How does sleep apnea testing work?

I can’t be the only one who dreads medical tests. The instructions ahead of time, driving to the facility, and sitting in the waiting room always trigger my anxiety. Yet to accurately diagnose conditions like sleep apnea, medical testing is required. For a sleep apnea evaluation specifically, there are two options—and one removes the stress of in-lab testing. Continue reading to learn how to test for sleep apnea either in a sleep center or at home.

Diagnosing sleep apnea requires a sleep study, which can be done at a nearby sleep center, hospital, or in your home. Both options may accurately assess if you have sleep apnea, but one involves an overnight clinic stay, a waitlist, and higher costs. The other lets you sleep in your own bed, is more affordable, and can be done shortly after a healthcare provider recommends testing. 

One of these two tests is required for an official sleep apnea diagnosis. Here’s a full breakdown of the two options and when each is appropriate, as well as a step-by-step walk through of what testing looks like, and how to interpret results. 

What are the options for sleep apnea testing?

When it comes to testing for sleep apnea, there wasn’t a reliable tool until the 1950s, according to the Journal of Sleep Research. That’s when researchers started to develop polysomnography (PSG), aka the in-lab sleep study. For decades after that, it was the gold standard of sleep testing. Now, however, it’s possible to diagnose sleep apnea at home thanks to virtual sleep clinics and at-home tests.

“The at-home sleep test has made diagnosis much more accessible,” says Jessica Meers, PhD, DBSM, licensed clinical psychologist at Rhythm Wellness, a therapy practice specializing in sleep conditions, “It’s convenient, affordable, and works well for many patients.”

Home sleep test

• What it is: A home sleep apnea test facilitated by a virtual sleep clinic

• Who it’s for: Many people looking for an accessible, convenient, and affordable option

• How it works: You first schedule a virtual appointment with a sleep provider via telehealth, through a virtual sleep clinic. If a sleep apnea test is recommended by the provider, the sleep clinic will ship the testing device to the patient. The device is small and worn at night. It captures important data like (respiratory rate and mandibular jaw movement) that a sleep specialist can use to determine if someone has sleep apnea. 

• Advantages: This test is taken from your own bed and requires no travel. FDA-approved tests, such as the one from Dreem Health, are easy to set up and can offer a clinical-grade diagnosis without any wires or clunky machinery. At-home tests also provide quicker access to results and a sleep specialist who can interpret them after testing.

• Limitations: At-home tests don’t measure as many metrics as in-lab sleep studies, says Dr. Meers. For most people, this isn’t a concern, but for those with complex medical conditions or a history of neurological concerns, these tests might not provide a full picture.

• Insurance and cost: Generally more affordable, and it’s often covered by insurance when a healthcare provider prescribes it because a patient displays symptoms of sleep apnea.

In-lab sleep study at a clinic or hospital

• What it is: An overnight sleep apnea test delivered in a sleep lab or clinic 

• Who it’s for: A sleep lab polysomnography is more appropriate for people with complex medical conditions, such as movement disorders, says Dr. Meers. According to a review published in JAMA, it’s also generally preferred for people in professions where diagnostic certainty is especially important (such as pilots or drivers).

• How it works: A patient arrives about two hours before bedtime. Once in the lab, a technician hooks up electrodes to the scalp, chin, and eyelids. Trained staff then observe the patient as they sleep. The electrodes and other monitors in the room provide data on the patient’s heart rate, how fast they fall asleep, when they wake up, their breathing, and movement throughout the night. 

• Advantages: A polysomnography is a comprehensive test that measures multiple metrics to determine if sleep apnea is present. It was the gold standard for many decades, meaning many centers are well-versed in delivering it. As a highly sensitive test, an in-lab study is also generally better at detecting mild obstructive sleep apnea, per Sleep Advances.

• Limitations: As the name suggests, an in-lab sleep study requires someone to travel to a sleep clinic and sleep there overnight. This means arranging transportation and childcare for the evening, sleeping in an unfamiliar setting, and being connected to heavy-duty equipment. These centers also deliver results slower than virtual sleep clinics, and many labs have a 2-4+ month waitlist, meaning it can take months to begin treatment to improve your sleep

• Insurance and cost: Usually more expensive, though it may be covered by insurance when recommended by a healthcare provider. Even with insurance, someone is still responsible for arranging (and paying for) transportation to the clinic and childcare if needed.

Still unsure which is right for you? Read our full side-by-side comparison of the two.

Who is a good candidate for a home sleep test?

Home sleep testing and in-lab tests are both clinically legitimate, FDA-approved, and covered by many insurance providers. Given the convenience of home tests, it’s easy to see why they’re so popular. But they aren’t the right option for everyone. 

“Deciding who should have a lab test versus an at-home test is often oversimplified,” says Dr. Meers. “Patients with complex medical histories, possible movement disorders, or symptoms that don’t match their results need a full polysomnography. The at-home test can miss things that a trained technician would notice right away during an in-lab study.”

Good candidates for at-home testing

• Presence of symptoms: Sleep apnea tests aren’t designed to be preventive. Instead, they’re for those who have symptoms associated with sleep apnea (think: loud, abrasive snoring, breathing that stops, gasping for air, daytime sleepiness. Sleep apnea symptoms in women may look a little different).

• Provider referral: A healthcare provider must prescribe an at-home sleep test. This could be a primary care provider, though virtual sleep clinics also offer digital evaluations with sleep experts.

• Minimal tossing and turning at night: To make sure the device stays in place, someone needs to be able to consistently sleep in one position—unless it’s the test from Dreem Health, which is designed to stay on no matter your sleeping position.

• No other sleep disorders suspected: At-home options specifically tests for sleep apnea. If symptoms could be due to another condition, the National Heart, Lung, and Blood Institute reports a healthcare provider may recommend an in-lab sleep study where a sleep technician can watch for multiple sleep conditions at once. 

• No complex conditions that affect sleep: If someone has one or more complex medical conditions that affect how they sleep, an at-home test may not be suitable. 

May be better suited for an in-lab test

• Complex medical conditions present that affect sleep: Certain medical conditions may indicate that in-lab testing will provide more accurate results, according to the American Association of Sleep Medicine. These include congestive heart failure, lung diseases, and neurological disorders, like Alzheimer’s or Parkinson’s disease.

• Use of pacemakers: Most home tests are not FDA-cleared or -approved for those who use a pacemaker. That’s because a pacemaker interferes with the at-home testing device, leading to potentially inaccurate results. 

• Taking certain medications: If you take medications that affect upper airway function, such as opioids, an at-home sleep test may not be appropriate, per the Journal of Clinical Sleep Medicine. Home tests can’t identify what disruptions come from the medications versus sleep apnea. 

• Work in an industry with serious safety risks: Undiagnosed sleep disorders present serious safety risks in certain professions, such as commercial truck drivers or pilots. If you work in one of these industries, consider an in-lab test. It tests for multiple sleep disorders, not just sleep apnea, and that comprehensiveness may be necessary when lives are on the line. 

• Previous inconclusive at-home sleep apnea test: This one might go without saying, but if you already took an at-home test and the results were inconclusive, an in-lab evaluation may be more appropriate. 

The good news is you don’t have to decide which category you fall into on your own. Before either test, a healthcare provider will assess your symptoms and medical history and recommend one option of the other. 

What does the home sleep testing process actually look like?

Whenever possible, I prefer a play-by-play before getting any medical tests done. If you’re the same, here’s what modern home sleep testing looks like:

1. Meet with a sleep medicine specialist via a virtual sleep clinic (like Dreem Health). Since the clinic is virtual, your appointment will also be online.

2. During the assessment, the specialist will evaluate symptoms, your lifestyle, and your medical history. From there, they will decide what test is appropriate.

3. If a home sleep apnea test is recommended, the clinic will ship the home sleep test device. 

4. While it’s shipping, you can track the device’s location using a tracking number provided by the virtual clinic. 

5. The test will arrive with instructions on how to use it. These devices are typically designed to be easy to use.

6. Before bed, do everything as you normally would. Avoid napping, late afternoon caffeine, or anything else that may make it hard to sleep.

7. Wear the device to bed so it can track your breathing as you sleep. 

8. The device captures results, which you can then talk through with the same sleep medicine specialist who recommended the evaluation. 

How do you read sleep apnea test results?

According to Medline Plus, a sleep study tracks various metrics: 

• apnea (how often you stop breathing for ten seconds or longer)

• hypopnea (when breathing is partially blocked for at least ten seconds)

• the effort it takes to breathe

Luckily, there’s only one metric you need to keep track of: the apnea-hypopnea index (AHI). This number is reported per hour, and someone with five or more AHIs may have sleep apnea, according to the National Library of Medicine. 

Specific AHI ranges are: 

• 0 to 5 per hour: Normal breathing

• 5 to 15 per hour: Mild sleep apnea

• 15 to 30 per hour: Moderate sleep apnea

• 30 or more per hour: Severe sleep apnea

While the AHI is useful, Dr. Meers recommends viewing it as a starting point, not the whole story. “Two people with the same score can have very different clinical situations,” explains Dr. Meers, “And treatment decisions should never be based solely on that number.” 

That’s why quality sleep clinics, whether virtual or in-person, provide follow-up appointments. In these check-ins, sleep medicine specialists can interpret results and decide on next steps, whether that’s a continuous positive airway pressure (CPAP) machine, which keeps the airways open and prevents breathing pauses during the night, or something else. 

How do I get started?

If you suspect you may have sleep apnea, the next step is to make an appointment with a healthcare provider who can assess symptoms and determine if testing is appropriate. They can also help you decide if an at-home or in-lab makes more sense in your situation. 

Fortunately, you don’t need to wait months for a referral from a primary care provider. Dreem Health can connect you with a sleep medicine specialist for an assessment within the same week. 

The bottom line

Getting tested for sleep apnea can be done from the comfort of your home or during an overnight stay at a sleep clinic. Both options are clinically effective. Even if you prefer one over the other, discuss both with a healthcare provider, which can be done during a virtual or in-person assessment with a sleep medicine specialist. 

Frequently asked questions (FAQs) 

Can I test myself for sleep apnea?

Currently, there is not a reliable way to self-diagnose sleep apnea. If you believe you may have sleep apnea symptoms, visit a healthcare provider who can then prescribe a suitable sleep apnea test. Assessment options include in-lab sleep studies and home sleep apnea tests, such as the FDA-approved, insurance-covered test from Dreem Health.

What are the warning signs of sleep apnea?

The warning signs of sleep apnea include gasping for air during the night, breathing that starts and stops when sleeping, loud snoring (the latter is more common in men than women), morning headaches and dry mouth. Alongside these direct symptoms, many people with untreated sleep apnea report feeling exhausted, even if they were in bed for eight hours. That’s because sleep apnea wakes someone up throughout the night, often without knowing it.

Does insurance cover sleep apnea testing?

Most insurance plans cover sleep apnea testing when it’s recommended by a healthcare provider. However, they typically won’t cover routine testing without a  provider referral. This can vary based on insurance provider and plan type, so check with your insurance provider about what’s covered ahead of time.

How is sleep apnea diagnosed?

Sleep apnea is diagnosed via a sleep test. This could be a polysomnography conducted  in a sleep center or lab. A more convenient option is an FDA-approved at-home test, such as the one from Dreem Health.