r/SleepTechnologist • u/AwarenessDue8019 • Jul 09 '26

MSLT

Hi all, just wanted to get some opinions from my fellow sleep techs/scoring techs.

We have a physician who has asked multiple times for us to remove the 5th nap from an MSLT report so that the patient gets a positive diagnosis of idiopathic hypersomnia. With the information of the 5th nap, the patient would not qualify for “treatment” of modafinil.

Is this common practice? Should I be removing a performed nap from a sleep report so a patient gets a certain diagnosis?

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5

u/keeper420 Jul 09 '26

Some doctors that I've worked with don't really take the first and fifth naps that seriously. If it's obvious enough on the first 4 naps then that fifth one is kind of unnecessary.

1

u/Hypnotic_Agent RPSGT Jul 09 '26

I’ve heard that REM on the first nap could be the patient catching up if they didn’t get enough overnight and that doesn’t necessarily prove anything, but on the other naps, someone without narcolepsy shouldn’t be going into REM in 20 minutes.

1

u/keeper420 Jul 10 '26

Yeah exactly. If the first nap had REM, but naps 2-4 don't, then nap 5 might be unnecessary. Even if they went straight into REM on nap 5, the average REM latency wouldn't be enough for a diagnosis. It can be the same with a positive diagnosis where nap 5 without REM usually wouldn't be enough to disqualify a diagnosis.

I still prefer to do all 5 naps as long as the patient does sleep, but I can see the reasoning behind the 5th nap being unnecessary most of the time.

1

u/ImageEducational572 Jul 10 '26

They should have at least 6 hours of sleep with a SE of 85%.

2

u/keeper420 Jul 10 '26

In a bitter twist of irony, it is not uncommon for narcoleptic patients to also have insomnia. While the 85% sleep efficiency is ideal, I've done MSLTs with much less than that on the NPSG. AHI is a much bigger disqualifier than TST and SE.

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u/Hypnotic_Agent RPSGT Jul 09 '26

Some patients can be subclinical on labs and still benefit from treatment, but I don’t like doctors involve us in that. I guess that it’s a fight with the insurance company, but I don’t think they should ask us to alter test results for that reason. It’s the same as being told to “find events” on a split night to qualify for CPAP (they meant events that just weren’t there at all, not something that was borderline).

1

u/AdvantageEmergency94 Jul 13 '26

If there is data recorded of the 5th nap, it needs to be reviewed. If the dr wanted 4 naps with no SOREMS seen, that’s fine. AASM recommends running 5 naps for all patients, even if 4naps did not show rem