As many as 80 percent of people with obstructive sleep apnea (OSA) are undiagnosed. That means they don’t get the treatment they need to improve their sleep and reduce their risk of serious diseases.
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Fortunately, diagnosis is becoming easier as access to in-lab sleep studies improves, says Nancy Foldvary-Schaefer, DO, MS, Director of Cleveland Clinic’s Sleep Disorders Center. And many patients can benefit from simpler home sleep testing.
Answer these 8 questions
Before asking about a sleep test, answer these eight questions:
- Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
- Do you often feel tired, fatigued or sleepy during the day?
- Has anyone observed you stop breathing while you sleep?
- Do you have high blood Pressure?
- Is your body mass index (BMI) more than 35?
- Are you over age 50?
- Is your neck circumference more than 40 centimeters (15.75 inches)?
- Is your gender male?
Dr. Foldvary-Schaefer says, “If you say yes to at least three of eight questions, you have a high probability of OSA.”
Home testing: confirming suspicions
A “yes” to three of eight questions also means you may be a prime candidate for home sleep testing.
Home testing is a stripped-down version of what occurs in a lab-based sleep test. That may sound appealing to all patients, but home testing is just for people with a high probability of OSA who do not have other sleep disorders, such as restless legs syndrome or insomnia, or medical disorders, such as cardiac arrhythmias or heart failure.
“We just want to prove a diagnosis so we can start treatment with a CPAP machine,” Dr. Foldvary-Schaefer notes. “If we can prove it on a home sleep test at a lower cost, we will do so.”
For a home test, typically you will receive education from a sleep technologist first. Then you will receive a home kit with simple instructions for use. Over the course of a night’s sleep, four sensors will measure the airflow through your mouth and nose, movements in your chest wall, your oxygen levels and your heart rate.
If the testing confirms OSA, you’ll be ready to get the treatment you need.
Lab testing: for complex cases
Home testing is not for everybody. It is not a screening tool, Dr. Foldvary-Schaefer says, because it does not differentiate mild disease from normal sleep.
It also does not work for people whose probability of OSA is unclear, such as those who do not meet many of the criteria in the eight questions above. For these people, as well as those with certain heart and neurological conditions, a sleep test in the lab (polysomnogram) is still the gold standard.
Where home testing measures four parameters, in-lab testing measures up to 20, including brain waves, carbon dioxide levels and other more advanced metrics. The goal is to offer a more precise diagnosis in more complicated cases.
Many people are nervous about lab tests, but sleep centers try to mimic the home environment as much as possible, with comfortable beds and a hotel-like atmosphere. You’re encouraged to bring everything you need for your usual bedtime routine: reading materials, medications, your favorite pillow, even your family members.
“Most people won’t sleep like they do at home,” Dr. Foldvary-Schaefer says. “But if we’re able to capture a few hours of sleep, we usually get what we need to make a diagnosis and help patients get treated.”