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Adventures in Sleep

When to Split a Sleep Study

Published December 8, 2011 9:24 AM by Amy Reavis

This is one of the biggest debates among sleep techs. Should split night studies be performed and when should they be performed?  There are those who believe that you should never do a split night study. There are those, usually with a financial stake, who believe that you should always do a split study.  Different labs have different policies on the subject. 

The benefit to a split night study usually is solely for that of the patient and the payer. You have one test that diagnoses and treats the patient. We now have technology that can monitor the patient after the test if the study was not complete and adjust the pressure based on the download. It gives you a good base to start using therapy right away. You have less chance of the patient not receiving therapy and you can start them at home much faster. Insurance companies like it because they are just paying for one test.

The drawbacks are seen with compliance and with how well the titration was completed. You go into the room at 1-2 a.m. and you put a mask on a patient and tell them to go back to sleep. You have half the night to make them comfortable with the mask and to find a final pressure for the patient. The drawback is that 1 a.m. is not an optimal time to introduce new therapy. It limits how many REM cycles you have. It also limits dealing with issues with mask fit or anxiety.

There are times where a split study is ideal. If the patient has severe sleep apnea it is better to get them titrated sooner rather than later. You can also bring them back after they have gotten used to the therapy to complete the titration. If a patient is requalifying for PAP then a split allows it to be done easier. You already know they have sleep apnea, you are just redemonstrating it to the insurance company. It saves the patient a copay and gets them their new equipment sooner. 

I do not believe there is a right side or a wrong side to this argument. I think that like all sleep studies it is a very individual decision based on the patient's needs. If a patient is high anxiety or claustrophobic, a split would not be ideal for them. If the patient has severe sleep apnea then doing a split study will allow them to have equipment sooner. As long as you make the interest of the patient your priority,  you can not make a wrong decision.


Ah! To Split or Not to Split that is the question. OK. The patient comes first. So, if you can get to a point where it is obvious that obstructive sleep apnea is the culprit and you can get there when you still have a good three hours to titrate then by all means "Split" the patient. The insurance companies want of minimum of 180 minutes on the machine. Also, look at what you are doing. As a therapist, I tend to titrate fairly aggressively, at least in the beginning. If you look at the pressure traces and you are seeing flow restriction you have to correct for it. If you patient is stable, hemodynamically, push the pressure. If they start to get Tachy or hypertensive or show central emergence, slow down. To a Respiratory Therapist, decreasing venous return is always in your mind. To a straight sleep tech, you have to rely on the guidelines. Start simple. Don't go straight to a full face mask. Even if the patient says he is a mouth breather. People are obligate nose breathers from birth. Mouth breathing is a learned behavior. Once you find their critical opening pressure and there is no obvious septal occlusion or history of trauma. You will do fine with a nasal mask or pillows. Sure there are exceptions. That is why we assess patient response. Finally, don't jump the gun on the FLEX or EPR. They may complain about that feeling of having to push to exhale but the Diaphragm adapts quickly.  Once you have a good mental picture of what is going on in the airway, learning to ventilate get a lot easier.

Gary Rushworth, Polysomnography - Chief, LDC Sleep Center July 17, 2013 2:37 AM
Milford CT

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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