scoring arousals when alpha intrudes in all stages

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scoring arousals when alpha intrudes in all stages

Postby pg55 » Wed Mar 16, 2016 8:23 am

I read the very informative thread about alpha intrusion but that didn't clarify enough for me to be sure I'm scoring this correctly. I'm new to scoring and work alone in my lab. My patient has alpha in all stages of sleep, a lot of alpha. I have scored stages pretty much based on snore, eye movement, chin emg changes and whether or not I see sleep spindles or k complexes. Where I am really second guessing myself is deciding which if any of the alpha bursts to score as arousals. I would love a clear cut answer, but I think the best possible scenario is going to be someone more experienced willing to tell me what they would do. Most bursts are less than 3 seconds but not all, but I don't think I have more than 10 to 15 seconds of sleep without alpha in the entire night except during REM. There is alpha in REM just not as much. Yes she does have fibro and "doesn't like to take" her pain pills. Any help would be appreciated, a simple clear cut rule and I will love you forever.
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Re: scoring arousals when alpha intrudes in all stages

Postby somnonaut » Wed Mar 16, 2016 12:50 pm

Arousals are the source of our existence. If it was not for arousals, our whole field would be kaput. The thought of having "a simple clear cut rule" is so out of this world and this shows in that even after 80 years of dicking around with this thing we call sleep, we have not been able to come up with more than 3 sentences for arousal rules.

My biggest complaint is there is ruling governing OFFSET to "alpha" (more rightfully called non-sleep EEG) such that we do not even know how our internal 3 second clock should stop counting in our tagging of these minimal events.

There are other threads where we could slice and dice arousals IF we had this simple offset rule.

viewtopic.php?f=15&t=3259

As for your sepcific situtation, why do you feel compelled to give the patient sleep, when the EEG states otherwise? There is nothing that says we HAVE to look through the alpha to "see the sleep." That is the probably the genesis of the complaint that brought the patient in. Score the epochs that drop their non-sleep eeg to levels within the standard rules and be done with it. This is very neat case because you say the patient DOES NOT take her meds, so it may not be pseudo-spindling (make sure you are counting those waves and they are not FASTER than alpha.) Unless there are other med interactions, and there too, you would want to present a PSG report with proper objective descriptions of the study, not subjective accounting of the patient "trying to get sleep." If the patient is not getting "rule based sleep" at night, then that is what should be described. That is the reason for rules in the first place.
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Re: scoring arousals when alpha intrudes in all stages

Postby respbarb » Thu Mar 17, 2016 9:14 pm

Are you teaching yourself to score? This might be helpful


http://192.168.1.1:8181/http://www.n2sl ... 0SLEEP.pdf
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Re: scoring arousals when alpha intrudes in all stages

Postby somnonaut » Thu Mar 17, 2016 10:21 pm

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Re: scoring arousals when alpha intrudes in all stages

Postby respbarb » Fri Mar 18, 2016 9:40 pm

Haha- thanks Claude!
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Re: scoring arousals when alpha intrudes in all stages

Postby somnonaut » Mon Mar 21, 2016 11:46 am

After I actually read the link, I would LOVE to rescind my help in finding it. Massive amount of incorrect information in there. I would not use it to learn the AASM Scoring rules or the R&K rules. Sorry, but it is just wrong in places.
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Re: scoring arousals when alpha intrudes in all stages

Postby respbarb » Mon Mar 21, 2016 8:14 pm

Yeah- its old, but still helpful with visual aids to recognize sleep.
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Re: scoring arousals when alpha intrudes in all stages

Postby somnonaut » Mon Mar 21, 2016 9:57 pm

It's not "old", it is wrong. SWA was NEVER .5-3 hz. That is just completely wrong.
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Re: scoring arousals when alpha intrudes in all stages

Postby respbarb » Wed Mar 23, 2016 8:50 pm

you're right- that's Glen's work
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Re: scoring arousals when alpha intrudes in all stages

Postby somnonaut » Wed Mar 23, 2016 10:10 pm

I know.
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Re: scoring arousals when alpha intrudes in all stages

Postby respbarb » Wed Mar 23, 2016 10:39 pm

thanks old eagle eye!
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