Sleep staging at home versus in the lab

Almost every sleep study we run happens at home. This is a considered choice, and there are cases where it is the wrong one.

The case for home

People sleep better in their own bed. In-laboratory polysomnography introduces a first-night effect that is well documented and often substantial: fragmented sleep, reduced REM, and an architecture that does not resemble a normal night. Recording two consecutive nights at home mitigates this and produces data that is more representative of how the person actually sleeps.

For moderate to severe obstructive sleep apnoea, home devices show good agreement with laboratory studies on apnoea-hypopnoea index. That covers most of what we are looking for.

Where it falls short

Sensitivity drops for mild disease, and home devices underestimate the index when total sleep time is inferred rather than measured by EEG. Periodic limb movement, parasomnia and suspected narcolepsy all need a laboratory. So does any study where the first attempt produced insufficient recording time.

How we decide

If the clinical question is snoring, witnessed apnoea or unrefreshing sleep with a plausible obstructive picture, we start at home. If the picture is atypical, or if the home study is negative and the symptoms persist, we refer to a laboratory. Roughly one study in eight ends up there.