Raymond Miles has obstructive sleep apnea, a breathing disorder in which the airway closes repeatedly during sleep and cuts off oxygen to his lungs. He wakes up briefly (though he doesn't become conscious), sometimes many times an hour. The condition is no minor matter: It ups the risk of automobile accidents, heart disease, and stroke—not to mention the level of lethargy and sleepiness. After seeing numerous doctors and being tested several times, the 57-year-old from Oakland, Calif., is still gasping himself awake dozens of times each night. Meanwhile, Miles's wife, who also has sleep apnea, has been sleeping like a baby for the past three years.
The difference: While both were tested thoroughly in an overnight sleep lab and prescribed a continuous positive airway pressure, or CPAP, machine, a masklike device that blows air down the windpipe at a preset pressure, she got ongoing guidance from her doctor while he did not. In fact, when the machine stopped working properly for him after a year, he didn't even get a return phone call. The restless nights came back.
"That's not uncommon," says Barbara Phillips, a sleep physician and member of the National Sleep Foundation's board of directors. She explains that a recent government decision to start reimbursing Medicare beneficiaries for CPAP treatments when sleep apnea is detected through new and more convenient home tests, rather than in a professional sleep study, means that many more Americans will soon be winding up with prescriptions. Though Phillips isn't against the change, she worries that the decision may exacerbate the follow-up problem.
Proponents are pleased that many more people will now have access to sleep apnea screening, since the home-based tests are generally cheaper, more comfortable, and much, much more convenient. "This is a huge gain for patients," says William Abraham, director of cardiovascular medicine at the Ohio State University Medical Center, noting that at this point only about 5 percent of people who actually have the condition are getting tested now. New screening tests, such as this one from Astro-Med, are rolling out by the day.
Some physicians—including many from the American Academy of Sleep Medicine—think the pared-down tests might not give enough information, and they raise concerns about who will be interpreting the results. Overnight sleep tests in a lab, or polysomnography, generally collect 12 "channels" of information, including blood oxygen levels, nasal and oral airflow, and electrical information. A home test need only include three such channels of information. You might wear monitors while you sleep that measure airflow and breathing patterns, for example, and a gadget on your fingertip that indicates the level of oxygen in your blood. And sleep specialists have experience finding the meaning in sleep study data. Now, people who test at home might well take the results to their own physician.
If Miles's case is any guide, the success of treatment—however diagnosis is made—depends on that physician expertise. "The most important thing to do," advises Phillips, "is find a clinician who will follow you until they get the treatment right."