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Sleep Monitoring

What is Actigraphy?

Actigraphy is an objective, ambulatory monitoring method for tracking a patient’s sleep/wake activity patterns over time. Monitoring is done with an actigraph device.
 

An actigraph device is worn continuously like a standard wristwatch. It can be used in the comfort of the patient’s own home, for multiple days and nights. The device is noninvasive and can be worn easily, 24/7, by almost all patient populations. It’s especially useful when self-reporting is not an option, as with patients who cannot accurately or reliably self-report sleep information. Actigraphy analysis provides sleep schedule variability, sleep quantity and quality statistics, and daytime activity patterns for weeks at a time. It has been widely used and well validated in the field of sleep research for years. The long-term data collected from the home environment by actigraphy also provides sleep efficiency, total sleep time and sleep start and end times not available from any other methods.

Actiwatch Family of Ambulatory Actigraphy Devices:

Actiwatches are small, rugged, actigraphy-based data loggers that record a digitally integrated measure of gross motor activity. Each model of Actiwatch actigraph is equipped with a highly sensitive accelerometer as well as the ability to record additional data channels. The Actiwatch Score, Actiwatch-2, and Actiwatch Spectrum use actigraphy principles to provide sleep schedule variability, sleep quantity and quality statistics and daytime activity patterns so you can better identify therapeutic options and understand responses to treatment for patients. All three models collect reliable, objective data on sleep/wake patterns for multiple days in a subject’s ambulatory environment with the comfort and aesthetics of a standard wrist watch.

Activity level is recognized as a valuable indicator for medical problems and can provide answers to many research questions. Activity levels correlate with sleep/wake patterns, pain level, mood, energy expenditure, fatigue/alertness and other quantifiable parameters. An Actiwatch actigraph also provides an objective record for tracking and documenting normal and abnormal sleep/wake patterns.

Two examples of the use of the Actiwatch are:
Sleep/Wake Patterns and General Activity Level

A digitally integrated recording of wrist activity is a reliable indicator of Sleep/Wake state. The Actiwatch is an actigraphy device that is the size of a standard wrist watch. It allows for the recording of the smallest movements for days, weeks, or even months.

When worn on the wrist, an Actiwatch actigraph can generate an Activity record like the one shown below to be used as a tool to document:

  • Sleep/Wake Patterns
  • Sleep Disorders
  • Circadian Rhythms Disorders
  • Disturbances brought on by Shift WorkReal time impedance display
  • Basic Activity Levels 
  • Compliance with Exercise Routines

Actogram Examples

 
Normal Sleeper

Humans typically display a pronounced decrease in activity during rest. Rest periods are characterized by small intermittent movements while active periods show significant, constant movement. Rest and activity together display a pattern that is relatively stable over the 24-hour-day for normal sleepers. In the example to the right, from a typical normal sleeper, a relatively stable rest activity cycle is shown. The actogram is a graphical tool that allows for the rapid identification of this 24-hour pattern. Activity during these periods is reduced when compared to the active periods. Additionally, rest periods commonly occur between 2100 hours and 0800 hours with some variation for weekends.

Click  to enlarge
Black= Activity periods
Aqua = rest periods

Sleep Statistics for a Normal Sleeper
Sleep Statistics for identified sleep intervals are generated by scoring algorithms validated in patients with sleep disorders and infants. When used along with the actogram, these statistics provide objective documentation of sleep history to help shape treatment strategies during diagnosis, treatment and follow up. This objective evidence is used to inform the patient of the impact of behavioral, social, or environmental factors upon sleep patterns, quantity, and quality.

Commonly Used Statistics:

Sleep Time, Sleep Efficiency, Wake After Sleep Onset, Number of Wake Bouts, Sleep Onset Latency. 


Click to enlarge

Insomniac

For patients with sleep disorders, rest and activity data display an unstable or shifted pattern that is easy to see on an actogram. Activity depicts elevated levels at just

about any time of day. Rest periods are variable in length and timing.


Click to enlarge
Black= Activity periods
Aqua = rest periods

Shift Work Sleep Disorder

Individuals required to alter their pattern of sleep/wake in order to work at jobs with variable hours can also be tracked using the Actiwatch device. It is easy to see not

only the drastic changes in timing of the active periods, but also the fragmentation of consolidated sleep periods surrounding shift changes.


Click to enlarge
Black= Activity periods
Aqua = rest periods


Citations:

The International Classification of Sleep Disorders

Diagnostic and Coding Manual 2nd Edition American

Academy of Sleep Medicine, Westchester, Illinois. 2005
Click here for a list of papers where Actiwatch was used.

Other actogram examples are available here on pages 2 to 4.

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