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Waveform Window #14: New Sleep Scoring

On July I, 2008 a new scoring manual was implemented by the American Academy of Sleep Medicine. The goal was to update scoring methods which had been in use for over 40 years, and to create comprehensive and standardized criteria for recording and staging of sleep and scoring of sleep related events. The manual has instrumentation guidelines (for standardization of filters, sampling rates, etc.), as well as criteria for information which should be included in sleep study reports. The technical methods for recording of sleep have changed minimally with the addition of frontal leads (F3 and F4); the renaming of the EOG (electrooculogram) leads as E1 and E2; and renaming of the reference leads as M 1 and M2 (left and right mastoid). The major changes in staging of sleep include the renaming of stages to N 1, N2 and N3 (indicating non-REM 1, 2, and 3); the combining of stages 3 and 4 sleep into stage N3; and the elimination of a score for movement time. Epochs with body movements are scored as Wake if any alpha is noted or if the epoch is preceded or followed by an epoch of Wake or the same as the following epoch. In addition, the three-minute rule of Stage 2 has been eliminated. Although these changes are not drastic, the major visual adjustment will be scoring six channels of EEG instead of the traditional four.