Selecting Target Groups and Arranging for the Survey to be Administered

A lot of this week was spent contacting various teachers at other schools to see if administering my survey at a public high school would be a possibility. Many many emails later, I learned I'd need to seek district approval before I could proceed with my surveys. Unfortunately, it turns out that the process for seeking approval is very long and wouldn't be completed in time for my project :/

Because of this, I ended up changing the topic of my research again. Instead of looking at the sleeping habits of kids at a BASIS and at a public school, I limited my target group to include just BASIS students. However, since BASIS's high school is small and would only render around 80 usable surveys, I also expanded my target group to all of BASIS Peoria's population (Grades 5-12). I plan to deliver these surveys next week during the lunch periods. 

Creating the Surveys

This week, in addition to my regular schedule at my internship, I begun finalizing the research portion of my project. Seeing as the main goal of my project involves finding trends in the sleeping patterns of students in different school environments, it seemed fitting for me to collect data via a survey.

Truth be told, creating the survey was a lot harder than I had initially expected. The first issue I had was figuring out which questions were important to ask and which ones could be left out (because nobody would opt to fill out a super long survey). The second issue I faced was actually phrasing the questions in a clear and coherent manner. While I, and everyone who helped me write the questions, knew what the expected answer was, I needed to make sure that when I gave the survey to a complete stranger, they would also know what I'm asking them for.

Several drafts and proofreaders later, I think I finally have a working survey! Next, I need to arrange for the surveys to be administered to my target groups!

As promised, here's some more information on the patient interaction part of the process. I recently discovered that most patients who haven't had a sleep study before are surprised by what their room looks like. Most of them are expecting a stereotypical hospital bed in a generally unfriendly environment. However, the rooms the patients spend their night in are pretty much hotel rooms with a comfortable, full size bed, a bathroom, a TV.

In terms of the hookup itself, below is an image of the "box" which I mentioned earlier. Every electrode is connected to this box and it is hung up on the wall next to the patient's bed. As such, the wires are neatly bundled which allows the patient to move around comfortably (comfortable being a relative term). If the patient needs to get up for any reason, the technician can remove the box from the wall, hand it to the patient (there's also a strap so the patient can hang the box around their neck) and the patient can get up and do what they needed to do. 

I apologize again for taking so long to put out this post, my internship keeps me busy pretty much all the time. Over the past few weeks I've learned a ton and I've become fairly proficient at analyzing the polysomnograms. Primarily, I've focused on identifying apneic events such as hypopneas (where the patient pauses their breath or as the term literally translates to, "under-breathes"). These hypopneas usually come in one of two varieties: obstructive or central.

An obstructive hypopnea is caused by a partial blockage in the airway. When we sleep, our throat muscles relax and allow for fatty tissue and the tongue to potentially fall back and block the airway. That's the noise you hear when someone snores. When this blockage is significant however, it reduces the airflow to the body and signals the brain to partially awaken from sleep (this is called an arousal) and instruct the body to breath. If you've heard someone with sleep apnea during the night, this is what is happening when they make a choking sound or gasp for air. 

A central hypopnea, on the other hand, is not a "mechanical" problem, but a "communication" problem. Central hypopneas occur when the brain temporarily fails to signal the muscles which are responsible for breathing. Central hypopneas are far less common and occur in less than 20% of apneic patients. 

In order to mark an event as an obstructive hypopnea, a 3% oxygen desaturation must be present. For medicare patients, due to the differing requirements they set, there must be a 4% desaturation. To mark an event as a central hypopnea, in addition to those criteria, there must be "no effort made to breath". Among the many things attached to a patient, there are two belts (one above the chest and one around the abdomen). These belts allow us to see whether the patient is actively trying to breath by expanding and contracting their diaphragm. If the readings from these belts indicate the patient is not moving the muscles necessary to breath while the desaturation occurs, the event will be marked as a central.

What took me by surprise the most is how common these events can be. In order to determine the severity of someone's sleep apnea, the AHI (apnea-hypopnea index) is used. This index essentially conveys how many events a patient has per hour. According to this index, it's normal for a person without any sleep apnea to undergo up to 5 events (which are marked by 10 seconds of not breathing/under breathing) per hour! Patients with very severe sleep apnea can undergo over 30 events per hour. That's 300 seconds of incomplete breathing. 5 minutes out of every hour! Knowing this information helped me understand why apneic patients are generally tired during the day, instead of resting overnight, their brain is continually awoken so that it can focus on ensuring proper breathing. 

I'm so Good at Sleeping That I Can do it With my Eyes Closed!

It took a little longer than I expected to put out this next post - but here it is! The last week and a half has been really busy, but I'm thoroughly excited as my project is falling into place. I've been going to the sleep center almost every night from 8/8:30-11pm. As you can imagine, that's left me in an endless state of tiredness. Fortunately, now that I'm almost caught up to where I should be in terms of hours, I'll be able to take a few nights off.

Anyways, the internship itself has been amazing! I'll start out by explaining how the usual night goes: So when I first arrive at the center, we're mainly engaging in prep work (gathering the appropriate paperwork, making sure the rooms are neat, preparing the cart with everything we'll need to hook the patient up). At this point, we usually only need to wait a few minutes for the patients to arrive. Once they do, we show them to their room and allow them to get ready for bed. As soon as they're ready, the polysomnographic technologist begins to place the electrodes. This is where things begin to get complex.

There are, in all, about 20 electrodes and sensors which go on various places of the body. Two EMGs (which are not as precise as the other electrodes) go on each leg (to detect motions that may be indicative of restless leg syndrome), two EKGs are put on the chest area (to monitor the heart), two near the eyes (to help identify the stage of sleep), some on the chin and cheek area (to detect tension in the jaw area or grinding of the teeth) and finally, several electrodes are placed on the scalp (as shown in the picture below). Placing these electrodes is, or at least seems to be, just as complex as it looks - although I've been told it gets easier over time. This process is easily the most time consuming of them all.

But wait.. that's not all! In addition to these, there are: two belts placed around the abdomen and chest area (to monitor the patient's breathing), a snore mic taped either to the cheek or on the neck (as you can guess, to record any snoring), a sensor clipped onto the finger (to monitor the patient's oxygen level), and (if applicable) a thermistor sensor is used (to measure airflow from the nose). 

Now, when all of these have been attached, the patient is finally ready to lay down! (You might be wondering what would happen if someone needed to use the restroom at night, if the patient doesn't ask this on their own, we always let them know that the box to which all of these wires are connected is portable. A night tech can simply dismount the box from the wall and the patient may carry it into the bathroom with them.) 

While everything up to this point is truly amazing, this next part is probably my favorite. At this point, we return to the tech room which has a computer linked to each room. After setting up the program, the screen displays all of the data gathered from the various sensors. It took me forever to find this picture below, but I still don't really like it. Each tech and/or program has a different way of displaying all of the information, so this one is just not visually pleasing to me. Hopefully later on I'll be able to post a picture of the ones I'm used to seeing. As of right now, I'm pretty good at deciphering eye movements and characteristics of the first stage of sleep. In the image below, the green line shows the movement of the eyes. Each sharp, symmetrical bump is, if I am correct (which I might not be, I'm really unfamiliar with this montage), a blink of the eye. Seeing as the patient is blinking, and the pattern of the waves displayed at the top (I'll get into those in a different post), the patient is not yet sleeping. Once they start falling asleep, you'd see what are called "rolling eye movements" which I like to think of as blunt and stretched out blinks. Furthermore, there will be some signs in the waves above (such as sleep spindles and K complexes) which I shall discuss at a later time.

Anyways, so in the tech room, along with the above image, we see a live video feed of the patient and can communicate with them via intercom (Their end is always turned on so they don't need to press a button to speak). This is my favorite part, essentially, in order to make sure the readings on the screen correspond with what is actually happening, we ask the patient to do certain things (such as look right, left, down, up, blink 5 times, move your leg, make a snoring sound, and grit your teeth). I love this part because it's actually really cool to see each of these actions and watch them translate to something as simple as a 2-D wave on the screen. This part has also helped me pick up on things I should be looking for while looking at the polysomnogram. I could probably go on forever talking about all of the things I've seen, but I'll save the rest for next time. 

After this, I watch as the techs score the patients sleep until 11 and discuss any questions I have regarding what I see or any events they point out. Then I leave and get some sleep for myself!

Shout out to Antonio, Fernando, Renee, and Michelle for all of their help at my internship!

And to Mr. Tran for the sleep joke!

Introduction

Hi Everyone!

My name is Radhika and I'm currently a senior at BASIS Peoria High School. Basically, during the third trimester, instead of having formal classes, we're given the opportunity to conduct our own research project while interning with a professional in the field. In may, we'll be presenting these projects to the school and community!

Without further ado, my project will be on sleep apnea and I'll be interning at Valley Sleep Center! Usually, this is the point at which someone makes the joke about how they love sleeping. However, I'll be interning during their night studies which begin at 8:30 and end the next morning (but I'll probably leave around midnight). So it goes without saying that sleep isn't something I'm going to be getting much of. Normally that would be a problem, but I'm really excited to assist the sleep techs with their work!

I've always been really fascinated with sleep, although it started out a little superficially. At first I was just interested in the concept of sleep. I made sleeping for at least 8-9 hours a night a priority because I thought, as some studies confirm, that it would improve my quality of life. I actually begun tracking (and still track) how many hours I sleep each night with an app called SleepBot. However, after taking AP Psychology, my interest shifted to the actual workings of the brain during sleep. In fact, I became so fascinated with the brain that over the past years I can say with a decent amount of confidence that I want to pursue a career in neuroscience!

Back to my SRP, even though I've only gone to the center once, I'm still really awed by everything that goes on at the sleep lab and how much data they can collect regarding the patient's sleep. It's amazing how they can utilize that data to help their patient improve their quality of sleep!

Anyways, I'll be able to make a more specific blog post tomorrow. I bought black scrubs today and I'll be interning for the first time tonight! I couldn't be more excited for this opportunity!