Snoring is one of the most common, and frequently the most annoying, of all sleep problems. Snoring is often associated “sleep disordered breathing,” the most common sleep problem in the US. According to the National Commission on Sleep Disorders Research, 7-18 million Americans are mild snorers and 2-4 million have relatively severe cases. The risk of developing sleep disordered breathing increases with age, and almost 90 percent of people who have it are never diagnosed.
The most common variety of sleep disordered breathing is obstructive sleep apnea, or OSA. The definition of OSA is “a disorder in which a person frequently stops breathing during his or her sleep.” The cardinal signs of OSA are also known as “The Three S’s”: Snoring, (daytime) Sleepiness, and Significant other (complaints about it).
Daytime sleepiness is a serious enough condition. People with severe OSA are more likely to become involved in automobile accidents or to suffer from poor productivity at work. But long-term OSA has been associated with a number of serious health consequences, such as high blood pressure, stroke, heart disease, and diabetes.
The gold standard for diagnosing OSA is the sleep study. This is a test, usually performed overnight, or over several nights, traditionally in a specialized facility. Such tests involve several monitors and probes, and are attended by a trained sleep technician to monitor the test in progress.
In 2007, the American Academy of Sleep Medicine (AASM) issued a recommendation suggesting that a simplified version of the sleep study could be performed in a patient’s home. The AASM suggested considering this Home Sleep Testing (HST) in patients with a high likelihood of having moderate to severe OSA, and who had a low likelihood of having other complicating disorders such as epilepsy or chronic obstructive lung disease. In 2009, the Centers for Medicaid and Medicare Services (CMS), adopted guidelines allowing insurance coverage for home OSA testing.
The HST device is small and portable. It consists of three parts: an airflow sensor for the nose and mouth, elastic bands to measure chest and abdomen movement, and a finger probe to measure blood oxygen levels. Use of the device is straightforward to teach, and patients report it is comfortable to wear, especially in the comfort of one’s own home.
The Benefits of Home Sleep Testing
If a physician believes there is a high probability that the “Three S’s” are caused by OSA, then there are several good reasons to prefer HST to a traditional sleep study
- Cost: Estimates vary, but HST is anywhere from 75%-90% less expensive than traditional sleep studies.
- Accessibility: Many OSA sufferers live far away from centers that perform sleep studies. The HST device is easy to obtain and can be performed anywhere you normally sleep.
- Comfort: Traditional sleep studies involve, among other things, electroencephalogram probes that must be attached with glue to the scalp. By comparison, the HST is substantially more comfortable to wear. The relative comfort of familiar surroundings enhances sleep enormously.
- I am being watched: Some patients find it difficult to sleep in a strange room while they are aware of being under constant observation. As a result, the quality of the sleep measured may not be as good.
There are relatively few reasons why HST may not be the best option.
If a physician suspects that a patient may have a more complicated problem, such as heart failure or emphysema, then a traditional sleep study may be required. Such problems are usually easily detected based on history and physical exam. On occasion, an insurance company may pay only for the traditional sleep study. In such a circumstance, some patients opt to pay the roughly $300 cost of the HST out of pocket.
OSA and other sleep disordered breathing problems need not go undiagnosed, as they have been in the past. As America becomes an older, and a more obese, nation, the need to identify OSA will become even more important. The diagnosis is fairly straightforward to make, and can be done in the comfort of the patient’s home. The long-term cost savings of successful treatment of OSA are substantial. We cannot afford to lose any more sleep.