Human Sleep and

Polysomnography
Roadmap to Dreamland
Definition of sleep
Principles and components of
polysomnography
Brief tour of other measures of
sleep (eg. Actigraphy and sleep
diaries).
So, what is sleep?
A reversible behavioral state.
Involves a disengagement from and substantial
decrease in responsiveness to the environment.
Usually (in humans)
involves a specific
recumbent posture,
quiescence and closed
eyes.
What types of sleep are there?
[NREM]Nonrapid eye movement
NREM sleep is subdivided into four stages
mostly on the basis of electroencephalography
(EEG) and these roughly parallel depth of sleep.
[REM]Rapid eye movement
REM sleep is characterized by more activated
EEG, muscle atonia in the skeletal muscles and
episodic bursts of rapid eye movements
Polysomnography
requires three
necessary types of
measurement to reliably
determine sleep stages
EEG (Electroencephalogram) measures continuous
variance in voltage (from the 5 200 microvolts range)
and is in the lower portion of the EEG spectrum (0.5 to 14
Hz).
EOG (Electro-oculogram) to detect the slow-rolling eye
movements (SEM) associated with sleep onset and the
cardinal rapid eye movements in REM sleep.
EMG (electromyogram) to measure changes in muscle
tone that may occur during sleep onset but more
importantly to detect the skeletal muscle atonia during
REM sleep.
Getting started with the hook-up
EEG- reliable recording of the EEG begins with
accurate measurement of the skull according to the
international 10-20 system. For sleep recordings,
electrodes are usually attached on the scalp over the
central region of the cortex between the motor and
sensory cortex (at locations C3 or C4) and the occipital
lobe (O1 & 02).
Still hookingup.
EOG- Electrodes placed at left and right outer
canthus with one below and one beneath the
horizontal plane. EOG recording are based on
the electro-potential difference between the
cornea (positively charged) and the retina
(negatively charged). This strategy allow for eye
movements in any direction to be seen as out-of-
phase oscillations
EMG Three electrodes are placed beneath
the chin overlying the mentalis and submentalis
muscles. This is done for the sake of
convenience and since these muscles are
particularly sensitive to changes in muscle tone.
STAGES OF SLEEP
WAKEFULNESS
When we are awake, we might be in one of two different
states according to the EEG:
1.) a relaxed mental state (alpha waves in the 8-12 Hz
range) and typically seen in the EEG with eyes closed
2.) an alert mental state (beta waves in the 13-30Hz range).
When we are asleep, we enter into several different states
including theta & delta waves which are much slower
than those in the awake state.
Stage 1 sleep (Transitional sleep)
This stage of sleep marks the transition from the alpha
waves of relaxed wakefulness to a relatively slower low-
voltage, mixed frequency EEG activity and
accompanying SEMs (eye movements seen on only a
single channel below).
Stage 2 Sleep
The PSG recording segment shows the two defining EEG patterns
below the C3-A2 derivation.
1.) K complexes - a typically large and slow (2Hz of slower) EEG wave
starting with a negative sharp wave followed immediately by a
positive wave.
2.) Sleep spindles - short bursts of 12-14Hz lasting between 0.5 and
1.5 seconds
[Note:These phenomenon occur with a background of mostly theta and
some scattered Delta wave activity.
Delta Sleep (Stage 3 and 4) a.k.a.
Slow Wave Sleep
This figure shows tracings consistent with deep sleep, or stage 4
[i.e., more than 50% of the epoch (30 sec segment) with high
amplitude delta waves]. The recording segment shows that (delta)
wave activity is prominent in central EEG channel (C3-A2) and also
in other channels including occulographic channels. Stage 3 would
have 20 50% of the epoch with these slow (0.5 3.0 Hz) and high
amplitude (greater than 75uv) waves. Note the synchronization.
REM Sleep
This figure shows the three coinciding activity criteria
for the determination of REM sleep
1.) Activatedor desynchronizedEEG (relatively
low voltage mixed frequency).
2.) Bursts of rapid eye movements.
3.) Suppression of EMG activity in skeletal muscles.
Sleep Architecture
[*This progression of
stages occurs in roughly
90-minute cycles
throughout the night with
increasing amounts of
REM sleep and
decreasing amounts of
delta activity.]
Additional Measures in PSG
EKG (electrocardiogram) measures cardiac function.
Leg EMG measures limb movements by placing EMG sensors on
both right and left tibialis muscles.
Respiratory function (to detect sleep disordered breathing
phenomenon
1.) Airflow measured by thermally-sensitive devices detecting both
oral and nasal airflow
2.) Respiratory effort strain belts often using piezo electrodes to
measure abdominal and thoracic effort
3.) Oximetry a photosensitive sensor is placed on the finger or
earlobe (highly vascularized areas) to detect blood oxygenation
levels.
[All three of these previous respiratory measures use the Principle of
Transduction a way to represent physiological phenomena and
how they change over time in terms of varying voltages.]
4.) Snoring either decibel meter or movement detector
5.) Position sensor first calibrated than placed over chestplate to
measure position in ambulatory studies.
All together now
This is what it looks like after
applying all the sensors and
electrodes!
Other Measures of Sleep
Actigraphy = a small, portable
movement detector typically using
a piezoelectric accelerometer that generates
voltages when motion is detected across three
planes. The data are stored in a self-contained
memory chip which can collect data for up to 8
weeks and is then downloaded via wireless
technology for analysis.
*** [Important to note that an actigraph does not measure
sleep, but sleep is inferred by relative quiescence and
wakefulness is inferred by comparatively increased
movement.]
Actigraphy data displays
24 and 12-hour period
Multi-day
SLEEP LOGS/DIARIES
Sleep logs = individuals keep a daily log
estimating a variety of sleep behaviors and
patterns for extended periods of time. Thought
subjective, this method is often an excellent way
to determine the patients sense of their sleep
habits and if treatments are being perceived as
effective.
***[Actigraphy and sleep logs are often used together as
an objective and subjective measure of sleep, but their
agreement tends to decrease with more disturbed
sleepers]
Sleep Log (for flavor)
(Example from National Sleep Foundation)
How do PSG, Actigraphy and sleep
logs compare to each other?
PSG is considered the Gold Standardof
measuring sleep.
Actigraphy vs. PSG?
80-90% agreement for most sleep variables, but
less agreement with more disturbed sleepers.
Sleep logs vs. PSG?
Some agreement, but all sleepers consistently
underestimate the number of awakenings and
overestimate the time it takes them to fall
asleep. Reliability and validity of sleep logs are
increased if consecutive multiple nights are
used.
More comparisons
How about sleep logs and actigraphy?
These measures are now commonly paired as
complementary assessment tools in both clinical
and research settings.
However, they have rather poor agreement
especially when used with those that have
disturbed sleep. Only consistent agreement is
with total amount of time slept in a night. But
they are still well-suited to capturing variability of
sleep patterns for long periods of time. PSG is
just too expensive and time-consuming.
Sleep Disorders Most Commonly
Diagnosed by PSG
Sleep Apnea= intermittent stopping of breathing during
sleep
Narcolepsy= frequent, unexpected periods of sleep or
sleepiness during the day. Includes one or more of these
symptoms (the Tetrad):
1. Gradual/sudden onset of sleepiness
2. Cataplexy: muscle weakness while remaining awake.
Often triggered by strong emotions
3. Sleep paralysis: inability to move when falling asleep
or waking up
4. Hypnagogic hallucinations: dreamlike experiences at
the beginning of sleep. Equivalent to REM-like sleep
intruding into the awake state
Periodic Limb Movement D/O = during NREM sleep
individual moves legs and sometimes arms every 20-30
seconds for minutes or hours
More Sleep Disorders (less commonly
using PSG for diagnoses)
REM Behavior Disorder = during REM sleep individual
moves vigorously or violently (kick, punch, etc.); dreams
of violent nature; occurs mostly in older men with brain
diseases, esp. PD. Physiologically, there is muscle
activity in REM where there should be muscle atonia
Night Terrors = an experience of intense anxiety from
which one wakes up screaming usually during the
transition from Stage 2 to Stage 3 sleep.
Sleepwalking = occurs in Delta sleep mostly with
children.
Insomnia= not sleeping enough due to (1) difficulty
falling asleep (onset insomnia), (2) frequent awakening
during sleep (maintenance insomnia), or (3) waking up
too early (termination insomnia)