Is a Home Sleep Test as Good as an in lab Sleep Test?

What is a Home Sleep Test, and is it as good as in lab sleep test?

Home Sleep Test

It’s exciting to see the advancements in sleep medicine.  Along with all the changes taking place in the insurance industry, Technology, and the economy in general. Many of these developments are changing how sleep studies are performed. For instance, a Home Sleep Test is becoming more common.

So, let’s take a rather brief look at a Home Sleep Test, and see how it compares with an in lab sleep study.

About Insurance

First of all, insurance is a major player in sleep medicine. And in order to keep premiums down, insurance companies push for the least expensive tests. The reason behind this is that the less the insurance company pays out, the lower your premiums will be; which makes sense. There’s also the economic pressure to keep costs down.

Now consider that one Technologist can do two, maybe three in lab sleep studies at a time. However, that same Technologist can handle more Home sleep tests at once. And a Home Sleeps test, or HST doesn’t cost as much. So you can see where this trend is going.

But, are HST’s as good as in lab sleep tests? Let’s first take a look at the type of sleep tests available. Then we’ll look at a typical Home Sleep Study. We’ll also compare costs and see who can have an HST. I’ll also explain why some people shouldn’t have an HST; in fact, can’t even qualify for one.

Types of Sleep Tests

The Centers for Medicare and Medicaid Services or CMS defines 4 types of sleep studies, based on what’s being monitored. A type 1 study is an in lab sleep study,  attended by a Technologist. This has been the gold standard of sleep tests, as it’s the most thorough.

Types 2-4 are home studies. These studies are defined by the number of channels recorded. Type 2 studies record more channels than type 3 studies. While type 4 studies record the fewest channels. And while an in lab study can test for a whole range of sleep disorders, an HST only monitors breathing.

Another downside to an HST is that something can come unhooked during the night while you’re sleeping. And that could make the study incomplete.

With that in mind, let’s take a look at a typical Home Sleep Test.

A Typical Home Sleep Test

You go into the sleep center the evening of your study and pick up the equipment needed for the night. The Technologist will go over everything with you; showing you how to put things on, and should answer your questions.

Then, in the comfort of your own home, you hook yourself up and (hopefully) go to sleep. In the morning, you bring the equipment back to the sleep center, where they’ll download your data. If it’s determined that you need CPAP, you’ll be set up with what’s called an auto-PAP machine. This type of device is set to automatically change pressures through the night based on how you’re breathing.

You can keep the auto-pap. But you might also have the option to get a CPAP machine. In that case, you’ll bring the auto-pap in and they’ll download the data. Then they’ll  use that to determine your optimal pressure. And they’ll give you a CPAP machine set to your best therapy level.

Other Home Sleep Test Information

Cost of a Home Sleep Test vs an in lab study

An in lab study can run anywhere from $600, to $5,000; with an average being around $1,000. However, a Home Sleep Test runs anywhere from $150 to $500. And insurance covers both.

Who should not have an HSAT?

A Home Sleep Test just monitors breathing. Therefore, it only detects sleep apnea, but none of the other sleep disorders. That’s why a careful assessment of your medical history is important. For example, if you have any heart or lung conditions, you might need an in lab study.

Other reasons you might need an in lab study

If your Doctor suspects you might have some other sleep disorder, he/she could order an in lab study. And anyone 18 years and younger would need an in lab study as well.

So, While A Home Sleep Test is becoming more common, it’s not for everyone. And even with all the advancements in sleep medicine, there might always be a place for in-lab sleep studies.

Conclusion

We’ve taken a rather brief look at a Home sleep test. We’ve seen the advantages of an HST. And also discovered why a Home Sleep Test isn’t for everyone. We’ve also seen why this type of test might become more common in the future.

How about you? Have you had a Home Sleep Study?  Would you like to share your experience? Or do you have questions about HST’s vs in lab studies? Please leave a comment and let me know what you think.

Till next time…Blessings.

what Happens While You’re Sleeping?

While you’re sleeping.

In this article, I give a brief history of the evolution of sleep studies. I’ll  also take a little peek into the future and think about what’s to come. SleepingSo keep in touch, as I’ll be adding on to this information, and more, as I continue to study this fascinating field.

Of Rabbits and Monkeys

Researcher’s in the 1700’s demonstrated that living tissue has electrical properties. This paved the road for further work into recording brain activity, known as electroencephalography, or EEG. And by the mid-1800’s scientists were hooking up electrodes to the heads of rabbits and monkeys. Thus making the first recordings of brainwaves.

Where We’ve Been

It was 1925 when Dr. Hans Berger plugged a person in and recorded the first human EEG. Up until this time, sleeping was thought of as a state of unconsciousness; a merely passive process where we just rested. Now, however, sleeping is known to be a very active state; with a number of things going on.

Then in the 1950’s, Dr. William C. Dement, considered the father of sleep medicine, conducted the first sleep studies. These studies identified the different sleep stages and the discovery of REM sleep.

Sleeping
Man hooked up for a sleep study

However, sleep studies weren’t very popular in those early days. Not only because medical science had not yet embraced this field as something even worth noting. But researchers had to stay up all night and monitor a sleeping person. Yet, in spite of all that, the field grew. With more sensors being added as we learned what to look for. And that evolved into what we see in the sleep lab today.

In 1965, Obstructive Sleep Apnea was first described. And treatment for sleep apnea at that time was a tracheotomy. A tracheotomy involves making a surgical opening through your neck into your windpipe; thus allowing you to breathe.

And in 1978 a small group of sleep professionals met, with the goal of forming an organization; now known as the American Association of Sleep Technologists, or AAST. One of the first things they did was create an education and examination board; known as the  Board of Registered Polysomnographic Technologists or  BRPT. Together, these organizations provide us sleep professionals with standardized testing as well as ongoing training.

But it wasn’t until 1981 that Dr. Collin Sullivan, from Sydney Australia, invented the first CPAP machine. This revolutionized the treatment of sleep apnea. And advancements in both diagnosing and treating the various sleep disorders continues.

Where We’re Going

The gold standard for diagnosing obstructive sleep apnea is an in lab overnight sleep study. However, insurance companies are now giving the O.K. For home sleep testing, or HST’s. However, most HST’s can’t determine when you’re sleeping; they only monitor breathing. Therefore, they’re not very accurate in evaluating sleep disorders. However, further advancements could change that.

One of the ways this might come about is with the advancements in smart homes. Imagine downloading the sleep lab app, and apply whatever type of device we’ll have by then, and presto! An in lab quality sleep study done in the comfort of your own home, complete with live monitoring 24/7! And then, of course, your in-home follow up Doctor visit via the internet.

As a Sleep Technologist, I see the field evolving before my eyes. It’s quite exciting to think about where we’ll be in 10-20 years; and beyond. And being a Star Trek fan, I imagine (in the far future) sleep studies being conducted on a holodeck. Even though that technology might, realistically, be impossible, it’s fun to imagine.

And of course just keeping the public up to date via the internet or other forms of media is critical. Knowledge is power. And a well-informed public is more likely to access the help that they need. For us Sleep Technologists, this means keeping up with advancements in sleep medicine and taking on the role of educator.

Conclusion

Up til now, we’ve taken a rather short journey into the history of sleep studies. We’ve seen how our ideas of sleeping have changed. As well as took a look at where we could be going. I’m doing ongoing research and will share with you some of the highlights of this fascinating field.

If you have any questions or concerns about the ever-expanding field of sleep studies and how it might impact you, please leave a comment below.

Till next time…Blessings.

How Exercise can Help you Sleep Better

Exercise doesn’t have to be hard in order to gain something from it. You don’t even have to work up a sweat to get the benefit of a better nights sleep. And that’s what this article is all about. I’ll show you some easy exercises that can not only improve your sleep but also reduce both snoring and the severity of sleep apnea. And you don’t need any special equipment. How cool is that?

Sleeping in Space is Better

Astronauts report they sleep better in space. And some studies done on sleep in Earth orbit show an improvement of both obstructive breathing and snoring.

So while being in zero gravity, (or micro-gravity in Earth orbit), has its benefits, it comes with a price. You see, weightlessness does some things to your body that aren’t so nice. These effects include loss of muscle and bone mass; as well as a decrease in strength and endurance. Exposure to weightlessness also increases your risk of Kidney stones.

However, these effects are reversible once you return to Earth. This is because gravity provides the resistance our bodies need to maintain health.

exercise
Astronaut Sleeping on board the International Space Station

Thus, when we’re weightless, we can sleep better, but our bodies deteriorate more quickly. Yet while on Earth, our sleep is worse, but our bodies deteriorate more slowly.

Therefore, zero gravity is ideal for sleep. Yet, while we’re awake and actually doing things, we need gravity; something we can push against, or our bodies weaken. Gravity is good in that it gives our bodies the resistance it needs for health. But at the same time, it causes lower quality sleep; with an increase in the severity of OSA. Too bad we all couldn’t have a zero-G chamber to sleep in.

Anyway, that’s why astronauts need exercise to provide the resistance their bodies need while in space. But even us Earthlings can benefit from a proper workout.

Better Sleep for us Earthlings

We know that we need some resistance just to maintain a semblance of health. But again it’s all about balance, neither too little or too much. Remember, we’re not talking about muscle building exercise here, we just want to improve our sleep. And in that case, not only the type of exercise but the timing of the exercise is important. Not only that, but you don’t need a bunch of fancy equipment. In fact, you can get by without any equipment!

There’s actually a bit of a debate as to the best time of the day to exercise. Some reports say it’s best right after you get up. Although other studies show that people who exercise before going to bed benefit as much as those who worked out right after they woke up. So maybe it’s really based on what works best for you.

Let’s start with a walk. Even a stroll as short as 20 minutes can be beneficial. And if the sun’s out, you can get your daily dose of vitamin D as well. And by the way, a deficiency of vitamin D  leads to osteoporosis, increases your risk of heart disease, and makes you more susceptible to cancer; so it’s kinda good to have enough of that vitamin available.

But walking can also reduce the severity of OSA. Here’s how.

Fluid accumulates in your legs during the day. Then at night, when you lay down, that fluid shifts to your upper body/neck. This makes sleep apnea worse. Lack of exercise encourages the fluid build up in your legs. Therefore, regular brisk walks can reduce the severity of OSA. And the longer and more frequent the walk, the greater reduction in OSA.

However, walks outside, sun or no sun, aren’t always possible. Sometimes the weather just doesn’t co-operate.

Other Types of Exercise

Any physical activity that increases your heart rate is good. But you don’t want to increase your heart rate too much. So if you’re feeling a little more oomph, there’s a target zone you should shoot for. Click here for an interactive target heart rate zone calculator. Some good cardio exercises include: Walking, riding a bike, running, swimming and jumping rope. But if you have an injury, consult your healthcare professional before doing any type of exercise.

Sleep apnea some of your problem? Did you know there are exercises you can do that reduce snoring as well as the severity of obstructive sleep apnea? Let’s look at a couple of these.

Speech Therapy Training strengthens your upper airway. studies show these types of exercises significantly reduce the severity of obstructive sleep apnea.

exercise
Aboriginal man playing a Didgeridoo

You can either get yourself a digeridoo which can effectively strengthen your upper airway. Or you can try the following upper airway strengthening exercises. But be patient, it could take a few months of being consistent before you began to see any results. So hang in there. But, yes, these exercises have been proven to reduce both snoring and the severity of sleep apnea.

Ain’t Gonna Happen

I know how it is, even if you have the energy, and the time, other things can still get in the way. And good intentions alone usually don’t get very far. You need to not only plan to exercise but actually write down specifics. Put it on your calendar. Set realistic goals, and write them down. It’s been proven that people who write down their goals are 80% or more successful than those who don’t.

But what if you really do want to exercise, but just don’t have the energy?

I’m too Exhausted to Exercise

“If I could get more sleep, I’d have more energy, and then, maybe I could exercise.” And really, when you’re truly exhausted, just the thought of any kind of exercise can be overwhelming. Especially if exhaustion has now led to depression.

When people think of exercise or ‘working out’, thoughts of hard physical effort usually come to mind. But as you’ve seen, exercise doesn’t have to be strenuous in order to be beneficial. Remember, we’re not talking about working out to get physically fit, the goal is to get a better nights sleep.

So if nothing else, a good walk on a sunny day can be just what the Doctor ordered. And if you have sleep apnea, you can work on those upper airway muscles at the same time. Weather permitting, of course. But, don’t feel bad, or be hard on yourself if some days you really just can’t do anything, even if the weather’s co-operating.

Conclusion

We’ve seen how exercise can help you not only sleep better but can also reduce snoring and the severity of sleep apnea. We’ve looked at some specific exercises needed for this purpose; as well as how setting goals and writing them down will increase your chance of success.

If you have any exercises you do, or some success story you’d like to share, please leave a comment below.

Till next time…Blessings.

My Wife Always Complains About my Snoring

My wife’s made me aware of my snoring for several months now.

Snoring
Me, chillin’ by our Lilac Bushes

So I’ve finally decided to talk with my Doctor about having a sleep study. Please join me in my journey as I share some personal experiences and other insights.

This then is my story…kind of.

Is it More Than Snoring?

A sharp jab to my side jars me from a sound slumber.

“Kent, you’re snoring!” (It’s never “Honey, you’re snoring”. No, when it’s bad, I’m always on a first name basis). I usually end up mumbling something, turn over, and go back to sleep. There are, however, times when I wake myself up choking or something else that’s quite disturbing.

For example, I travel to different hospitals and occasionally stay at hotels. One time in particular, I was rudely awakened; finding myself totally unable to breathe. I also had a bad burning sensation in my throat and the most horrible taste. I was literally halfway onto my feet before I fully woke up, and ran to the bathroom.

Not being able to breathe was bad enough. But with only a locked door between me and any chance of rescue only made it worse. I did end up catching my breath but also threw up some crud. That only happened once (so far). But more and more I wake with some real thick phlegm stuck in my throat. I can still breathe o.k., but it’s a bit uncomfortable.

My wife’s complaints of my snoring surprised me at first. But now that surprise has turned to concern. And because I’m aware of the dangers of untreated sleep apnea, I began to wonder if I might have fallen victim to this thing. So while I don’t fit the profile of a typical person with obstructive sleep apnea (OSA), that doesn’t automatically rule me out.

But just what does a typical person with sleep apnea look like?

A Typical Sleep Apnea Person

Although the average person with OSA is an overweight middle-aged male, almost anyone can have sleep apnea. In fact, I’d be willing to bet that 100% of the population of planet Earth has moments throughout the night where they stop breathing for a time. So it’s not just a matter of if you stop breathing, but how often do you stop breathing. And how long do you stop breathing for?

As for me, I’m 6 ft. tall (72 inches), and I weigh 180 pounds. That puts my  Body Mass Index (BMI) at 24.4, which is average for a fellow my age (I’m 60). Yet I’m displaying some of the symptoms of OSA.

And my wife has made me aware of my snoring for some time now. Plus, every now and then I do wake myself up choking; though it doesn’t happen often. But, I rarely wake up with a headache, and only score a 3 on a sleepiness questionnaire.

Also, my dad died of a heart attack at 71; although I don’t recall snoring being an issue with him. I’m also not on any prescription medications, and really don’t feel too bad. And even though I spend many hours a night (and day), at a computer, I do try and stay pretty active. For instance, I have a couple road bicycles, and my wife and I like to go for walks as well. But, I figure I should at least get a checkup.

Would you Have a Sleep Study?

I’m trying to imagine what it would be like to not know what happens during a sleep study. What if I wasn’t aware of the dangers of sleep apnea? Would I even have any reasons to talk with my Doctor? I’m not sure, but the following are some things that come to mind:

My wife says my snoring is really bad, and sometimes I breathe really shallow.  I’m tired sometimes, but isn’t everybody? Why should I waste my money on some expensive test, and for what? What if I don’t have this sleep acne, or whatever they call it? And if I do and get this breathing machine, what will that do? Help me sleep better?  I really don’t sleep all that bad now. Oh, I won’t snore, and that’ll make my wife happy. But I could just get some of those breathe right strips and be done with it, no?

The problem with that thinking is that breathe right strips open your nasal passages, and can stop the snoring caused by that. However, they do nothing in the way of holding your airway open. And that’s where the problem is. Besides, CPAP does more than give you a better nights sleep. That’s really just a beneficial side effect. It can literally save your life.

What if it’s More Than Just Snoring?

On the one hand, I hope that I don’t have obstructive sleep apnea. Or should I say sleep apnea that needs to be treated.

You see, there are various degrees of OSA. The severity of sleep apnea is based on a formula we call the AHI scale. This AHI scale stands for Apnea Hypopnea Index. It’s calculated based on the number of times you stop breathing each hour. But we don’t even count every time you stop breathing, only those times you stop for 10 seconds or more.

Also, if your airway is going to collapse, it will after you’ve breathed out. So try this once, breathe out and then stop breathing for at least 10 seconds. This describes apneas. That’s when your airway closes completely. If your airway only partially collapses, we call that a hypopnea.

Now consider that you usually will stop breathing for way more than 10 seconds before waking. And your heart is taking quite a beating during this time. But you’re not going to die from suffocation. Your brain will wake you long before then. However, your heart can only take so much.

So, if I do need CPAP, I’ll be very compliant with treatment. ‘Cause, even though I’m not afraid to die, I don’t want to just yet.

Now What?

So I met with my Doctor yesterday(Friday), and I have some doubts about having sleep apnea. And although he did order a sleep study, we both agreed that it’s not really that much of an issue with me. I think I’d still feel better if I had the test, and at least rule it out. However, I’m going to spend some time looking more into this and see if I really need to go through with it.

I’ll keep you updated.

Conclusion

I’ve shared some of my personal concerns about snoring and sleep apnea. And this has also made me more aware of what a person might be thinking who doesn’t know the dangers of OSA.

Now, what about you? Whether you’ve had a sleep study or not; or even if you suspect you might have sleep apnea, I want to hear your insights. Please leave an appropriate comment or question.

Till next time…Blessings.

How do you Manage Chronic Pain?

Pain is our bodies warning system, alerting us to a problem. But pain can outlive its purpose and become chronic pain. When that happens, it causes even more harm. Let’s see what can be done about that.

Good Pain bad Pain

Short-term, or acute pain, is good pain.  This pain not only draws our Chronic Painattention to a problem, it also protects a damaged area from further harm (more on this later). There’s also long-term or chronic pain. This type of pain has outlived its purpose and is no longer useful. In fact, it now begins to cause its own injuries. But why does pain sometimes persist long after it’s needed?

Let’s explore these things, shall we?

Acute Pain is Your Friend

Imagine life without pain. What would it be like? If you’re suffering from chronic pain, living life pain-free probably sounds pretty good about now. Imagine how it would be to not feel pain…ever. But pain is our bodies warning system, alerting us to a potential problem.

But think about it.

You’re walking along barefoot somewhere, step on something, and slice your foot open. But, you don’t have any pain, so you pay no attention. Then there’s that sunburn, which makes your skin hypersensitive to light and touch. This keeps you from touching that area or exposing it to further light so that it can heal faster.

Or if you dislocate your hip, the pain will (hopefully) keep you from putting weight on it; thus causing more damage. And what about that chest pain that sent you to the hospital. That pain possibly saved your life. Think of the damage caused by not feeling any pain. So then, pain serves an initial purpose.

However, the very pain that saved your life can become your enemy.

Chronic Pain is Your Enemy

So that injury you had a while back is healed, but you’re still in pain. Or maybe some pain just started.  There seems to be no reason for it, but it won’t go away. What causes this?

First of all, chronic pain complaints increase with age.  And there are many causes. For example, just the changes that accompany normal aging can result in joint pain. Yet, on the other hand, older people tend to cope with pain better than younger people. This is due in part to peoples life experiences, and also health expectations in general.

But what damage does chronic pain cause? To begin with, it takes more effort to do daily tasks. Over time, this saps your strength. And that can make social interaction more difficult; as a result, you began to isolate more and more. Now it’s quite natural to become anxious about this. Eventually, depression can set in. However, anxiety and depression increase the sensation of pain; so it takes on a bit of a snowball effect.

But that’s not your only problem

Studies show that chronic pain actually changes your brain chemistry. This leads to memory and concentration problems. But perhaps the damage caused by stress is the most serious. And pain causes stress. And when stress becomes chronic, it causes chronic inflammation. Now you’re vulnerable to a whole bunch of other diseases.

And of course, pain also affects your sleep.

Chronic Pain and Sleep

If you have chronic pain, you’ll also suffer from fatigue and sleepiness. Your memory and quality of life will be reduced as well. The reason it has this effect is at least two-fold. First, chronic pain can cause you to wake up many times at night. But it also changes the amount of time spent in each sleep stage.

This is important because we need to spend a certain amount of time in each sleep stage. For instance, specific hormones are released in stage 3 sleep that help with the growth and restoration of your body. And Rapid Eye Movement (REM) sleep is important for memory consolidation. Additionally, some sleep stages affect your perception of pain.

And while pain causes sleep fragmentation, poor sleep can cause an increase in perceived pain. This starts a vicious cycle. Because the anxiety and depression from pain and lack of sleep increase the feeling of chronic pain.

When Mice Don’t Sleep

When lab animals were deprived of sleep, their body temperature dropped, internal organs shut down, and they died fairly quickly. How does this happen?  One study indicated these mice used up their energy almost twice as fast as other mice that were left to sleep. And because they couldn’t keep up with the energy loss, they died within 32 days!

With humans, hallucinations and paranoia set in long before more serious physical symptoms do. And although no human has been reported to die from sleep deprivation, it still has done some serious harm. Thus the once beneficial pain that alerted you to trouble, has now turned against you and is actually causing damage itself.

So if poor quality sleep leads to increased pain, it follows that getting a good nights rest can reduce pain. But how are you supposed to get some good quality sleep when you can’t even get comfortable?

Let’s look at some treatment options that can help us achieve this.

Treatment Options 

Conventional

A group of medications known as Nonsteroidal Antiinflammatory Drugs are commonly used to treat pain. Some of these are Motrin and Aleve. However, studies now show there are dangers in taking these medications. These risks include:

1-Increased risk of Heart failure.

2-Ulcers and internal bleeding.

3-Kidney failure

4-Serious allergic reactions

5-Dangers to children and teenagers.

Then there’re the narcotics, such as Tylenol with codeine, and Vicodin. However, these not only slow down your breathing but cause you to breathe more shallow as well. And if you already struggle with breathing in your sleep, these medications will only make things worse. Additionally, narcotics also reduce Stage 3 sleep, which is essential for the growth and restoration of your body.

So, whenever possible, treat the cause of the pain, don’t just numb it.

Alternative 

Exercise and other stressors release a chemical in our brains called Endorphins. The word Endorphin comes from 2 Greek words: Endo (from within), and Morpheús (The god of dreams), where we get the word MorphineThis is why physical exercise can make you feel good. Think runners high here.

But physical activity does more than just release endorphins. Additionally, physical activity (exercise) can prevent, or at least delay, pain;  because pain can increase with immobility. So although being too physical can increase pain, lack of physical exercise has the same effect. Therefore balance is the key.

Cognitive Behavior Therapy (CBT) is another interesting thing you might want to check out.

So again, doing things to reduce pain can help you sleep better. And when you sleep better, pain is further reduced. In all this, the real challenge is to allow the good acute pain in, but keep the bad chronic pain out.

Conclusion

Acute pain protects us from further injury. But chronic pain just causes more damage. We need to be able to reduce chronic pain as best we can, while not affecting the benefits of acute pain. If you’ve found something that has helped your chronic pain, please leave a comment. You can help others suffering from this as well.

Till next time…Blessings.