourself to get up early and perform your regular duties. Failing that, take on a labor-intensive job that takes up the afternoon. Do something to provoke greater than usual fatigue that will likely override any mental obstacles you have going in. Be relaxed in the knowledge that if you can’t sleep, you can always resort to the PAT…though there’s still the matter of getting titrated if you indeed have apnea. You should probably accept that an in-clinic evaluation is going to happen at some point. Some outfits offer an in-home study, but you’re probably going to be just as uncomfortable at home with a strange dude in the adjacent room as you will be in the clinic. Good luck.
Response:
Barb-Do you recall the name of the test or equipment you used? Dan – Hide quoted text — Show quoted text -Berkeley_Barb wrote: > Hi Dan > I am lucky enough to belong to Kaiser and they provided a test that was > taken at home. I had to take it twice, because one thing didn’t work, > but we finally got it done. It was painless and I feel, very good. If > you have a HMO maybe they would do the test. > Good luck > Berkeley Barb > Dan wrote: >>I think I may have a sleep related problem, and had an initial >>consultation with a sleep center in the area, which (not > surprisingly) >>recommended their in-center sleep study. Around $2-3,000, as I > recall. >> At the time (about a year ago) I did not have insurance (I do now) > so >>the cost put me off, but even more of a concern is the fact that I > have >>ZERO doubt I would not be able to sleep 2 winks in the setting they >>showed me. I often have enough trouble falling asleep in a very nice >>hotel room with my wife when we travel, let alone all wired up in a > lab. >> When I told them this & asked what they do in such cases, they > replied >>that after about 6 miserable hours of tossing & turning, they would > call >>the dr. at home & get authorization to give sleep medication. I’m no >>expert, but it seems to me this might well skew the data. Also, to > my >>question "And if I DON’T sleep, do I still have to PAY???" They of >>course replied "yes". It occurred to me that SOMEONE must have put >>software on a laptop one could take home which would record at least > the >>majority of data required to come up with some findings, conclusions >>which it would seem would be more representative than what you’d get >>under the artificial & stressful atmosphere of a lab, especially if >>you’re drugged. Even if they wanted to "observe" you, I’m sure this >>could be done at home with modern digital video technology. And I’m >>sure most of us have the brains to be able to stick on the requisite >>test leads etc. as instructed by the doctor & staff while sitting on > the >>edge of our beds at home. I guess they figure it’d be harder to get >>people to pony up 3 grand for this. I did a brief search & did find > at >>least one place that offers a home test, called "Sleep Quest", the >>portion of their web site dealing with at-home testing is >>http://store.yahoo.com/sleepquest/testsection.html The have a rig > that >>fits entirely on the patient’s left arm, and is said to "measure >>peripheral arterial tone (PAT). (Peripheral arterial tone accurately >>identifies respiratory events during sleep). In addition to the PAT >>Signal, the Watch_PAT100 records oxygen saturation, pulse rate, > movement >>(actigraphy) and sleep/wake states". $495.00, including a report for >>your doctor. Before I look any further, I thought I see if any of > the >>knowledgable people on this NG have had any experience with home > testing >>in general and "Sleep Quest" in particular. >>TIA >>Dan
Response:
I completely agree! This dr made a big deal of how they give you a continental breakfast in the morning, after which you hang around till about 11 when they have you take a nap for another test. I’d be even LESS likely to sleep during THAT portion! Screw the breakfast, how about an open bar!!! Jeez, I’m sounding like a real boozer here, in fact I generally have maybe 2-3 glasses of red wine a night with dinner. I’ll definately keep the Ambien in mind. Dan – Hide quoted text — Show quoted text -Tom Devlin wrote: > Dan <prograd…@hotmail.com> wrote: >>Thanks Rob, I have used Ambien a time or 2, it does perform as >>advertised. I know I’d need SOMETHING & I doubt they’d let me bring in >>a couple bottles of 2 buck chuck > I’ve always thought that someone who usually has a couple of drinks in > the evening should be allowed to do the same at a sleep test. Isn’t > the whole idea to re-create your normal sleeping environment? > Anyway… My sleep doctors both prescribed Ambien when I mentioned > that I had trouble sleeping in strange locations. Just make sure that > the folks at the sleep lab know about the prescription, they get > positively _frosty_ about "unapproved" sleep meds. > Tom
Response:
SS-Well, call me cynical, but my personal opinion is they like the lab tests because they can CHARGE a helluva lot more. Especially if they have all the equipment sitting there. Even if newer/smaller/faster/better approaches have come about (as they are likely to do with testing that’s as computer/electronic in nature as somnography) the drs who have a big investment in the older approach are going to want to stick with it (even if all those 3 grand a pop overnighters paid it off long ago… ) The US in general is very "procedure oriented" when it comes to health care compared to other countries. Interesting that despite all out "high tech", we rank 37th globally in life expectancy, right between Costa Rica & Slovenia. Obviously something’s wrong ;-( Anyway, do you recall if the test/apparatus you used had a particular name? Thanks, Dan – Hide quoted text — Show quoted text -Sleepsearch wrote: > I was also lucky enough to have a test at home. I had to go and be > instructed by the polysomnographer about how to wire up the leads, but > then I took the small data collection and battery unit, along with the > leads, home. I had slender tube in my nose, a strap across the chest > to monitor heart beat, a stap across the abdomen for respiration, a > thing on my wrist to measure movement, a blood oxygen monitor in my > finger, and motion sensors on both legs. I took 1/2 valium and slept > fine. Then I had to bring the equipment back into the lab the next day > before the battery wore out. This equip could not only tell when I > fell asleep and woke up and how many apnea episodes I had, it could > tell my sleeping position! I can’t see why they’d need to have you in > a lab if they can tell all that from a relatively simple set of > equipment.
Response:
"Sleepsearch" <alans…@comcast.net> wrote in message
news:1103504710.854943.73040@z14g2000cwz.googlegroups.com… > I was also lucky enough to have a test at home. I had to go and be > instructed by the polysomnographer about how to wire up the leads, but > then I took the small data collection and battery unit, along with the > leads, home. I had slender tube in my nose, a strap across the chest > to monitor heart beat, a stap across the abdomen for respiration, a > thing on my wrist to measure movement, a blood oxygen monitor in my > finger, and motion sensors on both legs. I took 1/2 valium and slept > fine. Then I had to bring the equipment back into the lab the next day > before the battery wore out. This equip could not only tell when I > fell asleep and woke up and how many apnea episodes I had, it could > tell my sleeping position! I can’t see why they’d need to have you in > a lab if they can tell all that from a relatively simple set of > equipment.
Doctors need Mauii condos?
Response:
Dan <prograd…@hotmail.com> wrote: >Thanks Rob, I have used Ambien a time or 2, it does perform as >advertised. I know I’d need SOMETHING & I doubt they’d let me bring in >a couple bottles of 2 buck chuck
I’ve always thought that someone who usually has a couple of drinks in the evening should be allowed to do the same at a sleep test. Isn’t the whole idea to re-create your normal sleeping environment? Anyway… My sleep doctors both prescribed Ambien when I mentioned that I had trouble sleeping in strange locations. Just make sure that the folks at the sleep lab know about the prescription, they get positively _frosty_ about "unapproved" sleep meds. Tom
Response:
I was also lucky enough to have a test at home. I had to go and be instructed by the polysomnographer about how to wire up the leads, but then I took the small data collection and battery unit, along with the leads, home. I had slender tube in my nose, a strap across the chest to monitor heart beat, a stap across the abdomen for respiration, a thing on my wrist to measure movement, a blood oxygen monitor in my finger, and motion sensors on both legs. I took 1/2 valium and slept fine. Then I had to bring the equipment back into the lab the next day before the battery wore out. This equip could not only tell when I fell asleep and woke up and how many apnea episodes I had, it could tell my sleeping position! I can’t see why they’d need to have you in a lab if they can tell all that from a relatively simple set of equipment.
Response:
Hi Dan I am lucky enough to belong to Kaiser and they provided a test that was taken at home. I had to take it twice, because one thing didn’t work, but we finally got it done. It was painless and I feel, very good. If you have a HMO maybe they would do the test. Good luck Berkeley Barb – Hide quoted text — Show quoted text -Dan wrote: > I think I may have a sleep related problem, and had an initial > consultation with a sleep center in the area, which (not surprisingly) > recommended their in-center sleep study. Around $2-3,000, as I recall. > At the time (about a year ago) I did not have insurance (I do now) so > the cost put me off, but even more of a concern is the fact that I have > ZERO doubt I would not be able to sleep 2 winks in the setting they > showed me. I often have enough trouble falling asleep in a very nice > hotel room with my wife when we travel, let alone all wired up in a lab. > When I told them this & asked what they do in such cases, they replied > that after about 6 miserable hours of tossing & turning, they would call > the dr. at home & get authorization to give sleep medication. I’m no > expert, but it seems to me this might well skew the data. Also, to my > question "And if I DON’T sleep, do I still have to PAY???" They of > course replied "yes". It occurred to me that SOMEONE must have put > software on a laptop one could take home which would record at least the > majority of data required to come up with some findings, conclusions > which it would seem would be more representative than what you’d get > under the artificial & stressful atmosphere of a lab, especially if > you’re drugged. Even if they wanted to "observe" you, I’m sure this > could be done at home with modern digital video technology. And I’m > sure most of us have the brains to be able to stick on the requisite > test leads etc. as instructed by the doctor & staff while sitting on the > edge of our beds at home. I guess they figure it’d be harder to get > people to pony up 3 grand for this. I did a brief search & did find at > least one place that offers a home test, called "Sleep Quest", the > portion of their web site dealing with at-home testing is > http://store.yahoo.com/sleepquest/testsection.html The have a rig that > fits entirely on the patient’s left arm, and is said to "measure > peripheral arterial tone (PAT). (Peripheral arterial tone accurately > identifies respiratory events during sleep). In addition to the PAT > Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement > (actigraphy) and sleep/wake states". $495.00, including a report for > your doctor. Before I look any further, I thought I see if any of the > knowledgable people on this NG have had any experience with home testing > in general and "Sleep Quest" in particular. > TIA > Dan
Response:
Thanks Rob, I have used Ambien a time or 2, it does perform as advertised. I know I’d need SOMETHING & I doubt they’d let me bring in a couple bottles of 2 buck chuck The dr (who I didn’t really like on a number of levels, but I digress… ) said that when evaluating the data they’d just keep the drug’s presence in mind. My wife & I are in the process of moving so are sort of in limbo now, but when we finally settle I’ll check into this more aggressively. Dan – Hide quoted text — Show quoted text -rob wrote: > If you decide to go for a sleep lab test ask your doctor for a ambien > sleeping pill. It will put you asleep quickly and keep you asleep for > 2.5 hours. Maybe you will stay asleep. This will not effect the data > by a significant amount. Some of the HMO use at home sleep testing. > You might contact them to find out about the availablity of Home sleep > tests in your area.
Response:
I agree as well. If OSA is suspected and needs to be verified and quantified I believe a home evaluation would be adaquate in a great many cases and then available to a much larger number of people. The OP commented that a full sleep study in the lab would cost him $2000-$3000 and that you would think someone could have put this on a PC or something so that people could do this at home mentioning that the majority of us were smart enough to wire themselves up. It was only this that I disagree with. I don’t think the "smart" part (although still a factor) is as much of an issue as the physical/mechanical part. and then there is the monitoring afterwards. This all in the context of a full study. -Quick
Response:
- Hide quoted text — Show quoted text -Dan wrote: > I think I may have a sleep related problem, and had an initial > consultation with a sleep center in the area, which (not surprisingly) > recommended their in-center sleep study. Around $2-3,000, as I recall. > At the time (about a year ago) I did not have insurance (I do now) so > the cost put me off, but even more of a concern is the fact that I have > ZERO doubt I would not be able to sleep 2 winks in the setting they > showed me. I often have enough trouble falling asleep in a very nice > hotel room with my wife when we travel, let alone all wired up in a lab. > When I told them this & asked what they do in such cases, they replied > that after about 6 miserable hours of tossing & turning, they would call > the dr. at home & get authorization to give sleep medication. I’m no > expert, but it seems to me this might well skew the data. Also, to my > question "And if I DON’T sleep, do I still have to PAY???" They of > course replied "yes". It occurred to me that SOMEONE must have put > software on a laptop one could take home which would record at least the > majority of data required to come up with some findings, conclusions > which it would seem would be more representative than what you’d get > under the artificial & stressful atmosphere of a lab, especially if > you’re drugged. Even if they wanted to "observe" you, I’m sure this > could be done at home with modern digital video technology. And I’m > sure most of us have the brains to be able to stick on the requisite > test leads etc. as instructed by the doctor & staff while sitting on the > edge of our beds at home. I guess they figure it’d be harder to get > people to pony up 3 grand for this. I did a brief search & did find at > least one place that offers a home test, called "Sleep Quest", the > portion of their web site dealing with at-home testing is > http://store.yahoo.com/sleepquest/testsection.html The have a rig that > fits entirely on the patient’s left arm, and is said to "measure > peripheral arterial tone (PAT). (Peripheral arterial tone accurately > identifies respiratory events during sleep). In addition to the PAT > Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement > (actigraphy) and sleep/wake states". $495.00, including a report for > your doctor. Before I look any further, I thought I see if any of the > knowledgable people on this NG have had any experience with home testing > in general and "Sleep Quest" in particular. > TIA > Dan
If you decide to go for a sleep lab test ask your doctor for a ambien sleeping pill. It will put you asleep quickly and keep you asleep for 2.5 hours. Maybe you will stay asleep. This will not effect the data by a significant amount. Some of the HMO use at home sleep testing. You might contact them to find out about the availablity of Home sleep tests in your area.
Response:
> Actually, to get wired for a full sleep study, I’d be willing to bet > that greater than 90% would fail. and then who is going to be able > to tell you that lead #12 has come loose a couple of hours later… > > -Quick No doubt there are some for whom home testing is not a good approach, but I think with proper instruction the figure would be much lower, and a bit of reading I’ve done on MedLine and elsewhere since posting here supports this. According to one study done in Barcelona, the data acquisition failure rate for was 2.8% in the lab & 5.7% at home, an insignificant difference. A study at Brigham and Women’s hospital in Boston titled "Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation" tested the device used by the people I referred to in my OP and concluded "In a population of patients suspected of having obstructive sleep apnea, the Watch_PAT can quantify an Oxygen Desaturation Index that compares very well with Medicare criteria for defining respiratory events and an Respiratory Disturbance Index that compares favorably with Chicago criteria for defining respiratory events. The device can be used with a low failure rate for single use in the lab and home for self-administered testing". Another study carried out at the University on Minnesota this year concluded "median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters. Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting. Call me cynical, but I think as with all things in life, it pays to "follow the money". If the center I went to a year ago is typical (and it probably is), a lot of sleep doctors have a heavy investment in lab setups which they are inclined to utlize as much as possible. Dan – Hide quoted text — Show quoted text –
Response:
Andy-I agree. You have to wonder if a full-bore polysomnograph is actually required in each case, at the very least for initial screening. And as you said, there’s more than just cost & convenience at stake here; the current lab approach limits the number of patients able to access care. In the US we have often a tendency to throw a lot more costly technology at a health problem than is required, in the end increasing cost while lowering access. Dan – Hide quoted text — Show quoted text -Andy Hall wrote: > Two points here. > If OSA is strongly suspected by the doctor and/or partner/parent etc. > then a test just for that can be done without large numbers of sensors > and data being gathered. This is the purpose of simpler home testing > equipment – i,e, reaching more people at lower cost and with an > environment and test regime that does the job. It seems to me tha > tputting a small child in a hospital and wiring him up with a load of > electrodes isn’t ideal. > For more sophisticated testing, it is surprising how.smart equipment > has become. I recently went for an ECG at my GP surgery. THe > machine connected via 12 electrodes, IIRC and the doctor transposed > two of them by mistake. There was a message on the display that this > had happened and which two it was.
Response:
On Tue, 23 Nov 2004 10:22:43 -0800, "Quick" <quick7135-n…@NOSPAMyahoo.com> wrote: >I’d love to hear more about this. I have 3 boys – 6, 5, and 5. >I’m pretty sure one of the 5yr olds has OSA. I’m working up >to getting him tested. This would be great for kids. >Just looking at the thing on the web I wonder if it’s much more >than an advanced, recording, oximeter?
There’s a whole range of them now, starting from an oximeter and then adding various forms of movement detection, pulse transit time http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&… and so on. >> "Dan" <Prograd…@hotmail.com> wrote in message >[snip] >>> And I’m sure most of us have the brains to be able to >>> stick on the requisite test leads etc. as instructed by the doctor & >>> staff while sitting on the edge of our beds at home. >Actually, to get wired for a full sleep study, I’d be willing to bet >that greater than 90% would fail. and then who is going to be able >to tell you that lead #12 has come loose a couple of hours later…
Two points here. If OSA is strongly suspected by the doctor and/or partner/parent etc. then a test just for that can be done without large numbers of sensors and data being gathered. This is the purpose of simpler home testing equipment – i,e, reaching more people at lower cost and with an environment and test regime that does the job. It seems to me tha tputting a small child in a hospital and wiring him up with a load of electrodes isn’t ideal. For more sophisticated testing, it is surprising how.smart equipment has become. I recently went for an ECG at my GP surgery. THe machine connected via 12 electrodes, IIRC and the doctor transposed two of them by mistake. There was a message on the display that this had happened and which two it was. — .andy To email, substitute .nospam with .gl
Response:
I’d love to hear more about this. I have 3 boys – 6, 5, and 5. I’m pretty sure one of the 5yr olds has OSA. I’m working up to getting him tested. This would be great for kids. Just looking at the thing on the web I wonder if it’s much more than an advanced, recording, oximeter? > "Dan" <Prograd…@hotmail.com> wrote in message [snip] >> And I’m sure most of us have the brains to be able to >> stick on the requisite test leads etc. as instructed by the doctor & >> staff while sitting on the edge of our beds at home.
Actually, to get wired for a full sleep study, I’d be willing to bet that greater than 90% would fail. and then who is going to be able to tell you that lead #12 has come loose a couple of hours later… -Quick
Response:
On Mon, 22 Nov 2004 19:44:11 -0500, Dan wrote: >I think I may have a sleep related problem, and had an initial >consultation with a sleep center in the area, which (not surprisingly) >recommended their in-center sleep study. Around $2-3,000, as I recall. > At the time (about a year ago) I did not have insurance (I do now) so >the cost put me off, but even more of a concern is the fact that I have >ZERO doubt I would not be able to sleep 2 winks in the setting they >showed me.
A lot of insurance won’t pay for in-home sleep studies because they have trouble getting good data. Unless they’re somebody who uses a polysomnogram data acquisition module with a laptop/portable PC…. but that’s likely to be as expensive as in-center.
Response:
Some HMO’s will let you do home sleep study like the "Star Dust" by Respironics for example. Gee I did not know that sleep study will cost that much without insurance. "Dan" <Prograd…@hotmail.com> wrote in message
news:30ffeoF2smdf3U1@uni-berlin.de… – Hide quoted text — Show quoted text -> I think I may have a sleep related problem, and had an initial > consultation with a sleep center in the area, which (not surprisingly) > recommended their in-center sleep study. Around $2-3,000, as I recall. > At the time (about a year ago) I did not have insurance (I do now) so > the cost put me off, but even more of a concern is the fact that I have > ZERO doubt I would not be able to sleep 2 winks in the setting they > showed me. I often have enough trouble falling asleep in a very nice > hotel room with my wife when we travel, let alone all wired up in a lab. > When I told them this & asked what they do in such cases, they replied > that after about 6 miserable hours of tossing & turning, they would call > the dr. at home & get authorization to give sleep medication. I’m no > expert, but it seems to me this might well skew the data. Also, to my > question "And if I DON’T sleep, do I still have to PAY???" They of > course replied "yes". It occurred to me that SOMEONE must have put > software on a laptop one could take home which would record at least the > majority of data required to come up with some findings, conclusions > which it would seem would be more representative than what you’d get > under the artificial & stressful atmosphere of a lab, especially if > you’re drugged. Even if they wanted to "observe" you, I’m sure this > could be done at home with modern digital video technology. And I’m > sure most of us have the brains to be able to stick on the requisite > test leads etc. as instructed by the doctor & staff while sitting on the > edge of our beds at home. I guess they figure it’d be harder to get > people to pony up 3 grand for this. I did a brief search & did find at > least one place that offers a home test, called "Sleep Quest", the > portion of their web site dealing with at-home testing is > http://store.yahoo.com/sleepquest/testsection.html The have a rig that > fits entirely on the patient’s left arm, and is said to "measure > peripheral arterial tone (PAT). (Peripheral arterial tone accurately > identifies respiratory events during sleep). In addition to the PAT > Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement > (actigraphy) and sleep/wake states". $495.00, including a report for > your doctor. Before I look any further, I thought I see if any of the > knowledgable people on this NG have had any experience with home testing > in general and "Sleep Quest" in particular. > TIA > Dan
Response:
I think I may have a sleep related problem, and had an initial consultation with a sleep center in the area, which (not surprisingly) recommended their in-center sleep study. Around $2-3,000, as I recall. At the time (about a year ago) I did not have insurance (I do now) so the cost put me off, but even more of a concern is the fact that I have ZERO doubt I would not be able to sleep 2 winks in the setting they showed me. I often have enough trouble falling asleep in a very nice hotel room with my wife when we travel, let alone all wired up in a lab. When I told them this & asked what they do in such cases, they replied that after about 6 miserable hours of tossing & turning, they would call the dr. at home & get authorization to give sleep medication. I’m no expert, but it seems to me this might well skew the data. Also, to my question "And if I DON’T sleep, do I still have to PAY???" They of course replied "yes". It occurred to me that SOMEONE must have put software on a laptop one could take home which would record at least the majority of data required to come up with some findings, conclusions which it would seem would be more representative than what you’d get under the artificial & stressful atmosphere of a lab, especially if you’re drugged. Even if they wanted to "observe" you, I’m sure this could be done at home with modern digital video technology. And I’m sure most of us have the brains to be able to stick on the requisite test leads etc. as instructed by the doctor & staff while sitting on the edge of our beds at home. I guess they figure it’d be harder to get people to pony up 3 grand for this. I did a brief search & did find at least one place that offers a home test, called "Sleep Quest", the portion of their web site dealing with at-home testing is http://store.yahoo.com/sleepquest/testsection.html The have a rig that fits entirely on the patient’s left arm, and is said to "measure peripheral arterial tone (PAT). (Peripheral arterial tone accurately identifies respiratory events during sleep). In addition to the PAT Signal, the Watch_PAT100 records oxygen saturation, pulse rate, movement (actigraphy) and sleep/wake states". $495.00, including a report for your doctor. Before I look any further, I thought I see if any of the knowledgable people on this NG have had any experience with home testing in general and "Sleep Quest" in particular. TIA Dan
