[UK] At-home sleep study

[InitialConditions]

My first thought was of keeping the kit until eventually you get psss-out sleep (and then thinking with a lot of these illnesses it surely needs to be more than just a 12hr slot on one designated night anyway) or them booking in for it to be lent for more days just in case next time

The NHS is under such constraints that they need the devices back ASAP. Mine had to be back before 11am the next day, which in itself would be a problem had I not got my mum to help with stuff like this.

A question in my head too is just what their reaction would be to those who sleep at unusual times (and sleep hygiene being imposed made it so bad as it makes me/cfs worse so it’s a terror it might get suggested) I mean how awful to instead of be intrigued by what’s going on to focus on telling you what you know (you sleep at wrong times) but then suggesting wrongly that’s the cause not the symptom.

They program the devices to record from 11 pm until 7 am, but this can be changed according to the patient's sleep habits. Although I don't know how they'd approach someone with complete sleep reversal.

 

[Mij]

I was monitored by a low-light video camera to see what was happening in the room when the lights go out. How weird was that? They watched me reading a book for hours with the light on b/c I couldn't initiate sleep. Then the technologist came and told me to 'try' to sleep. Did they think I came to the hospital to read?

 

[nataliezzz]

I meant to say before...the best option for home sleep study (and maybe even the best option in general) may be WatchPAT, especially for those who have difficulty tolerating more stuff on them, as it is only a watch, a finger sensor, and a sensor on the chest.

The reason I say it may be the best option in general is that I think you are actually more likely to get an OSA diagnosis (AHI ≥ 5; and most sleep doctors will only prescribe treatment based on meeting this arbitrary cutoff) from WatchPAT than from an in-lab or home polysomnogram (PSG). WatchPAT appears to often inflate AHI as there are no airflow sensors so it cannot distinguish between a non-hypoxic hypopnea terminating in an arousal and a respiratory effort-related arousal (RERA) (there really is no difference besides degree of airflow reduction); I think it tends to score respiratory-related arousals that would normally be scored as RERAs on PSG as hypopneas. I had an AHI of 7.1 on WatchPAT vs. AHIs of 3.6 and 1.2 on in-lab PSGs.

You can call around to clinics and see who uses WatchPAT for home sleep studies. If you live in the US, Anil Rama is also a doctor who is licensed in 20 states and does telehealth; he can order a WatchPAT home study and rent people CPAP, BiPAP and ASV machines via mail to try out (this is an appealing option as many people don't tolerate CPAP -- or may technically tolerate it, but do much better on bilevel devices -- and it is difficult to get most doctors to prescribe bilevel devices and for insurance to cover them).

Discussion on CPAP vs. bilevel devices here:

Clinically, ASV (adaptive servo-ventilation, a type of bilevel* positive airway pressure (PAP) device that can alter pressure support -- the difference between inspiratory and expiratory pressure -- on a breath-to-breath basis) led to remission (ISI < 8) in 68% of cases compared to 24% on CPAP (Fisher's exact p = 0.010). Measures of impairment, residual objective sleep breathing events, and normalized breathing periods consistently demonstrated larger beneficial effects for ASV over CPAP.

*Bilevel devices have adjustable pressure support (PS) - the difference between inspiratory pressure (IPAP) and expiratory pressure (EPAP), whereas CPAP provides one fixed, continuous pressure on inhalation and exhalation (ResMed CPAP machines have expiratory pressure relief [EPR] and Philips CPAP machines have C-Flex/A-Flex, which lower the pressure on exhalation, but EPR/Flex have different algorithms than PS and only go up to 3 cm H2O).

A discussion of bilevel devices by Dr. Krakow: https://apneaboard.com/wiki/index.php/Flow_Limitation/UARS_and_BiPAP
One potentially relevant factor: consistent with Dr. Gold's olfactory-limbic model, lower expiratory pressure may reduce the iatrogenic stressor of PAP on a sensitized limbic system, producing a stimulus closer to normal unobstructed breathing.

A discussion of why many patients tolerate and benefit from bilevel devices (BiPAP/ASV) over CPAP by Dr. Krakow: