Who should get a sleep apnea test?

“I look like the alien from Predator!” This was the caption that accompanied the photo I texted my husband while I was hooked up to the wires for my sleep study. I had started snoring, and my doctor wanted to check me for sleep apnea—a condition where you repeatedly stop breathing in your sleep. As the mother of young children, in some ways I relished the chance for a night of uninterrupted rest, but I can’t say it was relaxing. 

It was a strange night, but I was glad I consented to the study. It turned out I have severe sleep apnea, and I had no idea.

What are the warning signs of sleep apnea?

There are two types of sleep apnea. Obstructive sleep apnea (OSA) is the most common. Airways repeatedly become blocked or partially blocked during sleep, which reduces or stops airflow. Less commonly, central sleep apnea occurs when the brain does not send the signals needed to breathe.

Symptoms of sleep apnea include:

• Excessive daytime sleepiness
• Apnea episodes (stopping and starting of breathing)
• Snoring
• Gasping for air during sleep
• Daytime fatigue
• Dry mouth when waking
• Headaches when waking
• Decreases in attention, vigilance, concentration, motor skills, and verbal and visuospatial memory
• Waking often (or waking up often to pee)
• Sexual dysfunction/decreased libido
• Depression
• Irritability/mood swings
• Hypertension
• Weight gain
• Insomnia

Symptoms in children can include: bedwetting, asthma exacerbations, hyperactivity, and learning and academic performance issues.

“Until sleep apnea is treated, symptoms and side effects will only get worse,” says Kent Smith, DDS, the founding director of Sleep Dallas, a dental sleep medicine practice that provides oral appliance therapy to patients with sleep apnea. “Prolonged sleep deprivation increases a person’s risk of developing serious and/or life-threatening health conditions including obesity, diabetes, high blood pressure, heart disease, and stroke.”

What should someone do if they suspect they might have sleep apnea?

Start with a call to a healthcare provider, usually a general practitioner. If the healthcare provider feels sleep apnea is a possibility, you will make an appointment with a sleep specialist for a sleep apnea test.

“Since sleep apnea symptoms occur as you sleep, they can be hard to detect,” says Michelle Worley, RN, the clinical operations manager at Aeroflow Healthcare. “Because many people assume that they are just tired without thinking they have a sleep disorder, it is estimated that about 80% of sleep apnea cases remain undiagnosed. It is important to contact your doctor immediately if you have any symptoms of sleep apnea.” More often, your partner can help you identify if you snore, which is a common sign for sleep apnea. 

How to test for sleep apnea 

There are two main tests for sleep apnea: one done in a clinic, and one done at home.

Home sleep apnea testing

The home sleep test (HST) evaluates for obstructive sleep apnea your own home. This study measures oxygen saturation, heart rate and airflow, and movement in the chest and abdomen.

“An HST uses sensors—typically on the finger or wrist and on the chest,” says Dr. Smith. “[They are] simplified tests, usually to measure your heart rate, blood oxygen level, airflow and breathing patterns. While an HST isn’t as comprehensive as a PSG, it provides sufficient data to diagnose or rule out sleep apnea.”

Clinic sleep apnea test

“The polysomnography lab sleep study (PSG) is an overnight polysomnographic evaluation (sleep study) at an accredited sleep center,” says Worley. “This monitors your heart rhythm, brain waves, breathing rate, and airflow while you sleep. An in-lab sleep test offers the most accurate and comprehensive assessment of your condition and provides clinicians with the best information with which to diagnose obstructive sleep apnea.”

This is where my “Predator” look appeared. “During a PSG in a sleep lab sleep study, a person is outfitted with equipment that monitors their heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while they sleep,” Dr. Smith explains.

Wires were attached to the skin on my head and parts of my body with a small amount of toothpaste-like substance. These wires were attached to monitors that sent signals to the people running the study in their control room. At my sleep clinic, there were several bedrooms, each with one person. 

At a set time, we all laid down to go to sleep. If we needed something, such as to be unhooked to use the bathroom, we said so out loud and someone came to our aid. Occasionally, one of the overnight sleep study technicians would come in to reposition a rogue wire or monitor. 

I had been nervous about the study before I went, feeling it would be intrusive—but it wasn’t nearly as uncomfortable as I had pictured. My worries that I would feel like I was being “watched” were quickly assuaged.

After testing is completed and analyzed, a follow-up appointment with the sleep specialist is scheduled to discuss treatment options or further steps.

How is sleep apnea treated?

“Once diagnosed, sleep apnea can be treated in several ways, including continuous positive airway pressure (CPAP), oral appliances, surgery or surgical implants,” says Worley. “CPAP remains the leading choice for sleep apnea treatment, but each patient should consult their doctor and sleep therapists to identify the option that meets their individual needs.”

CPAP machines help keep airways open using pressurized air. There are various options when it comes to CPAP machines, including different masks and settings. While some settings are by a sleep specialist based on sleep study results, others are individualized for comfort. CPAP machines and accessories are usually obtained through CPAP and sleep equipment stores, and may be covered by insurance plans. 

“An alternative to the CPAP machine is a custom-fit, customized oral appliance that holds the mouth in a position that helps prevent the collapse of relaxed oral muscles and tissues, allowing the airway to stay unblocked,” Dr. Smith says.

Does testing need to be repeated at a later date?

A sleep physician or healthcare provider may ask you to do another sleep study with a CPAP machine or other treatment, both to determine proper settings, and to ensure the treatment is effective. More sleep studies could be administered down the line if you feel the treatment you are using has become less effective or isn’t working for you.

A repeat study may be conducted if there is reason to believe the first results were inaccurate. “At-home monitoring devices don’t always catch all cases of sleep apnea,” says Dr. Smith. “If your at-home test results are negative, but your doctor still suspects sleep disordered breathing, they might still recommend a clinical sleep study, just to be sure.”

Sleep studies are not quite a night away at a hotel, but they can be life-changing. “Don’t ignore your symptoms,” Worley says. “Treating sleep apnea can greatly improve your quality of life as well as your health and well-being.” Despite improving the quality of life, sleep apnea treatment also reduces the risk of heart disease and stroke. 

Despite not even suspecting I had sleep apnea, I noticed a big difference once I started using a CPAP machine. I sleep better, I’m more alert during the day, and I simply feel better overall. Don’t assume a snore is just a snore or fatigue is just fatigue—it’s worth it to be tested.