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.

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16 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.

  7. My doctor seems to just be making assumptions based on my home sleep test. I don’t even have prescribed range.
    I have no idea what my condition really is like and neither does he. Why am I tired? Maybe my circadian rhythm is out of whack. Shouldn’t we test that? Nope.
    All that matters is the average disturbances over the year, which is a fairly useless metric. It doesn’t take into account variances in sleep in a given night, etc.
    I’m still tired and don’t function well, but at least I’m not exhausted bro the core.
    I am pretty sure a real sleep study would have left me in better shape.

  8. My teen daughter ended up with a raised silver dollar sized welt in the middle of her forehead, Very painful with small pimple bump in the center. Three days later and it’s not much better! This is a horrible experience.

  9. My husband is a chronic snorer. On top of that, he startles for breath once or twice a night on occasion. We had the at home test last night and it was the first time in 10 years he didn’t snore. I stayed up until 3:30 am watching in disbelief. Not a single sound. He slept with his mouth closed. He barely breathed and never startled. I am at a loss. Was it the thing in his nose and the chest band that somehow caused him to NOT sleep as usual? It did beep several times telling him to check his chest band.

    Just disappointed. We waited so long for this test and then not a single startle or snore.

  10. Had a home sleep study done in Newcastle upon Tyne, England by the nhs.
    A complete waste of time as the first four hours that were used to diagnose me with moderate sleep apnea I later proved that I was awake.
    I had diagnosis reversed and the study scrapped.
    When technician showed me having what was supposed to have been my worst apnea I showed him a film of me sitting awake looking at a camera.
    Waste of time.

  11. I completed my sleep study well over a month ago. When I returned the in-home equipment, I mentioned to reception my inability to sleep that night. In fact, I said, I may have had a total of 2 hours of uninterrupted sleep. I just got my results today and was told I do not have apnea, AND I slept a total of eight hours. The last time I slept eight hours was when I was a teenager many, many years ago. Imagine my disappointment to learn over the phone that I do not have apnea and that I slept for eight hours uninterrupted. These suggestive findings are troubling especially when I have all the clinical signs of apnea. I found my concerns to be dismissive by the receptionist or medical assistant (who knows?). I requested an appointment because it is clear my concerns were not delivered to the medical professional. While I wait for my appointment, I will continue to snore loudly, have an enlarged tongue, remain tired all day, and experience chest pain. I am not impressed with the home study, the disregard of the practitioner’s office, and the expedited way insurance companies get away with NOT treating patients.

  12. I had a home test but I slept only a couple of hours, my nose was stuffy because of the end of a cold, the strap behind my head was loose, the sensor went off three times. I was diagnosis with mild sleep apnea. I went to a sleep lab. Used a bed wedge, sleep almost two hours with a diagnosis of no sleep apnea. My nose wasn’t stuffy. Still have fatigue.

  13. My husband has developed odd and inappropriate behaviors while sleeping and we needed to find out why this was happening to him at age 60. We were skeptical and immediately concerned with the validity of the home testing for several reasons: my husband only slept 4-5 hours, the finger monitor and oxygen tubes kept slipping or moving, and he seemed to be hindered by the chest belt wrapped around his waist. The insurance company required the home test, but we were very disappointed and frustrated to be told that all of his activities were within “normal parameters” – whatever that means. We did not receive copies of the test data or a detailed explanation of the results. We felt it was a waste of time.
    So we contacted the local hospital’s new sleep lab (non-accredited) for an overnight test. Since he has no memory or recollection of any of the behaviors I have observed (a marker for certain parasomnias), I was asked to come for the pre-interview to explain what I was observing and hearing every night. During the pre-interview I specifically described the types of l behaviors and vocalizations I was seeing and hearing, but instead of the response I was expecting, the doctor frowned at me, shook his head, and wrote nothing down. I felt foolish and defeated before the testing even began.
    When we were called in for the review of the results, I was shocked to discover that a different doctor, who did not know about the specific behaviors of the sleep disorder from the pre-interview or any of our other concerns, would be going over the results with us. Even though he had several “arousals” during the night and stopped breathing many times while snoring, it was not “bad enough” to be considered for a diagnosis of even sleep apnea. Again we were told his sleep activities were within the “normal ranges” and there was no mention of any inappropriate sexual movements or talking. We requested a copy of the test data specifically to see his brain wave patterns, but we were told it would mean we would have to visit the main hospital and complete paperwork, then wait several weeks before we could receive his sleep test data. Both sleep assessments seemed like a waste of our time and money, and worst of all, my husband is not getting the help he needs. Research has shown that behaviors associated with the sleep disorder can be successfully treated, but they must be diagnosed first by medical professionals with the knowledge and expertise to properly evaluate the data. Much has been reported about the rare and uncommon sleep disorders being misdiagnosed or a “missed” diagnosis due to the inexperienced medical staff. It is so discouraging!

  14. Do you have any reference material related to home sleep studies and their accuracy in detecting mild OSA? I know you mentioned in #5 about underestimating by 10-20%. Some links to these studies would be helpful to me. Thanks in advance

  15. Sleep Pattern: It takes me long to fall asleep and to fall back to sleep. I switch positions a lot, get up to urinate, and sometimes get up to walk off leg cramps. Lying down causes labored breathing, and falling asleep often results in choking.

    Home Sleep Study: The device is limited on what it can decisively reveal. Since it does not monitor brain waves or limb movements, the doctor could not determine when I was asleep (which was not much). Therefore, the sleep test was declared invalid. We wasted everyone’s time and my money (and insurance’s money) on it. The insurance always requires the “cheapest route” first. The route is not the cheapest when we already know the sleep pattern will require the in-house study. They also require the patient to show up for the results we already know are useless.

    Discussion With Doctor: I asked the doctor what information the home study provided, and he said it only would have been reliable to reveal sleep apnea should I have actually slept. While I did everything right (sleep, early hookup, proper hookup), the test was useless. I am supposed to try again with an in-house study. Perhaps they should “induce sleep” to ensure they can look for issues while in a sleep state. Doctors do not seem interested to address issues not in sleep state.

    How deep must sleep be to provide useful data or for doctors to address?
    How can we determine if a patient should be excluded for study due to issues that render the test useless?
    How can we get insurance companies to authorize the proper test the first time, based on sleep issues?
    Why are doctors unable or unwilling to do a phone or video appointment for results or at least schedule results followup while there? (Insurance, listen up.) I have to employ a driver each time I run out for these appointments. The test and followup are in different cities, for crying out loud!

  16. Yvonne,

    Some insightful comments!

    In answer to your questions…

    How deep must sleep be to provide useful data or for doctors to address?

    It’s not how deep, but how much uninterrupted sleep that’s useful to analyze. You can have plenty of total time in slow wave sleep (deep sleep), but if you keep waking up every 2 minutes, it’s not quality deep sleep. On the other hand, you may not be able to ever reach deep sleep because you stop breathing as you enter deep sleep, or if you’re taking a medication that prevents your brain from ever reaching deep sleep.

    How can we determine if a patient should be excluded for study due to issues that render the test useless?

    There are certain criteria for mandatory in-lab studies, such as heart disease, neurologic problems, or for children. The home test is designed to be used as both screening and diagnostic tool. It’s expectant that certain number of home sleep tests will not be useful. For example, if your finger’s oxygen monitor comes off at home, there no one monitoring you to come to your bed to put it back on.

    How can we get insurance companies to authorize the proper test the first time, based on sleep issues?

    Insurance companies don’t make the rules. The sleep medicine societies (the academy) and medicare (with the academy’s input) makes the rules, which the insurance companies follow.

    Why are doctors unable or unwilling to do a phone or video appointment for results or at least schedule results followup while there? (Insurance, listen up.) I have to employ a driver each time I run out for these appointments. The test and followup are in different cities, for crying out loud!

    Unfortunately, most patient phone calls are not paid for by insurance companies, or a minuscule amount that’s not worth it.

    Hope this help…