Some of the most common questions we get asked by our patients at The Alaska Sleep Clinic are: What is the difference between home sleep tests and in-lab sleep tests? Which is better? Which is more affordable? Which is best for diagnosing my disorder?
At The Alaska Sleep Clinic, we want to make sure that our current and future clients have the best up-to-date information available. For this reason, we have set out to create an article that explores the differences between these two types of sleep studies to give you all the information you need in choosing which study can best help diagnose (or rule out) your sleep disorder.
Difference Between a Sleep Clinic and a Sleep Lab1
- Sleep facility refers to a sleep center that comprise both a clinic, where patients are evaluated, and management occurs and a laboratory where the diagnostic testing is administered through in-center and home sleep apnea testing (HSAT).
- The sleep clinic is an outpatient location where patients with sleep disorders pursue evaluation and treatment; arrange diagnostic testing, and where patient management and follow up care is provided by professional staff. The location can be within the sleep facility, or in a separate off-site physical location.
- A sleep lab is the location is which diagnostic testing is performed; either in-center testing or home sleep apnea testing.
Locations of sleep tests
One of the biggest differences between home sleep tests and in-lab sleep tests is the location at which they take place.
Home Sleep Tests are exactly what they sound like: sleep tests that are taken from the comfort of one's own home. For a home sleep test, the user usually comes into the sleep clinic the day of the test to pick up his HST and is given a demonstration on how to use the machine properly before taking the equipment home. Testing is performed by the user, and the data stored on the equipment is uploaded the following day at the sleep clinic.
For an in-lab sleep study the patient must come into the facility for an overnight study. Patients generally arrive between 8-9 p.m. to fill out paper work and be given an overview of the procedure by a registered polysomnographic technologist (RPSGT). Patients will have to spend the night in the facility as the test usually concludes around 6-7 a.m.
Diagnostics of sleep tests
What the tests diagnose is really what sets the two apart from each other. An overnight sleep study, also known as a polysomnogram (PSG), can test for and diagnose a whole range of sleep disorders including: breathing disorders, periodic limb movement disorders (PLMD), circadian rhythm disorders, hypersomnia, insomnia, and many more. A HST however, is only capable of testing for breathing disorders such as obstructive sleep apnea.
Home sleep tests are primarily used to diagnose patients with obstructive sleep apnea. A sleep physician will recommend a HST only if it is believed that the patient has a very likely chance that they have moderate to severe sleep apnea. This is because HST's tend to under-diagnose breathing disorders. If a patient has mild to low-moderate sleep apnea, the test may falsely conclude that the patient doesn't have sleep apnea, or conclude that the patient's sleep apnea is not as prevalent as it really is.
HST's are not recommended for patients who may have other sleep disorder comorbidities, or who have certain medical conditions such as chronic obstructive pulmonary disease, congestive heart failure, and neuromuscular disease. As we focus on health, and how to improve it, it is important to consider the impacts not just of diet and exercise but also sleep. So many individuals experience a lack of sleep in overall quantity or quality, whether it be due to nighttime awakenings to care for children or loved ones, a job that is demanding or requires work at evening hours, or other health conditions that contribute to insomnia, like substances in your body.
As healthcare practitioners, on a daily basis we likely see other aspects of health worsening when patients are unable to sleep. When we sleep, our inner cleaning squad goes to work and removes all toxins that have accumulated in our brain throughout the day.
Equipment used in sleep tests
A PSG uses a whole slew of monitoring devices to accurately diagnose a variety of sleep disorders. This includes:
Electrodes on the head to measure brain activity
Electrodes on the face to measure eye and jaw muscle activity
Elastic belts to measure breathing effort
Electrodes on the legs to record muscle movement
EKG monitors to measure heart rate and rhythm
Other devices to measure oxygen levels, breathing activity, and snoring
Because a HST is used strictly for diagnosing breathing disorders, it requires far less equipment. A HST comes in a small package that includes devices that are easy for patients to apply themselves including:
a small nasal cannula to measure airflow
a belt around the upper chest to measure respiratory effort
a finger clip to measure the oxygen saturation in the blood
When it comes to diagnosing sleep disorders, an in-lab sleep study is by far the most accurate of the two tests. Even when it comes to obstructive sleep apnea, a PSG is much more likely to give the best results. This is because of the added monitoring devices that measure brain and eye activity that helps tell a RPSGT exactly when the patient is sleeping, and what stage of sleep they are in.
During an in-lab sleep study, only data recorded during actual sleep is scored, making diagnosing a sleep disorder far more accurate. In comparison, a HST study is scored from beginning to end which is why sleep apnea is often under-diagnosed because it is also recording one's breathing while they are awake, which is when they are less likely to suffer any apnea events.
Supervision of sleep tests
In an in-lab sleep study a registered polysomnographic technologist is on-hand during the entire study observing the sleep activities of the patient from a monitoring station. They are able to calibrate the equipment to the patient's needs and make necessary adjustments or reattach disconnected equipment as needed for best results of the study.
In a home sleep test, the user is responsible for making sure the equipment is on properly and functioning. One of the problems with a HST is that if something becomes disconnected in the middle of the night and the patient doesn't wake up, the test may not get enough data for a complete study, and the test will have to be retaken.
Getting results back from sleep tests
Results from in-lab sleep tests are often quicker to get back to the patient. In-lab sleep studies are scored as the study takes place by a RPSGT and are often ready for a sleep physician to review them the next day. Results from a HST take slightly longer because the data has to be scored the day after the test when the patient returns the equipment with the results stored on an internal SD card. The technician then has to score the study after the test has been taken, and send the results to the sleep physician. It usually takes a day or two longer to receive HST results than PSG results.
Cost of sleep studies
Home sleep tests are by far the most affordable at about 1/4 the cost of an in-lab sleep study. For this reason, many insurance companies require a HST as a first-line diagnostics tool. With proper screening, up to 75% of patients suspected of having moderate to severe sleep apnea will only need to have a HST performed to get their diagnosis, making an in-lab sleep study unnecessarily expensive.
Please contact the Alaska Sleep Clinic for current prices.
We are in network and contracted with most insurance providers in Alaska, further reducing the costs of the studies, and making them much more affordable for what you will actually have to pay. We also offer discounts for patients willing to pay in-full for the tests. Contact us to get the exact amount of your plan's contracted rate with us.
As you can see, both HST's and PSG's have their benefits and drawbacks. Choosing which one is best really comes down to a patient-by-patient basis. For accuracy, diagnosing a variety of sleep disorders, and diagnosing sleep disorders with other medical conditions, a polysomnogram may be the test that your doctor or sleep physician recommends. If your doctor is fairly certain you have obstructive sleep apnea and simply wants to test for the severity of the condition, a home sleep test is often the forerunner for diagnosis.
1.American Academy of Sleep Medicine. https://aasm.org/clinic-versus-lab-fact-sheet/