During this COVID-19 pandemic, most “elective” medical care has come to a standstill. Sleep testing and various surgical options are also included.
Jennifer is a 53-year-old woman who made an appointment to see me this July. This was the earliest appointment she could get with me since my schedule is booked completely for many months. She recently called me to say that her snoring and apneas are getting worse and that her husband is complaining.
The first good news is that due to the pandemic, our state (NY) changed the requirements to allow doctors to diagnose and treat new patients over the phone or by video. Insurers are now required to pay for this service. Now that our elective operative cases are canceled, I’m doing a lot of video telehealth sessions for new and follow-up patients. For the first time in years, patients are able to “see” me within 1-2 weeks.
The second good news is that the vast majority of testing for obstructive sleep apnea can be done at home using validated home sleep units. In most cases, this still involves going into a sleep lab to see a sleep physician and to physically take home the testing unit. You also have to bring back the unit to the sleep lab. If there’s a concern for other sleep conditions besides obstructive sleep apnea, then you may have to wait for an in-lab study.
The third good news is that there are a number of home sleep testing companies that will mail patients the home sleep testing equipment. The patient sleep with it as directed and mails it back the next day. This is definitely much more convenient, but a doctor still has to order the test.
In the US, many of the common insurance carriers are requiring home sleep testing as the first-line test to see if you have obstructive sleep apnea. Numerous studies have validated home testing to be relatively reliable compared to in-lab testing. In general, home testing is equivalent to in-lab testing for people with moderate to severe obstructive sleep apnea, but may underestimate sleep apnea severity in patients with mild sleep apnea. So if your home sleep test is positive, it’s reliable. If it’s negative, it’s not as reliable, especially if you still can’t sleep.
Once you’ve been officially diagnosed with obstructive sleep apnea through an in-lab study, then the next step in the traditional model is to go back to the sleep lab for a CPAP (continuous positive airway pressure) titration study. This is another sleep study using a mask with different levels of air pressure to calibrate the exact pressure that’s needed to eliminate all your apneas. However, if you underwent home testing, and you’re OSA positive, then your sleep doctor will order an APAP (automatic PAP) device. An equipment company will deliver it to your house and show you how to use it. Because this is considered an essential service, home testing, and CPAP/APAP equipment services are still very active. It’s important to work with your doctor and equipment company to troubleshoot and fine-tune your positive airway pressure device.
A number of studies have shown that out-of-sleep testing and therapy can be just as effective as the traditional in-lab pathways, even when overseen by primary care physicians, nurse practitioners, or physician assistants.
If you already tried your CPAP or APAP device and still don’t find any benefit, then it’s time to talk to your sleep doctor about other options, including dental devices and various other surgical options.
So if you’ve been sitting on the fence about when to get a sleep study, or you’re just putting it off for various reasons, there’s no excuse. Find a sleep doctor today that will do a video consultation with you.