Sleep Study: Is a Home Sleep Test For Sleep Apnea Right for You? A Guide for Patients
Quick Summary
A Home Sleep Apnea Test (HSAT) is a suitable option for diagnosing obstructive sleep apnea (OSA) in adults who have a high likelihood of moderate to severe OSA and no other significant medical conditions (aka “uncomplicated” patients).
An in-lab sleep study (polysomnography or PSG) is strongly recommended for patients with certain conditions, such as significant heart or lung disease, and to diagnose specific sleep disorders like narcolepsy or REM behaviour disorder (RBD).
Many common sleep disorders, such as insomnia and circadian rhythm disorders, are diagnosed through a comprehensive clinical interview, not a sleep study. For these sleep disorders a sleep test is not required.
If an HSAT result is negative, inconclusive, or technically inadequate, an in-lab PSG should be performed to ensure an accurate diagnosis of a sleep breathing disorder.
Thinking of getting a sleep test? Or have you been told you need a sleep study? It can be confusing to know which type of sleep study is right for you or whether you even need a sleep test.
Some clinics might suggest a home sleep apnea test (HSAT) as a first step for everyone. But surprisingly, and depending on sleep disorder and situation, a home test for sleep apnea is not always the most appropriate or effective tool, and sometimes it’s not even required.
This guide, based on current international (American Academy of Sleep Medicine) and local (Australasian Sleep Association) clinical practice guidelines, answers common questions to help you have an informed discussion with your doctor or sleep clinic.
What is a Home Sleep Apnea Test (HSAT)?
A home sleep apnea test (in British english, the spelling “sleep apnoea” can also be used) uses a portable device to measure key indicators of your sleep and breathing at home. Modern devices use a variety of sensors—such as those on your finger, wrist, or chest—to track signals like oxygen levels, heart rate, and breathing effort. Some advanced systems can also identify breathing disruptions indirectly by measuring changes in your blood flow, a technology known as peripheral arterial tonometry (PAT).
What is an In-Lab Sleep Study (PSG)?
An in-lab polysomnogram (PSG), on the other hand, is a much more comprehensive test conducted overnight in a sleep center. In addition to monitoring your breathing, it tracks brain waves (EEG), eye movements, muscle activity, and more. This allows it to diagnose physical sleep disorders like OSA, central sleep apnea, parasomnias, or sleep-related movement disorders with great accuracy.
What Is the Main Difference Between an Home Test for Sleep Apnea and a PSG?
The key difference is comprehensiveness versus convenience. An HSAT is a more convenient, focused test for obstructive sleep apnea that you can do in your own bed. A PSG is a more detailed, attended study in a lab that can diagnose a much wider range of sleep disorders and is considered the gold standard for accuracy. Now, let's look at who is a good candidate for each.
When Is a Home Sleep Apnea Test (HSAT) Recommended?
A Home Sleep Apnea Test (HSAT) is recommended for uncomplicated adult patients who present with signs and symptoms that indicate an increased risk of moderate to severe obstructive sleep apnea (Kapur et al., 2017; Ellender et al., 2024).
What Is An "Uncomplicated Patient" for Home Sleep Test Purposes?
An HSAT is recommended for "uncomplicated" adult patients who have a high risk of moderate to severe obstructive sleep apnea (Kapur et al., 2017; Ellender et al., 2024). According to both the American and Australasian guidelines, you are an uncomplicated patient and a good candidate for a home sleep test if you have:
A high pre-test probability of moderate to severe OSA. This is often indicated by having excessive daytime sleepiness along with at least two of the following: habitual loud snoring, witnessed apneas (pauses in breathing), or diagnosed high blood pressure (Kapur et al., 2017).
No suspicion of other physical sleep disorders. If your doctor only suspects straightforward obstructive sleep apnea, an HSAT can be an efficient diagnostic tool.
No significant coexisting medical conditions that would require the more detailed monitoring of an in-lab PSG.
When Should You Have an In-Lab Sleep Study (aka Polysomnography or PSG)?
While many sleep issues are diagnosed via clinical interview, an in-lab polysomnogram (PSG) is the better and more definitive choice in several situations. Both the American and Australasian guidelines strongly recommend a PSG instead of an HSAT for patients with certain coexisting health conditions where a home test may not be accurate or sufficient (Kapur et al., 2017; Ellender et al., 2024).
An in-lab study is primarily used to investigate physical issues occurring during sleep. You should speak to your doctor about an in-lab study if you have any of the following:
Significant cardiorespiratory disease, such as congestive heart failure or chronic obstructive pulmonary disease (COPD).
Potential respiratory muscle weakness, for example, from a neuromuscular condition.
Suspicion of sleep-related hypoventilation (abnormally slow or shallow breathing), including from conditions like Obesity Hypoventilation Syndrome.
Chronic opioid medication use, which can affect breathing during sleep in complex ways.
A history of stroke.
Suspicion of other physical sleep disorders that an HSAT cannot detect, such as narcolepsy, REM sleep behavior disorder, or periodic limb movement disorder.
Insomnia that hasn't responded to treatment. In this case, a PSG may be used to rule out an underlying physical cause (like sleep apnea) that could be disrupting your sleep. The insomnia itself, however, is diagnosed clinically.
Do I Need a Sleep Study Or Sleep Test if I Suspect I Have Insomnia?
Generally, no. It's important to know that many sleep disorders, particularly insomnia and circadian rhythm disorders, are diagnosed based on your sleep history in a detailed clinical interview, not with an overnight study. A sleep test is not the default for every sleep problem. The clinical interview also contributes to treatment for insomnia and sleep disorders such as delayed sleep phase and shiftwork disorder.
However, if your insomnia or other sleep disorder hasn't responded to the gold standard recommended treatment for insomnia, CBT for insomnia, a doctor may recommend an in-lab PSG. In this case, the goal is to rule out an underlying physical cause (like undiagnosed sleep apnea) that could be disrupting your sleep. The insomnia itself, however, is diagnosed clinically.
What if My Home Test For Sleep Apnea is Negative? Can a Sleep Test be Wrong?
This is a critical point. An HSAT is less sensitive than a PSG and can sometimes miss cases of sleep apnea, especially milder ones. Both the American and Australasian guidelines strongly recommend that if a single HSAT is negative, inconclusive, or technically inadequate, a PSG should be performed, particularly if clinical suspicion for OSA remains (Kapur et al., 2017; Ellender et al., 2024). A negative home test isn't the final word if you still have symptoms.
How Can I Ensure I'm Getting Good Advice About A Sleep Study?
A sleep test should never happen in a vacuum. A key principle of good medical practice is that any diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up (Kapur et al., 2017; Ellender et al., 2024). For many sleep complaints, especially insomnia, this clinical evaluation is the primary diagnostic tool.
If a clinic wants to schedule you for a test without a thorough consultation with a certified sleep medicine doctor or qualified provider, that could be a red flag. Before agreeing to any test, you should have a complete evaluation that includes:
A thorough sleep history.
A physical examination.
A discussion of your symptoms and medical history.
This evaluation helps establish whether a test is needed at all. As the latest ASA guideline notes, choosing the right test requires complex decision-making and is not a simple binary choice; it depends entirely on your individual clinical situation (Ellender et al., 2024).
What Are the Practical Takeaways for Considering Whether A Home Sleep Apnoea Test Is Right For Me?
A home sleep apnea study is for suspected Obstructive Sleep Apnea (OSA). If you are in good health but have classic, strong symptoms of OSA, an HSAT is a reasonable first step.
Not required for some common sleep disorders. A home sleep study/test or in-lab sleep test is not required for insomnia or a circadian rhythm disorder.
Complexity requires the lab. If you have heart failure, COPD, use opioids, or have other significant medical issues, an in-lab PSG is the recommended and safer choice for diagnosing a sleep breathing disorder.
A negative HSAT isn't the final word. If your home test is negative but your symptoms persist, insist on a follow-up in-lab PSG to definitively rule out sleep apnea.
Demand a full evaluation. A comprehensive consultation with a sleep specialist is the gold standard for diagnosing all sleep disorders, and for many conditions like insomnia, it's the only tool you need.
By understanding these guidelines, you can be a more active and informed partner in your healthcare, ensuring you get the most accurate diagnosis and the best possible treatment for your sleep.
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Frequently Asked Questions About Sleep Apnea Testing
Q1: What is the main difference between a home sleep apnea test (HSAT) and an in-lab sleep study (PSG)?
A1: A home sleep apnea test (HSAT) is a portable device you use at home to measure a limited basic sleep indicators like oxygen levels and breathing effort. An in-lab polysomnogram (PSG), on the other hand, is a comprehensive test conducted overnight in a sleep center, monitoring a wider range of factors including brain waves, eye movements, and muscle activity, in addition to breathing. This allows the PSG to diagnose a broader spectrum of physical sleep disorders with greater accuracy.
Q2: When is a home sleep apnea test (HSAT) recommended?
A2: An HSAT is generally recommended for adults who have a high likelihood of moderate to severe obstructive sleep apnea (OSA) and no other significant medical conditions. This often means you experience excessive daytime sleepiness along with loud snoring, witnessed pauses in breathing, or diagnosed high blood pressure. If your doctor primarily suspects straightforward OSA and you're otherwise healthy, an HSAT can be a good first step.
Q3: When should I have an in-lab sleep study (PSG) instead of an HSAT?
A3: An in-lab sleep study (PSG) is strongly recommended if you have significant coexisting medical conditions such as congestive heart failure, chronic obstructive pulmonary disease (COPD), potential respiratory muscle weakness, or a history of stroke. It's also the definitive choice if your doctor suspects other physical sleep disorders like narcolepsy, REM sleep behavior disorder, or periodic limb movement disorder, which an HSAT cannot detect.
Q4: Is a sleep test needed to diagnose insomnia?
A4: No, an home sleep apnoea test is primarily designed to diagnose obstructive sleep apnea (OSA). Many common sleep disorders, such as insomnia and circadian rhythm disorders, are diagnosed through a comprehensive clinical interview with a sleep specialist, not through a sleep study.
Q5: Can a home sleep apnoea test diagnose all sleep disorders?
A5: No, a home sleep apnoea test cannot detect more complex physical sleep disorders like central sleep apnea, narcolepsy, or parasomnias. An in-lab PSG is typically required for these conditions.
Q6: What should I do if my home sleep apnea test (HSAT) is negative but my symptoms persist?
A6: This is a critical point: if your HSAT is negative, inconclusive, or technically inadequate, but you still experience symptoms like snoring, daytime sleepiness, or fatigue, you should insist on a follow-up in-lab polysomnogram (PSG). An HSAT is less sensitive than a PSG and can sometimes miss cases of sleep apnea, especially milder ones. A PSG will provide a more definitive answer regarding a potential breathing disorder.
Q7: How can I ensure I'm getting good advice about sleep testing?
A7: Always seek a comprehensive sleep evaluation from a sleep medicine physician or qualified provider before undergoing any sleep test. This evaluation should include a thorough sleep history, a physical examination, and a detailed discussion of your symptoms and medical history. A sleep test should never be scheduled without this crucial initial consultation, as it helps determine if a test is even necessary and which type is most appropriate for your individual situation.
References
Ellender, C. M., Joyce, R., Worsnop, C., Mercer, J., Ruehland, W. R., Duce, B., Naughton, M., Hucins, C. A., Wheatley, J., & Cunnington, D. (2024). Australasian Sleep Association 2024 guidelines for sleep studies in adults. Sleep. Advance online publication. https://doi.org/10.1093/sleep/zsae107
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(3), 479–504.
Written By The Better Sleep Clinic
Reviewed By Dan Ford, Sleep Psychologist
