Evaluation for conditions that disrupt sleep quality. Diagnosis is clarified through history, sleep questionnaires, and polysomnography (sleep study) when needed.
Indication
- Loud snoring, breathing pauses (apnea) at night, and waking with a sense of choking
- Excessive daytime sleepiness with risk of traffic or work accidents
- Difficulty falling or staying asleep (insomnia)
- Restless sensation in the legs and periodic limb movements during sleep
- Suspected narcolepsy (sudden sleep attacks, loss of muscle tone)
- Morning headaches, uncontrolled hypertension, treatment-resistant cardiac arrhythmia
- REM sleep behavior disorder (shouting, kicking, or arm movements during sleep)
Preparation
- Keep a 1-2 week sleep diary (bedtimes, wake times, number of awakenings, daytime naps)
- Share information about coexisting conditions, medications, and caffeine/alcohol use
- Bring comfortable pajamas, bath supplies, and necessary medications when coming for the sleep test
- Avoid caffeine, alcohol, and daytime naps on the evening of the test
- Hair should be clean and free of gel/spray (so that electrodes adhere)
How it's performed
- The physician completes the sleep history and standard scales such as Epworth and STOP-Bang
- Coexisting conditions (cardiac, pulmonary, thyroid, depression) and medication use are reviewed
- If indicated, in-hospital or home polysomnography (sleep study) is planned
- Polysomnography records sleep stages, respiration, oxygen, heart rhythm, and leg movements
- Sleep apnea severity is determined using the apnea-hypopnea index (AHI); AHI 5-14 is mild, 15-29 moderate, and at least 30 severe
- Based on the results, weight loss, position therapy, an oral appliance, CPAP, or advanced treatment is planned
Post-procedure
- Result evaluation and treatment planning within 1-2 weeks after the test
- In patients started on CPAP, monitoring of adherence, mask fit, and pressure settings during the first month
- Follow-up of weight loss, alcohol/smoking reduction, and sleep hygiene recommendations
- Annual follow-up and review of device reports (adherence, AHI) when needed
- Further evaluation if sleepiness or cardiac/blood pressure problems do not improve with treatment
Risks
- Mild skin irritation related to electrodes during the sleep test
- Sleep that differs from normal due to the first-night effect, with possible need to repeat the test
- Difficulty adapting to CPAP, nasal congestion, dry mouth (usually resolved by adjustment)
- Increased risk of cardiac, vascular, and traffic accidents from uncontrolled sleep apnea if undiagnosed
- Delay in diagnosis and treatment if the polysomnography appointment is postponed
FAQ
Is a home sleep test sufficient?
In suspected uncomplicated sleep apnea, home testing is often sufficient. If there are coexisting conditions or suspicion of a different sleep disorder, full polysomnography in a hospital setting is preferred.
Is CPAP used for life?
Most patients require long-term use; however, in cases of significant weight loss or surgery, the need may decrease. Response is assessed with follow-up tests.
I only snore — do I have to take a sleep test?
Testing is recommended if there are witnessed breathing pauses, excessive daytime sleepiness, treatment-resistant hypertension, or cardiac arrhythmia. For mild snoring alone, lifestyle changes and follow-up may be sufficient.
Wouldn't sleeping pills be enough?
Sleeping pills do not treat underlying causes such as apnea or restless legs and may worsen symptoms. Diagnosis must come first, followed by targeted treatment.
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