Sleep Studies

If you find yourself waking up exhausted or suspect you might have sleep apnea, the most common question is: “Where do I even start?”

Your first point of contact should be your primary care physician, or you can reach out to us. In either case, the goal is to get you connected with a board-certified sleep specialist. Primary care doctors can order a sleep study directly and you will ultimately need a formal sleep study to determine exactly what is happening while you sleep.

Sleep Study Types:

Sleep studies generally fall into two categories: Home Sleep Tests (HSTs) and Polysomnograms (PSGs), or in-lab tests.

Home testing has evolved rapidly. Older “Type 2” HSTs are more comprehensive; they utilize several attachments and sensors to provide highly detailed data, though they can be somewhat cumbersome to wear and confusing to set up on your own. 

On the other end of the spectrum are smaller HSTs like the WatchPAT One or NightOwl. These have become popular because they are inexpensive, disposable, and simple.

Because these smaller devices require very little setup and education, the data can sometimes be more reliable, if not as detailed. The fact that they are disposable means that they are readily available and it’s not necessary for the office to wait for one patient to return their HST before they can lend it out to another patient.

Regardless of which device you use, always ensure it is FDA-approved for sleep apnea diagnosis and that your final report is interpreted by a board-certified sleep specialist.

The In-Lab Study

The most comprehensive option is the in-lab study or Polysomnogram (PSG). While more cumbersome due to the number of sensors involved, a PSG provides a wealth of information that a home test simply cannot capture, such as brain wave activity and precise sleep stages.

Because of the cost difference, many insurance providers require a patient to complete a cheaper home test before they will authorize an in-lab study. However, if a home test comes back inconclusive or suggests unusual underlying issues, a PSG becomes a necessary next step. Many patients find it difficult to fall asleep in a lab with equipment attached to them. The data is superior, but it is only useful if you can actually achieve a representative night of sleep while there.

It is helpful to remember that any sleep study is merely a snapshot of one single night in your life. Because sleep quality fluctuates, your results can be influenced by outside factors. If you are congested or particularly stressed on the night of your test, your reading might show a more severe condition than usual. Conversely, if you have a “good night” despite having severe sleep apnea, your test might return a milder reading than what you really have. Ideally, tracking sleep over multiple nights provides a much more accurate average of how your sleep.

Telemedicine in Sleep Care

As home testing technology has become more accessible, a wave of telemedicine companies has emerged, offering “end-to-end” service—from mailing you a test to prescribing treatment via video chat. The convenience of fitting a medical consultation into a lunch break is a draw. However, telemedicine has its boundaries. A doctor cannot perform a physical examination of your airway, mouth or neck over a screen. Sleep apnea is only one of many possible sleep disorders; seeing a provider in person allows for a more complete physical exam and a higher chance of catching subtle diagnostic clues.

Furthermore, there is an ethical landscape to navigate with “all-in-one” companies. You may notice that many of these businesses do not accept Medicare or Medicaid. This is because federal regulations generally prohibit a single entity from owning both the diagnostic process and the treatment equipment (like CPAP machines or dental appliances). This is intended to prevent a conflict of interest—it is ethically problematic for a company to profit more if they “find” a condition that requires you to buy their equipment. While private insurers may not always make this distinction, it is a factor worth considering.

When choosing a provider, ask yourself: Is the company incentivized to give me a specific diagnosis? If your treatment isn’t working or your equipment malfunctions six months from now, will you have a local advocate to help you fix it? We saw the risks of “direct-to-consumer” healthcare with the bankruptcy of Smile Direct Club, which left many patients stranded with unfinished treatments and no refunds. Choosing a provider who offers continuity of care ensures that you aren’t just a “one-time transaction.”

If you’re in Connecticut and have questions, give us a call or send us a text or email.