The American Sleep Association estimates that about 12 million Americans have obstructive sleep apnea, a condition in which breathing stops for short periods multiple times during the night. Sleep apnea doesn’t only cause excessive daytime sleepiness, its most noticeable effect; it also increases risk for heart attack and stroke, making it a serious medical condition for the millions who don’t know they have it.
Even if a sleep partner or spouse notices the telltale deep snores that stop abruptly and then resume with a coughing or gasping sound, many people shy away from having the condition assessed—in part because the idea of sleeping in a lab with monitors and wires tracking respiration, heart rate and blood pressure while a technician observes on closed-circuit video is less than appealing. But a new option is emerging and gaining popularity—home sleep studies.
“In home sleep apnea tests, there are a number of sensors that the patient applies in the comfort of their home with guidance from a sleep technologist either prior to obtaining the device in the lab or over the phone,” explains Julie Toomey, manager of the Sleep/EEG Center at Barnes-Jewish West County Hospital. “The information is collected on a recorder that the patient must return for review. The data will show if there are attempts at breathing that are blocked, or obstructed in the airway.”
Home sleep studies have not been approved to diagnose any other sleep disorders, but insurance companies are beginning to require home testing as a first step in the diagnostic process. “A home sleep study is much cheaper, and insurance companies look at it as much easier, and they can save themselves money,” says Dr. Kevin Postol, a dentist who works with patients and their physicians to treat sleep apnea with removable oral appliances, which are worn at night to help ensure that the upper airways remain open.
Postol notes that the appliances are a treatment option for some patients who have difficulty tolerating continuous positive airway pressure (CPAP), a small mask worn over the nose that uses mild air pressure to prevent the airway from collapsing or becoming blocked. “The appliance pulls the lower jaw forward to help open the airway,” he says. “It gives the mouth a little more room for the tongue and soft palate so you can breathe a little bit easier.”
Although home sleep studies are becoming more common, patients who show evidence of obstructive sleep apnea still need to report to a hospital sleep center in order to determine the proper treatment. CPAP or oral appliances must be adjusted by experts to ensure they are most effective.
“Sleep studies in the laboratory are the gold standard because they monitor individuals for all sleeping disorders, not just OSA,” Toomey says. “Many more sensors are applied, and the patient is continuously monitored by a sleep technologist who can intervene if one of the sensors becomes dislodged or fails. Sleep techs also can start treatment options according to the physician's order so that if a patient does have moderate to severe sleep apnea, treatment efficacy can be monitored that same night.”
Whether at home or in a sleep center, anyone with at least two of the risk factors or symptoms of sleep apnea—loud snoring, daytime sleepiness, waking up choking or gasping for air, unexplained high blood pressure, obesity, and/or a thick neck (more than 17 inches for men and 16 inches for women)—should talk with their primary-care physician about testing.