Several years ago, following a period of prolonged fatigue, 48-year-old Mary Sutter got connected to a series of wires, probes, and monitors, then headed to a hotel-like room set up by the Cleveland Clinic, and tried to get a good night’s sleep under the watchful eyes of sleep specialists.
Sutter was taking part in a traditional sleep study (also called polysomnography) to determine if sleep apnea was the culprit for her ongoing lack of energy. Nothing in particular showed up from the overnight testing, and Sutter returned home feeling relieved that apnea wasn’t the issue.
Then, last year, Sutter’s fatigue returned. Her doctor again ordered a sleep study. But this time, she was able to do it all in the comfort of her home.
Sutter says the at-home kit arrived in a box with specific, easy-to-follow instructions. “I had to put probes on my chest and in my nose, and wear an oximeter,” she says. “Then I turned it on and went to sleep.”
At-home sleep study kits to test for obstructive sleep apnea (OSA) first appeared on the market over a decade ago. And while they were initially the outlier for determining if a patient had the condition, physicians are now turning to home tests more often than in-lab studies.
Why sleep studies are moving home
The main reason for the increased popularity of at-home sleep studies is how much they’ve improved in both reliability and sophistication, says Dr. Asim Roy, medical director of the Ohio Sleep Medicine Institute near Columbus, Ohio.
“The first generation of at-home sleep tests were watered-down versions of what we did in-clinic,” he says. “But today, it’s a well-accepted approach we use regularly. And if the at-home results are inconclusive, we can bring that person into the lab for further testing.”
Roy estimates that in-home tests can now detect apnea in 80% to 90% of cases, especially when the condition is moderate to severe. That’s a testament to how sensitive the tests have gotten in recent years.
“One of the problems of the early generations of in-home tests was that they didn’t measure how much a patient was actually sleeping,” says Roy. “Our gold standard measurement is the apnea hypopnea index (AHI), which records the number of apneas per night of sleep, divided by the hours of sleep.” Because the home-based tests couldn’t measure total sleep, the data wasn’t that useful.
But some sleep test kits can now track total sleep hours, bringing the results closer to what you’d see in a clinic.
The improvement in these at-home tests couldn’t have come at a better time, as sleep apnea rates are on the rise in tandem with increasing rates of obesity (a risk factor for sleep apnea). Today, it’s estimated that at least 30 million American adults have sleep apnea.
And that number is likely even higher, as the majority of cases — as many as 90% of OSA cases, by some estimates — are undiagnosed. That poses a problem for patients and healthcare providers alike. In 2016, the American Academy of Sleep Medicine (AASM) released an economic analysis of the cost of undiagnosed OSA. The analysis determined that by diagnosing and treating every person with the condition, annual savings would exceed $100 billion.
This potential savings, coupled with the cheaper price tag of in-home testing, has led insurance companies to begin limiting their approval for in-lab testing and encouraging physicians to use at-home kits instead. “A home study can run $200 to $300, compared to 10 times that for one done in a hospital-owned lab,” says Roy.
Should you try an at-home sleep apnea test?
Like any medical advancement, there are pros and cons to home sleep tests. One reason to give it a shot is that a sleep test done in your own bed can be both more comfortable and more accurate.
Whereas sleep clinics are a foreign environment, “patients are more relaxed at home,” says Ellen Wermter, a nurse practitioner at Charlottesville Neurology and Sleep Medicine in Virginia. “Research shows that on a first night sleeping away from home, our brains are on alert, trying to ensure we are in a safe environment. That doesn’t come into play at home.”
But home testing isn’t without its issues, either, says Sutter, who felt she slept better during the in-lab experience. “At home, I had my dog on the bed with me, and I kept worrying about her getting tangled in the wires,” she says. “And when I had to get up to use the bathroom, the at-home kit was a bit more unwieldy to lug around, which made it tougher to fall back to sleep.”
Other potential shortcomings to in-home testing include its limitations in picking up underlying issues like heart or lung conditions. But that’s where a thorough intake exam comes into play, says Wermter. “Sometimes healthcare providers have to push back on insurance when it wants us to use in-home kits,” she says. “Until we’ve done a history with a patient to accompany the testing, we’re not getting the full picture.”
With the trend toward in-home testing only accelerated by the pandemic and reduced clinic capacities, however, there seems to be no turning back. “We’re currently conducting about 70% of apnea tests at home,” says Roy. “And because the diagnostics will only continue to improve, this is the present and the future of apnea testing.”
Starting the conversation with your doctor
When it comes to discussing at-home sleep tests with your doctor, it also helps to be prepared with examples of your symptoms. Of course, outlining symptoms that show during the day is easy. But symptoms that show up at night, such as tossing and turning, can be harder to detect. Even total sleep time can be hard to measure if you're not sure exactly when you fall asleep or if you wake up throughout the night.
That's where sleep trackers may be able to come in handy. Rather than asking a partner — or your tired brain — keep tabs on every sleep metric, use a tracker to help collect additional data over a longer period of time. While these apps shouldn't replace your doctor's diagnosis or the results of an at-home sleep study, they can help point you in the right direction so you can make strides towards improved sleep.
