Sleep Clinic vs. At-Home Sleep Testing: What's Right for You?

Sleep disorders like sleep apnea can affect your health if they are not diagnosed and treated. Two main ways to diagnose them are testing at a sleep clinic and at-home sleep testing, and a medical provider helps decide which one fits your situation.

Sleep Clinics: A Comprehensive Approach

Sleep clinics, or sleep labs, offer a thorough evaluation of your sleep patterns. During a sleep study, known as polysomnography, various sensors monitor your body systems, such as brain waves, heart activity, and breathing patterns. Attended polysomnography in a sleep lab is considered the reference standard for diagnosing obstructive sleep apnea (OSA) (CMS NCD 240.4.1).

• Standard of Care: Polysomnography is the standard diagnostic test for OSA in adults when there is concern for OSA based on a comprehensive sleep evaluation (Kapur et al., 2017).
• Comprehensive Monitoring: Patients are observed throughout the night, allowing for a detailed analysis of sleep stages and disruptions.

At-Home Sleep Testing

A home sleep apnea test (HSAT) is an alternative to polysomnography for diagnosing OSA in uncomplicated adults who have signs and symptoms that indicate an increased risk of moderate to severe OSA (Rosen et al., 2018). Home testing usually costs less than an in-lab study, and coverage varies by plan.

• Ease of Use: You sleep at home wearing sensors that collect information about how you breathe, and you will usually set up the equipment yourself. A member of the sleep team gives you instructions. The devices measure your breathing and blood oxygen level, and some also measure heart rate or other information about your body (AASM Sleep Education).
• Fit: A home test is not right for everyone. A provider may not recommend it if your doctor suspects another sleep disorder, or if you have certain medical conditions such as pulmonary disease, neuromuscular disease or congestive heart failure (AASM Sleep Education).

Making the Right Choice for You

Deciding between a sleep clinic and at-home sleep testing depends on your health needs. Here are some guidelines:

• Choose a sleep clinic if:

• You have symptoms suggesting multiple sleep disorders.
• You have existing medical conditions that could complicate sleep apnea diagnosis.

• Consider at-home testing if:

• You suspect sleep apnea without complicating factors.
• You prefer a convenient option and your provider agrees it fits.

Consulting with a healthcare professional is important to determine the most appropriate approach for diagnosing your sleep health issues. Understanding the differences between these methods can help you make informed decisions about your sleep health.

Understanding Sleep Clinics

Sleep clinics provide a detailed approach to diagnosing and treating sleep disorders. If you're struggling with sleep issues, knowing what a sleep clinic offers can be meaningful.

What Happens in a Sleep Clinic?

During a visit, you typically undergo polysomnography (PSG), an overnight study in a controlled environment. Medical professionals monitor various aspects of your sleep, recording:

• Brain waves
• Heart activity
• Eye movements
• Breathing patterns
• Oxygen levels

This comprehensive data collection helps doctors identify various sleep disorders, including obstructive sleep apnea (OSA), narcolepsy, and limb movement disorders.

Types of Disorders Diagnosed

Sleep clinics can diagnose several sleep-related issues, such as:

• Obstructive Sleep Apnea (OSA): Interruptions in breathing during sleep, which can lead to serious health risks if untreated.
• Narcolepsy: Excessive daytime sleepiness and sudden sleep attacks.
• Restless Legs Syndrome: An urge to move the legs with uncomfortable sensations.

The Environment and Cost

Sleep clinics are designed for attended monitoring. Patients sleep in private rooms equipped with monitoring technology, and a technologist supervises the recording and can intervene if needed (CMS NCD 240.4.1). An in-lab study usually costs more than a home test, and coverage varies by plan.

Why Choose a Sleep Clinic?

For complex sleep issues or underlying medical conditions, a sleep clinic is often the most appropriate option. The AASM guideline recommends polysomnography, rather than home sleep apnea testing, for patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to a neuromuscular condition, awake hypoventilation or suspected sleep related hypoventilation, chronic opioid medication use, a history of stroke or severe insomnia (Kapur et al., 2017).

Sleep clinics play an important role in diagnosing and treating sleep disorders, particularly in complex cases. If you suspect a sleep disorder, talk with your doctor or sleep provider about which test fits your situation.

Exploring At-Home Sleep Testing

At-home sleep testing is an option for adults who suspect sleep apnea and whose provider agrees it fits. It lets you record breathing data in your own bed instead of spending a night in a clinic.

How At-Home Sleep Testing Works

A medical provider orders the test after reviewing your symptoms and medical history. You then sleep at home wearing a device that collects information about your breathing and blood oxygen level (AASM Sleep Education). When you wake up in the morning, you remove the sensors. The sleep team scores and interprets the information collected, which may take several days or weeks (AASM Sleep Education).

A single home sleep apnea test is conducted over at least one night (Kapur et al., 2017).

Advantages of At-Home Testing

• Cost: Home testing usually costs less than an in-lab study, and coverage varies by plan.
• Convenience: You can test in the comfort of your home instead of a clinical setting.
• Insurance Coverage: Medicare Part B covers Type I, II, III and IV sleep tests and devices if you are eligible, and your doctor or other health care provider must order the test (Medicare.gov).

Limitations to Consider

At-home sleep testing is not the right fit for everyone:

• Focus on Sleep Apnea: A home sleep apnea test is used to diagnose sleep apnea. If your doctor suspects another sleep disorder, an in-lab study may be recommended (AASM Sleep Education).
• Follow-Up Testing: If a single home sleep apnea test is negative, inconclusive or technically inadequate, the AASM guideline recommends polysomnography for the diagnosis (Kapur et al., 2017).
• Setup at Home: You will usually set up the equipment yourself. If it is physically difficult for you to administer the test at home, a home test may not be a fit (AASM Sleep Education).

Who Should Consider At-Home Testing?

A provider may recommend a home sleep apnea test if it is highly likely that you have moderate to severe sleep apnea and you have no significant medical conditions other than the suspected sleep apnea (AASM Sleep Education). Common symptoms to mention to your provider include loud snoring, disrupted sleep and daytime sleepiness. If you have other medical conditions or your symptoms persist, an overnight study in a sleep clinic may be recommended.

A home sleep apnea test can be a convenient option for people who are likely to have sleep apnea and have no complicating conditions. Talk with your doctor or sleep provider about whether it fits your situation.

Comparing Accuracy and Diagnostic Capabilities

Understanding the Diagnostic Differences

Which test fits depends on your symptoms and medical history, and a medical provider makes that decision with you.

Sleep Clinics

Sleep clinics use polysomnography (PSG). A sleep study records your brain waves, heartbeats and breathing as you sleep, and it also tracks your eye, leg and arm movements and the oxygen levels in your blood (AASM Sleep Education).

• Diagnosis: The AASM guideline recommends polysomnography, or home sleep apnea testing with a technically adequate device, for the diagnosis of OSA in uncomplicated adults with signs and symptoms that indicate an increased risk of moderate to severe OSA (Kapur et al., 2017).
• Broader Evaluation: Beyond OSA, a sleep clinic evaluation can address other conditions such as narcolepsy and restless legs syndrome, which matters for people with more than one sleep-related issue.

At-Home Sleep Testing

A home sleep apnea test lets you sleep in your own bed while equipment collects information about how you breathe during sleep (AASM Sleep Education).

• Ordered by a Provider: A home sleep apnea test is a medical assessment that must be ordered by a medical provider to diagnose OSA (Rosen et al., 2018).
• Based on Your History: The need for, and appropriateness of, a home sleep apnea test must be based on your medical history and a face-to-face examination by a medical provider, either in person or by telemedicine (Rosen et al., 2018).

Key Takeaways

• Diagnostic Range: Sleep clinics can evaluate a range of sleep disorders, while a home sleep apnea test is used to diagnose sleep apnea.
• Provider Decision: Either test is part of a comprehensive sleep evaluation with a medical provider, and the AASM guideline states that diagnostic testing for OSA should be performed in conjunction with that evaluation and adequate follow-up (Kapur et al., 2017).

Understanding these differences can help you talk with your provider about which testing method fits your symptoms and needs. If you are experiencing signs of sleep apnea or other sleep disorders, talk with your doctor or sleep provider.

Choosing the Right Option for Your Needs

Choosing between a sleep clinic and at-home sleep testing for suspected sleep apnea depends on your health conditions and sleep problems.

Understanding Your Symptoms

If you suspect you have obstructive sleep apnea, look for common symptoms such as loud snoring, waking up tired, or daytime sleepiness, and share them with your doctor. A home sleep apnea test measures your breathing and blood oxygen level, and a provider may recommend it when it is highly likely that you have moderate to severe sleep apnea and you have no significant medical conditions other than the suspected sleep apnea (AASM Sleep Education). Home testing usually costs less than an in-lab study, and coverage varies by plan.

When to Choose a Sleep Clinic

If you have complex symptoms or significant medical conditions, your provider may recommend polysomnography in a sleep clinic. The AASM guideline recommends polysomnography rather than home sleep apnea testing for the patient groups listed earlier in this article (Kapur et al., 2017).

The Importance of Professional Guidance

Before making a decision, consult with a healthcare professional. They can assess your symptoms and medical history to determine which testing method is more appropriate. The AASM position is that only a medical provider can diagnose medical conditions such as OSA (Rosen et al., 2018).

Conclusion

Whether you choose a sleep clinic or at-home testing, understanding your health conditions and symptoms helps you and your provider decide. Talk with your doctor or sleep provider about which test fits your situation and what to do after you receive results.

Wesper develops FDA-cleared home sleep testing medical devices used by clinicians. A medical provider orders the test. Talk with your doctor or sleep provider about home sleep testing. Providers can learn more on the Wesper professional page.

Sources: Kapur VK, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):479-504 (AASM); Rosen IM, et al. Clinical use of a home sleep apnea test: an updated AASM position statement. J Clin Sleep Med. 2018;14(12):2075-2077 (AASM); AASM Sleep Education, Home Sleep Apnea Test and Sleep Study; CMS NCD 240.4.1 Sleep Testing for Obstructive Sleep Apnea; Medicare.gov, Sleep studies.