1. Polysomnography: Recording and Sleep staging

4. Recording a polysomnogram

8. Recording room with study subject

9. Recording video camera

10. Monitoring room for the technician

12. Briefing Hair wash, Avoid afternoon nap Stop nonessential medications Nocturnal Polysomnography PSG components 4 channel EEG EOG Chin EMG Tibial EMG ECG Airflow monitor Pulse oximeter Respiratory effort Body position

13. PSG monitor with all the channels

15. Specific channels and Utility Male impotence Nocturnal penile tumescence Cardiac arhrythmias ECG Oxygen desaturation Transcutaneous oxymetry Chest/ abdominal respiratory effort Inductive plethysmography Disorders of respiration Thermistor/ thermocouple Respiratory effort Intercostal EMG Movement disorders Superficial EMGs: Tibialis anterior, gastrocnemius, wrist extensor

17. EEG Electrodes

18. EEG electrodes: occipital electrodes

19. EEG central electrodes, EOG electrodes

27. Limb EMG electrode placement

31. Thermistor

33. Sensors for plethysmography

34. Sensors for respiratory effort

35. Transducer for thoracoabdominal movement

36. Transducer for thoracoabdominal movement

47. Snoring monitors

48. Chin EMG, airflow and snoring sensors

49. Snoring monitor

54. Oxymetry sensor

55. Oxymetry sensor

60. Electrocardiogram

63. Artifacts

70. Sleep Staging

71. Sleep staging NREM REM Stage 1 Stage 2 Stage 3 Stage 4 CAP Non-CAP Phase B Phase A

73. Stage W: Awake state Eyes open: slow eye movements when drowsy. Eyes closed: REMs or none. Relatively high tonic activity. Voluntary control. Voluntary control Eyes closed: rhythmic α , occipital dominant; disappears on eye opening. Eyes open: low voltage mixed frequency. EMG EOG EEG

77. Stage 2 Tonic activity low No eye movements, or occasional SEMs. Background: Relatively low voltage, mixed frequency(3-7/sec). Sleep spindles: K complex: Biphasic; maximum at vertex. Delta activity <20% EMG EOG EEG

83. Stage 4 Stage 3 Low level tonic activity. None. Delta activity (2/sec or less), high amplitude(> 75 µV). 20%-50% of epoch. Maximum in central. Sleep spindles may be seen. Low level tonic activity. None. Delta activity with high amplitude(> 75 µV) comprising >50% of epoch. Sleep spindles and K complex occur rarely. EMG EOG EEG

87. Stage REM Tonic: suppression. Phasic: twitches. Phasic: intense REM. Tonic: none or few. Relatively low voltage, mixed frequency saw tooth waves; theta activity; slow alpha. Initial REM period at times contains some low-voltage spindles. EMG EOG EEG

89. Stages of sleep

90. Proportion of sleep stages

91. Sleep stages and age

92. Sleep terminology Time spent in sleep/ time in bed (Normal >85%) Sleep efficiency (REM+ NREM)- awake time Total sleep time Light off to sleep onset. Latency of sleep onset 3 consecutive epochs of Stage 1 NREM, or first epoch of any other Stage. Sleep onset Total minutes spent in bed. Time in bed End of recording. Light on Start of recording. Lights out Fixed time domain of 30 sec. Epoch

97. Generating a report

103. Sleep parameters 0.0 60.1 174.7 Stage Wake 25.5 85.5 248.5 Non-REM 32.5 14.5 42.0 Stage REM 51.5 0.2 0.5 Stage 4 43.0 15.1 44.0 Stage 3 26.0 56.1 163.0 Stage 2 25.5 14.1 41.0 Stage 1 Latencies %TST Minutes

104. Arousal analysis 26 0 5.4 26 Arousal associated with Snores 1 0 0.2 1 Arousal associated with Hypopnea 0 0 0.0 0 Arousal associated with Central Apneas 0 0 0.0 0 Arousal associated with mixed Apneas 1 0 0.2 1 Arousal associated with OSA 1 0 0.2 1 Arousal associated with resp. Events 10 0 2.1 10 Arousal associated with periodic Movement 0 0 0.0 0 Arousal associated with Desaturations 52 1 10.9 53 Arousals NREM REM Index No

105. Leg movements 0.6 3 3 0 Isolated with arousal 3.9 19 16 3 Isolated (Total) 2.1 10 10 0 Periodic with arousal 28.1 136 124 12 Periodic (Total) Index Total No of Movements NREM REM Movement Types

106. Respiratory events and sleep Stages 12.8 10.8 12.8 Max Duration 12.8 10.8 12.8 Min Duration 11.3 10.8 11.5 Mean Duration 3 1 2 # HYPOPNEA - - - Max Duration - - - Min Duration - - - Mean Duration 0 0 0 # OBSTRUCTIVE - - - Max Duration - - - Min Duration - - - Mean Duration 0 0 0 # MIXED - - - Max Duration - - - Min Duration - - - Mean Duration 0 0 0 # CENTRAL Total REM NREM