Polysomnography
Sleep study; Polysomnogram; Rapid eye movement studies; Split night polysomnography; PSG; OSA - sleep study; Obstructive sleep apnea - sleep study; Sleep apnea - sleep study
Polysomnography is a sleep study. This test records certain body functions as you sleep, or try to sleep. Polysomnography is used to diagnose sleep disorders.
How the Test is Performed
There are two types of sleep:
- 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.
- Non-rapid eye movement (NREM) sleep. NREM sleep is divided into 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 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.
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.
- The 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 health care provider 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 provider will observe you while you sleep and note any changes in your breathing or heart rate.
- The 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.
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.
How to Prepare for the Test
Whether the 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.
Why the Test is Performed
The 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)
You tuck yourself under the covers, turn out the light, and look forward to eight hours of blissful slumber. But, after turning for hours you're still exhausted, and no closer to sleep than when you first got into bed. Let's talk toady about sleep disorders. Sleep disorders fall into four basic categories. The scenario I described, in which you toss and turn because you can't fall asleep, is called insomnia. Another type of insomnia is when you wake up in the middle of the night and can't get back to sleep. Sometimes people get insomnia for a night or two because they're stressed out over a big meeting at work, or they're excited about an upcoming trip. Others can't sleep night after night, and that's called chronic insomnia. People with the second category of sleep disorders have a hard time staying awake during the day, even if they slept well the night before. This is called hypersomnia. Sometimes doctors can't find a cause for hypersomnia. But in many cases, a health condition like fibromyalgia, a thyroid problem, a disease like mononucleosis, obesity, or obstructive sleep apnea, can make you sleepy. If you notice a co-worker is nodding off in the middle of meetings, he might have narcolepsy, a sleep disorder that causes people to sleep uncontrollably at inappropriate times during the day. Narcolepsy isn't only embarrassing, it can be dangerous if you nod off behind the wheel of a car. A sleep rhythm problem means that you can't stick to a normal sleep schedule. Maybe you work the night shift at your job, or you're always traveling to different time zones and are constantly battling jet lag. Well, whatever the cause, the lack of a normal sleep pattern is called a sleep rhythm disorder. And finally, there are the types of sleep disorders that wake you up with a jolt in the middle of the night, and, these are called parasomnias, and they can severely interrupt your sleep. You may walk in your sleep, or act out your dreams. Children often have night terrors, in which they wake up from a deep sleep in a terrified state. The good news is that you don't have to live on fewer hours of sleep, because there are decent treatments for sleep disorders. If you're struggling to sleep throughout the night, and dragging through the day as a result, talk to your doctor, who can refer you to a sleep specialist for an evaluation.
Normal Results
A 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. AHI results are used to diagnose obstructive or central sleep apnea.
Normal test result show:
- Few or no episodes of stopping breathing. In adults, an AHI of less than 5 is considered normal.
- Normal patterns of brain waves and muscle movements during sleep.
What Abnormal Results Mean
In adults, an apnea-hypopnea index (AHI) above 5 may mean you have sleep apnea:
- 5 to 14 is mild sleep apnea.
- 15 to 29 is moderate sleep apnea.
- 30 or more 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
References
Avidan AY. Sleep and its disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 101.
Kirk V, Baughn J, D'Andrea L, et al. American Academy of Sleep Medicine position paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med. 2017;13(10):1199-1203. PMID: 28877820
Sarber KM, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 15.
Shangold L. Clinical polysomnography. In: Friedman M, Jacobowitz O, eds. Sleep Apnea and Snoring. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 4.
Version Info
Last reviewed on: 1/1/2022
Reviewed by: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutgers New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
