Barry Krakow, MD, Victor Ulibarri, RPGST, and Natalia McIver, RPGST from the Sleep & Human Health Institute, and the Maimonides Sleep Arts and Sciences, Ltd, in Albuquerque, NM, and the Los Alamos Medical Center, in Los Alamos, NM, preview their article appearing online ahead of print and in the December 2014 issue of Mayo Clinic Proceedings, to provide clinicians with a new theory on the co-morbidity of insomnia and sleep apnea among insomnia patients failing drug therapy, including new assessment tools to diagnose sleep apnea when medications fail. Available at: http://tinyurl.com/kgz3q3s
With the growth of the HST model, sleep apnea patients are increasingly complaining about the lack of opportunities to undergo a titration in the sleep lab when their responses are suboptimal to PAP. In our second opinion practice, we occasionally meet sleep apnea patients dissatisfied with their care at a sleep center in another state; and, believe it or not, some of these patients have never spent a night in the lab. A sleep study was never recommended, or if a patient requested a titration it was refused. Despite their best efforts to express their suboptimal responses, the sleep professionals they dealt with argued back that nothing new would be gained by a titration or retitration in a sleep lab. In this brave new world of auto-adjusting devices, we are informed that the sleep lab is essentially obsolete.