The conventional global standard for diagnosing OSA was in-lab polysomnography (PSG). Home sleep tests (HSTs) can, however, be used to evaluate this issue in the right patient. The same breathing apparatus, pulse oximetry devices, and motion and positional sensors are used in both PSG and HSTs. The results of each test are examined in the same way. Several investigations have found a strong link between the outcomes of multichannel HSTs and PSGs.

Even so, an observed sleep study is necessary if a patient is unable to follow the directions for home sleep testing owing to age or cognitive problems.

An Overview of Home Sleep Study Tests 

The necessity for, and relevance of, a HST, according to health professionals, should be premised on the health history of an individual and consultation by a healthcare professional, either personally or through telemedicine. A HST is a clinical diagnosis that must be instructed by a physician to diagnose OSA or assess the efficacy of the treatment. It should never be used for general screening of undiagnosed people.

A HST has the benefit of being a portable sleep apnea device allowing monitoring to take place in the patient’s own home with minimal equipment, resulting in a more relaxed sleeping environment. In addition, sleep apnea diagnostic devices are far less costly and more generally available than PSGs used in facilities.  They can be used to diagnose OSA and titrate positive airway pressure (PAP) therapy at home. There are also no reported complications related to sleep testing at home.

HSTs however have a limited capacity to quickly identify and address operational faults, as well as the incapability to detect various forms of sleep disorders and greater involvement for the patient in terms of device installation and use, which may make some patients uneasy.

Furthermore, because sleep and waking states are not directly examined, the complete sleep duration cannot be estimated from a HST recording. Inadequately prepping the patient for HST or misplacing the equipment can result in unclear findings or erroneous readings, just as they might with PSG. However, with a portable sleep apnea device, there is usually no attendant available to resolve these difficulties as they emerge, so the individual may have to redo the study.

Levels of HST Devices

There are four levels of sleep apnea diagnostic devices available; Level 1 through Level 4. They include:

Level 1 

A level I sleep test involves the continuous and simultaneous monitoring and recording of numerous physiological and pathophysiological sleep characteristics, as well as physician assessment, analysis, and reporting. It is performed in a medical institution and is usually composed of a lead electroencephalogram (EEG), electrooculogram (EOG), submental electromyogram (EMG), and electrocardiogram (ECG). It should additionally measure and record the following sleep-related characteristics:

• Flow of air
• Breathing effort
• Oxygen saturation by oximetry
• Can be done as an entire night of monitoring for diagnosis alone or as a split overnight study for diagnosis and therapy evaluation.

Level 2

A level 2 sleep study is typically conducted in the comfort of one’s home but some level 2 sleep studies may be done in a sleep lab or sleep clinic. A level 2 sleep study examines cerebral and muscle movement in addition to respiratory activity, oxygen saturation, and heart rate. A level 2 sleep study is so effective it can track leg and body movement, detect periodic limb movement disorder (PLMD), and give a more in-depth examination of the overall length and quality of your sleep.

Level  3

A Level 3 Sleep Study, commonly known as a portable monitoring device or HSAT, can be used to identify obstructive sleep apnea (OSA). Many people prefer this strategy if they don’t have serious symptoms and can do the test on their own at home. If one suspects they have moderate to severe sleep apnea, it’s typically preferable to have a full sleep study done in a lab to provide the most precise findings, as portable monitors tend to underestimate the severity of OSA when contrasted to a sleep test done in a lab.

Level 3 Sleep Studies, which measure oxygen saturation, heart rate, airflow, and exertion while also collecting data about snoring, are now a more useful and available technique to confirm OSA.  One utilizes a sleep kit at home to record the respiratory activities, oxygen saturation, and heart rate throughout the night with a level 3 sleep study. A level 3 sleep study measures both snoring and airflow and determines whether you have obstructive sleep apnea.

Level 4

Level IV devices are used to monitor only one or two parameters, for example, oxygen levels or airflow, and they usually contain oximetry, but not just oximetry. As the technology continues to advance, however, modern devices have at least three channels.

Conclusion

Sleep apnea diagnostic devices use a varied number of channels to evaluate respiratory measurements, oxygen levels, pulse rate, chest, and abdominal movement and snoring.

Nose prongs, similar to those used to administer nasal oxygen, are commonly employed to measure airflow. An oral thermistor may be used to detect mouth breathing, and a sensor measures pressure changes. For the majority of HSTs, a pulse oximeter is placed on a finger or earlobe to measure oxygen saturation. A single-lead ECG with an electrode placed to the upper chest can be used to measure heart rate.

Snoring may be detected with a microphone worn around the neck. Respiratory effort is measured using chest and abdominal belts, which helps to distinguish between central and obstructive apneic episodes.

The total absence of movement of either belt is considered a central apneic episode. An obstructive apneic episode, on the other hand, is defined as paradoxical movement during breathing, such as belly expansion during inhalation but no chest expansion.

A bad night’s sleep can be caused by a variety of reasons. These include taking caffeine right before bedtime, working late, too much noise, extreme tiredness, and many other reasons. Then there is sleep apnea, which causes more than just a few nights of poor sleep. One may find themselves wondering, what is sleep apnea?

In layman’s terms, sleep apnea is a condition in which a person’s breathing is regularly interrupted while sleeping. Apnea can disrupt sleep up to thirty times in an hour for some people, which can be very discomforting. The brain then sends signals and wakes one up, usually with a bodily jerk or a gasp for air. These nightly disruptions in sleep can have a significant impact on your general health.

We are all aware that insufficient sleep may have a negative influence on a person’s mental and physical health. Constant exhaustion due to sleeplessness makes it hard to focus and get tasks done.

Sleep apnea is far more widespread than people realize. According to the research, sleep apnea affects up to 20% of the population, and about 80% of people with sleep apnea are oblivious that they have it. This might be because the symptoms of sleep apnea are so common.

When the usual risk factors or indicators of sleep apnea, such as obesity and heavy snoring, are lacking, diagnosing sleep apnea can be very difficult. The majority of people seek professional help when their snoring is disturbing somebody else’s sleep, such as a bed partner or roommates.

However, snoring is not the only symptom of sleep apnea. Other indications include fatigue even after hours of sleep,  having a dry mouth early in the morning, a sore throat and headaches on waking up, and daytime drowsiness.

Diagnosing Sleep Apnea

The diagnosis of sleep apnea is done by a medical practitioner who will examine the genetic history, signs, and any health problems that may cause sleep apnea. The physician may examine the neck, jaw size, tongue, lungs, heart, and neurological systems for signs of sleep apnea issues.

They may order a sleep study, also known as polysomnography, after the clinical examination to identify sleep apnea.  During the sleep study, a sleep technician monitors patients’ blood oxygen levels, brain activity, heartbeat, and respiration as they sleep in a sleep lab.

Doctors may do an endoscopy after a sleep apnea diagnosis to determine the location of the airway obstructions.

Some specialists may prescribe a home test instead of a lab test because it is more convenient. A home sleep apnea diagnosis is not as precise as those done in the lab because it just assesses breathing. Home testing is not the best for people with respiratory illnesses, cardiac problems, respiratory distress, restless leg syndrome, or central sleep apnea.

Causes of Sleep Apnea

When awake, throat muscles maintain the firmness and openness of the airway so air can flow into the lungs. These muscles get more relaxed while we sleep. Usually, the airway remains open to enable airflow into the lungs regardless of the relaxed throat muscles. Your airway might be closed or constricted during sleep if you have sleep apnea. The airway may be obstructed for multiple reasons:

• The chest muscles and tongue relaxing more
• Obesity can result in the addition of fat tissue in the body that can thicken the wall of the windpipe, narrowing its opening.
• The structure of the head and neck may cause a narrower airway between the throat and mouth.
• Smoking is substantially more likely to cause obstructive sleep apnea. It causes inflammation and fluid accumulation in the upper airway
• Congestion in the nose. You’re more prone to develop obstructive sleep apnea if you have trouble breathing via your nose, whether due to anatomic issues or allergies.
• Medical problems. Conditions such as heart problems, hypertension, high blood sugar, asthma, and Parkinson’s disease can all raise the risk of obstructive sleep apnea.
• Growing old increases the risk of both obstructive and central sleep apneas.
• Men are up to three times more likely compared to women to suffer from sleep apnea. Women, on the other hand, are at higher risk if they are obese.

Types of Sleep Apnea

Whenever the question, “What is sleep apnea?” is raised, it cannot be conclusively defined without mentioning the types of sleep apnea. There are three common types of apnea. They include obstructive sleep apnea, central sleep apnea, and complex sleep apnea.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most widespread kind of sleep apnea. The muscles at the back of the throat, which usually relax during sleep, collapse so much in those with OSA, limiting proper airflow. The soft tissues in the back of the throat, including the soft palate, uvula, tonsils, and tongue, are supported by the throat muscles, so when those muscles relax too much, those tissues can drop back into the throat, partially or fully restricting the normal passage of air in the airway.

When the airway is partially closed, a person often begins to snore, which is a typical symptom of OSA. Simply defined, obstructive sleep apnea occurs when there is insufficient air in your lungs throughout the night, and your brain wakes you up to breathe.

Central Sleep Apnea

Central sleep apnea is less common than OSA. It is also more difficult to identify and cure. Central sleep apnea occurs when the brain does not deliver the necessary signals to muscles that coordinate breathing, unlike obstructive sleep apnea, which is caused by a  condition that restricts the airway.

Central sleep apnea is caused by a neurological condition. While central and obstructive sleep apneas share many signs, such as breathing interruptions, frequent awakenings throughout the period of sleep, and daytime drowsiness, central sleep apnea frequently affects individuals who have chronic underlying conditions.

Complex Sleep Apnea

It is the result of a combination of obstructive and central sleep apnea. This kind of sleep apnea may appear to be obstructive sleep apnea at first examination. However, unlike normal obstructive sleep apnea individuals, the symptoms of these patients are not entirely addressed by the use of a continuous positive airway pressure machine(CPAP).

Because CPAP is normally very effective in treating obstructive sleep apnea, the patient’s inability to improve could indicate central sleep apnea. Breathing issues remain in people with complex sleep apnea syndrome even when the airway blockage is addressed and treated, indicating that something other than collapsing throat muscles is contributing to the apnea.

Conclusion

After diagnosing sleep apnea, the doctor may prescribe the use of treatment devices, therapies, or even a surgical procedure to open up the airway in moderate to severe conditions.

Continuous positive airway pressure (CPAP), in which a machine distributes constant air pressure through a mask into the nose or mouth, or a mouthpiece intended to keep a patient’s throat open, are common treatments.

In mild cases where patients are having trouble sleeping, the doctor may recommend lifestyle adjustments such as regularly engaging in various physical exercises, but not doing so shortly before bedtime, as this can stimulate adrenaline and keep the patient awake.

Also, reduction of alcohol consumption may help as too much indulgence may disrupt sleep. Caffeine should be avoided before going to bed and development of a sleep ritual that includes taking a warm bath, decreasing the lights, and drinking herbal tea could help.

We all hear of how crucial it is to care for our cardiovascular health through proper exercise and a clean diet. What’s more, high-quality sleep is equally important for the health of the heart. 

A significant number of people wake up either exhausted, experiencing headaches, or with a dry mouth. Sleep apnea may be the reason. Untreated sleep apnea, in particular, is linked to an elevated risk of cardiovascular and metabolic disorders. Worse still, many people may not even be aware that they have this widespread issue. 

Sleep apnea occurs when the muscles in the chest and neck area relax and close up the airway, preventing you from obtaining adequate oxygen. Breathing is stopped for more than ten seconds while sleeping.  If one has sleep apnea, the throat muscles relax, and the airway constricts, causing cessation of breathing until the reflexes cause it to resume. 

Home sleep study monitoring is a relatively quick and simple approach to see if one is suffering from breathing problems compared to the studies done in the lab. The doctor sends you home with portable home sleep study equipment.  

A patient may also opt to have an in-home sleep study company to help in the procedure. 

It is inexpensive as most home sleep studies are a lot more affordable than lab studies. The regular bedtime routine of sleep is followed.  The majority of sleep apnea monitoring equipment is simple to set up. A pulse oximeter that detects the oxygen levels and heart rate, a nasal cannula that measures oxygen and airflow, and respiratory sensors that track the rise and fall of your chest are all common components included in sleep study equipment.

Types of Sleep Apnea

There are three common types of sleep apnea. They are categorized according to severity. The following are types of sleep apnea that are usually diagnosed by doctors.

Obstructive Sleep Apnea (OSA)

This is a condition in which the airway in the back of the throat gets physically obstructed while sleeping. It is the most common type of sleep apnea. This blockage produces breathlessness for a short period. The blockage occurs in the throat and mouth. The tongue touches the soft palate while sleeping, and the soft palate and uvula subsequently press against the throat. Breathing becomes increasingly labored, even impossible. 

Because these organs rattle, it might cause snoring. It may also make a person feel as if they are unable to breathe when waking up. The lungs function normally, and as the person tries to breathe, it becomes impossible to get enough air into the upper airway. 

This condition is more likely when people grow older, gain weight, get pregnant, or have a habit of sleeping on their back. Some of the symptoms comprise waking up fatigued or sleepy, feeling anxious after waking up, snoring and breathing heavily while sleeping, regular headaches, dry mouth on waking up, and feeling confused or the inability to stay focused on one’s tasks.

Central Sleep Apnea (CSA)

It occurs when the brain directs the muscles necessary in respiration malfunctions, resulting in slow and shallow breathing. It occurs at night but is not caused by a blockage of the upper airway. Rather, the source of the problem is neurological. 

In contrast to OSA, central sleep apnea causes no snoring since the body does not attempt to breathe. Conversely, breathing ceases as a result of the brain and neurological system not providing signals appropriately. Some of the symptoms one may experience include sleeplessness, sleepiness during the day, and difficulty paying attention.

Mixed Sleep Apnea or Complicated Sleep Apnea

This is when one has a combination of Obstructive Sleep Apnea and Central Sleep Apnea, a state also known as complex sleep apnea. 

In some cases, the presence of complex sleep apnea could be detected during a preliminary sleep examination. When apnea does not respond to a standard continuous positive airway pressure (CPAP) machine or other basic OSA therapies, it becomes evident. Frequent waking from sleep, daytime exhaustion, confusion upon awakening, headaches, dry mouth, and low quality sleep are all signs that are comparable to those of OSA.

Causes of Sleep Apnea

There are a number of reasons that may explain sleep apnea. These include:

• Obesity – It is a major cause of OSA and also could be an inherent risk factor. Obesity causes structural constriction of airways.
• Background of the family –  People with sleep disorders are more prone to passing it down to their kin.
• Sleeping on the back –  Tissue collapsing around the airways and causing obstructions is easy in this resting position.
• Smoking –  People who smoke heavily have been reported to have a higher probability of developing apnea than those who do not.
• Features of anatomy –  Flow of air is directly affected by the size and posture of the organs between the neck and mouth.
• Medications –  The tissue in the throat could relax due to sedatives and substances like drugs and alcohol, making it simpler for the airways to become clogged.
• Hormonal imbalances – An underactive thyroid (as in hypothyroidism)  and excess growth hormone are hormonal diseases that might elevate the risk of OSA by triggering tissue swelling near the airway. 
• Congestion in the nose-   Difficulty breathing through one’s nose due to clogging is more likely to develop OSA.

Home Sleep Study Equipment

On consulting a physician for possible sleep apnea, symptoms experienced are discussed beforehand in order to diagnose sleep apnea. If the physician suspects sleep apnea, a sleep monitoring test may be recommended. It entails staying overnight at a laboratory, clinic, or hospital. While you sleep, breathing and other vital signs are recorded by home sleep study equipment. 

This can also be done from the comfort of the patient’s home. If the symptoms indicate sleep apnea, the physician may recommend at-home sleep monitoring. Most physicians who treat sleep-related conditions are usually in touch with a home sleep study company and can easily avail a test kit. 

Sleep Data Monitor

A home sleep study monitor is the most essential device for the study. Breathing habits, blood oxygen levels, respiration strain, and heart rate patterns are recorded and stored by this device. The doctor should be able to ascertain if one has sleep apnea using the data collected.

Nasal Cannula

A nasal cannula is placed in the nose to record your breathing pattern and respiration activity. This gadget comprises a tubular loop connected to the home study sleep monitor and two smaller tubes inserted into the patient’s nose.

Fingertip Heart Rate Sensor

Heart rates and blood oxygen concentration are monitored with a pulse oximeter probe, more commonly known as a heart rate fingertip sensor. This device is also connected to the sleep data monitor.

Adjustable Chest Strap

It keeps the sleep monitor in place because this chest strap is stretchy and adjustable. Attempts to breathe are recorded by the chest strap. This aids in the differentiation of obstructive and central respiratory events.

Conclusion

The concept of having one’s sleep monitored in an unfamiliar environment can be disturbing and frightening for most people. 

As a result, having a sleep test done from the comfort of their home seems to be an instinctive choice. It is less intrusive, and one can stick to their normal routine. 

This form of sleep test is perfect for housebound people, such as the elderly, and people with chronic conditions. It’s also useful for busy people because they can conduct the study at their convenience. The accuracy is also high, which allows for a great recommendation for a treatment protocol by the doctor.