Sleep Study tonight

[DFH65]

Sleep Study tonight - Update

As I have probably mentioned before I had a previous diagnosis for OSA about 10 years ago and didn't do anything about it. Besides losing weight (down 46.2 as of today) I am trying to get everything else squared away (and just feel better too) so I can possibly get flying again. One of the obstacles is dealing with this old diagnosis and getting all my ducks in a row.

So anything I need to know? Anything I need to ask or do (other than sleep)?

I tried studying for the sleep test but still not sure I am prepared.

 

[Papa Foxtrot]

Don't plan to get much sleep. They'll let you sleep just long enough to get what they need on the data record. Really not much else to do in preparation.

 

[Papa Foxtrot]

As I have probably mentioned before I had a previous diagnosis for OSA about 10 years ago and didn't do anything about it.

Good grief man!! Just read this again, you've had OSA for 10 years with no treatment???

 

[Matthew]

They'll run about 300 wires from your head into the wall, then tell you to go to sleep.

After a while, they'll wake you up, plug you into a cpap then tell you to go back to sleep. During that time they'll adjust the cpap to find an optimal setting. Then they'll wake you up and send you home.

Not much to it. Expect the report back in a couple weeks.

 

[DFH65]

Good grief man!! Just read this again, you've had OSA for 10 years with no treatment???

Some people smoke (I don't) some people drink (I don't) some people do other stupid things (well ya got me there).

It is a long story but I was unemployed at the time and the ENT I saws first recommendation was to fix a deviated septum (although he did say that might not fix the problem). I was looking for jobs pretty desperately at the time so put off surgery and weeks became months, months years and well here I am trying to get it resolved now. Water over the bridge.

 

[DFH65]

I know what the process is just wondering if there is anything specific I should ask or avoid? Assuming you need a machine do they provide one or do they just provide you the settings and you go buy one?

 

[AuntPeggy]

You want to be comfortable. Remember, the purpose of a sleep study is to diagnose with a sleep disorder. Wear comfortable pajamas that you can run wires down. You will be video taped. If you are cold, or even cool, demand enough blankets that you do not wake up from the chill. If something about the setup is keeping you awake, complain about it and possibly call off the test until it is fixed. Seriously. They expect you to have disturbed sleep. Don't enable them.

Expect it will take at least an hour to affix all the wires and mask.

 

[Gary F]

I know what the process is just wondering if there is anything specific I should ask or avoid? Assuming you need a machine do they provide one or do they just provide you the settings and you go buy one?

A good sleep physician will carefully prescribe the right machine and settings and test it on you with a another sleep study. I think that at some places they can try out a CPAP machine during the second half of the study if you flunk the first part.

 

[DFH65]

This place is interesting being in a smaller town instead of of being at a sleep clinic like the first one I had in a bigger city they are set up at a Hampton Inn just down the road from the hospital.

I guess from their stand point it make sense someone to clean the sheets, a more comfortable atmosphere and such. Hopefully I will wake up with both kidneys still in place.

 

[Papa Foxtrot]

Assuming you need a machine do they provide one or do they just provide you the settings and you go buy one?

You likely won't find out if you need a machine until the follow-up with the sleep doc a couple weeks later. This is where it gets tricky. Ask what machine they're going to sell you and find out its capabilities. For example, all the machines that my sleep center sells log compliance data only and they sell them for much more than I can buy a more capable machine for online.

Figure out what your insurance is going to pay. With my copay and the inflated prices my sleep center is charging for machines, I'm better off out of pocket with a better machine purchased online. To buy online, your doc will need to give you a prescription for the machine and "accessories"(even masks require a script these days).

There are several forums online to find out about the different machines and their capabilities and there are several of us here that have lots of experience "on the machine". Feel free to ask!

 

[Papa Foxtrot]

Water over the bridge.

Understand - sometimes life happens while we aren't paying attention. I've got 16 years on the machine. It would be nice if there was a "cure", but until then I sleep well with it.

 

[Matthew]

I know what the process is just wondering if there is anything specific I should ask or avoid? Assuming you need a machine do they provide one or do they just provide you the settings and you go buy one?

They'll send a report to you or your doc. Your doc will write a prescription. After that, it's up to you. You can go through your ins co who will deal with a DME supplier - in that case they will give you whatever machine fits the script, and makes them the largest profit. Or, you can go online and buy your own and get exactly what you want, then get reimbursed by your ins co. It's up to you, it's no different from shopping pharmacies to see who has the best deal. The most important thing - make sure that whatever machine you get has recording/reporting capabilties. Not all do, FAA is startng to require machine reports.

The other deal is masks. For this, the first time, I recommend using a DME supplier. You'll see a real person, get fitted, and may be able to try several masks to find what works best for you. After that, mail order any replacements and save a few bucks.

Basically, look at the machine as just a machine, get one that has recording ability, and shop around. Look at the mask like a pair of shoes and you don't know the size, so get properly fitted the first time.

 

[DFH65]

Great info thanks. I have a high deductible plan with an HSA and I don't think I am at all close to the deductable this year so will probably pay out of pocket but the insurance company I am certain will have some negotiated prices but knowing them online will still be cheaper.

 

[AggieMike88]

Basically, look at the machine as just a machine, get one that has recording ability, and shop around. Look at the mask like a pair of shoes and you don't know the size, so get properly fitted the first time.

Well said.

The mask is a very personal choice and Matthew's shoe analogy is very applicable. One brand and style might fit me very well and I find very comfortable, but for you, they'd be like Steve Martin's Cruel Shoes. But for the machine itself, Matthew and I both like the DeVillbiss line of Intellipap's. It does a great job at recording information, and has a free web based report generator. Making getting the required reports for the Doctor and AME a super easy thing.

www.cpap-supply.com is a great resource to know about for mail order.

 

[DFH65]

Assuming I need a machine. I know I would need reporting but does the FAA have any specific things they don't allow? For example are auto-adjusting machines good to go?

Also I assume humidification is a good thing to have if you are blowing air into your head.

 

[Papa Foxtrot]

Assuming I need a machine. I know I would need reporting but does the FAA have any specific things they don't allow? For example are auto-adjusting machines good to go?

AFAIK, FAA is mainly interested in compliance, but they'll look at any data you give them...

Also I assume humidification is a good thing to have if you are blowing air into your head.

I may be in the minority on this one, but I'd skip the humidifier to begin with. I've never used one and having one greatly complicates travel. Plus, you have condensation issues; which means insulated or heated hose - just gets complicated in a hurry. I've gone 16 years without it and the only issue I've experienced is dry mouth due to leakage. My next machine will record leakage for sure...

 

[AggieMike88]

From my experience, the FAA just wants to know that you are complying with CPAP therapy. It's between you and your doc about which machine is best for your situation.

An Auto Adjusting Machine is what I have (click this link). My prescription is 10cm H2O. The DeVillbiss Intellipap starts off the night at a low very comfortable pressure of 5cm H20. Then as the night progresses, it changes the pressure as my needs change. If I'm having a good night, it will keep the pressure low. But if it senses that more pressure is needed (as in, it detects severe apnea events) it will ramp up the pressure as needed.

Another nice feature is that it senses my breathing cycle, decreasing as I exhale and increasing as I inhale.

It is also extremely quiet.

Heated Humidity is a nice feature, especially if you are prone to dry sinuses.

 

[Papa Foxtrot]

We've been concentrating on the machine side of this, but if you come out of the study with an OSA diagnosis, then that's a Special Issuance(SI) medical with the FAA. For the SI and annually thereafter, you'll need the compliance report from the machine and a letter from your sleep doc stating the following:

(1) appears well rested
(2) no apparent tendency beyond normal to fall asleep/Epworth score (usually a questionnaire)
(3) compliant with treatment, and
(4) No gross right heart failure

 

[Papa Foxtrot]

Also, if you need the SI, then let me be the first to recommend that you secure the services of Dr. Chien. His modest fees are well worth the service he provides.

 

[Matthew]

Problem is - the first issuance of an OSA SI typically has to go through FAA in OKC and they are shut down. The good Dr can work a lot of magic, but this might be beyond even his super powers.

 

[Papa Foxtrot]

Problem is - the first issuance of an OSA SI typically has to go through FAA in OKC and they are shut down. The good Dr can work a lot of magic, but this might be beyond even his super powers.

Yep - we'll have to see what the "new normal" looks like once they get back to work. Regardless, Bruce can help cut through the backlog...

 

[AggieMike88]

Dr. Bruce can usually get the OSA SI done in office when OKC is operating normally.

So for DHF65's needs, I also would recommend Dr. Bruce. But plan on a bit more time for Bruce and the OKC docs to clear some backlog before you show up for the appointment.

 

[AggieMike88]

We've been concentrating on the machine side of this, but if you come out of the study with an OSA diagnosis, then that's a Special Issuance(SI) medical with the FAA. For the SI and annually thereafter, you'll need the compliance report from the machine and a letter from your sleep doc stating the following:

(1) appears well rested
(2) no apparent tendency beyond normal to fall asleep/Epworth score (usually a questionnaire)
(3) compliant with treatment, and
(4) No gross right heart failure

Two minor amendments to this.

1. You don't need the sleep doc to write the letter. Your regular doc will do.
2. And the right heart failure needs to have the words "on exam" in the sentence.

 

[DFH65]

I have time. I have to find some flying money and get some flying time in anyway as it has been a long time. Just getting prepared as best I can should my ship come in. I told my wife I was going to lose 100 pounds and buy an airplane. Well I am almost halfway to the goal on weight but not so much on the airplane financing.

I have emailed Dr. Bruce and have an initial list of supporting information i will need for this and a RBBB issue (that is resolved) but I need to gather all of the documentation. Definitely plan to use him when the time comes.

Assuming I still have OSA then I will need to get a month or so on the machine anyway so I have something to report. I also set a goal of hitting my weight at my last 3rd class medical (20ish years ago) before I start taking some lessons again good Lord willing and the creek don't rise I predict that will be around Christmas.

 

[Papa Foxtrot]

I have time. I have to find some flying money and get some flying time in anyway as it has been a long time. Just getting prepared as best I can should my ship come in. I told my wife I was going to lose 100 pounds and buy an airplane. Well I am almost halfway to the goal on weight but not so much on the airplane financing.

I have emailed Dr. Bruce and have an initial list of supporting information i will need for this and a RBBB issue (that is resolved) but I need to gather all of the documentation. Definitely plan to use him when the time comes.

Assuming I still have OSA then I will need to get a month or so on the machine anyway so I have something to report. I also set a goal of hitting my weight at my last 3rd class medical (20ish years ago) before I start taking some lessons again good Lord willing and the creek don't rise I predict that will be around Christmas.

I'd say you're well on your way. Best of luck to you!

 

[AggieMike88]

I too wish you success. A strong desire to fly is an excellent motivator to obtaining and maintaining improved health!!

(PS. Tell your wife to get ready for the New Years Party where a sexy World War I flying ace will steal her away for a night of glitz and glamour!)

 

[DFH65]

Well just got home. I would like to say it went well but not so sure. I am hoping I actually slept enough for them to get the information they need. I really struggled to sleep and it is one of those things that the harder you try to do the harder it is. Admittedly the thought that this is costing me a lot of money and you need to do it right the first time added to the pressure of the whole situation.

The Tech came in at 2:50 to fix a probe and I decided to use the bathroom she asked me if I normally slept that restless that I was in and out of sleep quite a bit. Well sometimes yes but not usually. I just don't sleep well in strange places, never have, weird noises and such tend to wake me or keep me from sleeping (like the air conditioner in the room, on and off on and off on and off). Then strap all sorts of probes to you and it just makes it worse. I know this is probably odd but I also am a bit uncomfortable knowing I am being watched while I sleep.

I know I was up for at least an hour or more at that point trying to get back to sleep. Then just before 5:00 I could hear them talking to a patient in another room having them go through the calibration steps to check their equipment at the end of the test. She must have realized I was awake at that point because she said I can get you up now if you want.

The Tech didn't tell me exactly but my guess is I slept 3 hours or less all night. I did ask her in the morning if she thought I slept enough to get the information they need and she said she thought so but that she is hesitant to say anything because the Doctor who reviews the results may think otherwise you never know. In any case at this point it is what it is. Here is hoping they got what they need.

They didn't come in and strap a CPAP on me not sure if that is because I didn't sleep enough or I didn't hit the threshold. Before I went to sleep she said if you have 80 events by 1:30AM they will come in and put the machine on.

So now I guess it is a waiting game 7-14 days. Maybe I should blame the full moon.

 

[Papa Foxtrot]

Well just got home. I would like to say it went well but not so sure. I am hoping I actually slept enough for them to get the information they need. I really struggled to sleep and it is one of those things that the harder you try to do the harder it is.

I'm a bit surprised that they didn't give you something to make you sleep. I had a follow-up study 'bout two years ago. When they told me it was going to be a "dual" study; beginning w/o CPAP, I tried to explain that was a waste of time. I don't sleep w/o the machine. They gave me about an hour to try and then gave me an Ambien.

The Tech didn't tell me exactly but my guess is I slept 3 hours or less all night. I did ask her in the morning if she thought I slept enough to get the information they need and she said she thought so but that she is hesitant to say anything because the Doctor who reviews the results may think otherwise you never know.

I would think 3 hours should be enough. I believe they just want to see you get to REM a few times and record how your breathing responds. You may have been out more than you think.

They didn't come in and strap a CPAP on me not sure if that is because I didn't sleep enough or I didn't hit the threshold. Before I went to sleep she said if you have 80 events by 1:30AM they will come in and put the machine on.

If no CPAP, then I'm guessing you passed, but...

So now I guess it is a waiting game 7-14 days.

Yep. The doctor makes the call. You might want to touch base with Bruce to see what documentation you need to confirm "no dx" if that's the way it goes. Good luck! Stay positive!

 

[AggieMike88]

My very first sleep study (2008) was not the split study. First night was without the machine, and second was with. Like DFH, it was difficult to fall asleep due to new environment.

Second study was a "renewal" to get the recent information for the SI. That one was a split study. Fortunately they set that one up earlier in evening and it was easier to drop off.

And I think you're correct that they want to see a few cycles of REM. I remember the second (and much better) doctor explaining the print out of the results on and off of the blower, and both studies had captured some REM cycles.

DFH; hopefully you're working directly with one of the good sleep docs in your area. My first I never met. The second, Dr. John Debus of Plano, TX, was top shelf and took plenty of time to personally do the exam, review the results, and more. Even wrote out the initial FAA letter while I was waiting in his office. If you got a good one, take advantage of the doc's time to fully understand what was discovered.

 

[DFH65]

DFH; hopefully you're working directly with one of the good sleep docs in your area. My first I never met. The second, Dr. John Debus of Plano, TX, was top shelf and took plenty of time to personally do the exam, review the results, and more. Even wrote out the initial FAA letter while I was waiting in his office. If you got a good one, take advantage of the doc's time to fully understand what was discovered.

Going to have to look into this. The referral was from my PCP. Not sure who the sleep person who will review and make recommendations will be but I will find out. I intend to ask for a complete copy of the report. My PCP is pretty good about providing me with the things I ask for. When I was there for my "wellness" visit a few weeks ago I gave him a heads up on the things I was likely going to need for a class 3. He seemed confident they had it all but it might take a few days to put together.

 

[AggieMike88]

Going to have to look into this. The referral was from my PCP. Not sure who the sleep person who will review and make recommendations will be but I will find out. I intend to ask for a complete copy of the report. My PCP is pretty good about providing me with the things I ask for. When I was there for my "wellness" visit a few weeks ago I gave him a heads up on the things I was likely going to need for a class 3. He seemed confident they had it all but it might take a few days to put together.

Sounds like my first sleep lab visit. Was clueless on what was going on; was referred by the PCP; never met the interpreting sleep doc; and my PCP barely gave me any info other than I was being diagnosed with OSA.

And pile on the less than stellar experience with the DME provider (okay machine, not the best service, and I was way over charged for it).

I left Dr. Debus' office with a complete understanding of my results and a the offer to purchase a new machine with better data features at a very competitive price to the mail order houses. (I declined since my existing machine was working fine at the time, and I had already purchased the cable and software).

You have the right to know what's going on with you and the results. If the PCP is good at explaining things and what the report says, then good on ya for that. But if not, then ask to meet directly with the sleep doc.

As Bruce and the other docs here remind us frequently, "Health first!! Fly later."

 

[bbchien]

Well just got home. I would like to say it went well but not so sure. I am hoping I actually slept enough for them to get the information they need. I really struggled to sleep and it is one of those things that the harder you try to do the harder it is. Admittedly the thought that this is costing me a lot of money and you need to do it right the first time added to the pressure of the whole situation.

The Tech came in at 2:50 to fix a probe and I decided to use the bathroom she asked me if I normally slept that restless that I was in and out of sleep quite a bit. Well sometimes yes but not usually. I just don't sleep well in strange places, never have, weird noises and such tend to wake me or keep me from sleeping (like the air conditioner in the room, on and off on and off on and off). Then strap all sorts of probes to you and it just makes it worse. I know this is probably odd but I also am a bit uncomfortable knowing I am being watched while I sleep.

I know I was up for at least an hour or more at that point trying to get back to sleep. Then just before 5:00 I could hear them talking to a patient in another room having them go through the calibration steps to check their equipment at the end of the test. She must have realized I was awake at that point because she said I can get you up now if you want.

The Tech didn't tell me exactly but my guess is I slept 3 hours or less all night. I did ask her in the morning if she thought I slept enough to get the information they need and she said she thought so but that she is hesitant to say anything because the Doctor who reviews the results may think otherwise you never know. In any case at this point it is what it is. Here is hoping they got what they need.

They didn't come in and strap a CPAP on me not sure if that is because I didn't sleep enough or I didn't hit the threshold. Before I went to sleep she said if you have 80 events by 1:30AM they will come in and put the machine on.

So now I guess it is a waiting game 7-14 days. Maybe I should blame the full moon.

That does NOT sound good.

 

[Rigged4Flight]

I did a sleep study last night as well. Slipped the Gleim study guide under my pillow. Results were negative across the board.

 

[AggieMike88]

I did a sleep study last night as well. Slipped the Gleim study guide under my pillow. Results were negative across the board.

Shoulda switched to a King DVD.

 

[Rigged4Flight]

Shoulda switched to a King DVD.

Good idea. The Gleim book was a bit thick.

 

[Papa Foxtrot]

That does NOT sound good.

As a former co-worker of mine liked to say, "Could you elaborate less briefly?"

 

[DFH65]

That does NOT sound good.

Your like the guy who takes people flying and out of the blue says that's not good.

Of course I slept great last night no problem falling asleep since I had so little sleep the night before. Started falling asleep on the couch at 9:30 went to bed at 10 and slept through until just before 7:00. No wires, no air conditioner making noise, no people talking it was great.

 

[JimNtexas]

My sleep study was a frack'n nightmare. I could barely sleep at all for the same reasons mentioned above the first night.

When I came back the second time to sleep with their very primitive CPAP it was slightly less horrible just because I'd done the first night. But it was still horrible.

I never spoke to the 'sleep doctor', I'm not even sure he/she really exists. My GP got a fax with recommended setttings and a draft prescrption for a CPAP machine and that was it.

Based on research I did , I had my GP add the words 'Resmed S-9 Autoset' to the prescription, because they got me a top of the line machine, not the cheapest POS the insurance company might deign to pay for.

It's a hassle to get the reports the FAA will want for the SI, I was very thankful that I'd engaged Dr Chen to help me get my ducks in row for the medical. I was able to walk out of his office with an SI.

Since I started on CPAP 14 months ago I've lost about 70 pounds. I'm not sure I even need it anymore. I used my FSA to buy a recording pulse oximeter to see if I could get some real data. Without CPAP my O2 saturation runs 96%, the same as in the first sleep study. With CPAP it's running 98%, for whatever that's worth.

There are a couple of places here in Austin where you can get a 'take home' sleep study, which involves a box about the size of an iPod and four or five sensors that you attach and sleep in your own bed.

Before I have to renew my SI this coming spring I may try the take home test to see if I still need the CPAP or not.

But if you need it, you need it. It's worth the hassle.

I will not repeat my standard angry rant on how the FAA's approach to OSA is counter to safety.

 

[Matthew]

My sleep study was a frack'n nightmare. I could barely sleep at all for the same reasons mentioned above the first night.

When I came back the second time to sleep with their very primitive CPAP it was slightly less horrible just because I'd done the first night. But it was still horrible.

I never spoke to the 'sleep doctor', I'm not even sure he/she really exists. My GP got a fax with recommended setttings and a draft prescrption for a CPAP machine and that was it.

Based on research I did , I had my GP add the words 'Resmed S-9 Autoset' to the prescription, because they got me a top of the line machine, not the cheapest POS the insurance company might deign to pay for.

It's a hassle to get the reports the FAA will want for the SI, I was very thankful that I'd engaged Dr Chen to help me get my ducks in row for the medical. I was able to walk out of his office with an SI.

Since I started on CPAP 14 months ago I've lost about 70 pounds. I'm not sure I even need it anymore. I used my FSA to buy a recording pulse oximeter to see if I could get some real data. Without CPAP my O2 saturation runs 96%, the same as in the first sleep study. With CPAP it's running 98%, for whatever that's worth.

There are a couple of places here in Austin where you can get a 'take home' sleep study, which involves a box about the size of an iPod and four or five sensors that you attach and sleep in your own bed.

Before I have to renew my SI this coming spring I may try the take home test to see if I still need the CPAP or not.

But if you need it, you need it. It's worth the hassle.

I will not repeat my standard angry rant on how the FAA's approach to OSA is counter to safety.

I think you found the trick. If the DIY study shows no OSA, maybe another sleep study will show the same thing. Then you might be able to drop the SI.

 

[DFH65]

My sleep study was a frack'n nightmare. I could barely sleep at all for the same reasons mentioned above the first night.

When I came back the second time to sleep with their very primitive CPAP it was slightly less horrible just because I'd done the first night. But it was still horrible.

I never spoke to the 'sleep doctor', I'm not even sure he/she really exists. My GP got a fax with recommended setttings and a draft prescrption for a CPAP machine and that was it.

Based on research I did , I had my GP add the words 'Resmed S-9 Autoset' to the prescription, because they got me a top of the line machine, not the cheapest POS the insurance company might deign to pay for.

It's a hassle to get the reports the FAA will want for the SI, I was very thankful that I'd engaged Dr Chen to help me get my ducks in row for the medical. I was able to walk out of his office with an SI.

Since I started on CPAP 14 months ago I've lost about 70 pounds. I'm not sure I even need it anymore. I used my FSA to buy a recording pulse oximeter to see if I could get some real data. Without CPAP my O2 saturation runs 96%, the same as in the first sleep study. With CPAP it's running 98%, for whatever that's worth.

There are a couple of places here in Austin where you can get a 'take home' sleep study, which involves a box about the size of an iPod and four or five sensors that you attach and sleep in your own bed.

Before I have to renew my SI this coming spring I may try the take home test to see if I still need the CPAP or not.

But if you need it, you need it. It's worth the hassle.

I will not repeat my standard angry rant on how the FAA's approach to OSA is counter to safety.

Maybe some of the folks here would know. If you had an autoadjusting CPAP with good reporting couldn't it kind of tell you if you didn't need the machine anymore? I understand they have a min and max but if you were constantly at the min I would think you could talk to the sleep doc and have that dropped lower to get an idea of where you were at.

I mean obviously you need to get a sleep study to satisfy the FAA but I would think the data from the machine could tell you a lot. Or am I wrong?