Usually, people know when they have problems getting enough sleep. But what if they are sleeping enough hours—but still feel tired in the morning? Sleep disorders, including obstructive sleep apnea (OSA), restless leg syndrome, circadian rhythm disorders and parasomnias can lead to feeling unrested the next morning—not to mention the disruption to bed partners’ sleep patterns. Home sleep testing (HST) may hold the answer, at least for obstructive sleep apnea and some types of insomnia.
An at-home sleep test is often prescribed when a patient is suspected to have sleep apnea. A physician orders the test, which is shipped to the patient’s home by a provider. It’s important for home medical equipment (HME) providers to note that if they provide the HST to Medicare patients, Medicare will not reimburse if they provide the same patient with a CPAP. (See the article “How the Medicare CPAP Payment Prohibition Affects Your Business” at this link for more information.)
A home test for sleep apnea should meet the American Academy of Sleep Medicine’s (AASM) SCOPER guidelines (or Sleep, Cardiovascular, Oximetry, Position, Effort and Respiratory), said Dr. Joseph Krainin, founder and president of Singular Sleep, a provider of home sleep tests. These devices measure airflow through a nasal cannula, respiratory effort via a respiratory inductance plethysmography or piezoelectric belt, and pulse oximetry, he said.
As many as 25 million Americans may have sleep apnea, according the AASM—and many are undiagnosed. However, Kevin Coldren, solutions leader for OSA Business at Philips, said the growing use of sleep trackers in wearable devices such as Apple Watches and Fitbits will likely lead to more people seeking diagnoses for their sleep problems.
Upon approval for a sleep study, many insurance companies are now tracking patients into HSTs. Krainin added that there may be an argument that specialists are getting a more accurate view of the patient’s typical sleep patterns and breathing when they do a sleep study at home than when they’re in a lab setting.
However, patients with lung disease, hypertension, heart disease or other chronic conditions will need to have a lab-based test, or polysomnography (PSG). And HSTs cannot diagnose more complex sleep disorders such as narcolepsy, parasomnias or nocturnal seizures. Home sleep tests also may not be sensitive enough to detect positional sleep apnea, which is relieved when the patient changes positions, said Coldren. The Philips home sleep test, the Alice NightOne, can.
Erasing Barriers to Entry
There is a lower cost of entry for a home sleep test, which, in addition to being more appealing to insurance companies, may also help patients and providers. Providers may see a higher flow of patients getting treatment for their sleep apnea, Coldren said.
“In my opinion, when you think about the financial burden of sleep apnea, more patients will seek treatment for their sleep apnea if they aren’t burdened by the cost of testing. When a patient has a large financial burden for the in-lab test, especially at the beginning of the year when deductibles have not been met, they may not fill their CPAP prescription,” said Coldren.
“Physicians are often pressed for time and hospital-based labs are backlogged so they don’t serve patients in a timely fashion,” said Chaz Hollins, vice president of neurology at Virtuox, a provider of home sleep tests and other sleep solutions.
Home sleep tests empower the patient to take ownership of their health, Hollins said.
“After testing, the goal is to keep patients in the home adhering to therapy to minimize visits to the emergency room associated with congestive heart failure and chronic obstructive pulmonary disease. Both of these conditions are correlated to sleep-disordered breathing,” he said.
Caring for Patients
Home sleep test patients may own their care, but they also have more needs when they arrive at their local HME dealer.
“An in-lab patient has a titration test in the lab to dial in on what they need and fit for a mask. An in-home patient, on the other hand, will not have had a titration test, may have more questions and may have never used a mask,” said Coldren.
Philips offers a mask selector to help patients, HMEs and sleep labs choose the best mask for their needs. The Philips DreamMapper allows patients to set goals and stay on track with their therapy.
Roughly 40 million Americans live with insomnia, making it the most prevalent sleep disorder. An HST for sleep apnea will not examine brain waves the way an in-lab PSG will. So Virtuox is working to tackle and diagnose insomnia in the home.
“Right now, if you went to a physician’s office with high blood pressure and headaches, the doctor would check your blood pressure and then try to lower it without medication,” said Hollins. “But for an insomnia patient, the physician will write out 30 days of a sleep prescription such as Lunesta or Ambien.”
Hollins added that a physician can’t really know if there is a better course of action to treat the insomnia.
Acute insomnia happens to everyone once in a while, Hollins said, especially during times of stress. The AASM guidelines say it occurs in 15% to 20% of people and can last for up to three months. Insomnia is chronic if it happens three times per week for three months or longer; around 10% of people have chronic insomnia, according to the AASM.
Virtuox offers an overnight electroencephalogram (EEG) for patients with suspected insomnia to test sleep patterns in their own home. The VirtuSOM management program can help patients reduce their use of medicinal sleep aids through a titration program.
“Our goal isn’t to take away the medication, but to provide the safest dosage,” said Hollins.
More Growth to Come
Research indicates that home sleep testing will only grow during the next few years. Global Market Insights, Inc. recently reported that the market for home sleep testing devices would reach $1.4 billion by 2025. HME providers caring for their tired sleep patients should remember that sleep is an opportunity for both reimbursement and cash sales. Resupply sales for CPAP machines are vital to keeping patients healthy, while supplements for sleep, such as the booming CBD oil market, can offer a healthy retail market path.