Ashwin Lewis
Sleep deprivation can be diagnosed by a healthcare provider through a series of questions about sleep habits, personal routine, and health history. However, further tests are sometimes required to determine if a related condition is contributing to or resulting from sleep deprivation. These tests include sleep apnea testing, electroencephalogram (EEG) testing, actigraphy, multiple sleep latency tests (MSLT), and maintenance of wakefulness tests (MWT). Sleep apnea testing can be done overnight in a lab or at home, while EEG testing detects and records brain waves to identify unusual brain activity. Actigraphy involves wearing a device that tracks sleep patterns, and MSLT and MWT assess daytime sleepiness and alertness, respectively.
| Characteristics | Values |
|---|---|
| Self-report techniques | Stanford Sleepiness Scale (SSS) |
| Epworth Sleepiness Scale (ESS) | |
| Pupillography | An objective, laboratory-based method of electronically monitoring the size of a person's pupil |
| Electroencephalography (EEG) | Detects and records brain waves |
| Electrocardiography (EKG or ECG) | Examines heart activity |
| Electromyogram (EMG) | Tracks muscle movement |
| Electro-oculography (EOG) | Detects eye activity |
| Pulse oximeter | Reads pulse and the level of oxygen in the blood |
| Actigraphy | Tracks sleep patterns |
| Multiple Sleep Latency Test (MSLT) | Examines whether a person is prone to falling asleep during the daytime |
| Maintenance of Wakefulness Test (MWT) | Looks for whether or not a person can resist falling asleep in situations where it would be easy to do so |
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What You'll Learn
Sleep apnea testing
Sleep apnea is a condition in which a person's breathing is interrupted during sleep, often for more than ten seconds. It occurs when the throat muscles relax and combine with a narrowed airway to obstruct breathing. Symptoms of sleep apnea include waking up tired, with a headache, or a dry mouth. If you are experiencing these symptoms, your doctor may recommend a sleep apnea test, also known as a polysomnogram (PSG). This test can be conducted in a sleep disorder centre or at home, depending on the complexity of the case.
A polysomnogram is a multiple-component test that electronically records specific physical activities while you sleep. During the test, surface electrodes will be placed on your face and scalp to record electrical signals generated by your brain and muscle activity. Belts will be placed around your chest and abdomen to measure your breathing, and a bandage-like oximeter probe on your finger will measure the oxygen levels in your blood. The data collected will then be analysed by a qualified sleep specialist to determine if you have sleep apnea or another sleep disorder.
If you opt for an at-home sleep apnea test, you will use a simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort. This typically involves wearing sensors, including a small probe over your finger and another mask with tubes inserted into your nostrils, secured around your ears. Additional sensors may be placed on your abdomen and chest to measure their movement as you breathe. At-home tests are generally more affordable and convenient but may not capture the full range of data that an overnight sleep study in a lab can provide.
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Electroencephalogram (EEG)
EEG is used to detect subtle seizures, like absence seizures or focal seizures, and can be useful in identifying brain activity that may not be present when a person is awake. It can also be used to detect abnormal brain activity that could contribute to sleep problems or other conditions.
During an EEG, electrodes are attached to the scalp to record brain activity. The patient is encouraged to relax and close their eyes, and the test begins. It is important that the patient remains as still as possible during the test, as even blinking or swallowing can affect the reading. The patient may be encouraged to doze off during the test, and a technician will monitor them for any signs of seizures.
The test typically takes a few hours, and the patient can go home immediately afterward. The results are then interpreted by a board-certified neurologist, who looks for any abnormal electrical activity and surveys the recording for any overt seizures.
EEG is generally safe and painless, and most people experience little to no discomfort. However, sleep deprivation can trigger a seizure, so patients who are predisposed to this condition are carefully monitored throughout the procedure. If a seizure occurs, the patient will be treated with fast-acting anti-seizure medication.
Prior to the test, patients are typically asked to sleep less or avoid sleep completely the night before. They should also refrain from consuming caffeine and ensure their hair and scalp are clean, as hair products and oils can interfere with the placement of the electrodes.
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Actigraphy
The actigraphic device is usually worn on the wrist or ankle and contains an accelerometer that records movement, a data storage unit, and a programmable timing mechanism. The data collection process is typically performed over several days or weeks, with minimal interference to your day-to-day life.
- What time you fall asleep
- What time you wake up
- How long you take to fall asleep
- How long you sleep in total
- How much time you spend awake during the night after falling asleep
These parameters help medical professionals identify any peculiarities in your sleep schedule. Actigraphy may be used on its own or in combination with another sleep test, such as a sleep log or an overnight sleep test.
The American Academy of Sleep Medicine acknowledges the potential benefits of using actigraphy for people with the following sleep disorders:
- Insomnia
- Circadian Rhythm Sleep-Wake Disorders
- Sleep Apnea
- Insufficient Sleep Syndrome
- Multiple Sleep Latency Test
The process of actigraphy is simple and requires little to no preparation. The actigraphy device is typically worn on the non-dominant wrist and should not be covered with clothing. Your doctor will instruct you on how to use it, how long you need to wear it, and how to troubleshoot any problems. Once you have finished collecting the data, you return the device to your doctor, who uploads the data into a computer for interpretation.
Potential new measures
While actigraphy is a well-established method for assessing sleep parameters, there is a lack of consistency in the definition and technical details of these parameters across studies. This inconsistency can make it challenging to compare results and draw conclusions. To address this issue, here are some potential new measures that could be considered:
- Standardisation of sleep measures: There is a need to standardise the definition, criteria, and methods used to derive sleep parameters across different actigraphic devices and software. This would facilitate communication among researchers and enable direct comparisons of results.
- Intra-individual variability: Actigraphy can collect data over multiple days or weeks, but most studies focus on the mean values of sleep parameters rather than their day-to-day variability. By calculating the standard deviation of sleep parameters across sampling days, researchers can gain insights into the consistency of sleep patterns within individuals.
- Combined measures: Researchers can create new measures by combining the overall mean and day-to-day variability of a sleep parameter. For example, participants can be classified as short and consistent sleepers, long and consistent sleepers, short and variable sleepers, or long and variable sleepers based on both the mean and variability of their sleep duration.
- Chronotype: Actigraphic data can be used to assess chronotype, an individual's preferred time for sleeping. This information can be valuable when examining associations between chronotype and psychological or physical well-being.
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Multiple sleep latency test (MSLT)
The Multiple Sleep Latency Test (MSLT) is a test that examines whether a person is prone to falling asleep during the daytime. It is often used as a key part of diagnosing narcolepsy and idiopathic hypersomnia. The MSLT is a full-day test that consists of four to five scheduled naps. After the first nap trial, each subsequent trial should begin two hours after the start of the previous one. The test is always done following a sleep study that measures a patient's sleep quality and duration.
During each nap trial, the patient lies quietly in bed and tries to fall asleep. The test measures how long it takes for the patient to fall asleep, as well as how quickly REM sleep begins. If the patient does not fall asleep within 20 minutes, the nap trial ends. The sleep environment is dark and quiet, intended to be comfortable for the patient and to isolate any external factors that may affect their ability to fall asleep. A series of sensors are used to measure whether the patient is asleep, as well as to determine their sleep stage.
The MSLT is considered positive when the patient falls asleep with a mean sleep latency below eight minutes in the naps, and had no more than one nap (for idiopathic hypersomnia) or two naps (for narcolepsy diagnosis) where REM sleep was reached. The results of the MSLT are interpreted by a board-certified sleep medicine physician, who then makes a diagnosis and contacts the patient to discuss a treatment plan.
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Maintenance of wakefulness test (MWT)
The Maintenance of Wakefulness Test (MWT) is a test that measures how alert a person is during the day and their ability to stay awake for a defined period. The test is based on the idea that, in some cases, a person's ability to stay awake may be more important than how fast they fall asleep. This is an indicator of how well they can function and remain alert during quiet times of inactivity.
The MWT is performed in a dark, quiet room to isolate the patient from outside factors that can influence their ability to fall asleep, such as temperature. The test consists of four sleep trials with two-hour breaks in between. Non-invasive sensors are placed on the patient's head, face, and chin to record vital signs and monitor their rest. The patient sits quietly in bed and is instructed to remain awake for as long as possible without doing anything to keep themselves awake, such as slapping their face. If the patient falls asleep, they are awakened after 90 seconds. If the patient does not fall asleep within 40 minutes, the test ends.
The MWT is often used to evaluate the effectiveness of a patient's treatment plan for a sleep disorder and to determine if a person is too sleepy to drive or perform other daily tasks, especially those involving public safety, such as truck driving and public transportation. The test results can help assess the potential risk of a work-related accident.
The results of the MWT take about two weeks to be analysed and interpreted by a sleep technologist and a doctor. If a patient's sleep latency is less than eight minutes during the test, this would be considered abnormal.
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Frequently asked questions
Sleep deprivation is when a person doesn’t get enough sleep or good quality sleep. It can be a short-term or long-term issue and can have very disruptive symptoms.
If you often feel sleepy during the day, don't wake up feeling refreshed and alert, or are having trouble adapting to shift work, you may be sleep deprived. Other signs include trouble thinking, focusing and remembering, and slowed reaction times.
Doctors might not identify sleep problems during routine office visits, so it's important to let your doctor know if you think you might have a sleep problem. They will ask you about your sleep habits and may also ask about your personal routine and habits, such as your work and exercise routines, and your use of caffeine, tobacco, alcohol, or any medications. They may also recommend that you keep a sleep diary for a few weeks to track your sleep patterns and how you feel during the day.
There are several tests that can be done to diagnose sleep deprivation, including:
- Sleep studies (polysomnography): These are painless tests that measure how well you sleep and how your body responds to sleep problems. They involve recording multiple body systems, including your brain, heart, and breathing, during a full night of sleep.
- Multiple sleep latency tests: These tests measure how quickly you fall asleep during a series of daytime naps and use sensors to record your brain activity and eye movements.
- Maintenance of wakefulness test: This test measures your ability to stay awake and alert during the day.
- Activity monitors: These are worn at home for several days or weeks to help doctors see how much and how well you sleep.
