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.
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!
Great Post! I enjoyed the graphics. It seems like a lot of connections to the patient are required. I would have a hard time sleeping like that. Do you think it might be possible for you to go one morning instead of an evening in order to watch the end process?
ReplyDeleteI'm looking forward to reading all your future insights.
Thanks! I agree, it seems pretty difficult. Surprisingly though, most patients end up falling asleep fairly easily.
DeleteI'm trying to plan something, the only problem is that the studies usually end around 5 or 6 in the morning, so it might be a little difficult.