COVID-19 has caused most sleep labs to close. The close proximity that is required to conduct an in-lab polysomnogram is completely antithetical to social distancing protocol. In all likelihood, many of these sleep lab facilities will not reopen for months, if ever again. If you're in dire need of a sleep study and can't wait, what are your options?
There are two scenarios worth exploring:
1. Diagnostic Sleep Studies
In the vast majority of cases, it is appropriate to substitute a home sleep study for an in-lab diagnostic polysomnogram. If you have moderate to severe pulmonary disease, neuromuscular disease or heart failure, home sleep apnea tests are not recommended by the American Academy of Sleep Medicine's guideline.
Other reasons to possibly not have a home sleep apnea test include being high risk for central sleep apnea (which is very rare overall) and severe insomnia.
If any of these absolute or relative contraindications applies to you, you might be able to find a company that offers full, attended sleep studies in your home, although these outfits are exceedingly rare these days.
2. PAP Titration Sleep Studies
If you've already been diagnosed with sleep apnea and are waiting to get in for a PAP titration study to find out what pressure to set a fixed-pressure CPAP machine to, auto-PAP machines may be a workaround. Auto-PAP machines gradually adjust the pressure based on your bodies needs and have found to be just as effective and somewhat more tolerable than fixed-pressure CPAP machines. Potential reasons to not use Auto-CPAP include a diagnosis of central sleep apnea or hypoventilation/hypoxemic disorders. There are more advanced machines like Auto-BPAP or Auto-ASV that could be used in these situations.
If you already have a fixed-pressure CPAP machine but the setting needs to be reevaluated due to weight loss, weight gain, or some other change, the "Kaiser Permanente" protocol can be used. Kaiser typically gives someone a home trial of an APAP for 8 nights and then a clinician reviews the data from the machine to find the best pressure and then sets your CPAP machine accordingly.
The bottom line is, it's a bad idea to wait to address sleep apnea and get on the proper therapy. There are effective sleep apnea solutions that don't involve setting foot in the sleep lab.
Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center. He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep medicine and neurology.