Sleep Health

  • Sleep Apnea, Sleep Study

    Rethinking What Counts as ‘Well-Treated’ Obstructive Sleep Apnea

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    A patient advocate realizes that perfect can become the enemy of good care for OSA patients who fail or refuse CPAP.

    By Emma Cooksey | Original Post SLEEP REVIEW

    Years ago, I got into a heated exchange with an Italian dentist on social media. I cringe when I reflect on it now. 

    The dentist shared that he had a patient with severe obstructive sleep apnea (OSA) who was unable to use his CPAP machine. Fitting a custom oral appliance, the dentist reduced the man’s apnea-hypopnea index (AHI) from the 70s to only nine events per hour. Instead of applauding a good outcome and the improved quality of life the patient was experiencing, I complained, “Obstructive sleep apnea isn’t properly treated until the AHI is under five events per hour.” 

    The exasperated dentist calmly pointed out that the patient had abandoned his CPAP therapy and had left his OSA entirely untreated before he got his oral appliance.

    “Isn’t an AHI of nine with an oral appliance better than an AHI in the 70s with no treatment?” he asked.

    Physicians Consulting

    Since this exchange, I have been ruminating on this question. In that time, I have recorded more than 140 episodes of my podcast, “Sleep Apnea Stories,” interviewing people living with sleep apnea about their treatment choices as well as experts from different specialties. I have learned so much about the broad spectrum of experiences in our sleep apnea community and the reasoning behind individual treatment choices. 

    I can understand the frustration of board-certified sleep specialists who prescribe CPAP therapy to their patients, only to see it abandoned. I am a huge advocate of more support and resources for new CPAP users struggling to adapt to their therapy. Early intervention with practical troubleshooting and empathy can be all that’s needed to take someone from giving up on their therapy to successful adherence. This could be a group CPAP therapy clinic for new users to get support in person, or an online coaching model similar to what companies like Lofta and BetterNight provide.

    The very best sleep clinics offering superb support to new CPAP users still have a significant number of people who either never start CPAP therapy or abandon it over time. For those people who are leaving their OSA entirely untreated, we need a new attitude of pragmatism. Arguing that CPAP therapy offers the best results in people who use it isn’t helping the group who won’t or can’t use their machine.

    The great news for patients is that the range of viable treatment options for OSA is expanding. The GLP-1 tirzepatide is already available as Zepbound, an injectable medication for people with both OSA and obesity. The oral pill version orforglipron has recently reported positive phase 3 trial results. Also in the “coming soon” category is Apnimed’s AD109, a once nightly oral pill that works to maintain upper airway muscle tone during sleep. The successful phase 3 trials for AD109 open up a whole new frontier of using pharmacotherapy to target the cause of OSA. 

    The dental sleep medicine community, not to be outdone, has been working hard on appliances with integrated SpO2 sensors. These oral appliances will enable the sharing of data, including wear time, oxygen desaturation index, pulse rate, and more, not only with patients but also directly with doctors. 

    Ear, nose, and throat surgeons have more techniques at their disposal than ever too. Top surgeons continue to refine throat surgeries to include new techniques like transoral robotic surgery. Hypoglossal nerve stimulation implants are evolving with the new Inspire V system with quicker surgery time and a Bluetooth patient remote. Nxyoah’s Genio neurostimulator just earned FDA clearance.

    With so many treatment options currently available, and on the horizon, it is time we adopt a more pragmatic approach to considering a person’s OSA “well-treated.” Offering a treatment other than CPAP to lessen the severity of the OSA is far better for quality of life and health outcomes than no treatment at all.

    As a patient advocate, I feel strongly that every person with an OSA diagnosis should be educated on and offered all the treatment options that could be useful to them.

    I have, in short, changed my tune and now agree with the Italian dentist I argued with. I wish I could remember his name so I could apologize directly. Reducing the severity of obstructive sleep apnea and improving the quality of life for each individual is a worthy goal, even without hitting fewer than five events per hour.

  • Sleep, Sleep Health

    Why sleep soothes distress: Neurobiology explained

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    Original Post | Caroline Pierce, Medical Express

    A study published in Nature Reviews Neuroscience by an international team including the Woolcock’s Dr. Rick Wassing examined research into sleep disorders over more than two decades to prove a good night’s sleep is the perfect remedy for emotional distress.

    Nothing we haven’t known forever, some would argue, but Dr. Wassing who has spent the past two years on the project says there’s much more to it than that.

    “What we have done with this study is explain why. We looked at studies in neurobiology, neurochemistry and clinical psychology to get a real understanding of the mechanisms underlying how sleep helps us to deal with our emotional memories.”

    What the team of researchers believe after aggregating more than 20 years’ of scientific knowledge is that the way certain neurochemicals (for example, serotonin and noradrenaline) are regulated during sleep is crucial for the processing of emotional memories and our long-term mental health.

    Chemistry and circuitry

    Serotonin is involved in many, if not almost all, aspects of learning emotional experiences. It helps us assess and understand the world around us. Noradrenaline is all about “fight or flight”—it allows us to assess and respond to danger. Both are turned off during rapid eye movement (REM) sleep and that creates this “really beautiful opportunity for the brain to engage in processes that are otherwise not doable when we are awake,” explains Dr. Wassing.

    There are two main ways we process emotional memory during sleep, he says, and they involve the brain’s hippocampus and amygdala.

    Our brains store what we learn each day. This learning is governed by the hippocampus aggregating and cataloging this new information into the “novelty” memory store as we process it. At the same time, if that new experience is emotional, the amygdala is very active and coupled with the autonomic nervous system—think racing heart, knots in your stomach, skin crawling.

    During REM sleep, our brains reactivate these new memories. It is as if the brain replays a summary of what had happened when we experienced the memory. But during REM sleep, when the noradrenergic and serotonergic systems are turned off, these memories can be moved into the “familiar” storage without experiencing the physical “fight or flight” response. That can’t happen while we’re awake or—as is the case for people with sleep disorders—when we don’t get consistent blocks of REM sleep.

    Shining a light on the brain

    Much of what we now know about the way information is processed by the brain comes from the relatively new field of optogenetics which is used to activate or inhibit very specific cell types in a neuronal network. This has allowed researchers to see what cell types and brain regions are involved in encoding emotional memories.

    According to Dr. Wassing, it has meant real breakthroughs in terms of our understanding of brain circuitry and neurobiology.

    It’s all well and good, he says, to look at neurons and receptors and circuits, but the researchers also assessed clinical psychology studies and found that their findings, especially relating to disconnecting amygdala reactivity and shutting down the autonomic nervous system, were corroborated.

    “All three levels of neuroscience align to produce the same conclusion, that the way the brain functions during REM sleep is important for processing emotional memories.”

    Making ‘good sleepers’

    So, where to now? “We know that with insomnia or other sleep disorders where people wake up from sleep a lot, we see an increased risk of developing mental health problems. Our hypothesis would be that that these awakenings from sleep lead to the fact that the noradrenergic system is not shut down for long periods of time (in fact, they might actually show enhanced activity) and that’s why these people might not be able to regulate emotional memories.”

    “The solution is to try to get a good night’s sleep, yes, but the problem is how then do we do that? We know that two out of three people with insomnia benefit from cognitive behavioral therapy for insomnia (CBTI) but that is mostly based on subjective ratings. There’s less evidence on objective sleep measures. The insomnia patient after CBTI is not necessarily a good sleeping individual, they still have some sleep disturbances but CBTI is enabling them to better deal with them.”

    “We need to critically think more about the mechanisms that regulate sleep. It’s very hard to target one system because sleep is very dynamic—the noradrenergic system shuts down during REM sleep, but it actually needs to be active during non-REM sleep so you can’t just turn it off for the entire sleep cycle.”

    “We need really creative ideas about how to design an intervention or a drug that can target these dynamics that happen during sleep and enable those systems to renormalize. We need to be targeting objective sleep and making people with insomnia good sleepers again.”

  • Sleep Apnea, Sleep Health, Sleep Study

    Recent studies show how a migraine can be predicted.

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    Sleep quality and energy levels are two of the biggest indicators of an impending migraine attack, the study showed. Get inspired by a weekly roundup on living well, made simple.  

    Wouldn’t it be helpful to have a sense of when a debilitating migraine may be on the way?

    You may be able to do so, a new study has shown.

    Migraine

    “The major finding from this study was that changes in sleep quality and energy on the prior day were related to incident headache in the next day,” said Dr. Kathleen Merikangas, principal investigator of the study that published Wednesday in the journal Neurology.

    Migraines are nothing to shake your head at, and they certainly aren’t just nuisance headaches. Chronic migraines are the leading cause of disability in people younger than 50, according to a February 2018 study.

    More symptoms than you think may be tied to your migraines

    The study team found that sleep quality and energy were important indicators of a migraine attack on the following day.

    Those who had bad sleep quality and low energy one day were more likely to have migraines the next morning, the data showed. An increase in energy and greater-than-average stress usually foretold a migraine would appear later the next day.

    “It’s a very exciting study because of how well done and how detailed and how large it is,” said Dr. Stewart Tepper, vice president of the New England Institute for Neurology and Headache in Stamford, Connecticut. Tepper was not involved in the research.

    The differences point to the importance of your circadian rhythm — which regulates your cycles of sleep and wakefulness — in how headaches manifest. The findings may inform the treatment and prevention of migraine attacks.

    Migraine prevention

    Knowing when a migraine is coming can make all the difference — especially with growing interest in treating one before it starts, Tepper said.

    “If we can identify things in the environment that people can change, then we’d like to be able to prevent the attack in the first place,” Merikangas said. “If we can do that with behavioral interventions … then they may be able to prevent it by either going to sleep to offset it or some other intervention that would prevent us from having to use medication to prevent the attack.”

    Tepper, however, said he is not so sure if changes in behavior can always prevent a migraine attack.

    FDA approves new nasal spray to treat migraine headaches in adults, Pfizer says

    A migraine attack isn’t just a headache. And warning signs such as fatigue, neck pain and sleep disturbance may be early symptoms of an attack — not only a trigger of one, he added.

    Instead, Tepper advises intervening with medication before the head pain starts in hopes of warding off any pain at all.

    How much is too much?

    It makes sense that people might be conservative about using medication for migraine pain, Tepper said.

    An older class of medications, called triptans, was associated with more migraines and a resulting chronic migraine condition if used more than 10 days in a month, he said.

    But a newer option, rimegepant — sold as Nurtec — doesn’t seem to carry the same risk.

    “There’s no downside because rimegepant has almost no side effects and is not associated with transformation into chronic migraine,” Tepper said.

    What you can do about migraines

    Your doctor can recommend pain medication to address your migraines, but it also helps to know the signs of an upcoming attack, Tepper said.

    As well as monitoring sleep, exercise and diet, Merikangas suggests finding a way to monitor stress to be able to track the indicators of a migraine.

    There are five typical signs of an oncoming migraine headache, Tepper said. Those are sensitivity to light, fatigue, neck pain, and sensitivity to noise and dizziness, he said.

    5 ways to reduce your stress this year

    Cognitive behavioral therapy is often useful to help manage the stress that can trigger migraine attacks. What’s more, taking vitamins and supplements, such as magnesium and riboflavin, can be effective in reducing migraine frequency, Kylie Petrarca, a nurse and education program director at the Association of Migraine Disorders, said in a previous CNN article.

    It isn’t just about avoiding the pain, Merikangas said.

    “It’s really important to think of the full context of our health,” she said. “By being able to characterize not just headaches, but also all these other systems, we might be able then to get a handle on causes of negative health events.”

  • Sleep Apnea, Sleep Health

    Why people should prioritize sleep quality over quantity.

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    By Analisa Novak – February 19, 2024 / 11:59 AM EST / CBS News

    When it comes to maintaining heart health, it’s not just how long you sleep — it’s how well you sleep that matters equally, if not more, said Dr. Shelby Harris, a behavioral sleep psychologist and clinical associate professor at Albert Einstein College of Medicine.

    “Poor quality sleep really can influence our heart health as well,” Harris told “CBS Mornings” in an interview during American Heart Month. 

    Harris said the body’s balance of ghrelin and leptin, hormones that regulate hunger, is also disrupted by poor sleep, leading to increased consumption of high-sugar and high-fat foods. 

    Sleep disorders like sleep apnea and insomnia are closely linked to heart health. Sleep apnea, characterized by snoring and breathing pauses, affects both men and women, though women are evaluated less frequently for it. 

    Strategies for improving sleep quality include limiting alcohol and caffeine intake, reducing screen time before bed and managing how much liquid you drink before bed. 

    “Once you have better quality then we try to work on the quantity of sleep possible,” Harris said.

    For those struggling to achieve a longer sleep duration, getting a good quality amount of sleep but shorter is ideal when you first are trying to tackle this goal. 

    “For some people, I might have them go to bed later and then I might slowly have them go to bed earlier over time as opposed to that shifting back and forth. Because that can create a lot of problems for people as well,” she said. 

    Harris said that sleeping pills and aids are not ideal for most people, but said cognitive-behavioral therapy for insomnia may offer an alternative solution to medication. 

    She said most people try four to eight sessions of the therapy and if that doesn’t work, then she would recommend sleeping aids. 

    “You work on not just the hygiene but you work on the timing of sleep. … We work on thoughts about sleep, a lot of people put pressure on themselves to sleep and they worry about what’s going to happen if they don’t sleep and so we work on that aspect,” she said. 

    Harris said dietary choices also play a role in a good night’s sleep. She said people should avoid consuming large or heavy meals, such as a big dinner, before going to bed.

    Instead, opting for a small, light snack that includes a mix of protein and carbohydrates can be beneficial. “That’s a really good mix to help you throughout the night so you don’t wake up hungry, which a lot of people do as well,” said Harris.

  • Sleep Apnea, Sleep Apnea Dentist, Sleep Health

    Five Weird Signs of Sleep Apnea

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    Original Article | By Sandee Lamotte CNN

    Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.CNN — 

    If you snore the house down, you may be suffering from obstructive sleep apnea, or OSA — a potentially dangerous condition in which people stop breathing for 10 seconds or more at a time.

    The condition has been linked to smaller brain volume, damage to the white matter communication pathway in the brain and even a three times higher risk of dying from any cause. If left untreated, obstructive sleep apnea puts you at higher risk for hypertension, heart disease, type 2 diabetes, depression and even an early death, according to the American Academy of Sleep Medicine.

    Yet even if you’re a rock star at snoring, you may not know you have obstructive sleep apnea unless someone tells you about your nocturnal roars. That’s why it’s important for partners and friends to speak up and encourage snorers to get professional help.

    But what if you have an odd or quirky symptom besides snoring? You and your loved ones may have no idea that you are in danger, and the condition could go undiagnosed for years.

    “Greater than 30 million people have sleep apnea in the United States, yet it’s often underdiagnosed or misdiagnosed,” said sleep specialist and pulmonologist Dr. Raj Dasgupta, an associate professor of clinical medicine at the University of Southern California’s Keck School of Medicine.

    “It’s really misdiagnosed in women versus men because women may not present with the classic, heroic snoring that men often show,” he said.

    Here are five weird signs of obstructive sleep apnea to watch for, according to Dasgupta.

    Headache as a result of sleep apnea

    Night sweats

    There are many reasons people may sweat at night. It could be too hot, especially with the persistent heat waves in the past few years due to the climate crisis. Certain medications can cause night sweats, as can cancer, thyroid issues, the flu and bacterial infections, and the onset of menopausal symptoms, according to the Mayo Clinic.

    But research has shown that about 30% of people with obstructive sleep apnea have reported night sweats, Dasgupta said.

    “It’s because your body isn’t getting enough oxygen you fall into this sympathetic fight-or-flight mode, which triggers night sweats,” he said. “The research showed people with OSA that had night sweats were also more likely to have really low oxygen levels on top of having obstructive sleep apnea.”

    Sleep apnea can cause you to wake up tired, have difficulty regulating emotions and suffer from brain fog, experts say.

    Frequent awakenings

    Many people get up at night to empty their bladders — it can be caused by alcohol overindulgence, diabetes, edema, high blood pressure, certain medications, pregnancy, prostate issues and even drinking too many fluids before bed, according to the Cleveland Clinic.

    But getting up at least two times a night to urinate — which is called nocturia — can also be a sign of obstructive sleep apnea, Dasgupta said.

    “One study found about 50% of patients with OSA had nocturia, and they noted that treatment for the sleep disorder did cut back on awakenings,” he said.

    Nevertheless, frequent nighttime urination is not commonly asked about in screening questionnaires on sleep apnea in primary provider offices, Dasgupta said.

    Teeth grinding

    Grinding or clenching teeth while sleeping is called bruxism, and it too may be a sign of obstructive sleep apnea, Dasgupta said.

    “Certainly, anxiety and other factors can cause bruxism, but a common cause is obstructive sleep apnea,” he said. “There’s a theory on why — the airway becomes obstructed, so the muscles in the mouth and jaw move to try to free the blocked airway. That’s not been proven, but it is an interesting hypothesis.”

    Most people who grind or clench their teeth use a mouthguard suggested by their dentist for protection, but it won’t protect the jaw, Dasgupta said.

    “So, a person might also develop TMJ (dysfunction), which is pain in the temporomandibular joint, and that may also lead to other issues, such as headaches,” he said.

    Morning headaches

    Studies have found a link between having obstructive sleep apnea and waking up with a headache, Dasgupta said.

    “They typically occur daily or most days of the week and may last for several hours after awakening in the morning,” he said. “The cause of the headaches is not well-established and may be multifactorial.”

    Headaches caused by obstructive sleep apnea don’t appear to lead to nausea or increased sensitivity to light and sound. Instead, they seem to be a pressing sensation on both sides of the forehead that lasts about 30 minutes, according to a June 2015 study.

    Depression, fatigue and insomnia

    Some symptoms of obstructive sleep apnea can disguise themselves as issues of mental health, brain fog or other sleep problems, Dasgupta said.

    “Sleep affects our ability to think, react, remember and solve problems,” he said. “Women especially have a tendency to underreport atypical symptoms such as insomnia, fatigue and depression.”

    If obstructive sleep apnea awakens you, it may be hard to go back to sleep. A person may suspect insomnia, not realizing that a different issue may be triggering the awakenings.

    Symptoms of daytime fatigue include a lack of motivation to accomplish everyday tasks, a lack of productivity at work, memory problems and a low interest in being social, Dasgupta said. Those are also signs of depression, so if the sleep issues aren’t brought up at a health visit, the underlying cause may be missed.

  • Uncategorized

    Dangers of Uncontrolled Sleep Apnea

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    Original Article | JohnsHopkins.org

    You’ve probably heard that regular exercise and a heart-healthy diet are the most important things you can do for your cardiovascular health. As it turns out, though, the quality of sleep you receive is also critical to your heart’s wellbeing. 

    In particular, undiagnosed sleep apnea is directly tied to an increased risk in cardiovascular and metabolic health. The scariest part? You might not even know you have this very common problem.

    “Sleep apnea happens when upper airway muscles relax during sleep and pinch off the airway, which prevents you from getting enough air. Your breathing may pause for 10 seconds or more at a time, until your reflexes kick in and you start breathing again,” explains Jonathan Jun, M.D. , a pulmonary and sleep medicine specialist at the Johns Hopkins Sleep Disorders Center.

    Sleep apnea occurs in about 3 percent of normal weight individuals but affects over 20 percent of obese people, Jun says. In general, sleep apnea affects men more than women. However, sleep apnea rates increase sharply in women after menopause. Sleep apnea is often linked to heart disease and metabolic issues like diabetes.

    What are the signs of sleep apnea?

    There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when air can’t flow into or out of the nose or mouth, although you’re trying to breathe. Central sleep apnea happens when the brain fails to send the right signals to your muscles to make you start breathing. (This type is less common.)

    “Sleep apnea may be noticed more by the bed partner than by the sleeper,” says Jun. “Your bed partner might notice that your breathing pauses, or they may complain of your loud snoring.”

    That said, snoring itself—though annoying—isn’t the same as sleep apnea. Snoring is just the vibration sound created by airway resistance. You can snore loudly and not have sleep apnea, and you may even have sleep apnea without much snoring.

    People with sleep apnea might also suffer from unexplained fatigue and mood swings, because their breathing interruptions continually wake them and prevent them from settling into a deep, nourishing sleep.

    The consequences can be significant, Jun says. “We’re talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.”

    Other sufferers might wake up with a dry mouth, since sleep apnea tends to make you breathe with an open mouth, drying out your saliva. Some awaken with a headache, which may be caused by low oxygen or high carbon dioxide levels during sleep.

    How is Weight Control Linked to Sleep Apnea?

    “Weight control is very important. There are many studies showing that losing weight can either completely cure you of sleep apnea or at least make it less severe,” Jun says.


    Sleep apnea, cardiovascular risk and metabolism

    Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. “In most cases, obesity is the main culprit behind both conditions,” Jun explains.

    Still, it’s important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. “Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels,” says Jun.

    For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.

    Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally “male” areas like the tummy, and this leads to a greater chance of sleep apnea.

    “After menopause, hormones change and women tend to start looking like men in terms of where the weight gets put on. It’s a time to be paying attention to the risks of sleep apnea because women begin to catch up to men in the rates of apnea after menopause,” Jun says.15

    Diagnosing and treating sleep apnea for better health

    It’s important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apnea—such as with Judge Antonin Scalia —Jun says that the true risk is from damage done over time.

    Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index (AHI). The AHI measures the number of breathing pauses that you experience per hour that you sleep.

    Obstructive sleep apnea is classified by severity:

    • Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)
    • Moderate obstructive sleep apnea means that your AHI is between 15 and 30
    • Mild obstructive sleep apnea means that your AHI is between 5 and 15

    Whether or not you need treatment for sleep apnea depends on its severity, whether or not you have symptoms such as sleepiness and other health conditions. For example, if you have risk factors for heart disease, your doctor might opt to treat you even for mild sleep apnea. On the other hand, if you have a severe case of sleep apnea, your doctor might insist on treatment even if you’re not sleepy.

    The main choice of therapy is a breathing device called a CPAP, or continuous positive airway pressure machine. A CPAP machine pipes humidified air through the nose, which creates air pressure to keep your throat open while asleep. This prevents pauses in breathing.

    “CPAP is the first-line treatment, and it’s very effective,” Jun says. A recent Johns Hopkins study looked at what happens to metabolism at night when sleep apnea patients don’t wear their CPAP. The study found that the resulting apnea caused a spike in blood sugar, heart rate, blood pressure and stress hormones—a response similar to what might happen if you were asked to get up in front of a crowd to speak. “It’s very similar to that type of a stress response,” says Jun. “I would liken sleep apnea to something like that happening on a nightly basis.”

    CPAP is not the only alternative.

    Many cannot tolerate the CPAP machine and are able to obtain the help they need from a Sleep Apnea Dental Specialist. Their use of an oral appliance has helped hundreds of thousands resolve their medical issues as they pertain to Sleep Apnea.

    Get the Medical Equipment You Need at Home

    Many studies show that regular use of CPAP or oral devices reduces blood pressure and improves wakefulness during the day. People with sleep apnea who use sleep apnea therapeutic devices also report improved quality of life. In some observational studies that compare people with apnea who seek sleep apnea remedies versus those who don’t, those seeking treatment have lower risk of stroke and heart attack and lower blood glucose, Jun notes.

    If you or your partner has noticed signs of sleep apnea, visit your doctor. A sleep specialist can order a sleep apnea test, which uses equipment to monitor your breathing and oxygen levels while you sleep. Often, you’ll visit a laboratory to spend the night for monitoring. Other times, it’s possible to use a portable, take-home kit. You’ll rest easier knowing the results.