Multi-Modal Home Sleep Monitoring in Older Adults

Our protocol has increased both the reliability of acquiring high quality sleep monitoring data in the home as well as the ease of use for older adults. The implementation of an educational flip manual has created consistency during in-person training. In addition to providing step-by-step instructions for participants to reference at home.

This protocol improved the reliability of home sleep testing which can be used to diagnose some sleep disorders such as sleep apnea and periodic limb movement disorder. Monitoring sleep-wake activity in older adults may be important for studies and many areas of research including cardiovascular disease and dementia. Home sleep monitoring is more naturalistic and has a lower cost than sleep testing in a laboratory.

Begin by escorting the participant into the set up room. Instruct the participant about the home sleep test device or HST. Place the black lanyard strap around the neck and tighten until it is comfortably snug.

Next, have the participant stand up and position the blue belt with the holster around the chest directly under the armpits with the buckle almost centered. Then, place the other blue belt around the waist and tighten the belt until it is snug enough so it does not slide when moving during the night. Point the arrow on the belt buckle facing down.

Next, snap the white box into the holster on the chest belt. And open the device by sliding the button at the top of the device to the right. Plug the chest wires into the ports on the bottom of the chest belt buckle.

And plug the abdominal wires into the ports on the bottom of the abdominal belt buckle. Place the prongs of the white wire in the nose and wrap the wire around their ears. Pull the plastic piece up toward the neck to secure.

Position the second set of prongs in their nostrils and wrap tubing around the participants ears. Ensure that the two prongs from the canula fit just inside the nose and position the longer prong in front of the mouth. Slide the plastic piece up toward the neck to secure and use a small piece of tape to affix both sets of tubing to each cheek.

Then, run the long red and white leg wires through each pant leg along the side to avoid them getting tangled during the night and affix with sticky patches. Next, locate the anterior tibialis muscle on the outside of the participant’s leg and place the sticky patches directly on the muscle at least two finger widths apart from one another. Lastly, apply tape over each sticky patch to cover it.

Bend the knee and tape the wire above each knee to prevent them from getting tangled. Begin by pinching the top of the oximeter to open the clip. Match up the picture of a fingernail on the outside of the clip to the fingernail of the middle or index finger and place the oximeter on the index or middle finger.

Wrap tape around the outside of the oximeter clip to secure and tuck the extra oximeter cable in the chest belt to avoid getting tangled in the wire. Then unless using PAP look at the man on the display screen and confirm that no signals are flashing. Once all sensors are on properly, and lines are solid, close the device.

Tell the participant that if the yellow light on the outside of the device starts flashing during the night the device has lost a signal. If this happens, open up the device to check the display window to determine which signal has been lost. Once identified, reattach the sensor that has come off.

Then, press the circular event button on the outside of the device at lights out and again at lights on. Open the device and check the good study indicator circle. If the participant wears PAP attach a PAP titration kit to the device to measure PAP flow by twisting it into the connector designated for the nasal canula.

Ask the participant to attach the PAP mask to one side of the titration kit adaptor and the hose to the other side of the adaptor. Inform the participant that the line connected to the mouth and the yellow light on the device will flash the entire time if used with positive airway pressure or PAP. A piece of tape is placed over both flashing lights as a reminder to the participant.

Then, place the single channel EEG device over the participant’s head to demonstrate proper placement. Instruct the participant on how to adjust the head gear for proper fit and where to affix the electrodes on the forehead for accurate placement. Finally, instruct the participant to apply the device before the mask at night in order to allow removal of the mask without dislodging the device.

These results indicate a single channel EEG hypnogram showing artifact free data collection during different sleep stages. On the other hand these results show a hypnogram in which there was artifact. And thus the sensors on the single channel EEG were unable to record brain wave activity during different sleep stages.

Further, it is feasible to obtain high quality sleep monitoring at home in an elderly population with a single channel EEG device for sleep staging and an HST to screen for sleep disorders such as obstructive sleep apnea as shown here. The most important thing to remember in this protocol is to break the instructions down into small steps to simplify the procedure as much as possible for the participant. Following this procedure a clinical participant or research patient should be able to independently apply the home sleep testing equipment.

This procedure has allowed researchers to perform detailed sleep-wake assessments at home in older adults. Additionally we have used this procedure to study how sleep changes at different stages of Alzheimer’s disease.