Sleep Study this week - what to expect

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I am scheduled for a sleep study this week for likely OSA and am looking for advice from those who have been through the process on what I need to get from the doc going forward.

I just renewed my second class medical in June. This sleep study was pretty much a self-referral (I was not triaged by my AME). I have snored for a long time, but until just recently (last couple months), I haven't had any other symptoms of OSA.
 
If the sleep study is in a laboratory environment, then here's what you'll experience...

The room you'll be in in something like a decent hotel. There will be a comfy bed with clean sheets/pillow (bring your own if you wish), a TV and a bathroom. Also bring any night time medication and bedtime routine items (aka toothbrush)

Once you sign in, the better places will have the actual doctor there greet you and answer your questions. The not so better places will just be a lab tech. You will have some vitals taken and then you'll be given the chance to change into your jammies. Then the tech will come back in and begin wiring you up for the study. You will have lots of electrodes for the electroencephalogram (EEG) attached to your noggin so they can monitor your brain to determine what level of sleep you're in as the exam proceeds. You will also have sensors attached to monitor leg movement, breathing, snoring, and much more. You'll be wired for everything short of cable and high speed internet.

Then you will be left alone and allowed to go to sleep.

During the first half of the night, you will not be on CPAP therapy so the tech can capture if any sleep apneas happen, what type, how frequent and how severe.

Half way through, they will wake you up and fit you with a CPAP mask, get you comfortable again, and let you go back to sleep. As you sleep, they will make changes to the air pressure the CPAP system is delivering. This happens slowly so you don't notice while sleeping, but it will range from small pressure to the highest pressure you can tolerate. By titrating (changing) the pressure, they are looking for the range that alleviates you of apneas, but not so high as to keep you from getting into the most restful level of sleep.

The next morning, the tech will return to unwire you. Then you clean up, change into your day clothes and head out to take on the world.

In a few days, the better places will have the sleep doc call you in and he/she will personally review the findings with you. The not so better places send the bare minimum report to your referring doctor. (can you tell I've experienced both?)

The lab results will show the details of how well you slept before CPAP and while on CPAP. It should detail the frequency and severity of apneas in both phases. If CPAP therapy is recommended, then you will also have the recommendation of how much pressure to set your machine too. This is measured in centimeters H20.

Make sure to obtain and retain a few copies of this lab study. One copy you want to keep in the file you keep at home. Another will need to go to the AME and FAA. And your referring or personal doc will want one.

Next Chapter: Obtaining your CPAP machine.
 
Of course if you don't actually have OSA then they might skip the CPAP part. My rare events waking up unable to breathe have nothing to do with obstruction as it turned out, so they didn't bother with that part.
 
Obtaining your CPAP machine...

Major takeaway: You have complete control on this process and have many choices in both providers, manufacturers, and mask types. Do not allow yourself into being pressured to buying from a "captured" or "in hours" durable medical equipment (DME) provider.

My first machine, I got pushed into this scenario because of not knowing better. I was provided a machine and told they would bill me and my insurance provider. Hindsight had me figuring out that I was provided a middle of the pack machine with no real recording features (more on this requirement in a moment), they billed me 10 payments of $75.00 and billed my insurance company the same. Do the math and you can say PT Barnum be very proud of them.

As far as the brick and mortar DME's, you should visit one to get fitted for a mask and to review your options for the machine. Mask selection in a big personal choice and will depend on needs and what you are comfortable with. Also how severe your case is. One end of the spectrum is a mask that fits over both your nose and your mouth. The other is what is known as nasal pillows where positive air pressure is through your nose only. In this range are many designs of the mask and the headgear.

Getting properly fitted with your choice of mask and headgear will make a big difference in both comfort and success of the therapy. So I suggest your first fitting be done at at a brick and mortar DME.

While this DME can show you what they have to offer in the way of machines, keep in mind that they are a for profit organization and will only show you the models they "like" and will have good margins on. This selection is by no means complete. Plus their prices may be inflated in order to make money even after the haggle hassle with your insurance carrier. And then keep in mind my experience where I was over billed.

Two of the online providers that many of us on PoA like are CPAP-Supply.com and CPAP.com. Both have a wide range of manufacturers and models, a good tech, tech, and service crew, and reasonable prices.

Which machine will be up to your research and personal choices. Slight caution, it is possible to over purchase and buy features that you really don't use. For the FAA purposes, a feature that your machine must have is long term recording. By this I mean the ability to record sleep and usage data to an SD card. And space to record at least a year's worth of data.

Many applicants got stuck when their machines didn't have the ability to record enough data and getting it off of the machine was difficult or required expensive accessories and proprietary software. Some other airmen also got a twisted tail when submitting for renewal when the requirements changed from 90 days of data to a year's worth of data. But if you purchase the right machine with long term recording capability, you're good to go from the start. And make sure this is record to an SD card.

The reason for the SD card is that you won't be cornered into expensive accessories or software to read the data. Some free software known as SleepyHead can read the data on the SD card and provide lots of great reports. And the summary reports are just right for the FAA.


If you have any additional questions about the lab ride or getting the right CPAP machine, let us know.
 
probably the one thing you would expect but won't get at a sleep study is .....

sleep! :)

Good luck!
 
Mike hit the highlights: Get all the probes and sensors wired to your head, face, and fingers, then told, "There, now get to sleep."

If there OSA indications, they'll wake you up and put a mask on you. They'll remotely adjust the pressure until they find a sweet spot. That's going to be your prescription pressure. If possible, ask if that prescription can be written as a range rather than a fixed pressure. The better CPAPs can automatically adjust during the night. There are times when a higher or lower pressure works best, like during allergy season or nights when your sinuses might be acting up. The fixed pressure is just what worked best for you that one night.

The report will show apnea events pre and post CPAP. Can't remember exactly, but I think that anything < 5 apneas + hypopneas per hour is considered normal (no OSA), and anything >=5 means OSA. Successful treatment gets you <5, but sometimes you can get down to <=1.

In my case they wanted me to shift positions a few times, from back to side (or the other way around). Might consider bringing your own pillow if you are particular to it. The goop they use to unstick the adhesive makes a mess, too. I am pretty sure that I got very little sleep during that study - but because they stuck a CPAP on me and got me down to zero apneas, the next several hours were spent in REM sleep (something you rarely get with OSA because you keep waking up before you get there) and the next day I felt great.
 
If its like mine, you'll show up at 7 or 8pm and some friendly nurse will greet you and put you in a room . She'll tell you someone will be with you shortly....2 hours later and now falling asleep you go to the nurses station to learn they forgot you were there and that as far as they can tell there are no sleep studies scheduled for that night...so you put your clothes back on and go home...
 
FlySince9 said:
If its like mine, you'll show up at 7 or 8pm and some friendly nurse will greet you and put you in a room . She'll tell you someone will be with you shortly....2 hours later and now falling asleep you go to the nurses station to learn they forgot you were there and that as far as they can tell there are no sleep studies scheduled for that night...so you put your clothes back on and go home...
Click to expand...
Crazy that that happened, but that is somewhat out of the ordinary..... especially for the better places that I mentioned.

FYI; if anyone is in DFW and looking to get this done, I can highly recommend Dr. John Debus in Plano. He is not only one of the top 5 sleep doctors for the area, but he also takes a personal interest in his patients. He was personally involved in each segment I went through instead of delegating key parts to underlings. He even did my post lab review in person and wrote up my FAA letter while I was sitting across from him.
 
and if you are diagnosed with OSA do you:

wait until your next medical and inform your AME and continue flying ... or
notify FAA immediately?
self ground immediately?
 
I slept like a baby..... I did need a 3am bathroom break then went right back to sleep. The nurse administering the test said I would most likely sleep through anything.
 
Bring a camera. How often do you get the chance to look like a Borg?
 
My OSA went away after weight loss, but I swear by my Resmed S9 autoset. in my case the sleep physician just made a recommendation to my family doctor. I had her prescribe the ResMed so that there would be no argument with an insurance company wanting to buy something cheap and crappy.
 
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