7 Reasons Why I Don’t Like Home Sleep Studies for Sleep Apnea

Barbara was angry. She was happy to hear that she didn’t have to spend a night in a sleep lab, sleeping in a strange bed with someone watching you all night. After watching the instructional video the night she was planning to do her study at home, she attached the finger probe, chest belt and the nasal probe as directed. As she started to fall asleep, she felt that her nose was stuffy and had trouble getting to sleep. Even when she was able to fall asleep, she kept waking up. To make matters worse, the device kept beeping and telling her to check her leads. The next day, she mailed it back to the company. One week later, her sleep doctor called to tell her that there wasn’t enough data for analysis and that she would have to do the test over again.
Granted, this is an extreme example, but I do see this happening more often than it should. Fortunately, technology has improved over the years, and many of these problems have improved as well. Some companies will have you do two or three nights in a row. Other companies have computer algorithms that can tell if you enough data for a useful study.
Most home sleep studies will measure the following 3 types of information: nasal airflow, finger oxygen level, chest/abdomen movement. Other units will also have sensors that can tell your sleep position and snoring levels.
In contrast, in-lab studies also include brain wave signals (which determine sleep stages), chin muscles activity, leg muscle activity, and oral airflow thermometer. Comprehensive testing can be done at home, but not very practical, since leads tend to fall off when you move around during sleep.
Here are 7 reasons why I prefer not to use home sleep studies and the reasons why:
1. Home studies can’t tell sleep stages. You need to see specific brain wave patterns (using scalp EEG, or electroencephalogram leads) to determine sleep stages (awake, light sleep, deep sleep, and REM sleep). Oftentimes, you’ll see that apneas happen much more often during REM sleep, especially on your back.
2. Home studies don’t measure limb movements. It’s important to see how often your legs move, as this can be a sign of periodic limb movement disorder (PLMD). 
3. Home studies can’t tell arousals. Since you don’t normally see brain activity, you won’t be able to see how often you wake from deep to light sleep or wake up completely.
4. More technical problems. Since there’s no technician to come in to troubleshoot, simple mechanical problems are less likely to be solved immediately. 
5. Not as good with mild disease. It’s been shown that home sleep studies will underestimate sleep apnea severity by about 10 to 20%, especially if you have mild obstructive sleep apnea. One particular reason is that an in-lab study is scored manually, with periods of wakefulness being ignored when calculating total sleep time. So if you remove the time that you’re awake from your total sleep time, the total avery number of obstructive events per hour will be higher.
6. Too many false alarms. To prevent errors when recording, these units will have built-in algorithms to sound an alarm if it detects that something is wrong. Somethings, it will keep beeping too much, leading to a bad night’s sleep.
7. Can cause more obstructions and arousals. This is a problem with both in-lab and home studies. The probe that’s placed in your nose to measure airflow is like an oxygen cannula that you use to deliver oxygen in hospitals. If you have flimsy nostrils, breathing in through your nose may cause your nostrils to cave in more, causing more nasal congestion, leading to more fragmented sleep. Having a stuffy nose due to having a cold or an allergy attack is why your sleep quality goes downhill temporarily. 
There are a number of different companies that make home sleep study units, but one in particular (Itamar) is very different. It uses one finger probe that measures oxygen levels and subtle blood vessel sympathetic tone changes, which has been found to correlate very well with apneas and hypopneas. It can even report sleep stages. All the different devices have additional variations, and their pros and cons, with sleep physicians having personal preferences. Although I prefer in-lab testing, I’m OK with home testing. Some insurances require home testing.
Despite all these problems, home sleep studies can be very helpful in making a sleep apnea diagnosis, especially for patients with a relatively high chance of having obstructive sleep apnea. This technology is rapidly advancing and is likely to get better and better. There are now smart phone apps being developed using sophisticated algorhithms that may be able to calculate the number of times you stop breathing. In the Apple Watch rumor mills, it’s been even speculated that the watch can not only measure heart rate, it has technology built in to potentially measure oxygen levels. 
Barbara eventually was able to undergo another home test, but this time, with lots of guidance from the home testing company, she was able to do the test properly, and was found to have moderate sleep apnea. She started using an APAP machine the following week, and is now sleeping much better every night.
If you’ve undergone a home sleep test, what are some problems that you experienced? Did it give you useful results? Was it convenient, or more of a pain? Please enter your comments below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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6 thoughts on “7 Reasons Why I Don’t Like Home Sleep Studies for Sleep Apnea

  1. I had a home study. it was useless. so were my in lab studies, because the lab didn’t know what they were looking for. Stanford found my apnea, and jaw surgery led to resolution of most of my problems, which were incapacitating. if my problem was so significant that I was incapacitated and it took jaw surgery to fix it, because CPAP and MAD and anything else I tried for OSA didn’t help, shouldn’t that have been detected on a typical in lab study or on a home study?

    there is something seriously wrong with how we are trying to diagnose OSA. I think that may be the point of your recent blogs.

  2. “If you’ve undergone a home sleep test, what are some problems that you experienced? Did it give you useful results? Was it convenient, or more of a pain? Please enter your comments below.”

    My pulmonologist chose an M.D. to read the results of my in home sleep study and the report said I had severe OSA. I was awake the entire time, 3 nights 4 hours each night. I was tried on CPAP machine with the widest sleep pressure allowed for that machine prescribed by my doctor. I tried medium and then large full face mask and then tried nasal mask. The APAP machine was supposed to start out at first with low pressures and then gradually give higher pressures in response to my breathing.

    In all three masks after about an hour of being on the machine, and I was awake the entire time, my mouth was definitely closed and I had a chin strap on with the nasal mask — and all three trial periods my closed mouth blew up like a balloon with my cheeks fully puffed out and my mouth was forced open to let that air out. My cheeks did not as fully blow up with the nasal mask but the balloon effect was still present and my mouth puffed open to let the air out. This balloon thing happened about every 3 or 4 minutes after about the first hour of being on the machine.

    My M.D. said he had never heard of any patient who had this balloon thing happen but the respiratory therapist who helped with the machine and the masks in my home said another RT had a patient like me and they tried several different pressure prescriptions and several different masks but they lady kept having the problem, the problem which prevents the machine from working correctly and deliver the help in breathing. The lady had to turn the machine back in to the company.

    I am going to turn my machine back in. My doctor now wants me to go to an in-lab sleep test so he can titrate me and he THINKS that a more precise presssure prescription will eliminate my balloon episodes. I do not think so. And I did not fall asleep the whole three nights, four hours each night, on the at home test so I know there is almost no chance I will fall asleep at a lab.

    I have lousy sleep quality last few years. I feel I probably do have severe sleep apnea but I agree with Dr. Deb’s comment above…
    “there is something seriously wrong with how we are trying to diagnose OSA”

    I have to be careful how many expensive tests I go for because I am on Medicare and a good supplemental insurance. No one has told me about the InspireSleep.com option of having a lead put in on my chest that sends an electrical stimulation every time my throat muscles relax too much. I am not sure I would want that but I think I have already ruled out CPAP and if my case is indeed severe then a MAD won’t be of help either and I think I at least all the possible treatment ways should be discussed with me.

    I have told my M.D. I am not going to decide to spend a lot of my Medicare money on another big expensive test if the goal of the test is CPAP and I know I cannot use CPAP. I would like to be able to take some tests, at home or at a lab where I know I can for sure fall asleep or that I can take the test properly for the purpose of getting a more precise diagnosis – mild moderate severe.

    I am overweight. I do have severe restless leg syndrom and whole body spasms every night when I am relaxing trying to go to sleep. I also have severe venous insufficiency and edema in my legs and possible mild to moder pulmonary hypertension estimated only through an echocardiogram. I have not had an EKGor an EEG.

    I have dyspnea and effort intolerance and just going around for all these medical tests is very difficulut for me.

  3. This test was a waste of time for me. I have long-standing chronic insomnia. I was even sent ti be a patient at Mayo Clinic Jacksonville and saw a sleep disorder doctor. He ordered this test for me. It beeped all night long and I did not sleep one single minute the whole night. I returned the device to Mayo the next morning and I let them know that I had not slept at all the previous night so how could the results be reliable? When I saw the sleep disorder doctor he said I had a perfect test and did not have a sleep disorder. He totally disregarded the fact that I had not slept a minute that night. It was a total waste of time and I never got a diagnosis or had any further testing from the famous Mayo Clinic. So much for diagnostics.

  4. I am morbidly obese, but have no trouble sleeping. I am to take a home sleep study next week. I don’t sleep on my back (on my sides) and don’t breath thru my nose. Will the test tell me anything? She also thought I had acid reflux and I told he I did not, and after the test….she said i did not. Why the sleep study. I am not tired during the day, and sleep well at night. Is it just for insurance? I could NEVER wear a mask….to confining and I do toss and turn at night, so I don’t know how I am going to do with all the wires and leads.

  5. I spent the night at a sleep lab recently at Montfort Hospital in Ottawa. Drifted off briefly for maybe 45 minutes early on, but awake otherwise. I was told my sleep results were “normal”. How would they know? They’ve never seen me sleep, but for a brief nap. How can anyone sleep with all those wires attached, in a crappy hospital bed to boot? I still have regular gagging episodes at night that cause me to wake up gasping for air, but the lab won’t ever see or hear those, because I could never fall into a deep enough sleep in that environment. Guess I’ll just have to deal with it somehow. I did purchase an OTC mouth appliance called ApneaRX that does help a fair amount. I’ve only woke up once choking with it in my mouth. Other than that, it has prevented the night time gagging episodes. I will continue to use that as it definitely prevents my throat from collapsing most nights.

  6. I did a home sleep study and it was AWFUL! The machine was supposed to fit over my forehead. I had to attach a patch to my forehead that in turn connected to the machine. The patch began to chemically burn my forehead! I was up most of the night crying, uncomfortable, listening to the stupid beeping of the machine, and just wanting to rip the darn thing off! They were able to catch a few apneas but weren’t concerned.

    Flash forward 4 years. I’m experiencing major daytime fatigue and waking up not feeling refreshed at all from sleep. Strangely, I’ve woken up a few times while experiencing my eyes moving as if I’m still asleep. It has made me feel sick and so I immediately close my eyes.

    Anyways, my doctor ordered a sleep study for me. Just spoke with the people at the sleep lab. Because I had the home sleep study done four years ago but it was not signed by a certified sleep technician, I have to start from scratch with the stupid home sleep study.

    I’m angry I have to do it again.