Sleep studies: (teaching) hospital vs. independent "sleep center"?
January 16, 2015 2:57 PM   Subscribe

Due to some longstanding issues with sleep and fatigue that I think could be related to sleep apnea, I'd like to have a sleep study. What are the differences/pros and cons of doing that at a hospital versus an unaffiliated "sleep center"? Experiences/thoughts on specific places to go in the SF Bay Area?

In general, my m.o. is that for anything "serious" requiring an expert, I go to a teaching hospital or a similarly well-regarded institution. In this case that would be UCSF (or I guess Stanford, though I'm closer to UCSF.)

I was looking at a site (ClearCost) connected to my insurance (thus, their estimates take my insurance & deductible into account) that estimates cost differences, and it suggests that sleep centers (specifically "California Center for Sleep Disorders," though I see there is also "Bay Sleep Clinic" and others) might be significantly cheaper, so I've been considering that option. I'm fairly low-income, but quality of healthcare is important to me and I have savings and no debt, so if there's a significant difference in quality of either the study or the workup/analysis of it, I'll go to the better place. Browsing online reviews suggested that people's experiences vary broadly. Medical anxiety is not a factor for me, and also I've had electrodes on my scalp as a study participant and it doesn't faze me.

Also, I'm generally curious if chain "sleep centers" are possibly some sort of commercial, one-trick pony that finds that /everyone/ needs a CPAP/other intervention. I generally trust doctors/hospitals not to be in the business of selling stuff and more services, but I don't have that feeling about independent centers that focus on one thing like that. This feeling might be totally off, though.
posted by needs more cowbell to Health & Fitness (6 answers total) 4 users marked this as a favorite
I'm not familiar with the sleep centers, but here's my recent experience.

I had a sleep study for sleep apnea in 2014. I thought I was going to have to spend the night somewhere, but my insurance or doctor had me get home sleep study using a thing called WatchPAT from the local hospital, which involved a watch like thing that had different things that attached to your fingers. I picked it up at the sleep study place, they gave me instructions and I was billed $501, which was the full amount of the test. I can't remember right now, but it seems to me that the test in the center was 3-4x that amount.

My doctor charged a total of $555 for two office visits.

My doctor gave me a referral for a cpap person in his office (so I guess he is selling them!), but I just asked her what model she was going to give me, and got my prescription and bought it online. I paid $1,066 for the machine and a bunch of supplies and the doctor's supplier wanted to charge me $1600 just for the machine.

I had no problems figuring the setup out, and I was just happy to get some sleep. If the home study is an option for your with your insurance/doctor, that might save you some money. My total costs before insurance were $1056 for doctors &testing and the the $1066 for the machine.

Good luck, I hope you find out what's going on and have a restful 2015.
posted by katinka-katinka at 4:55 PM on January 16, 2015

I think that finding a great primary care doctor and then seeing who they recommend is the best way of going about things like this. I've also found that many hospitals will not let patients self-refer for sleep studies and require a PCP to make the referral. You might also need other blood tests to tease out other possible causes of fatigue.

I did a sleep study through a hospital, although not a teaching hospital, just a little regional joint, and it was fine. Hospitals make money off of them, too, frankly. They're mostly done by techs, and I get the impression that they're not really difficult procedures and that the specific tech has a lot to do with the experience. My tech had about 13 years of experience, and he was extremely friendly and personable so I felt comfortable enough to sleep and get up to go to the bathroom without feeling nervous and waking myself up, which was great. So the other thing I'd say is that if you won't feel comfortable unless you're in a teaching hospital, then you want to go for the teaching hospital--being able to relax and fall asleep will go a long way towards making it not a completely miserable experience.
posted by internet fraud detective squad, station number 9 at 5:26 PM on January 16, 2015 [1 favorite]

I have been to both a chain sleep center and hospital affiliated sleep centers and I would say the biggest difference between them was not the study itself but the aftercare they provided. I have an unclear diagnosis and the chain center was the worst in terms of sticking to their theory of what was wrong with me long past the point where it was clear that 1) their theory was incorrect and 2) their interventions were making me feel worse, not better. I was also being treated by a doctor whose specialty was not even remotely connected to their suspected diagnosis and so a lot of my treatment was being determined by his supervisor who I only met once. This may not be as much of an issue for you if you suspect you have a more straightforward diagnosis like sleep apnea.

My current sleep center is great-- it's part of a hospital that is both one of the highest ranked in the area and also has one of the highest ranking neurology departments. One of the big positives of hospital clinics is that it's easy to get linked to other doctors within the hospital who specialize in the intersection between sleep disorders and their area of practice.

I was a broke student with lousy insurance when I first went to a hospital clinic, and the huge increase in the quality of care from the chain clinic was worth it. Unless the amount you have to pay for both the study and subsequent office visits is unmanageable, I would choose a hospital sleep center.
posted by fox problems at 5:39 PM on January 16, 2015 [1 favorite]

Full disclosure: I am a PA and I work in a private practice sleep center. It is not a "chain" center and is owned by a rather brilliant Standford graduate in sleep medicine.

Whether or not you should go to a teaching hospital or a private practice depends predominantly on the quality of the two institutions, which I know is difficult to assess. Teaching hospitals are full of brilliant minds but also full of fellows and of patients. Depending on the hospital you may see a fellow from start to finish. Fellows leave fellowships and so chances are your care may get switched between different providers. This is not necessarily a bad thing if you like the different providers but can be a pain if you switch to one you don't. You are less likely to have that issue at a private practice. So generally speaking I think it's easier to build a relationship in a private practice.

The other big issue you should consider is the complexity of your problem. Most sleep problems are pretty straight forward. Sleep apnea, central hypersonia, REM behavior disorder or restless leg/periodic limb movement disorder. There are some that are more ccomplex like nocturnal seizures, parasomnia, night terrors that may be better handled at a teaching hospital.

I would go to (and have sent loved ones) to the doctors in the private practice I work before I would ever go to the teaching hospital. But SF might be totally different. Is there a reason why you can't have a consultation at them both? Just because you go in for an evaluation doesn't mean you are stuck having the sleep study with them.
posted by teamnap at 6:42 PM on January 16, 2015 [1 favorite]

Response by poster: 1) My primary care practice (which I like and which serves my needs well) wrote me a referral to UCSF, and if I hadn't looked at the ClearCost site, I probably would have just gone there (although there's also an annoying 6-week+ wait for appointments there.) However, I have an insurance plan that doesn't require referrals per se. I trust UCSF, but I'm also not sure how much my primary care practice hand-picks the doctors they refer people to so I'm not necessarily committed to their recommendations. (They referred me to a dermatologist that had awful, awful reviews so I just saw someone a friend recommended instead.)

2) I guess what leaves me feeling weird is that from yelp reviews and websites, some of the sleep centers don't come across as doctors' private practices so much as (for-profit) businesses that employ doctors and other professionals. I realize that might be a fine line, and I know that doctors ultimately aim to make money from their practice, but...I don't get that "this is a business that employs doctors" impression from, say, my dermatologist's office.

But yeah, I don't know that I have anything particularly complicated going on, so I'm not sure that UCSF is necessary or warranted. I just don't want to go someplace that feels like a business more than a private practice.
posted by needs more cowbell at 10:32 PM on January 16, 2015

I suspect sleep centers can only exist on a scale that well exceeds the more typical specialist's private practice clinic comparable to your dentist, dermatologist, or the like. A sleep center is in some respects an expensive hotel with a very strange menu of services and a 24-hour medical staff for part of the week.

What would it cost you to get a consult at ClearCost, and then walk away? That might let you work out how you feel about the atmosphere before you spend the night.

Also, I don't know how common it is, but for some patients, doctors will prescribe a home study, which amounts to a piece of equipment that you take home, attach to yourself somehow, and sleep in your own bed. I don't have any idea what criteria one must meet to get that instead of an overnight study (which I did), but you might fit them.

For what it's worth, Sleep Research as we now know it was more or less invented at Stanford. Their Sleep Research Center was founded by Dr. William C. Dement, a pioneer in the science of Sleep Medicine.

It took me a month of waiting before my appt. for the sleep study after visiting my PCP, followed by a few days of followup, and then a week or so before I got fitted for my CPAP (which is by far the most rewarding piece of tech I own). After I got CPAP, I found myself wishing I'd done all that sooner. For that reason, I'd say go to the one that will get you in first.
posted by Sunburnt at 10:54 PM on January 16, 2015

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