What is polysomnography

Polysomnography is a sleep study, a test that records certain body functions as you sleep, or try to sleep. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. Polysomnography is used to diagnose sleep disorders.

Polysomnography is usually done at a sleep disorders unit within a hospital or at a sleep center. The test records your nighttime sleep patterns. Polysomnography is occasionally done during the day to accommodate shift workers who habitually sleep during the day.

In addition to helping diagnose sleep disorders, polysomnography may be used to help adjust your treatment plan if you’ve already been diagnosed with a sleep disorder.

There are two stages of sleep:

1. Rapid eye movement (REM) sleep. Most dreaming occurs during REM sleep. Under normal circumstances, your muscles, except for your eyes and breathing muscles, do not move during this stage of sleep.
2. Non-rapid eye movement (NREM) sleep. NREM has three stages that can be detected by brain waves (EEG).

REM sleep alternates with NREM sleep about every 90 minutes. A person with normal sleep most often has four to five cycles of REM and NREM sleep during a night.

A polysomnography sleep study measures your sleep cycles and stages by recording:

• Air flow in and out of your lungs as you breathe
• The level of oxygen in your blood
• Body position
• Brain waves (EEG)
• Breathing effort and rate
• Electrical activity of muscles
• Eye movement
• Heart rate

Polysomnography can be done either at a sleep center or in your home.

Polysomnography study at a sleep center

Full sleep studies are most often done at a special sleep center.

• You will be asked to arrive about 2 hours before bedtime.
• You will sleep in a bed at the center. Many sleep centers have comfortable bedrooms, similar to a hotel.
• Polysomnography test is most often done at night so that your normal sleep patterns can be studied. If you are a night shift worker, many centers can perform the test during your normal sleep hours.
• Your sleep doctor will place electrodes on your chin, scalp, and the outer edge of your eyelids. You will have monitors to record your heart rate and breathing attached to your chest. These will remain in place while you sleep.
• The electrodes record signals while you are awake (with your eyes closed) and during sleep. The test measures the amount of time it takes you to fall asleep and how long it takes you to enter REM sleep.
• A specially-trained sleep technician or nurse will observe you while you sleep and note any changes in your breathing or heart rate.
• Polysomnography test will record the number of times that you either stop breathing or almost stop breathing.
• There are also monitors to record your movements during sleep. Sometimes a video camera records your movements during sleep.

Polysomnography at home

You may be able to use a sleep study device in your home instead of at a sleep center to help diagnose sleep apnea. You either pick up the device at a sleep center or a trained therapist comes to your home to set it up.

Home testing may be used when:

• You are under the care of a sleep specialist.
• Your sleep doctor thinks you have obstructive sleep apnea.
• You do not have other sleep disorders.
• You do not have other serious health problems, such as heart disease or lung disease.

Why is polysomnography sleep study done?

Polysomnography monitors your sleep stages and cycles to identify if or when your sleep patterns are disrupted and why.

The normal process of falling asleep begins with a sleep stage called non-rapid eye movement (NREM) sleep. During this stage, your brain waves, as recorded by electroencephalography (EEG), slow down considerably.

Your eyes don’t move back and forth rapidly during NREM, in contrast to later stages of sleep. After an hour or two of NREM sleep, your brain activity picks up again, and rapid eye movement (REM) sleep begins. Most dreaming occurs during REM sleep.

You normally go through multiple sleep cycles a night, cycling between NREM and REM sleep in about 90 minutes. Sleep disorders can disturb this sleep process.

Your doctor may recommend polysomnography if he or she suspects you have:

• Sleep apnea or another sleep-related breathing disorder. In this condition, your breathing repeatedly stops and starts during sleep.
• Periodic limb movement disorder. In this sleep disorder, you involuntarily flex and extend your legs while sleeping. This condition is sometimes associated with restless legs syndrome.
• Narcolepsy. You experience overwhelming daytime drowsiness and sudden attacks of sleep in this condition.
• REM sleep behavior disorder (parasomnia). This sleep disorder involves acting out dreams as you sleep.
• Unusual behaviors during sleep. Your doctor may perform this test if you do unusual activities during sleep, such as walking, moving around a lot or rhythmic movements.
• Unexplained chronic insomnia. If you consistently have trouble falling asleep or staying asleep, your doctor may recommend polysomnography.

Polysomnography procedure

Whether the polysomnography test is at a sleep study center or at home, you prepare the same way. Unless directed to do so by your doctor, do not take any sleep medicine and do not drink alcohol or caffeinated beverages before the test. They can interfere with your sleep.

How you prepare

You may be advised to avoid drinks or food containing alcohol or caffeine during the afternoon and evening before polysomnography. Alcohol and caffeine can change your sleep patterns, and they may make symptoms of some sleep disorders worse.

Napping in the afternoon before a sleep study is discouraged. You’ll usually be asked to bathe or shower before your sleep study. But don’t put on lotions, gels, colognes or makeup before the test, as these can interfere with the use of the electrodes.

During polysomnography sleep study

You arrive at the sleep center in the evening for polysomnography and stay overnight. You may bring items you use for your bedtime routine, and you can sleep in your own nightclothes.

The room where polysomnography is done is similar to a hotel room, and it’s dark and quiet during the test. You won’t share the room with anyone else. Each room has its own bathroom.

The sleeping area will typically have a low-light video camera, so the polysomnography technologists monitoring you can see what’s happening in the room when the lights are out. It also has an audio system, so they can talk to you and hear you from their monitoring area outside the room.

After you get ready for bed, one of the technologists will place sensors on your scalp, temples, chest and legs using a mild adhesive, such as glue or tape. The sensors are connected by wires to a computer, but the wires are long enough to let you move around in bed. A small clip also is placed on your finger or ear to monitor the level of oxygen in your blood.

While you sleep, a sleep technologist monitors your:

• Brain waves
• Eye movements
• Heart rate
• Breathing pattern
• Blood oxygen level
• Body position
• Chest and abdominal movement
• Limb movement
• Snoring and other noise you may make as you sleep

Polysomnography technologists monitor you throughout the night. If you need assistance, you can talk to them through the monitoring equipment. They can come into the room to detach the wires if you need to get up during the night.

During the study, the technologist may have you try a positive airway pressure (PAP) machine for sleep apnea. This is a device that consists of a tight-sealing nosepiece through which a gentle stream of air is delivered to enhance your breathing.

Continuous positive airway pressure (CPAP) is one type of PAP machine. CPAP devices deliver a constant stream of air that keeps the airway passages open while you sleep.

For some people, bi-level positive airway pressure (biPap or bPap) machines may be a more comfortable choice. These devices deliver more pressure while you’re breathing in, and lower pressure when you exhale.

You may have the opportunity to try on a PAP device before the sleep study begins so that you are not surprised by it if the technologist suggests you try the device later in the night. If necessary, oxygen also may be used during the study to bolster your breathing.

Although you probably won’t fall asleep as easily or sleep as well at the sleep center as you do at home, this usually doesn’t affect the test results. A full night’s sleep isn’t required to obtain accurate polysomnography results.

After polysomnography sleep study

In the morning, the sensors are removed, and you may leave the sleep center. You’re given an appointment for a follow-up visit with the doctor who recommended the test. You can return to your usual activities after polysomnography

Polysomnography sleep study results

The measurements recorded during polysomnography provide a great deal of information about your sleep patterns. For example:

• Brain waves and eye movements during sleep can help your health care team assess your sleep stages and identify disruptions in the stages that may occur due to sleep disorders such as narcolepsy and REM sleep behavior disorder.
• Heart and breathing rate changes and changes in blood oxygen that are abnormal during sleep may suggest sleep apnea.
• Correct settings for positive airway pressure (PAP) or oxygen in case your doctor would like to prescribe these for home use.
• Frequent leg movements that disrupt your sleep may indicate periodic limb movement disorder.
• Unusual movements or behaviors during sleep may be signs of REM sleep behavior disorder or another sleep disorder.

The information gathered during polysomnography is evaluated first by a polysomnography technologist, who uses the data to chart your sleep stages and cycles. Then that information is reviewed by your sleep center doctor.

At a follow-up appointment, your doctor reviews the results with you. Based on the data gathered, your doctor will discuss any treatment or further evaluation that you may need.

The polysomnography test helps diagnose possible sleep disorders, including obstructive sleep apnea (OSA). Your provider may think you have OSA because you have these symptoms:

• Daytime sleepiness (falling asleep during the day)
• Loud snoring
• Periods of holding your breath while you sleep, followed by gasps or snorts
• Restless sleep

Polysomnography can also diagnose other sleep disorders:

• Narcolepsy
• Periodic limb movements disorder (moving your legs often during sleep)
• REM behavior disorder (physically “acting out” your dreams during sleep also called parasomnias)

Normal polysomnography sleep study results

A polysomnography sleep study tracks:

• How often you stop breathing for at least 10 seconds (called apnea)
• How often your breathing is partly blocked for 10 seconds (called hypopnea)
• Your brain waves and muscle movements during sleep

Most people have short periods during sleep where their breathing stops or is partly blocked. The Apnea-Hypopnea Index (AHI) is the number of apnea or hypopnea measured during a sleep study. Apnea-Hypopnea Index (AHI) results are used to diagnose obstructive sleep apnea.

Normal test result show:

• Few or no episodes of stopping breathing. An apnea-hypopnea index (AHI) of less than 5 is considered normal.
• Normal patterns of brain waves and muscle movements during sleep.

What abnormal polysomnography sleep study results mean

In adults, apnea-hypopnea index (AHI) results above 5 may mean you have sleep apnea:

• 5 to 15 is mild sleep apnea
• 15 to 30 is moderate sleep apnea
• More than 30 is severe sleep apnea

To make a diagnosis and decide on treatment, the sleep specialist must also look at:

• Other findings from the sleep study
• Your medical history and sleep-related complaints
• Your physical exam