I recently underwent a duo of sleep studies to help determine whether or not I have certain sleep disorders. The overnight Polysomnogram (PSG) monitored me all throughout the night, whether awake or asleep, to determine what happened with my brain and body during the night. If successful (meaning that no issues like obstructive sleep apnea or periodic limb movement were found during the PSG), I was to stay the next day for a Multiple Sleep Latency Test (MSLT). I attended both of these.
For the MSLT, I kept all of the electrodes attached to my head, face, and shoulders/chest, to monitor brain waves, eye movement, and ekg only. But unlike the PSG, I was told to wake up and stay awake until they told me I could take a nap. In between naps, I was allowed to move about the little room as I pleased, and engage in any activities that I wanted. There were two rules: NO caffeine and NO napping until it was nap time.
The problem, however, is that I do not sleep on command. I sleep when my body gets sleepy and forces me to sleep. This led to several problems during the MSLT:
- I had just spent the past 2 hours forcing myself to stay awake, so when nap time came, it was not so easy to switch modes and allow myself to go to sleep quickly.
- I was worried and nervous about falling asleep quickly so that the lab could record good/ample data from my naps, so I was unable to fall asleep quickly.
- I don’t get to choose when I am sleepy or when I want to fall asleep, which led to me napping accidentally in between my scheduled nap times (and thus, off the record).
I asked the technician why there are two-hour breaks in between each nap, and he told me that it was because some people only get sleepy at certain times of the day, so they schedule the naps at prime times or something like that. I was somewhat dissatisfied with that answer, but didn’t push it any further.
The thing that bothers me is that if you are studying a person with excessive daytime sleepiness (EDS), they are already having issues with controlling their sleep, so I don’t understand how forcing them into a sleep schedule will yield the best data. Now, I am not a sleep doctor or a neurologist or a neuroscientist or anything, so my observations are plainly that: observation. But if one is attempting to learn about the way a person’s body operates, wouldn’t it be best to study that person in their typical “environment”?
While browsing the forums on Narcolepsy Network, I came across thread after thread of people who had similar problems during their MSLTs. I’ve read countless stories of people who had to have more than one MSLT in order to “catch” them slipping into REM during a nap, and thus confirming their Narcolepsy diagnosis.
So, why oh why, can the sleep labs not adjust their procedure for the MSLT? Is it not possible to monitor a person all day (well, for 8-10 hours or so) and catch the data when they slip into a nap? Isn’t this pretty much what happens all night during the PSG? If they want you to take 20-minute naps, they can wake you up after you’ve been sleeping for 20 minutes instead of waiting for you to wake up on your own (if left unattended, I can nap for hours). Perhaps they don’t want to use the equipment to monitor people all day long, but I would argue that if this were the procedure, many people would get their 4-5 naps in MUCH sooner, then saving them time overall.
Now, from what I have read, people with Narcolepsy may not even slip into REM every day, so there is still a chance that the results will come back “normal”, but I still think this is a better option.
I also wonder about the nature of forced naps versus natural naps. I understand that for a classic, textbook case of narcolepsy, the person will slip into REM very soon after falling asleep. But from all the research I have done, each person with narcolepsy is very different, and there are varying degrees of how much each person is affected. Is it not possible that I slip into REM quickly during a natural nap, because that is my body telling me to go to sleep like it normally would, but actually FORCING myself to go to sleep is a difference process which may not yield REM as quickly?
Another thing, from what several doctors have told me, is that it is normal for people to get a bit sleepy around 10:00 am and 2:00 pm, and so they screen for this to weed out people who have deeper sleep issues from the people who just get a bit sleepy during “normal” down times. So perhaps watching *when* a person normally naps could be enlightening.
It seems to me that it would be more logical to monitor a person during their normal, natural naps than forcing them to adhere to scheduled naps and expecting to collect the best data.