Sleep Study... How many are necessary?

Dootson · December 12, 2007

I’m in the process of completing my pre-opt testing. I had a sleep study done in November and now the pulmonary Dr. wants me to undergo another sleep study because of inconclusive results. I don’t want to do another sleep study. It was a very unpleasant experience. I could not sleep with all of the wires and knowing that I was being watched. The thought of someone watching me just creeps me out. I know the results will be the same… inconclusive. I have difficulty falling asleep under those circumstances. The Dr. refuses to clear me for surgery if I don’t have the study. I’m thinking of seeing another pulmonary Dr. to get the clearance for my surgery. My surgery is scheduled for the third week of January ’08.

Has anyone else had to undergo multiple sleep studies?

:help:

jmarruda · December 12, 2007

I had to do 2 sleep studies as well. The first time I didn't sleep well, and the results were, well, inconclusive. The second time I took a sleeping pill so I could just zonk out, and it worked. The second time the results were in, mild sleep apnea. Luckily, I don't have it anymore, and only had to use the machine for 4 months. Good luck....

ALOCO53 · December 12, 2007

I also couldn't sleep with those wires and multiple trips to the bathroom. I would refuse to do another study, I can't sleep anywhere but my own bed and I have trouble doing that. duh! I hated it and I don't see why that's necessary. I think it's another way to get money from the insurance companies. BTW my insurance company paid almost $5,000 for my study in August.

Dootson · December 12, 2007

jmcamba,

Sorry you had to go through with the two sleep studies. I’m glad everything worked out well and you’re off the machine.

ALOCO53,

I agree with you. I also thought it was just another way to rip off the insurance company. My insurance company was billed almost $4,000. I had to pay an additional $350 out of my own pocket. There is no way I will have a second sleep study. I’ll see what the new Dr. says and I won’t mention anything about snoring when I meet with him. That was the BIG mistake I made with the first Dr.

WARNING to anyone going for per-opt testing… Don’t mention to them that you snore or else you will have to be subjected to a sleep study!!!

DrWatkins · December 13, 2007

Dootson,

Regarding sleep studies:

Screening for sleep apnea prior to surgery is to prevent a potentially dangerous situation whereby you send a patient (with untreated sleep apnea) home with narcotic pain pills (which lengthen deep sleep where sleep apnea occurs) and you stop breathing for dangerously long periods of time (people have died for this exact reason).

Some surgeons screen everyone for sleep apnea. Some surgeons ignore it completely. I fall in the middle and order the test only for high-risk individuals. In my mind, high risk individuals include obese male diabetic patients, neck circumference >43cm (17inches) or observed sleep apnea (your sleeping partner says, "you scare me because you stop breathing when you sleep"). Any of the above are at very high risk for having significant sleep apnea and should be screened prior to surgery and treated if found to have it.

What is sleep apnea?

Obesity increases the amount of tissue around your airway. While you are awake and upright your airway stays open. When you lay down to go to bed at night there is increased pressure on your airway and your laryngeal muscles work harder to keep your airway open. When you go into deep sleep, however, the laryngeal muscles relax and you get airway collapse (breathing stops). Sleep apnea interrupts your deep sleep causing daytime sleepiness and a host of other medical problems. Most people don't know they have it because it occurs in your sleep. Since you don't complain about it to your medical doctor, it is one of the most under-diagnosed serious medical conditions out there.

So, if a patient has significant, untreated sleep apnea and you send them home with narcotic pain pills, which lengthen deep sleep, you may cause long periods of no breathing resulting in death. This is the scenario all surgeons are trying to avoid.

Sleep apnea also causes pulmonary hypertension (high blood pressure in the lung blood vessels) and right heart ventricular strain. Treating sleep apnea prior to surgery puts the heart and lungs in the best state of health prior to anesthesia.

The typical treatment for sleep apnea is a CPAP machine (Continuous Positive Airway Pressure). This is a mask you wear at night while sleeping that will prevent airway collapse with positive air pressure. Most patients will cure their sleep apnea within a few months of weight loss and are able to discontinue the CPAP machine.

My opinion is that only moderate or severe sleep apnea needs to be treated prior to surgery. I do not treat mild sleep apnea.

Screening typically involves an overnight stay in a sleep lab with many monitors connected to your body. Home screening does exist. Some insurance companies don't cover home screening and some pulmonologists do not utilize this method. Some patients that don't want to bother with screening will rent auto-titrating CPAP machines to alleviate this concern quickly. It can be difficult to find a place that will rent an auto-titrating CPAP machine without a sleep study.

Hope that helps.

Success in lapband · December 13, 2007

Dootson;

I "have" sleep apnea and "had" sleep apnea before the surgery, I sleep with a CPAP at night and every single night.

My surgeon required me to take with machine to the hosp and spend the night, ONLY for my well being, he did not make one more penny on me for that requirement.

I suggest that "be happy" that your Dr. wants you to be healthy and alive after surgery.

Maybe this second sleep study will go better because you know what to expect.

Good luck ~ I would do it over again in a heart beat.

Kristin1031 · December 13, 2007

We have dear friends who lost their 25 year old son to sleep Apnea he was not Obese or overweight and he had it and did not know it, never was diagnosed or had a sleep study.

He died on night while sleeping, and trust me it is worth finding out if you have it that bad.

I had the study done preop and I hated it as well. I also told them I would never come back it was the most unrestful night of sleep I ever remember having. They came in many times in the night to reposition wires that had come lose on my face and head and would crawl into bed with me with a flash light and I was so mad. LOL

Turned out I had very mild sleep apnea. They wanted me to get a CPAP anyhow and I told them it was a racket they must be getting kick backs from the company selling the machines. I in no way needed CPAP with the case that was so very mild.

I understand you not wanting to go back.....But you should find out if you have it severly or not.

Just my opinion. Especially before being put under anesthesia. I was told it can cause problems bringing you out from being under as well.

newimage · December 14, 2007

I have sleep apnea. Had it not been for my family dr who recommended I have the sleep study done, I never would have known. I have been using the CPAP machine now for 2 1/2 yrs and it has saved my life.

Be thankful that the Pulmonary Dr is looking out for you.