I believe that sleep medicine is so ineffective because the basic science has not been done. Indeed to this day we have no idea how people sleep in their own home in their own bed night after night.
Why Sleep Testing Fails to Work in Real Life:
My daughter put it well; “It is all about the setting”.
There are many noted problems with the sleep testing process:
False negatives! False positives! First night effect!
“The worst night of sleep I have ever attempted”! “I had to come back for a second try”! “This is my third test in as many months”!
The problem with the in lab polysomnogram (sleep test) is very basic and very simple and simply a deal breaker. The setting is wrong.
The problem is that we do not normally sleep in a lab. Our “native sleeping environment” is in our own home in our own bed. Due to the differences and stresses of the “in lab” rather than the “in home” experience the data taken in the lab is very very likely different than what we would find if we measured sleep in our own beds in our own homes.
There is no data I can find to show that the current in lab sleep test tracks with how we sleep in real life. It appears that there is no proof of external validity. The results of the test only represent how you slept in that lab on that night. How you actually sleep in your own home night after night is still unknown.
Our “in lab” experience is very very different from our in bed normal night at home experience. To expand upon this a bit some of the issues are:
We are in this lab at great expense which causes us stress!!!
To get and be there we experienced different before bed procedures and lighting than we normally!
We were placed in a different bed than we normally sleep in.
The room we are trying to sleep in has very different temperature profiles than what we experience at home in our own bed.
The room and building we are trying to sleep in has different sounds than we hear while sleeping in our own bed in our own home.
We are all wired up!!!
We are aware of the fact that we are under direct observation all night which can cause stress!!!
Our future livelihood may be greatly affected by the results!!!!!!
With all of the differences and stresses involved we may well be given drugs to help us try to sleep!!!!!!!!
So when will it be that sleep medicine addresses this issue? Would it help to at least stop calling the current test “the golden standard” perhaps?
We really do need to develop the equipment and procedures to move the sleep test into the home and find out how we actually sleep night after night. We simply do.