Herbie Murray
Sleep studies, formally known as polysomnography, are a way to help diagnose sleep disorders such as sleep apnea, restless leg syndrome, insomnia, and narcolepsy. They are often recommended for people who have trouble falling asleep, snore, or have other symptoms of a sleep disorder. Sleep studies are performed at sleep labs, which are usually set up for overnight stays at hospitals or sleep centers. Sensors are used to monitor brain activity, eye movement, heart rate, and breathing patterns, among other signals. The results are then sent to a physician for interpretation. Home sleep studies are also an option, but they are less effective at detecting sleep disorders and are usually only used to evaluate for obstructive sleep apnea. For those with excessive daytime sleepiness, multiple sleep latency testing may be performed to identify narcolepsy, hypersomnia, or normal levels of sleepiness.
| Characteristics | Values |
|---|---|
| Purpose | To diagnose sleep disorders and their causes, and to monitor response to treatment |
| Type of test | Diagnostic test that tracks and records multiple body systems |
| Test name | Polysomnography or polysomnogram |
| Test location | Sleep labs, sleep centers, hospitals, clinics, standalone facilities, or at home |
| Test time | During normal sleeping hours, usually overnight |
| Test duration | One night |
| Check-in time | Between 8 and 10 p.m. |
| Departure time | Between 6 and 8 a.m. the next day |
| Test procedure | Sensors are glued or taped to the head and body to monitor brain activity, eye movement, heart rate, and breathing patterns |
| Test result interpretation | Results are sent to a doctor for interpretation and discussion with the patient |
| Test result usage | Used to diagnose sleep disorders and determine treatment |
| Alternative test | At-home sleep apnea test as a more convenient and affordable option |
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Polysomnography
PSG monitors many body functions, including brain activity (EEG), eye movements (EOG), muscle activity or skeletal muscle activation (EMG), and heart rhythm (ECG). It also evaluates breathing functions, respiratory airflow, and respiratory effort indicators. The electrooculogram (EOG) uses two electrodes, one placed above the outer canthus of the right eye and one below the left, to pick up eye activity. This helps determine when REM sleep occurs, characterised by rapid eye movements. The electromyogram (EMG) uses four electrodes to measure muscle tension and monitor for excessive leg movements, which may indicate periodic limb movement disorder (PLMD).
PSG is used to diagnose or rule out various sleep disorders, including narcolepsy, idiopathic hypersomnia, PLMD, REM behaviour disorder, parasomnias, and sleep apnea. It is often used to evaluate symptoms of sleep apnea, which involves breathing stopping and restarting during sleep, and can include PLMD or restless leg syndrome.
PSG typically takes place at a specialised sleep centre or hospital. The patient sleeps overnight in a private room, and a technician monitors them. The technician can communicate with the patient, who can ask any questions or voice concerns. The patient can bring their own pyjamas and other items to facilitate their bedtime routine.
PSG is also available as an at-home test, which may be more comfortable and affordable for the patient. However, these tests are less effective at detecting sleep disorders and are not recommended by the AASM for diagnosing sleep apnea.
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Sleep apnea
Sleep studies can take place during a patient's normal sleeping hours, either during the night or during the day for those who work overnight shifts. Sleep apnea can also be evaluated through an at-home sleep test, which is a cost-effective and convenient way to assess whether a patient is having trouble breathing. At-home sleep tests are typically recommended when a physician strongly suspects sleep apnea or for follow-up testing after treatment. These tests usually involve sensors that detect breathing and the movement of breathing-related muscles in the chest and abdomen. They may also include a small probe placed over a finger to measure oxygen levels.
For patients with more complex conditions, an overnight sleep study at a sleep center may be recommended. These studies are attended by a sleep technologist and capture more data, including brainwaves, muscle tone, and leg movements. During an overnight sleep study, surface electrodes are placed on the patient's face and scalp to record electrical signals from brain and muscle activity. Belts are also placed around the chest and abdomen to measure breathing, and an oximeter probe is placed on the finger to measure blood oxygen levels.
After a sleep study, the data is analyzed by a qualified sleep specialist, who may take some time to review the extensive data. The results are then sent to the patient's doctor, who will meet with the patient to discuss the findings and determine the next steps. Sleep studies are a crucial tool in diagnosing and treating sleep apnea, providing a comprehensive view of the patient's sleep quality and helping to identify any underlying causes for concern.
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Narcolepsy
There are two types of narcolepsy: type 1 (NT1) and type 2 (NT2). Type 1 involves cataplexy, which is a sudden loss of muscle tone or episode of muscle weakness while awake. This can lead to slurred speech, buckling knees, or even complete paralysis, usually triggered by strong emotions. Type 2 does not involve cataplexy. The majority of narcolepsy cases (about 80%) are type 2.
If a doctor suspects narcolepsy, they will usually recommend two specialized sleep studies: polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). PSG tracks your breathing, eye movement, muscle movement, and brain activity and is usually conducted overnight in a sleep clinic. It can reveal the presence of other disorders, such as sleep apnea. The MSLT is conducted the following day, where the patient is instructed to try to fall asleep at five separate intervals. It measures how quickly the patient falls asleep and how quickly they enter rapid eye movement (REM) sleep. People with narcolepsy usually fall asleep quickly and enter REM sleep very quickly as well.
Medication is the main method for treating narcolepsy. Most medications target excessive daytime sleepiness, but some target other symptoms as well.
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Sleep latency testing
The Multiple Sleep Latency Test (MSLT) is a full-day test that evaluates how long it takes for someone to fall asleep (sleep latency) and what sleep stages they experience during naps. The test is used to measure excessive daytime sleepiness and diagnose underlying sleep disorders such as narcolepsy and hypersomnia.
The MSLT is always performed after an overnight sleep study, which is used to determine the quality and duration of sleep. The sleep study also helps to rule out other sleep disorders, such as sleep apnea, that may be causing excessive daytime sleepiness. For the MSLT to be accurate, participants need to sleep for at least six hours during the sleep study.
The MSLT itself consists of four to five scheduled naps, with each nap trial beginning two hours after the start of the previous trial. During each trial, the participant lies quietly in a dark and quiet room, intended to be comfortable and to isolate any external factors that may affect their ability to fall asleep. Once the lights go off, the test will measure how long it takes for the participant to fall asleep. If the participant does not fall asleep within 20 minutes, the nap trial will end, and they will be awakened after 15 minutes.
Sensors are placed on the participant's head, face, and chin to show when they are asleep and awake, and to transmit data about when they are in REM sleep. A low-light video camera also allows the technologist to observe the participant from a nearby room. After the final nap, the participant is free to go home, and a healthcare provider will schedule a follow-up appointment to review the test results.
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Sleep medicine
A sleep study involves monitoring and recording various body functions during sleep to gain insights into the potential causes of an individual's sleep-related symptoms. Sensors are attached to the patient's head and body to track multiple body systems, including brain activity, eye movement, heart rate, respiratory function, muscle tone, and leg movements. This comprehensive approach allows healthcare providers to diagnose specific sleep disorders and develop effective treatment plans.
The process of undergoing a sleep study typically begins with a check-in at the sleep lab or clinic during the evening, with the goal of capturing at least seven hours of sleep. Patients are advised to follow their usual daily routines, avoid caffeine, and refrain from napping beforehand. During the study, a technologist monitors and records the patient's sleep patterns and assists with any issues. The results are then interpreted by a physician, who determines the presence of a sleep disorder and discusses the findings with the patient.
For individuals with excessive daytime sleepiness, additional testing may be recommended, such as the Multiple Sleep Latency Test (MSLT) or the Maintenance of Wakefulness Test. The MSLT involves taking naps at two-hour intervals the day after the overnight study, helping to identify conditions like narcolepsy, hypersomnia, or normal levels of daytime sleepiness. The Maintenance of Wakefulness Test, on the other hand, is designed for professions requiring sustained alertness, such as transportation professionals, to ensure they can remain awake in a quiet, slightly darkened space.
Home sleep studies, currently used primarily for evaluating obstructive sleep apnea, offer a convenient and cost-effective alternative. They typically involve simplified breathing monitors that track breathing patterns, oxygen levels, and breathing effort. However, home studies may not capture the full range of data provided by an overnight sleep study in a lab or clinic. Therefore, individuals with certain heart, breathing, or neuromuscular problems may benefit more from an overnight sleep study in a specialised facility.
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Frequently asked questions
A sleep study, formally known as a polysomnogram, is a diagnostic test that tracks and records how multiple body systems work while you’re asleep. This test involves sensors that track the activity of multiple body systems, including your heart, brain and respiratory system, giving healthcare providers a comprehensive view of the quality of your sleep.
Sleep studies are usually conducted overnight at a sleep lab, which could be a special department in a hospital or clinic, or a standalone facility. Most sleep studies take place over the course of one night, with check-in times between 8 and 10 pm and departure times between 6 and 8 am the next day. Before bedtime, a technologist will attach sensors to your head and body to record information while you sleep.
After the test, a sleep technologist will send the results to your physician, who will interpret them and discuss the findings with you. If symptoms persist, your physician might recommend an in-lab study for further evaluation.
Yes, home sleep studies are available, but they are currently only used to evaluate for obstructive sleep apnea (OSA). Home sleep studies are more convenient and affordable, but they are less effective at detecting OSA than polysomnography, so they are not recommended as the sole basis for diagnosis and treatment.
