When you think about sleep apnea, snoring is likely the first thing that comes to mind. But this condition, which causes those who suffer from it to temporarily stop breathing while they sleep, can also leave them feeling groggy while they’re awake.
From memory and productivity problems to a decrease in problem-solving capabilities, work efficiency, and mood, sleep apnea can cause a wide range of cognitive issues, explains Dr. Amer Khan, a board-certified sleep specialist and neurologist. And because most sleep apnea cases go undiagnosed and untreated, the condition can cause sleep deprivation over time — a trigger for numerous long-term health issues.
But here’s the good news: There is effective help for sleep apnea. Getting the right treatment starts with an official diagnosis — and that starts with getting a sleep apnea test.
Types of sleep apnea tests
The two main types of sleep apnea testing are an at-home test, which uses a portable device, and an in-lab sleep study, also known as a polysomnogram, which includes professional monitoring while you sleep.
In both tests, your data will be evaluated against the Apnea-Hypopnea Index (AHI). An apnea event occurs when you stop breathing or have reduced breathing capabilities to about 10% for 10 seconds or longer; hypopnea involves constricted breathing by over 30% for 10 seconds or longer. Your AHI is the average number of times you experience these two events per hour of sleep.
“Less than five (events) per hour for adults and less than one per hour for children is the norm,” Khan explains. If your medical provider determines your test results fall outside the normal range, you could receive a sleep apnea diagnosis.
A medical professional will determine the best testing for your situation.
Although the FDA has approved numerous at-home sleep apnea testing devices, the actual diagnosis isn’t a DIY affair, and will require a medical professional’s review. The official position of the American Academy of Sleep Medicine is that only a medical provider can interpret the results and diagnose obstructive sleep apnea.
“Your first stop usually is your primary care doctor,” recommends Khan. At-home testing devices can definitely detect sleep apnea, but only a trained professional can interpret the results. And, you’ll need a prescription to use this kind of device.
You’ll also need a medical professional to determine the right type of testing for you. That goes for both home sleep studies and in-lab tests. In some cases, doctors may recommend multi-night testing, but for at-home testing, single-night studies are usually the norm. Here are the details of types of sleep apnea tests, to help you learn which may be best for you.
Home sleep study
At-home sleep apnea tests measure how often you stop breathing or have trouble breathing while you sleep in the comfort of your own bed. However, they don’t measure your sleep stages like an in-lab study does.
During your at-home test, you’ll wear a portable device — essentially, a simplified version of the equipment used in a lab study. Instead of a technician overseeing the process, you’ll be the one responsible for making sure the device is correctly worn and used.
The American Academy of Sleep Medicine classifies at-home sleep apnea testing devices into several categories:
- Type II devices use the same sensor technology as in-lab studies without an attendant monitoring the test.
- Type III devices measure two separate respiratory variables (e.g., breathing effort and airflow), oxygen saturation, and a cardiac variable (e.g., heart rate).
- Type IV devices measure only one or two variables, usually heart rate and oxygen saturation.
At-home tests typically include a trio of Type III devices that have been used for decades: a chest belt to measure your chest movement, a nasal cannula to detect airflow, and a finger sensor to measure your oxygen levels and heart rate. A newer technology, peripheral arterial tonometry (PAT) assesses your airflow, sleep duration, sleep stage for each apnea event, and pulse strength.
Pros of home sleep testing
- Less expensive than sleep lab studies.
- More comfortable because you can sleep in your own bed, where you’re more likely to feel at ease.
- Monitors you in your usual sleep environment, which could provide more realistic results. In a lab, some people struggle to fall or stay asleep, says Khan.
- Fairly accurate when using an FDA-approved device as intended.
Cons of home sleep testing
- Not suitable for everyone, including people who have trouble sleeping and/or take a long time to fall asleep. (For example, if you’re an insomniac, your doctor may recommend an in-lab study instead.) They’re also not for people with severe or underlying health conditions and aren’t validated for kids.
- Possibility for error from technical malfunction and/or human error when you, rather than a technician, are using the device.
- Not all can distinguish among obstructive sleep apnea, central sleep apnea, and complex sleep apnea.
- Doesn’t measure your sleep stages, which can cause inaccuracies in your AHI score.
- Mild cases of sleep apnea can go undiagnosed.
Home sleep test process
If your doctor determines that you’re a candidate for an at-home sleep apnea test, they’ll prescribe a portable device and provide instructions to help you fit it properly. The idea is to wear the device and go to bed as you usually would — in your typical bedroom at your normal sleep time.
After the test is complete, your doctor will interpret the results. Some devices allow you to transmit data directly to your doctor through a Bluetooth-enabled smartphone app.
In-lab sleep study (Polysomnography)
For a polysomnography sleep study, you’ll go into a lab. There, a technician will hook you up to various wires and sensors and monitor you while you sleep in the lab — usually overnight. After the in-lab study, a trained specialist will interpret the information that’s collected by the machines.
Unlike an at-home test, polysomnography measures both your breathing and sleep stages. It collects data including:
- body and leg movement
- blood oxygen levels
- eye movements
- brain waves (EEG)
- heart rate and rhythm
- noises or unusual behavior
- what happens during different stages of sleep
- whether you’re in light or deep sleep (sleep stages)
- breathing
Polysomnography may be a good option for people with sleep disorders or those who have already had trouble using at-home testing devices. The detailed nature of an in-lab study is also appropriate for people who aren’t sure why they’re feeling tired and unrefreshed after a full night’s sleep.
Pros of an in-person sleep apnea study
In-person sleep apnea testing is the gold standard because it provides comprehensive, accurate results. If at-home testing suggests you don’t have sleep apnea even though you have some of the symptoms, your doctor may recommend in-lab testing.
The American Academy of Sleep Medicine recommends in-lab sleep testing instead of in-home testing if you:
- have serious heart disease or another underlying health condition
- have respiratory muscle weakness because of a neurological condition
- have a long-term history of opioid use
- experience shallow breathing while asleep or awake
Cons of an in-person sleep apnea study
In a lab, you won’t be able to sleep in your own bed, and the environment may not be conducive to relaxation — especially if you have medical-related anxiety. Research also suggests the possibility of false negatives with in-lab testing. Your results won’t reflect some environment-specific information, like a partner disrupting your sleep.
Other cons of an in-person sleep study include:
- Intrusive. It's not easy to feel comfortable or relaxed when wired up to various machines in a lab setting.
- Costly. Pricing varies by state and provider but averages about $5,000 without insurance, according to data collected by Fair Health.
- Limited availability. It could be difficult to find an accessible location or one that accommodates your sleep preference.
Self-evaluation tests for sleep apnea
Self-evaluations for sleep apnea are questionnaires you can fill out to determine how likely it is that you have the condition.
If you have a sneaking suspicion that you have sleep apnea — maybe because a partner points out that you snore loudly — filling out a self-evaluation is a good start. However, there are drawbacks to self-reported data.
People, it turns out, are pretty bad at estimating their sleep. One 2012 study found that participants’ self-reported sleep hours were not at all in line with actual recorded sleep data.
If your self-assessment score indicates you may have sleep apnea, talk to your primary care physician to determine the next best steps, Kahn says.
What is the STOP-BANG survey?
The STOP-BANG self-evaluation survey doesn’t diagnose sleep apnea, but research shows it’s an effective screening tool to determine if you need a sleep apnea test.
The name STOP-BANG is an abbreviation of the questions you’ll be asked. These include:
- Snoring: Do you snore loudly?
- Tiredness: Do you regularly feel tired or sleepy during waking hours?
- Observed Apnea: Has anyone ever observed that you stop breathing while you sleep?
- Pressure: Do you have high blood pressure?
- BMI: Is your BMI greater than 35?
- Age: Are you older than 50?
- Neck Circumference: Is your neck circumference larger than 16 inches?
- Gender: Are you male?
Answering “yes” to five or more questions puts you in the high-risk category. You’re also high-risk if you:
- answer yes to 2 or more STOP questions and are male.
- answer yes to 2 or more STOP questions and have a BMI greater than 35.
- answer yes to 2 or more STOP questions and have a neck circumference larger than 16 inches.
Want to try the STOP-BANG test for yourself? Find it here.
Sleep apnea study results and treatment
Once you complete your test, your doctor will interpret your data and deliver your results: negative, inconclusive, or diagnosed with sleep apnea. You will be diagnosed with sleep apnea if your AHI falls outside the normal range.
For adults, AHI scores correspond to three levels of sleep apnea severity:
- Mild: 5 to 14
- Moderate: 15 to 29
- Severe: 30+
Most at-home sleep apnea tests measure your breathing but not your sleep cycle. As a result, they calculate your AHI based on total recorded time — not the total time you’re actually asleep — and often underestimate sleep apnea severity. That makes it critical to have a medical professional evaluate your at-home test data.
Treatment based on results
Ultimately, it’s the type of sleep apnea that determines the course of treatment. “For obstructive sleep apnea, the gold standard is positive airway pressure therapy, which opens up the air passages by the force of air pressure,” says Khan. Continuous positive airway pressure (CPAP) devices are one example.
Other treatment options include:
- Oral appliances that physically open the airway by moving the chin forward can help with obstructive sleep apnea.
- Surgeries that help treat obstructive sleep apnea through tissue removal, jaw repositioning, or, in the case of life-threatening sleep apnea, tracheostomy. A newer treatment, hypoglossal nerve stimulation therapy involves inserting a stimulation device that temporarily shrinks the tongue for better airflow.
- Other airway pressure devices are available, such as bilevel positive airway pressure (BiPAPs) and automatic CPAPs. These can also help people with central sleep apnea breathe through the night.
- Treating underlying conditions of central sleep apnea, such as a neurological or cardiovascular disorder.
Which sleep apnea test should you take?
Depending on your situation and medical history, your doctor will recommend either a home or lab study. Both are reliable ways to detect sleep apnea — especially when their results are evaluated by your doctor. Filling out a self-evaluation questionnaire like the STOP-BANG survey can help you determine whether to see a doctor for your symptoms.
An at-home test is a convenient, affordable alternative to the more detailed in-lab sleep study. However, it’s not appropriate for everyone. Some people, like those who have existing sleep disorders, may benefit from starting with an in-lab study.
Whether your doctor recommends an at-home or in-lab sleep apnea test, you’re already one step closer to getting effective treatment — and restful, uninterrupted sleep.
