Home Sleep Apnea Testing

The Process

• Home sleep apnea test requested or ordered
• Appointment to pick up the test device
  •  Instructions on how to wear the device
  • Instructions on how to operate the device
• At home you put the device on and wear for a night of sleep
• Appointment to return the device
• Follow up appointment with your physician for results

Description

Home sleep apnea testing is an overnight recording that you will carry out on your own. Home sleep apnea testing became available in 2005. It has been widely used in the field of sleep medicine since the government, through Medicare, accepted it as a diagnostic test for obstructive sleep apnea about six years later. There are multiple devices available. The FDA approves devices that are used by physicians. Your sleep testing facility will utilize one of these devices.

If your physician has ordered it for you, the day of your study you will have an appointment to pick up the testing it. You will be shown the unit and how to wear it for your test. They will help you fit any monitors that need adjustments. The units are easy to use and quite accurate. You will take the unit home to perform the test.

At your bedtime you will put on the testing apparatus and start the test with the push of a single button. When you get up for your day in the morning you will push the button to terminate the study recording. You will pack up the unit and return it to the Center where the information recorded will be downloaded.

The home sleep tests are purely tests for obstructive sleep apnea. They are exceptionally good at diagnosing obstructive apnea in the vast majority of individuals. People with milder forms of apnea, difficulty with initiating and staying asleep, and people with positional apnea, may have the condition missed on home sleep apnea testing. When mild apnea is suspect, a sleep test performed in a sleep center, a polysomnography, is the medically preferred test. Unfortunately many insurance providers require all patients who need testing for sleep disorders to have a home sleep apnea test as the first step in their testing evaluation with limited exceptions.

Sleep Test (Polysomnogram)

Sleep testing may be ordered for many reasons. Sleep test performed in a sleep testing facility are considered the standard for testing for sleep disorders. While apnea can be diagnosed with test performed by the individual at home, many problems with sleep can only be diagnosed with a polysomnogram (PSG).

The Test

The PSG is designed to measure sleep stages, breathing, body movements, heart function and oxygen levels. Measuring all of these functions is done with sensors that are placed on you. At the sleep facility you may be the first patient who the technologist connects to the equipment or follow someone else. This order is usually based on the time you normally go to sleep. You can expect the sleep technologist to spend between 30 and 45 minutes placing the sensors. Once you are connected to the monitors, you can go to sleep or read, watch TV, etc. until the test begins. The test will begin as close to your normal sleeping time as possible, but the center need to consider the time needed to complete the test. A minimum of six (6) hours of recording time is required.

The sleep technologist will explain the procedure of connecting you to the recording equipment. There will
be wires pasted on your head, chin and legs. A small sensor will be placed under your nose and heart monitoring leads on your chest. You will be wearing belts on your chest and abdomen. You will have a conducting paste in your hair and on your face. This paste conducts signals from your body to the monitors and gives us the information to make the needed measurements.

Most people worry that they will not be able to sleep during the test. Will I sleep long enough? Will it be good enough sleep to get results? These worries are usually unnecessary. The vast majority of patients sleep long enough and well enough for the equipment to get adequate information about their sleep.

Many individuals will be found to have obstructive apnea early in a sleep test. If the amount of apnea reaches a predetermined number per hour early in the test, treatment with positive airway pressure will be attempted during the remained of the night. The study is split between the diagnostic study and a treatment study. (Split Night Sleep Study)

Positive Airway Pressure Sleep Studies

A Positive Airway Pressure Sleep study is an overnight sleep test in a facility while wearing a form of positive airway pressure. Positive airway pressure is the most used form of treatment for obstructive sleep apnea.

Sleep testing on positive airway pressure may be ordered for many reasons. A new diagnosis of Obstructive Sleep Apnea is the most common. For a newly diagnosed patient, the study is started at a low pressure and the pressure is increased (titrated) upwards until the apnea is corrected. A positive airway pressure sleep test gives a patient experience with sleeping with pressure, a chance to try one or more types of masks and observe how the night affects the next day. The sleep physician
will benefit by being able to identify the best pressure or pressures, the type of machine that condition requires and if there are any additional sleep disorders present.

There are times that a sleep study on positive airway pressure is performed when apnea is known to be a problem and a person is already wearing positive airway pressure nightly. These tests are performed when a person has not responded to the therapy appropriately. Symptoms may have persisted. A second disorder of sleep is suspected.

The Test

The CPAP titration study is performed to measure the effect of breathing air at a pressure that is slightly higher than atmospheric pressure. The most common form of this test uses constant positive airway pressure (CPAP). While the subject sleeps, the technicians will monitor measurements for obstructive apnea and gradually increase the amount of pressure to control the obstructions. People who are found to have obstructive sleep apnea during a sleep study at home or on a facility diagnostic sleep test will benefit from a CPAP titration study.

Testing sleep on Positive Airway Pressure (PAP)

A sleep test with CPAP is very similar to a diagnostic sleep test. The only difference is that the air breathed will be room air at a slightly higher pressure through a special mask. Before the test is started the sleep
technician will assist you in selecting a mask to wear. Masks are specially designed and constructed to use with PAP treatment. All of the sensors used during a diagnostic study will be used again. The only addition
will be the positive airway pressure mask.

The sleep technicians are experienced professionals who have assisted hundreds of individuals with choosing a mask. They will guide your selection. If you have serious worries about wearing a mask during sleep, let the Sleep Center staff know and be sure to tell your sleep technician the night of your study.

Split Night Sleep Studies

A split night sleep test is an overnight sleep test done in a sleep testing facility.  It is usually a planned change in the testing no later than half way through the night. It occurs when a certain level of Obstructive Sleep Apnea is found during the first few hours of the sleep test. On some tests, the night will be split when severe apnea is discovered although it was not planned.

The first few hours of the test is performed to observe and record your usual sleep. Sleeping while wearing the diagnostic monitors may not feel like normal sleep to you, but sleep observed while wearing those monitors is usually representative of your typical sleep. The diagnostic portion of the study will be stopped when a certain level of apnea is observed.  You physician usually determines the level of apnea at which the study will be split.

For the remaining portion of the test time, treatment with positive airway pressure will be started and continued through the night of the test. Thus, the first half of the night is used to establish the diagnosis of obstructive sleep apnea while the second half is used to determine how much pressure will be needed to treat the apnea.

The pressure test performed during the second half of the night is called a Positive Airway Pressure titration or more commonly a PAP Titration. A PAP titration is performed to measure the effect of breathing air at a slightly higher pressure. During this stage of the test, the sleep technician monitors your measurements for obstructive apnea and gradually increases the amount of pressure to determine the pressure required to control the obstructions.

A person with sleep disordered breathing problems might be able to be diagnosed and have treatment assessed in one night when a split night test is performed. However, realize that you may still have significant sleep apnea even though you did not have a split night study.
Sometimes a scheduled split night test does not get split. This can occur when no apnea is observed, when the amount of apnea observed does not reach the level required to meet the criteria, or when there was not enough time left in the study to complete the titration.