I woke up in a strange bedroom with 24 electrodes glued all over my body and a plastic mask attached to a hose covering my face.<\/p>\n

The lab technician who watched me all night via video feed told me that I had \u201cwicked sleep apnea\u201d and that it was \u201ccentral sleep apnea\u201d \u2014 a type that originates in the brain and fails to tell the muscles to inhale.<\/p>\n

As a journalist \u2014 and one terrified by the diagnosis \u2014 I set out to do my own research. After a few weeks of sleuthing and interviewing experts, I reached two important conclusions.<\/p>\n

First, I had moderate apnea, if that, and it could be treated without the elaborate machines, mouthpieces, or other devices that specialists who had consulted on my care were talking about.<\/p>\n

Second, the American health care system has joined with commercial partners to define a medical condition \u2014 in this case, sleep apnea \u2014 in a way that allows both parties to generate revenue from a multitude of pricey diagnostic studies, equipment sales, and questionable treatments. I was on a conveyor belt.<\/p>\n

It all began with a desire for answers: I had been feeling drowsy during the day, and my wife told me I snored. Both can mean obstructive sleep apnea. With obstructive sleep apnea, the mouth and throat relax when a person is unconscious, sometimes blocking or narrowing the airway. That interrupts breathing, as well as sleep. Without treatment, the resulting disruption in oxygen flow might increase the risk of developing certain cardiovascular diseases.<\/p>\n

So I contacted a sleep-treatment center, and doctors gave me an at-home test ($365). Two weeks later, they told me I had \u201chigh-moderate\u201d sleep apnea and needed to acquire a continuous positive airway pressure, or CPAP, machine, at a cost of about $600.<\/p>\n

Though I had hoped to get the equipment and adjust the settings to see what worked best, my doctors said I had to come to the sleep lab for an overnight test ($1,900) to have them \u201ctitrate\u201d the optimal CPAP air pressure.<\/p>\n

\u201cHow do you treat central sleep apnea?\u201d I worriedly asked the technician after that first overnight stay. She said something about an ASV (adaptive servo-ventilation) machine ($4,000). And one pricey lab sleepover wasn\u2019t enough, she said. I needed to come back for another.<\/p>\n

(Most procedures and devices mentioned in this article were covered or would have been covered by insurance \u2014 in my case, Medicare, plus a supplemental plan. Unnecessary care is a big reason Americans\u2019 insurance costs \u2014 premiums, copays, and deductibles \u2014 tend to rise year after year.)<\/p>\n

As a journalist who spent years covering the business of health care, I found there was more motivating my expensive testing cascade than concerns about my health.<\/p>\n

The American Academy of Sleep Medicine, or AASM, a nonprofit based near Chicago, decides what is sleep apnea and how to treat it. Working with sleep societies around the world, it publishes the International Classification of Sleep Disorders, relied on by doctors everywhere to diagnose and categorize disease.<\/p>\n

But behind that effort lie considerable conflicts of interest. Like so much of U.S. health care, sleep medicine turns out to be a thriving industry. AASM finances its operations in part with payments from CPAP machine manufacturers and other companies that stand to profit from expensive treatments and expansive definitions of apnea and other sleep disorders.<\/p>\n

Zoll Itamar, which makes the at-home testing device<\/a> I used, as well as implantable nerve-stimulation hardware<\/a> for central sleep apnea, is a $60,000, \u201cplatinum\u201d partner in AASM\u2019s Industry Engagement Program<\/a>. So is Avadel Pharmaceuticals<\/a>, which is testing a drug to treat narcolepsy, characterized by intense daytime sleepiness.<\/p>\n

Other sponsors include the maker of an anti-insomnia drug<\/a>; another company with a narcolepsy drug<\/a>; Fisher & Paykel<\/a> Healthcare, which makes CPAP machines and masks; and Inspire Medical Systems<\/a>, maker of a heavily advertised surgical implant, costing tens of thousands of dollars, to treat apnea.<\/p>\n

Corporate sponsors for Sleep 2022<\/a>, a convention AASM put on in Charlotte, North Carolina, with other professional societies, included many of those companies, plus Philips Respironics<\/a> and ResMed<\/a>, two of the biggest CPAP machine makers.<\/p>\n

In a statement, AASM spokesperson Jennifer Gibson said a conflict-of-interest policy and a non-interference pledge from industry funders protect the integrity of the academy\u2019s work. Industry donations account for about $170,000 of AASM\u2019s annual revenue of about $15 million, she said. Other revenue comes from educational materials and membership and accreditation fees.<\/p>\n

Here\u2019s what else I found. Almost everybody breathes irregularly sometime at night, especially during REM sleep, characterized by rapid eye movement and dreams. Blood oxygen levels also fluctuate slightly.<\/p>\n

But recent European studies have shown that standards under the International Classification of Sleep Disorders would doom huge portions of the general population to a sleep apnea diagnosis \u2014 whether or not people had complaints of daytime tiredness or other sleep problems.<\/p>\n

A study in the Swiss city of Lausanne<\/a> showed that 50% of local men and 23% of the women 40 or older were positive for sleep apnea under such criteria.<\/p>\n

Such rates of disease are \u201cextraordinarily high,\u201d \u201castronomical,\u201d and \u201cimplausible,\u201d Dr. Dirk Pevernagie, a scientist at Belgium\u2019s Ghent University Hospital, wrote with colleagues two years ago<\/a> in a comprehensive study in the Journal of Sleep Research.<\/p>\n

\u201cRight now, there is no real evidence for the criteria that have been put forward to diagnose obstructive sleep apnea and rate its severity,\u201d he said in an interview.<\/p>\n

Likewise, 19% of middle-aged subjects in a 2016 Icelandic study<\/a> appeared to have moderate to severe \u201capnea\u201d under one definition in the International Classification of Sleep Disorders even though many reported no drowsiness.<\/p>\n

\u201cMost of them were really surprised,\u201d said Erna Sif Arnard\u00f3ttir, who led the study and is running a large European program<\/a> to refine detection and treatment of apnea.<\/p>\n

Nevertheless, the official AASM journal recommends<\/a> extremely broad screening for sleep apnea, looking for patients who have what it defines as illness. Everybody 18 and older should be screened every year for apnea if they have diabetes, obesity, untreated high blood pressure, or heart disease \u2014 even if they have never complained<\/a> about sleep problems, the group says.<\/p>\n