At-Home Sleep Tests and Studies

If you regularly wake up feeling less than well-rested or struggle to stay awake during the day, you may have a sleep disorder. Disorders such as insomnia, excessive daytime sleepiness, and sleep apnea all disrupt sleep and can have serious consequences if left untreated. Obstructive sleep apnea affects 2% to 9% of adults. However, researchers speculate that the majority of adults with sleep apnea go undiagnosed. Sleep apnea and other sleep disorders are typically detected in a laboratory sleep study, also called a polysomnogram. However, lab sleep studies can be both expensive and intrusive.
In some cases, at-home sleep tests serve as a valid alternative to undergoing a sleep study in a lab.

What Is an At-Home Sleep Test?

At-home sleep studies can be used to diagnose obstructive sleep apnea. These tests are designed to be convenient and comfortable. With them, you can sleep in your own bed for the test, rather than staying in a sleep lab. To prepare for an at-home sleep test, you must obtain the testing equipment needed and review the instructions on how to wear it properly. You may also get assistance from an in-home specialist. Once you are wearing the sleep test device, you can sleep as you normally would. The equipment records different measurements as you sleep and transmits them to your doctor or sleep specialist. Then, you review the results of your test with your sleep specialist. The results either confirm that you have obstructive sleep apnea or are negative or inconclusive. If results are inconclusive, your sleep specialist might ask you to do an in-lab sleep study to ensure no diagnosis has been missed.

Home Sleep Test Devices

There are several variations of sleep test devices used to perform at-home sleep trials. They are portable devices usually named and classified by the type and number of sensors the tests use.
Type 3 Home Sleep Apnea Testing (HSAT) devices typically include the following:
  • Respiratory Effort Sensor Belt: This belt wraps around your chest. It measures your respiratory effort throughout the night. The belt also secures the other components of the device.
  • Nasal Cannula: The plastic tube loops over both ears and is inserted into your nostrils. The cannula measures your body’s airflow.
  • Pulse Oximeter: The pulse oximeter sits on your index finger. The oximeter measures your blood’s oxygen saturation levels. In many home sleep devices, the oximeter also measures your heart rate.
Other sleep test devices are ARES and WatchPAT. ARES (Apnea Risk Evaluation System) devices are worn on the head like a headband. These measure airflow, oximetry, head position, and a limited electrical reading of the forehead. A WatchPAT is worn on the wrist, like a watch, and has a pulse oximeter you attach to your index finger. Unlike a Type 3 or ARES test, the WatchPAT doesn’t measure airflow. The appropriate home sleep test device depends on your sleep apnea symptoms and their severity. Your doctor can determine which device is appropriate for you.

Home Sleep Test Metrics

If you have obstructive sleep apnea, you likely experience snoring as you sleep. You might also snort, gasp, or choke during your sleep. At-home sleep tests can recognize some of these experiences.
Adequate home sleep tests measure, at a minimum:
  • Breathing and airflow
  • Nasal pressure
  • Oxygen levels
  • Most tests also measure a combination of other metrics, such as:
  • Respiratory effort
  • Heart rate
  • Chest movement
  • Body position
  • Motor activity
Unlike studies at a sleep center, most home sleep tests do not actually measure whether or not you are asleep, the sleep stage you are in, or the duration of your sleep. Additionally, the at-home tests can only estimate the severity of disordered breathing, whereas sleep studies in a lab can identify the severity. Because of the limitations of an at-home sleep study, experts recommend that the raw data results of your study be manually interpreted by a sleep technician or specialist. Automated data should also be reviewed and edited by a sleep technician or specialist. Incorrect results, such as a false negative, can delay appropriate treatment for obstructive sleep apnea.

How Do Home Sleep Studies Work?

Home sleep studies allow your doctors to monitor your sleep behavior while you enjoy the comfort of your home. When using a home sleep apnea testing device, you record your sleep habits for one night. Unlike a monitored sleep study at a sleep center, your metrics are not monitored in real-time. Instead, they are read and evaluated following the at-home study.
There are several steps to successfully completing a home sleep apnea study:
1. Physician Consult: First, consult with your doctor about your sleep problems. You might want to first keep track of your sleep experiences in a sleep diary. Your doctor can identify if your symptoms correspond to sleep apnea or if they are indicative of another disorder. Then, your physician may refer you to a sleep specialist.
2. Sleep Specialist Consult: Discuss with the sleep specialist which type of study is best for you: at-home or in the lab. A sleep specialist discusses the benefits and drawbacks of each sleep study type, such as convenience, cost, and accuracy. Before undergoing an at-home sleep study, verify your insurance coverage for the testing device your sleep specialist recommends. If the device is not covered, your sleep specialist may be able to select a different sleep testing device that is covered.
3. Acquire Sleep Study Equipment: You can learn how to use the equipment and pick up your diagnostic sleep device from your sleep specialist’s office. Although some websites sell at-home sleep test kits, make sure your device is approved by the sleep specialist, as they are the person who will be reading the results. Alternatively, a trained specialist can come to your home to help set up the device.
4. Sleep With the Equipment: Either independently or with the assistance of an in-home specialist, ensure the equipment is attached appropriately to your body. During a home sleep study, you typically have a monitor on your finger, a band around your chest, and nasal tubes in your nostrils. Follow your usual bedtime routine. However, do not take sleeping medication unless your doctor instructs you to do so. Also, avoid caffeine and alcohol, as these can interfere with your sleep and therefore affect test results.
5. Return the Sleep Equipment: Once you’ve completed your sleep test, return the equipment as you were directed. Be sure to follow all the given directions regarding care and cleaning.
6. Discuss the Results: Meet with the sleep specialist to follow up on your sleep test. They interpret the results of your study and identify next steps. If they diagnose you with obstructive sleep apnea, they may recommend a CPAP machine. If the results of your home study are inconclusive or negative, you may have to take a polysomnography in a sleep lab to ensure you do not have a false negative.

Home Sleep Studies vs. In-Lab Sleep Studies

At-home sleep studies differ from in-lab sleep studies in several ways.
Your home sleep apnea test allows you to conduct your usual nighttime routines and have the comfort of your own bed. While you are encouraged to bring items from home, such as your pillow, with you to the sleep lab, it won’t feel exactly like your bedroom. The room in the sleep study lab is similar to a hotel or hospital room. Sometimes, the sleep study room has a glass window in one wall, so you can be observed while you are sleeping.
An at-home sleep study is much less invasive than one conducted at a sleep center. Typically, the at-home device includes a chest band, a nasal tube, and a monitor that you place on one finger. In contrast, there are multiple sensors placed on your body at the lab. However, these sensors allow for deeper insights into your sleep patterns, including electrical activity in your brain. These machines can also measure when you’re asleep, how long you’re asleep, and the severity of your stopped breathing episodes.
Because the sleep lab study gives a more comprehensive picture of your sleep, it is more effective at detecting obstructive sleep apnea than an at-home study. Furthermore, these in-lab tests can diagnose other sleep disorders, including periodic limb movement disorder, REM sleep behavior disorder, and narcolepsy.
Another limit of at-home sleep studies is that they are recommended when moderate to severe sleep apnea is already suspected and there are no other underlying health conditions. If you have a lower risk for sleep apnea, the test might not accurately reflect the presence of sleep apnea, and you might have to take an additional lab sleep study.
While costs vary, in most cases, at-home sleep studies are less expensive than studies conducted in-lab. One trial study comparing home and lab sleep studies found that the at-home studies cost on average 25% less than studies in the lab. Many insurance providers have deductibles that must be met in order for the company to cover the cost of your sleep study, whether done at home or in a lab.
While home studies are less expensive in the short term, the cost-effectiveness of the home study is often reduced when used with patients who are not in moderate or severe risk groups for sleep apnea. Low-risk patients may have to do additional testing in the lab if the home sleep study results are negative or inconclusive, thereby increasing costs overall.
Read the full article: Sleep Foundation

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