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How Reliable Are The Psg And Mslt?


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#1 napper123

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Posted 31 October 2012 - 10:01 AM

Hi

After reading some of the posts on the forum, it seems like a number of people have had different results on the PSG and MSLT tests.

Does anyone know:
A) do narcoleptics ALWAYS have messed up REM patterns in the PSG, or can they vary from night to night, or month to month?

B) how reliable are the PSG and MSLT tests? how often do you get false positives or false negatives? (how would you even know?) and how do doctors use them? like are there people who are normal on the PSG and MSLT who have sleepiness problems that are still labeled narcoleptic? I think if you were sleep deprived you could still end up positive on the MSLT for narcolepsy because you would go into REM sleep really quickly... right?

thanks

#2 Megssosleepy

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Posted 31 October 2012 - 11:07 AM

Hi

After reading some of the posts on the forum, it seems like a number of people have had different results on the PSG and MSLT tests.

Does anyone know:
A) do narcoleptics ALWAYS have messed up REM patterns in the PSG, or can they vary from night to night, or month to month?

B) how reliable are the PSG and MSLT tests? how often do you get false positives or false negatives? (how would you even know?) and how do doctors use them? like are there people who are normal on the PSG and MSLT who have sleepiness problems that are still labeled narcoleptic? I think if you were sleep deprived you could still end up positive on the MSLT for narcolepsy because you would go into REM sleep really quickly... right?

thanks


I wish I had answers to all of your questions, but my doc didnt really explain my test results. All I know is mine were different then from the ones Ive read on here. My PSG shows only stage 1 sleep and no REM (although I remember dreaming, and they were vivid) Along with only stage 1 sleep I woke well over 20 times during the night... I only remember 6 or 7, but I still got a total of 7 hours.

My MSLT also didnt show REM, although once again I remember vivid dream 2 out of 4 naps... Didnt need the 5th cuz it was only taking me 20 seconds to 53 seconds to fall asleep. The 20 seconds was on the 4th nap... they also kept having to wake me during the day (I kept going for walks in the sunshine to try to perc up)... I asked why the test didn't show REM, and my doc wasn't sure... but was positive I had pretty yuck Narcolepsy.

I would be interested in hearing other peoples answers to your questions.

I do know certain drugs, certain foods, and schedule could effect results as well.

#3 DeathRabbit

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Posted 31 October 2012 - 11:11 AM

I wish I had answers to all of your questions, but my doc didnt really explain my test results. All I know is mine were different then from the ones Ive read on here. My PSG shows only stage 1 sleep and no REM (although I remember dreaming, and they were vivid) Along with only stage 1 sleep I woke well over 20 times during the night... I only remember 6 or 7, but I still got a total of 7 hours.

My MSLT also didnt show REM, although once again I remember vivid dream 2 out of 4 naps... Didnt need the 5th cuz it was only taking me 20 seconds to 53 seconds to fall asleep. The 20 seconds was on the 4th nap... they also kept having to wake me during the day (I kept going for walks in the sunshine to try to perc up)... I asked why the test didn't show REM, and my doc wasn't sure... but was positive I had pretty yuck Narcolepsy.

I would be interested in hearing other peoples answers to your questions.

I do know certain drugs, certain foods, and schedule could effect results as well.


I think the reason REM is suppressed during PSG/MSLT is anxiety. You're in a strange bed, worrying whether or not you might have a condition, whilst electrodes are all over your body. I stayed most of the time in stage 2, with REM onset at normal time, but only 16 minutes of SWS for the whole 8 hour affair. As bad as I was then, I'm pretty sure I wasn't getting only 16 minutes of SWS on average or I would be dead.

During my MSLT was when I showed the REM stuff. I fell asleep 4 out of 5 naps, had REM i n3 of them, one of them falling instantly to REM.

#4 Megssosleepy

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Posted 31 October 2012 - 02:48 PM

I think the reason REM is suppressed during PSG/MSLT is anxiety. You're in a strange bed, worrying whether or not you might have a condition, whilst electrodes are all over your body. I stayed most of the time in stage 2, with REM onset at normal time, but only 16 minutes of SWS for the whole 8 hour affair. As bad as I was then, I'm pretty sure I wasn't getting only 16 minutes of SWS on average or I would be dead.

During my MSLT was when I showed the REM stuff. I fell asleep 4 out of 5 naps, had REM i n3 of them, one of them falling instantly to REM.


I got no SWS during my sleep study... But I think you are right about the strange bed ect... plus I was cold and I brought the wrong pillow...

The thing is I remember dreaming... wonder if my eyeballs don't move or something lol :wacko: Or maybe I wonder since I am awake when I start dreaming if that is why it doesn't show?

#5 DeathRabbit

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Posted 31 October 2012 - 05:03 PM

I got no SWS during my sleep study... But I think you are right about the strange bed ect... plus I was cold and I brought the wrong pillow...

The thing is I remember dreaming... wonder if my eyeballs don't move or something lol :wacko: Or maybe I wonder since I am awake when I start dreaming if that is why it doesn't show?


When I get really derpy, my eyes actually want to roll around in my head at breakneck pace. I have to concentrate to stop it.

#6 MINItron

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Posted 31 October 2012 - 07:10 PM

Hi

After reading some of the posts on the forum, it seems like a number of people have had different results on the PSG and MSLT tests.

Does anyone know:
A) do narcoleptics ALWAYS have messed up REM patterns in the PSG, or can they vary from night to night, or month to month?

B) how reliable are the PSG and MSLT tests? how often do you get false positives or false negatives? (how would you even know?) and how do doctors use them? like are there people who are normal on the PSG and MSLT who have sleepiness problems that are still labeled narcoleptic? I think if you were sleep deprived you could still end up positive on the MSLT for narcolepsy because you would go into REM sleep really quickly... right?

thanks


My sleep doc told me that the sleep studies are not definitive. I know that for me the EEG probes had a definite ultrasonic hum that intruded into my sleep, and kept me from going into deeper sleep during my MSLT. I fell asleep for all 5 naps, and my mean latency was less than 5 minutes. I only had REM in one nap though, so I was not given a diagnosis of narcolepsy. The nap that I hit REM was the nap that I fell asleep in only 2 minutes. I have all of the classic symptoms of narcolepsy including having had a period of 3 or 4 years where I had cataplexy that was triggered by anxiety.

#7 Hank

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Posted 31 October 2012 - 09:15 PM

Hi

After reading some of the posts on the forum, it seems like a number of people have had different results on the PSG and MSLT tests.

Does anyone know:
A) do narcoleptics ALWAYS have messed up REM patterns in the PSG, or can they vary from night to night, or month to month?

B) how reliable are the PSG and MSLT tests? how often do you get false positives or false negatives? (how would you even know?) and how do doctors use them? like are there people who are normal on the PSG and MSLT who have sleepiness problems that are still labeled narcoleptic? I think if you were sleep deprived you could still end up positive on the MSLT for narcolepsy because you would go into REM sleep really quickly... right?

thanks



For me, my PSG showed very fragmented sleep with many "arousals". For my first MSLT, I was reducing off a medication which my doctor knew would invalidate the results. I did fall asleep on all 5 naps but did not have any REM.

When I repeated the MSLT 6 months later, I slept 5 of 5 naps. In 2 naps I reached REM in 3 minutes. Strangely, the naps I reached REM were the naps I did not think I slept at all. I remember telling the tech that I did not sleep. My dreams were an extension of what I was thinking about while falling asleep. I seemlessly went from remembering an event to dreaming about the event in great detail. It made me curious how many other times I did not know I was dreaming.

Even then, my doctor was not willing to say Narcolepsy, until we discussed Cataplexy in detail. Once she was certain about Cataplexy, she made the diagnosis.

For me, Narcolepsy was a rigorous diagnosis. My doctor strongly suspected it, but was very reluctant to make it- even when I had 2 sleep onset REM episodes and slept all 5 naps.

An MSLT is always done immediately following a PSG, so they can make sure you got enough sleep to make the MSLT valid. The MSLT is where the N diagnosis is made. The PSG is where a sleep apnea diagnosis is made. If you had sleep apnea, they would have put you on a CPAP.

#8 MINItron

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Posted 31 October 2012 - 10:19 PM

When I repeated the MSLT 6 months later, I slept 5 of 5 naps. In 2 naps I reached REM in 3 minutes. Strangely, the naps I reached REM were the naps I did not think I slept at all. I remember telling the tech that I did not sleep. My dreams were an extension of what I was thinking about while falling asleep. I seemlessly went from remembering an event to dreaming about the event in great detail. It made me curious how many other times I did not know I was dreaming.


My first nap during my MSLT showed no REM, but I had a VERY vivid dream that I can still remember in great detail almost two months later. The other four naps I had sleep paralysis from the minute I closed my eyes until the tech came back into the room, but only flashes of fragmented dreams.

#9 Megssosleepy

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Posted 01 November 2012 - 10:31 AM

My first nap during my MSLT showed no REM, but I had a VERY vivid dream that I can still remember in great detail almost two months later. The other four naps I had sleep paralysis from the minute I closed my eyes until the tech came back into the room, but only flashes of fragmented dreams.


I wonder why if we drempt it didnt show up with their test?... is vivid dreaming different from REM sleep? I normally only remember dreaming when I have normal dreams, but when they are vivid I remember every strange detail pretty much forever!

#10 DeathRabbit

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Posted 01 November 2012 - 11:30 AM

My first nap during my MSLT showed no REM, but I had a VERY vivid dream that I can still remember in great detail almost two months later. The other four naps I had sleep paralysis from the minute I closed my eyes until the tech came back into the room, but only flashes of fragmented dreams.


Could have been akin to a night terror. Sometimes, dream like stuff can occur in SWS.

#11 MINItron

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Posted 01 November 2012 - 08:03 PM

Could have been akin to a night terror. Sometimes, dream like stuff can occur in SWS.


I was floating through the plane that I work on, and all of the avionics were coming out of the racks. Then all of the circuit cards were coming out of the boxes. It was complete with the sounds and smells to go along with being in the plane. The hum of the EEG probes blended into the normal background noise on the plane, which is probably what set it off in the first place. It all passed very quickly. I was aware of the passage of time in all 5 of my naps, even the one where I hit REM. I knew I was asleep, but I never really clocked out.