SLEEP EEG
Dr Upasana Rai
• Sleep 2 broad types: nonrapid eye movement
(NREM) sleep and REM sleep.
• Based on EEG changes, NREM is divided
further into 4 stages (stage I, stage II, stage III,
stage IV).
• NREM and REM occur in alternating cycles,
each lasting approximately 90-100 minutes, with
a total of 4-6 cycles.
• healthy young adult NREM sleep accounts for
75-90% of sleep time (3-5% stage I, 50-60%
stage II, and 10-20% stages III and IV).
• Healthy young adult REM sleep accounts for
10-25% of sleep time.
• EARLY DROWSINESS In the adult, the onset
STAGE 1 of drowsiness is characterized by gradual or
brisk “alpha dropout”. The alpha waves are
SLEEP replaced by low-voltage slow activity, mainly
in the range of 2 to 7/sec.
• Alpha
dropout
• Alpha
dropout
• Slow rolling eye movements (SREMs): evidence of drowsiness seen
on the EEG. SREMs of drowsiness are most often horizontal, they are
slow (ie, typically 0.25-0.5 Hz).
• Slow rolling
eye
movements
• DEEP DROWSINESS
• Vertex waves- hallmark, sharply contoured waveforms, negative
polarity, maximal at the centre part of head (vertex).
• In late stage1, persist in stage2 but usually disappear later.
• amplitude is 50-150 µV.
• Unlike K complexes, vertex waves are narrower and more focal and
by themselves do not define stage II.
• Vertex waves
• Vertex waves
• Positive Occipital Sharp Transients of Sleep (POSTS)-
• positive maximum at the occiput, contoured sharply
• occur in early sleep (stages I and II).
• morphology as "reverse check mark"
• amplitude is 50-100 µV.
• occur in runs of 4-5 Hz
• persist in stage II sleep but usually disappear in subsequent stages.
• Positive
occipital
sharp
transients of
sleep
• SLEEP SPINDLES- a “group of rhythmic waves
characterised by progressively increasing, then
gradually decreasing amplitude”: a belly in the
middle tapering off to the left and to the right.
• The first spindle trains- around 14/sec, primarily
central, maximum over the vertex.
STAGE 2 • The 12/sec spindle train appears a little later
with deepening sleep, over frontal areas.
SLEEP • With deepening sleep (at the transition from
stage 2 to 3), even slower type of spindle
(around 10/sec) is commonly seen; with a
frontal maximum.
• Amplitude is usually 20-100 µV
• Sleep
spindles
• Sleep
spindles
• K complexes are high amplitude (>100 µV), broad (>200 ms),
diphasic, and transient and are often associated with sleep spindles
• Location is frontocentral, with a typical maximum at the vertex
• They occur spontaneously and are elicited as an arousal response
• Naming was made on the spur of the moment without attaching any
significance to the letter K. Also assumed that “K” stands for
“knocking” and the ensuing arousal activity in the EEG.
• K complex
• Slow background activity dominates the picture.
Delta frequencies in the 0.75 to 3/sec over the
anterior regions.
• Sleep spindles are still present but gradually
become less impressive
• Anterior delta activity with interspersed minor
STAGE 3 & sharp transients may form a pattern that has been
described as “mitten pattern.”
4 SLEEP • SWS is defined by the presence of such delta
activity for more than 20% of the time, and an
amplitude criterion of at least 75 µV is often applied.
• Stage III is defined by delta activity that occupies
20-50% of the time, whereas in stage IV, delta
activity represents greater than 50% of the time.
• Slow wave
sleep
• Slow wave
sleep
• observation requires a long waiting period,
does not appear before 60 to 90 minutes
after sleep onset
• patients with a history of narcolepsy,
severely disrupted sleep–waking cycles, in
REM delirium tremens, or with deep-seated
SLEEP lesions or disturbances involving the
brainstem may occasionally show early REM
phases.
• low-voltage, polyrhythmic, “sawtooth
waves” in the 2 to 6/sec range appear in
short bursts over frontal leads or vertex.
• REM sleep is defined by (1) rapid eye movements, (2) muscle atonia, and (3)
EEG desynchronization (compared to slow wave sleep). Thus, require EOG &
EMG.
• EEG desynchronization: The EEG background activity changes from that seen
in slow wave sleep (stage III or IV) to faster and lower voltage activity (theta
and beta), resembling wakefulness. Saw tooth waves are a special type of
central theta activity that has a notched morphology resembling the blade of a
saw.
• Rapid eye movements: These are saccadic, predominantly horizontal, and occur
in repetitive bursts.
• REM sleep
EEG Staging (Rechtschaffen and Kales)
• Stage 1 and
stage 2 sleep
EEG
• Stage 3 and
stage 4 Sleep
EEG
• REM stage Sleep
EEG
