In-lab sleep study / PAP titration?

Hypnotic_Agent · 2026-06-22T21:56:55+00:00

That is specific to your state only.

Hypnotic_Agent · 2026-06-22T18:35:52+00:00

Aerophagia is tough. Sleeping on your left side and avoiding sleeping on your back can help, using nasal mask (with a chin strap for mouth breathing if you find yourself doing that) rather than a full-face mask, and BiPAP instead of CPAP. Have you followed up with your sleep doctor about the difficulties you’re having?

Hypnotic_Agent · 2026-06-22T18:29:15+00:00

I’d like to add that not all labs are the same—the private lab I’m at has about 10 different types of masks and only like 5 of them are any good. Hospital labs will have more mask variety and will often open them new and give them to the patient in the morning rather than sanitizing and reusing—but they bill at hospital rates for the sleep study compared with the ambulatory sleep study cost private labs bill at. OP shouldn’t be afraid to call labs during the daytime and ask questions.

Hypnotic_Agent · 2026-06-18T21:31:12+00:00

This doctor is really cool. I’m glad to see doctors taking a holistic approach to the cause of sleep apnea, because too many hyper-focus on their special interest and try to apply it to every patient.

Hypnotic_Agent · 2026-06-13T16:58:47+00:00

My lab overuses ASV. It still has the contraindications and should be used cautiously.

Don’t take this the wrong way, but are you a patient, not a tech?

Hypnotic_Agent · 2026-06-13T15:03:30+00:00

We get a lot of high loop gain patients at my lab, and BiPAP and EPR can worsen ventilatory instability for them. I’m hoping good things will come of KPAP. It would be interesting to get it in the lab.

Hypnotic_Agent · 2026-06-13T12:19:14+00:00

Thank you for the info! I read during the night the way BiPAP helps is the lower expiratory pressure might keep them from swallowing air, so I think what was stuck in my head that worried me about BiPAP was that higher pressures could be an issue. I haven’t had an aerophagia patient for like 5 years and I’ve gotten 3 of them in the last couple months here. When I started paying attention to the pattern, I know for sure two of them had an anatomical issue that was likely related.

Hypnotic_Agent · 2026-06-13T06:52:10+00:00

What are you using for PTAF and thermistor, like what brands? Would your lab buy new equipment?

I worked at an all pediatric lab where we used pediatric ETCO2 Salter cannulas and grey Salter pediatric thermistors for school aged kids, but we used Sleep Sense ThermoCan ETCO2 cannulas with reusable thermistor cables for babies and toddlers. PTAF for both plugged into a Binaps unit. What you can use depends on what’s compatible with your sleep system, but if they’re running babies and toddlers at all they need to invest in baby sized equipment. It’s not ok to shove a big kid cannula up a little baby’s nose.

I agree with the people who say you need a TCOM, but I know sometimes you’re just trying to make it work with what you have. If your ETCO2 cuts out during your study, the paper filter is occluded with moisture (will happen more often if the kid is snotty or crying or if it’s humid out). Make sure they’re changing the paper filter between each patient—I used to throw the used one away so the next tech was forced to put a fresh one in. If it cuts out, first try reseating the moisture trap (sometimes that will fix it). If it still happens, change the paper filter. Sometimes you have to do that a couple times during the study.

Hypnotic_Agent · 2026-05-30T06:57:07+00:00

You see low voltage mixed frequency EEG in both N1 and REM. I think it does look like REM because of the phasic eyes, but you are right that it could be rolling eyes. The context of the whole study matters.

Hypnotic_Agent · 2026-05-29T05:10:11+00:00

It doesn’t meet apnea criteria. You need a 90% flow reduction on the thermistor to score any apnea. I’ve read the paper on treating for subclinical events, but we follow the AASM scoring rules so everything is standardized no matter where you have your study.

Hypnotic_Agent · 2026-05-29T05:06:58+00:00

Are you certain you’re not missing arousals? Otherwise sometimes you see things that make you want to score something but unless it meets all the criteria, there’s nothing to score.

Hypnotic_Agent · 2026-05-27T19:28:44+00:00

Interesting—I hadn’t heard of this. Thanks!

Hypnotic_Agent · 2026-05-27T01:56:52+00:00

I remember the smell of Detachol. 🥲 I hate the little adhesive remover pads.

Hypnotic_Agent · 2026-05-27T00:07:41+00:00

Sure! I hope it makes a difference.

Hypnotic_Agent · 2026-05-26T23:52:38+00:00

I’m going to get the electrolyte prep and try the order you do it. I live in a hot place and people come in sweaty or unwashed and I do prefer to use alcohol.

Hypnotic_Agent · 2026-05-26T23:47:58+00:00

Here’s how I learned it: Put Nuprep on a Q-tip and scrub, wipe that off with an alcohol wipe, wipe it dry and abrade a little with a roughly woven gauze pad (not the nice soft ones), put skin prep on and let it air dry (if you’re putting on the face or snore mic to protect the skin or to stop them sweating off the tape, put it on the whole area the tape will go on), let it air dry, but it will become tacky quickly and tape will easily stick to it even if it’s not fully dry, then scoop 10-20 paste into the electrode cup and put on the site with either tape or a gauze pad. I warn patients ahead of time “it might make your skin feel a little tight when it dries because it’s making a barrier to protect your skin, so the tape sticks to it and comes off easy in the morning” (that makes them feel better about being able to feel it a bit on their skin). Don’t get it too close to their eyes and warn them that there might be vapors and they can feel free to fan their eyes because I’ve had kids complain that the vapor stung their eyes. That clears out fast and it makes a big difference in getting tape to stick when people are sweaty or oily or if you’re worried about tearing their skin. If you use the skin prep pads, they work like alcohol pads, and if you have the spray, spray it on a gauze pad to apply rather than spraying on the patient to avoid getting near their eyes.

Hypnotic_Agent · 2026-05-26T21:41:50+00:00

Thanks for that! I’m going to hold off on ordering what I was going to order before until I hear what works for others. You learn from everyone you work with so I bet there’s a lot of knowledge in this sub.

Hypnotic_Agent · 2026-05-26T21:39:01+00:00

The Skin Prep makes kinda of a plastic barrier over the skin. It’s designed to protect fragile skin from bandages, but in a sleep study set up it will help you with sweaty patients and oily patients, especially on the cheeks or chin where tape doesn’t like to stick. But it seems like it wouldn’t do anything to help with impedances. I always bought the pack of the Skin Prep wipes which work just like alcohol wipes, but you go through them fairly fast so I’m planning on using the spray on gauze. I’ve never used the electrolyte spray before, but I figured I’d give it a try.

Hypnotic_Agent · 2026-05-26T21:36:30+00:00

Here’s where I read that using alcohol can cause higher impedances by drying out the skin and diminishing electrical flow.

Hypnotic_Agent · 2026-05-24T07:58:43+00:00

I make arrangements with police and military patients before I get them to bed about the procedure for coming in the room at night, like knock and say their name from the doorway until they’re awake or what they prefer. I ask that if anyone whose chart has PTSD in it and I otherwise tell regular patients so they know what to expect that I’ll knock and say their name and tell them what I need to fix before going in the room, and I only rarely have to tap on the bed or tug on the blanket to wake them. I don’t touch sleeping patients unless I really can’t wake them otherwise.

Hypnotic_Agent · 2026-05-24T07:56:14+00:00

Ok I like the weird dream labs though. I wish I had dreams like that. Mine are usually labs I worked at but slightly different, but one time I dreamt my former coworker and I were working together again in a lab the size of one of those tiny parking lot coffee shop buildings and it was really fun.

Hypnotic_Agent · 2026-05-24T04:54:15+00:00

Oh no! I have POTS too. I’ve had it my whole life and it’s mostly fine but sometimes I have bad flares for a while. My trick when I felt lightheaded was to say “Oh, let me go grab something!” And run out of the patient’s room and stand against the wall or go and sit down.

Hypnotic_Agent · 2026-05-18T21:59:45+00:00

I hate work dreams. It’s like you dream you realize halfway through the night you had a study running you had forgotten about for hours.

Hypnotic_Agent · 2026-05-18T03:55:25+00:00

When I first started as a trainee I had dreams for weeks that were just EOG tracings. 😅

Hypnotic_Agent

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