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DO I NEED ANOTHER SLEEP STUDY?
Routine or annual sleep studies are not a thing. Your provider must have a clinical question that justifies another sleep study. A repeat sleep study is needed to
(i) evaluate for a secondary sleep issue (not just a sleep breathing problem), (ii) change your device setting, (iii) upgrade to a different PAP device or (iv) to ensure a sleep issue is not missed following an initial negative study.
Below are some scenarios I frequently encounter in my practice that warrants a repeat sleep study:
Unable to tolerate CPAP following a home sleep test. Most patients do well on an Auto-CPAP device, but some may be misdiagnosed and require further evaluation in the sleep laboratory. In-lab studies monitor brain waves, eye movement, muscle movement, and breathing patterns, and a pulse oximeter may be used as an adjunct tool. A multiple sleep latency test may be used for conditions like narcolepsy, measuring how quickly you fall asleep. The choice between a sleep lab and home sleep apnea testing may vary depending on medical conditions, sleeping patterns, and recommendations from a sleep specialist or sleep medicine experts.
This is especially true if a mask change or device setting adjustment despite adequate use have not helped patient sleep through the night with CPAP.
Recurrence of symptoms that led to the initial sleep study such as snoring (even on CPAP), waking up tired, or sleepiness despite using CPAP are a few indications for a repeat study. Loud snoring is a key indicator of sleep apnea and should prompt further evaluation. Weight gain of more than 10% from initial weight when sleep tested may lead to recurrence of symptoms. Daytime sleepiness, daytime fatigue, and sleep apnea symptoms may indicate the need for repeat evaluation, especially if symptoms return after initial treatment.
Unresolved sleep symptoms despite adequate therapy with CPAP should prompt an in-laboratory sleep study. A home sleep study is a great tool if obstructive sleep apnea is suspected, however, it is not able to detect many other sleep-related issues that is best studied in a laboratory setting. Home sleep studies may miss other sleep disorders such as restless legs syndrome, periodic limb movement disorder, and neurological disorders, which may require in-lab testing. It is important to monitor sleep quality, sleep health, and closely monitor patients for changes in sleep data and apneic events.
Prior negative sleep study may have simply missed the sleep apnea diagnosis, referred to as a false negative study. A negative home sleep test with a high suspicion of a sleep disorder should prompt an in-laboratory sleep study or polysomnogram. The use of a diagnostic sleep study, diagnostic test, and apnea hypopnea index is important in confirming or ruling out sleep apnea.
In addition, a sleep study result that may not have prompted treatment in the past can progress to require treatment.
Cardio-pulmonary disease such as new or worsening heart failure and heart rhythm problems, or difficult to control lung disease may prompt your provider to repeat a sleep study. Untreated sleep apnea increases the risk of high blood pressure, heart attack, heart disease, and other health problems, and your healthcare provider or healthcare professionals may recommend repeat sleep testing in certain circumstances to manage these health issues.
Before repeating a sleep study, it is important to ensure:
- the CPAP settings are appropriate,
- adequate sleep time on CPAP (more than 7 hours),
- medications which cause sleepiness or sleeplessness are noted,
- use of drugs or increase in alcohol intake is explored.
Many factors, including weight change, weight loss, and significant changes in health or lifestyle, can necessitate reassessment of CPAP pressure, pressure settings, or switching to a different CPAP machine or oral appliances. Necessary adjustments to therapy, including PAP therapy, CPAP therapy, and positional therapy, may be required, and follow up testing is important to ensure effectiveness.
Please feel free to reach out to us for a second opinion or questions. Thank you and I hope you breathe well, sleep soundly. For ongoing management and to ensure your continuous positive airway pressure therapy is optimized, consult a sleep specialist or sleep medicine expert.
About the author – Dr. Avinesh Bhar, our online sleep medicine doctor
Dr. Bhar is fellowship-trained and board-certified in sleep, critical care and pulmonary medicine. He has been in practice for over eight years and established a telemedicine practice founded on personalized and convenient sleep and pulmonary care.
At Sliiip, we offer pulmonary and sleep telemedicine that allows you to receive video consultation, diagnosis, and follow up care – from the comfort of anywhere. Our physician, Dr. Bhar, believes that high-quality care only comes from a trustful physician-patient relationship.
To find out more about our services call 478-238-3552.
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