A sleep study can easily uncover sleep disorders—from a mild airway blockage to Obstructive Sleep Apnea (OSA). These tests are important and potentially life-saving. Yet, one of the leading reasons why those with sleep disorders fail to obtain an accurate diagnosis is a reluctance to commit to the sleep study itself. It’s understandable: who wants to sleep in a hospital bed, hooked up to sensors, and watched all night by a well-meaning stranger (i.e.: the sleep lab technician)?
This is one of the main reasons why people today opt for home sleep tests (HST) as a convenient alternative to lab-based options. Does this mean HST’s will eventually replace clinical sleep studies? Both tests have advantages and disadvantages, so to answer that question with a simple yes or no wouldn’t be fair to either. Instead, we’ll look at both options to help you decide which is right for you, starting with the basics of sleep apnea, OSA, and CPAP.
Obstructive Sleep Apnea, Snoring, and CPAP Therapy
Starting with the basics of sleep apnea, what is the difference between OSA and snoring and their relationship to CPAP?
Snoring can be a symptom of OSA, which one of three types of sleep apneas. The other two types of sleep apnea are Central Sleep Apnea (CSA) and Complex (Mixed) Sleep Apnea (CompSAS). If you have been told you snore, it’s best to complete a sleep study in the setting that’s right for you, but it’s also possible that your snoring is nothing more than noise pollution—the test results will let you know.
The relationship between OSA, CSA, and CompSAS to CPAP therapy is simple. CPAP therapy is a type of treatment for the different types of sleep apneas. There are also different types of PAPs, which stands for positive airway pressure. The C in CPAP stands for continuous. The other two types of PAPs are automatic positive airway pressure (APAP) and bilevel positive airway pressure (BiPAP). No one is any better or worst for treating sleep apnea—the right one is the one that works best for you based on the results of your sleep study.
Are Home Sleep Studies Accurate?
Simply put, yes, home sleep studies are accurate tests that are easy to complete from the comfort of your home.
Depending on your health needs, an in-lab sleep study may be better for you if you need your brain activity monitored.
Advantages of a Home Sleep Study
Convenience is the name of the game when it comes to the HST. From the comfort of your own bed, you can complete the sleep study, which will record valuable information that can be analyzed by a sleep specialist. Some advantages include:
- You Sleep at Home. Studies suggest that sleeping in a familiar environment facilitates an easier transition into rapid eye movement periods (REM) sleep, as evidenced by observed higher rates of sleep-onset REM periods in the home sleep study participants against counterparts in an in-lab environment. Another study backs this up by noting that participants of a polysomnography test actually experienced better nights of sleep two or three days after their night in the lab.
- It May Be Cheaper. Most HSTs cost a few hundred dollars or less, while a traditional sleep study can run five times that amount. Insurance is always a factor, so check with your provider to see what your coverage levels look like. If there is no price difference between either option, discuss the pros and cons of each with your doctor.
- You’re More Likely to Complete an At-Home Sleep Study. An HST is a good idea if you’re unlikely to complete a clinical sleep study due to any inconvenience (i.e. distance to a lab and how long you’ll need to wait for availability at the lab). With nearly 80% of those diagnosed with OSA failing to treat their condition, at-home sleep studies make it easier to take that important first step and have a higher completion rate.
Disadvantages of Home Sleep Studies
While HSTs offer several benefits, they may not be for everyone. Some of their disadvantages over in-lab tests include:
- Not Everyone Is Eligible. If you have pre-existing conditions related to your breathing, heart, or blood pressure you may not be a good candidate for a home sleep study. Some of those conditions have similar symptoms to sleep disorders, so a home sleep disorder may not accurately diagnose your OSA. When you discuss doing a sleep study with your physician, discuss your health history to assess which option is best for you.
- No Brain Activity Is Recorded. What happens in your brain while you sleep is part of understanding your sleep. Another disadvantage of a home sleep study is that brain activity isn’t recorded, although a diagnosis compliant with American Academy of Sleep Medicine (AASM) guidelines can be made through a home sleep study using the equipment provided.
HSTs Versus Polysomnography
Commonly referred to as the in-lab sleep study, its actual name is polysomnography and is also referred to as PSG. This is a comprehensive test that can diagnose several sleep disorders including, sleep apnea, restless leg syndrome, and narcolepsy. The test results are called a polysomnogram.
A PSG is conducted in a sleep center or hospital. The test is usually performed at night to record the person’s normal sleep pattern. Electrodes are placed on the scalp, the outer edge of the eyelids, and to the skin on the chin in preparation for the test.
Characteristic patterns from the electrodes are recorded during three stages: while you are awake, while your eyes are closed, and while you are asleep. Also, a computer is used to record the time it takes to fall asleep, the time it takes to enter the REM cycle, body movement, and breathing patterns. The PSG also records your sleep architecture, which is the structural organization of how long your body stays in each phase of sleep.
While not as comprehensive as the PSG, an HST still conforms to the AASM clinical guidelines, which states that a proper OSA evaluation requires portable monitoring equipment that records at least:
- Airflow (Pressure-Based)
- Pulse Oximetry
- Heart Rate
- Changes in the Amount of Air You Breathe In and Out While Sleeping
A traditional, clinic-based sleep study offers some benefits that home-based sleep tests can’t match. Though not nearly as convenient as the HST, a clinical study is also different in an possible important way depending on your medical history:
- Results Are Generally More Intensive. The amount of information is often more extensive among clinical sleep studies versus HSTs, and the number of trackable metrics that can be gleaned from the clinical study tends to beat a home-based study. By working with a qualified medical professional during the clinical sleep study, your test could be more accurate as the sleep lab technician will be there to assist if you accidentally disconnect any sensors while sleeping, for instance.
How Does a Home Sleep Test Work?
Since you now know some of the advantages and disadvantages of the HST and the PSG, you can decide if a home sleep test is right for you. If the HST sounds like it could work for you, here is what you can expect. You’ll typically receive:
- Electrodes for Your Chest (Soft Electrodes that Conform to Your Skin)
- A Small Oxygen Sensor Probe to be Placed Over Your Finger
- A Chest Belt To Measure Breaths and, if Needed, Sleep Position
- A Nasal Cannula To Measure Airflow. This Is a Mask With Tubes That Go Into the Nostrils and Is Secured Around the Ears, Similar to an Oxygen Mask
All of these sensors are hooked up to a small device about the size of a smartphone that records the data and is strapped to your chest over your sleepwear. When the night is over, you send the machine back to the sleep lab for analysis, and the results are sent to your physician to discuss your results and diagnosis.
Though rare, your home sleep study may be inconclusive or another disorder is suspected. In those cases, your doctor may prescribe an overnight sleep study at a sleep lab as a follow-up.
Doing a home sleep study or a clinical sleep study will ultimately come down to both preference along with considerations for which setting will provide you with the best diagnosis. An HST is a great place to start if you’re suffering from sleep-related health issues or have simply been told by your partner that you snore at night.
As always, the best place to start is with your doctor, listen to their input, and make a decision based on what you feel is right for your particular situation. If you decide a home sleep study is the way to go for you, we are ready to help you.
Daniela has researched and published over 60 articles covering topics that aim to inform and empower people living with Sleep Apnea. As an avid reader and researcher, Daniela continues to grow her knowledge about Sleep Apnea and CPAP therapy everyday with the help of coworkers, CPAP.com customers, and members of other CPAP communities online.