Polysomnography

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 their specific brain wave patterns (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.
• A sleep center technician 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 technician 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. Many sleep centers may also have a mail-to-home option so that the device can be delivered to your doorstep.

Home testing may be used when:

• You are under the care of a sleep specialist.
• Your sleep specialist 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.

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

The test helps diagnose possible sleep disorders, including obstructive sleep apnea (OSA). Your health care 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)

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 efforts to breathe
• 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 episodes that occur per hour measured during a sleep study. AHI results are used to diagnose obstructive or central sleep apnea.

Normal test results show:

• Few or no episodes of stopping breathing. In adults, an AHI of less than 5 per hour is considered normal.
• Normal patterns of brain waves and muscle movements during sleep.
  

In adults, an apnea-hypopnea index (AHI) of 5 per hour or above 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, your sleep specialist must also look at:

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

Sleep study; Polysomnogram; Rapid eye movement studies; Split night polysomnography; PSG; OSA - sleep study; Obstructive sleep apnea - sleep study; Sleep apnea - sleep study

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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 pubmed.ncbi.nlm.nih.gov/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.

Updated 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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.