Current economic conditions in the U.S. are forcing many consumers to cut back on health-care expenses. Yet sleep experts advise that the cost of a sleep study is a sound investment for millions of people who suffer from a sleep disorder.
The Centers for Disease Control and Prevention reports that about 15 million adults in the U.S. did not receive needed medical care in 2005 because they could not afford it. In July the National Association of Insurance Commissioners conducted a national survey. Results show that 22 percent of people have reduced the number of times they visit the doctor because of current economic conditions.
In such a challenging economy, should your sleep needs be a priority? Absolutely, said American Academy of Sleep Medicine President Dr. Mary Susan Esther.
“Sleep is one of the cornerstones of good health,” she said. “It affects everything from your weight and blood pressure to your energy and mood. If you have been struggling with an ongoing sleep problem, then a sleep study may be just what you need. It could be the key that unlocks the door to a dramatic improvement in your health and a better quality of life for you.”
The Need
The National Center on Sleep Disorders Research estimates that 50 million to 70 million Americans suffer from sleep problems. These problems affect men and women, children and the elderly, and people of all ethnicities.
Yet the majority of people with a sleep disorder remain undiagnosed and untreated. Often people who have a sleep disorder fail to recognize that something is wrong.
“People are notorious for underestimating how sleepy they are,” said AASM spokesperson Dr. David Kuhlmann. “People assume that their disrupted sleep and level of sleepiness when awake is normal for their age.”
Symptoms of some sleep disorders also can go unnoticed. For example loud snoring and gasping for breath during sleep are two warning signs for sleep apnea. But you may be unaware of these symptoms if you live or sleep alone.
As a result, millions of people go through each day wondering why they can’t stay awake. Others go to bed each night wondering why they can’t sleep. The answers to these questions often can be found by a sleep study.
The Benefits
Research shows that there are numerous benefits to detecting a sleep disorder with a sleep study. The study pinpoints the nature and cause of your sleep problem. This provides the foundation for an effective treatment plan.
Treating a sleep disorder promotes health and well-being. In the long run it also can save you money. These are some of the benefits of detecting and treating a sleep disorder:
Research has linked sleep disorders to many other health problems. These include heart disease, high blood pressure, stroke, diabetes and obesity. A study in the August 1 issue of the journal Sleep even shows that people with severe, untreated sleep apnea have five times the risk of dying from a heart problem. Effective treatment of a sleep disorder can reduce the risk and severity of other related health problems.
Studies have linked undetected and untreated sleep disorders to an increase in health-care utilization and spending. You are likely to make more visits to the doctor’s office each year. You also are likely to spend more money on your health care. Expenses may include testing, medications and hospitalization. Research shows that effective treatment of a sleep disorder can reduce your health-care spending. Compared to the high cost of remaining untreated, treating most sleep disorders is relatively inexpensive.
Studies have linked sleep disorders to lower productivity and more absences at work. A severe sleep disorder even may prevent you from being able to stay employed. Effective treatment of a sleep disorder can enable you to improve your job performance.
Research has linked sleep disorders to an increased risk of work-related injuries and motor-vehicle accidents. Effective treatment of a sleep disorder promotes your safety at work and on the road.
Sleep disorders can take a severe toll on your personal well-being. Effective treatment of a sleep disorder can lead to improvements in your mood, attitude, energy, memory and overall outlook on life. An untreated sleep disorder also can put a strain on your relationships. It may disturb the sleep of your spouse, bedpartner or other loved ones. Treatment can contribute to a more harmonious household.
The Study
A sleep study requires you to spend the night in a bedroom at a sleep disorders center. Many of these centers are located at a hospital or university. Others are “freestanding,” private practices.
A sleep study gathers the information that will help your doctor solve the riddle of your sleep problem. During the night sensors and electrodes record enough data to fill a textbook. Recorded signals include brain waves; heart activity; oxygen levels; breathing effort; airflow; and eye, chin, arm and leg movements.
A small microphone picks up your snoring or any other sounds you make. A video camera records your sleep to document any unusual behavior.
During the night a technician monitors the equipment to ensure that it functions properly. After the study all of the data is analyzed. According to AASM spokesperson Dr. Ron Kramer, the results of your study should be reviewed by a doctor who is board certified in sleep medicine.
“Patients will get the best care when their sleep study is overseen and interpreted by a board-certified sleep specialist,” he said.
The Coverage
Insurance coverage for sleep studies has expanded since Blue Shield of California began reimbursing patients for sleep services in 1975. Today most health insurance plans include coverage for sleep-medicine services.
“Health insurances generally pay for sleep studies in their entirety,” said Kuhlmann. He is the medical director of sleep medicine at Bothwell Regional Health Center in Sedalia, Mo.
Some insurance providers require that a sleep study be performed at an AASM-accredited sleep center. AASM accreditation ensures that a sleep-medicine provider meets the highest standards of quality patient care.
An alternative to the overnight sleep study is home sleep testing. It was endorsed by the AASM in December 2007. It also was approved by the Centers for Medicare and Medicaid Services last March.
As a result of these decisions many insurance providers have begun to cover home sleep tests. Coverage restrictions may vary by region of the country.
The advantages of a home sleep test are its convenience and its lower cost. But these “limited-channel” devices have a more limited usefulness. They record just a few signals and are only able to detect obstructive sleep apnea.
“Portable monitoring should not be performed when patients have significant medical comorbidities or when sleeping disorders other than obstructive sleep apnea are suspected,” said Kuhlmann.
The Discussion
Not everyone with a sleep problem needs a sleep study. For example, a doctor usually can determine the cause of insomnia without needing data from a sleep study.
Your doctor can decide if a sleep study is right for you. But your doctor is unlikely to refer you for a sleep study unless you first make him or her aware of your sleep problem. You should discuss your sleep the next time you visit your doctor.
Even patients with mild obstructive sleep apnea (OSA) experience symptoms that increase their risk of cardiovascular disease, according to a study in the journal American Journal of Respiratory and Critical Care Medicine. Researchers at the Oxford Center for Respiratory Medicine examined 64 patients with minimally symptomatic OSA and 15 control subjects without OSA. They found that patients with mild OSA experienced increased stiffness of the arteries and impaired vascular function, putting them at increased risk of cardiovascular disease. "It was previously known that people with OSA severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people, some of whom may be completely unaware that they even have OSA, are at risk than previously thought," the study's author, Dr. Malcolm Kohler, said in a press release from the American Thoracic Society. If you suspect you may have sleep apnea, see your doctor or call your medical insurance provider to find out if a referral is needed for a visit to a sleep center. 
According to a study in the journal Sleep, heavy snoring could significantly increase the risk of carotid atherosclerosis, or plaque buildup within the main arteries of the neck, which can lead to stroke. Researchers examined 110 volunteers, who were categorized into three different groups of snorers: mild, moderate and heavy. Using polysomnography and other tests to measure snoring and plaque buildup, they found that the prevalence of carotid atherosclerosis was 20 percent with mild snoring, 32 percent with moderate snoring and 64 percent with heavy snoring. The risk of buildup was found to be independent of other risk factors, such as the severity of obstructive sleep apnea.