Sleep Study At Home: What To Expect

Sleep apnea is a common sleep disorder that affects over 20 million Americans. It is caused by the repeated collapse of the upper airway during sleep, resulting in poor sleep quality and low oxygen levels. To diagnose sleep apnea, doctors used to rely solely on polysomnography, an in-lab test that monitors brain and muscle activity, heart rate, breathing effort, and other metrics. However, with the advent of at-home sleep studies, also known as home sleep apnea tests (HSAT), diagnosis has become more accessible and convenient for patients. These tests are designed to detect obstructive sleep apnea (OSA) and involve monitoring breathing, heart rate, oxygen levels, and other vital signs while the patient sleeps in their own bed. The tests are typically ordered by a sleep specialist, pulmonologist, or primary care physician, and the equipment is either mailed to the patient or picked up at a sleep lab or clinic. The patient then wears the gear for one night, after which the data is uploaded and sent to a specialist for review. At-home sleep studies are generally more affordable than in-lab tests and are often covered by insurance.

Preparation: Avoid caffeine and alcohol, and fill out a sleep questionnaire

Before your at-home sleep study, there are a few things you should do to prepare. Firstly, avoid consuming caffeine in the afternoon and evening of the day of your study. This includes coffee, tea, cola, and chocolate, as caffeine can contribute to insomnia and disrupt your sleep. Similarly, it's best to avoid alcoholic drinks such as beer, wine, or liquor during the afternoon and evening of the test, as alcohol can alter your normal sleep patterns and interfere with an accurate assessment.

If you usually take sleep medications, it's important to ask your doctor if it is appropriate to take them on the night of the test. It's also a good idea to stick to your regular bedtime routine as closely as possible, so bring along your usual bedclothes or any other items that help you sleep. You may also be asked to keep a sleep diary to record your sleep patterns and any symptoms you experience.

On the day of the study, you will need to fill out some paperwork and questionnaires. These will ask about your sleep habits and any specific problems or changes in your sleep patterns. It's important to be as detailed as possible in your responses, as this information will help the sleep specialists interpret your test results accurately.

Remember, the goal of your at-home sleep study is to get a clear understanding of your sleep patterns and any underlying issues. By following these preparation steps, you can help ensure that your test results are accurate and informative.

Equipment: A pulse oximeter, nasal cannula, microphone, and data collection device

A home sleep study is a simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort. It is a small commitment, usually used just for one night, and is also less expensive than a sleep study conducted in a clinic. Here is a detailed breakdown of the equipment used for the study:

Pulse Oximeter

A pulse oximeter is a small, clip-like device that measures your blood oxygen levels and pulse. It is placed on a body part, most commonly a finger, earlobe, or toe. The device uses small beams of light that pass through the blood in your finger, measuring the amount of oxygen. This is a painless and non-invasive procedure.

Nasal Cannula

A nasal cannula is a thin, flexible tube that delivers extra oxygen through two prongs that sit inside your nostrils. It wraps around your head, typically hooking over your ears, and connects to an oxygen supply like a tank or container. The cannula can be high-flow or low-flow, which refers to the amount of oxygen delivered per minute.

Microphone

A microphone is used to record any sounds made during sleep, such as snoring, snorting, or gasping, which may be indicators of sleep apnea.

Data Collection Device

A data collection device (DCS) is a computer application that facilitates the systematic gathering and storage of specific, structured information. In the context of a sleep study, it collects data from the sensors and devices mentioned above, such as the pulse oximeter, nasal cannula, and microphone. This data is then analysed by a sleep technologist to assess for any breathing abnormalities indicative of sleep apnea.

Test: Wear the gear for one night, during normal sleeping hours

Wearing the gear for one night during your normal sleeping hours is the core of the at-home sleep study. You will be given a device and training on how to use it. The device will monitor your breathing, heart rate, oxygen levels, and other vital signs while you sleep.

The device will include sensors to detect your breathing patterns. This will include a small probe over your finger to measure oxygen levels, and tubes inserted into your nostrils and secured around your ears, similar to an oxygen mask. Other sensors will be placed on your abdomen and chest to measure their rise and fall as you breathe.

The test should be done during your normal sleeping hours and in your normal sleeping position. You may be asked to keep a sleep diary to record your sleep patterns and any symptoms you experience. It is important to try to sleep and wake up at your normal times and avoid caffeine and alcohol, as they can affect your sleep.

Once you have completed the test, the data is uploaded and sent to a specialist for review. They will determine if you have sleep apnea and advise on next steps.

Results: A sleep technologist reviews the data and sends it to your physician

Once you've completed your at-home sleep study, the data is sent to a sleep technologist who reviews it before sending it to your physician. The technologist will look for signs of sleep apnea, which is a serious health problem that causes short interruptions to your sleep because you stop breathing, and your body reflexively wakes you up to breathe. This can cause heart disease and high blood pressure and may worsen diabetes.

There are two types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is the most common form and occurs when the muscles in the back of a person’s throat relax, allowing the soft tissues that they support to collapse and partially or completely block the airway. CSA is less common and occurs when the brain does not regulate sleep properly. CSA is associated with stroke and chronic heart failure. Although patients with CSA do not snore, symptoms of CSA and OSA are similar.

The data collected during your at-home sleep study will include measurements of your airflow, breathing effort, blood oxygen levels, and heart rate. This data will be used by the sleep technologist to determine if you have sleep apnea and, if so, which type. The technologist may also look for other sleep disorders, such as movement disorders that cause nighttime restlessness or narcolepsy, a neurological disorder that affects the body's sleep-wake cycles and causes excessive sleepiness.

If the results of your at-home sleep study indicate sleep apnea, the technologist will send the data to your physician, who will then work with you to determine the best treatment course. Treatment may include behavioural changes such as weight loss and abstaining from alcohol, or you may be prescribed continuous positive airway pressure therapy (CPAP), which is the standard treatment for sleep apnea and uses a mask worn over the nose and mouth to facilitate airflow during sleep.

If the results of your at-home sleep study are negative but you are still experiencing symptoms, your physician may recommend further testing, such as an in-lab sleep study, to guard against a false negative result. In-lab sleep studies are more comprehensive and can measure sleep quality and duration, as well as brain activity and movement in the eyes and limbs during the various stages of sleep.

Follow-up: Your doctor will discuss the results with you and recommend next steps

After your at-home sleep study, a healthcare provider will interpret the data and results. They will then contact you to let you know what they found and recommend next steps. In most cases, they will discuss your results in more detail at a follow-up appointment, where they will talk through treatment options and other next steps.

If your at-home sleep study results are positive, this may be enough to diagnose you with sleep apnea. However, your doctor may still order further testing, especially if you have symptoms of sleep apnea but receive a negative result. In this case, you may be referred for an in-center sleep study to guard against a false negative result.

If you have a relatively straightforward case of suspected moderate or severe sleep apnea and no other health conditions, then a home sleep apnea test is a good place to start. However, if you or your doctor have any reason to believe you need a more comprehensive test, then it might be worthwhile to skip the home test and go directly to the sleep lab, as results of a home sleep test may indicate further testing is needed.

If you have certain heart, breathing, or neuromuscular problems, an overnight sleep study at a sleep center may be better. Polysomnography, which is done in a sleep lab overnight, is a more comprehensive look at your sleep patterns and can screen for a host of conditions, including limb movements during sleep, other behaviors during sleep, and more complex sleep-related breathing disorders.

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