| I’ve been feeling extra tired lately. So a few weeks ago, my doctor sent me to a lab to have some tests done to see if there are new issues with my sleep apnea, which I’ve had for many years. The lab always reminds me of a set from a dystopian video game. A technician uses sticky paste to attach what seems like a billion electrodes (OK, really 20-25) to my head and torso. Over the next 20 hours, the machines measured my heart rate, breathing and sleep stages, while a camera recorded how often I tossed and turned. A week later, a close friend also had a sleep test. This one involved shipping an oversized thumb ring to my friend’s house. The ring was connected wirelessly to a phone app and worn on the thumb for two nights while sleeping at home. Then my friend mailed it back. I felt hoodwinked — why was I stuck in Frankenstein’s lab when a Jetson’s treatment was available? And it wasn’t just about convenience. My insurance company was billed more than $1,700 for the sleep lab. The ring test bill was about $330. People with sleep apnea stop breathing or have a significant reduction in airflow for short periods. A person is considered to have mild sleep apnea if this happens more than 5 and less than 15 times an hour as measured using the Apnea-Hypopnea Index or AHI. A person with an AHI more than 30 is considered severe. Mine has clocked in at 90. Left untreated, sleep apnea can cause high blood pressure, heart disease and lead to strokes. The majority of people who have the disorder are unaware, according to Sunil Sharma, chief of the division of pulmonary, critical care and sleep medicine at the West Virginia University School of Medicine. So a diagnosis and treatment could save your life. As wearable devices improve and millions are now wearing Oura’s health and fitness rings, can I bid adieu to sticky paste and electrodes? Not so fast, Sharma cautions. These at-home tests, and wearable devices, can be used to get an indication of a problem, he says, but shouldn’t be considered a true diagnostic tool. If your watch indicates your breathing is disturbed, your doctor is almost certainly going to send you to the sleep lab. My friend’s AHI was very mild, and didn’t require a follow-up. But getting a 60 AHI reading from a device, or some other warning before getting a clear diagnosis from a doctor can lead to panic. And some of the devices don’t work as well with darker skin tones, which could give a false sense of security, Sharma says. For people with sleep apnea, doctors often prescribe a Continuous Positive Airway Pressure machine, which has a mask worn to keep the airway open. It’s just as fun as that sounds, but is way better than a stroke. But a test in the sleep lab may determine you only have apnea when you lay on your side. So instead of a machine, you get a special pillow. A ring won’t be able to tell you that, Sharma says. Sharma’s been doing research on how hospitals could use the screening tools on admitted patients with high blood pressure, heart disease and strokes who don’t already have a sleep apnea diagnosis. This can provide treatment that might prevent future hospitalization, he says. His work as part of a sleep medicine task force will also be introduced at a symposium he’s chairing next year. “We are not diagnosing sleep apnea early enough and people are being admitted with stroke and heart failure again and again,” Sharma says. So if you’re over-tired, talk to your doctor. Maybe an at-home test can be the first step toward saving your life. But only the first step. — Jeff Green | 
