well come to this introductory video on the application and editing of sleep staging with sleep profiler.In this first segment of the video we will review the methods used to auto-stage sleep.From the frontal sensors,a differential recording from AF7,AF8 the primary signal used to States sleep.Power spectral characteristics the conventional EEG bands what's the power from thirty two to one hundred and twenty eight Hertz which we referred EMG.combined with the detection of spindles,arousal,micro arousal and ocular activity measured from the left and right EOG channels.stayed sleep,each stage has a desert made a color,signals presented in the upper portion of the screen provide behavioral measures of sleep new it,signals used to stay sleep are presented in the lower half of the screen,the upper hypno Graham identifies the stage is associated with the current screen presentation and the lower hypno Graham presents the entire night with blue markings to identify location of the current screen with respect to the entire record.sleep staging is based primarily on the interrelationship,between the power spectral density characteristics.snoring begins at sleep on set a decrease in both beta and emg power provides the most apparent change,increases in Delta and Theat of power increase only after the transition slow waves sleep.transitions between NREM and REM are commonly distinguished by a mark sigma and alpha power.increasing data power.in the top example the emg also decreases during rem,in the lower example the power spectra is less intense.However there is a marked change in Veda power,relative to the other frequency bands the transitions between nrem and rem Cortical arousal are used to define ethics to be staged in one,Cortical arousal require a minimum three second increase in alpha power.the media alpha across the previous one hundred and twenty seconds this quarter is confirmed by autonomic activation identified by a sixth beat per minute increase compared to the pulse rate from the previous are subsequent tenth second，micro arousal are also used to stage in one,micro arousals require a minimum three second increase in either alpha or emg activity in this example the emg is elevated primarily in the middle porch of the arousal sleep spindles are included in the staging of into, spindles require a spike in both the absolute and relative alpha power simultaneous suppression of data emg power is used to avoid detection of benzodiazepine related pseudo spindles.the amplitude of slow wave sleep is attenuated at the frontal polar sites thirty micro volt dashed lines assist in the confirmation of Delta similar to the conventionally measured seventy five micro volts sharp popular activity in combination with high data, and low emg, to assist with interpretation eeg signal is presented after the of ocular activity.a contiguous sequence or block of remix requires at least one epic to accompany any number of that Vicks with tonic rem secondary stripes identify epics that should be the focus of visual inspection,because the auto staging suggest an alternative stage may be appropriate.stage rules always a sign the first epic after awake two stage unless there is a sleep spindle it was gross emg activity will be staged awake despite the potential over half of the epic having undisturbed sleep.Note the timing and magnitude of the activity can be visually recognized ten minute presentation of the power spectra to assist in identifying those epics should be more carefully inspected the epochs in which the cortical arousal begins is a sign stage in one,epoch is staged in two because the cortical arousal began in the previous epoch with any number of spindles and only one arousal will be staged in two epoch with two arousal in any number of spindles will be staged in one cortical arousal detected during slow wave sleep are included in the arousal,but do not result in the epoch being staged in one sign light into or else when k complexes elevated alpha emg power is detected a proportion of total into sleep classified with the light into character is included in the tabular report ethics with date of birth are beta spindles in proximity to face a grim are class spite is tonic rem a proportion of total rem with basic activity is included in the tabular report signal segments contaminated with artifact are coloured red and win the eeg excessively contaminated the left are right eog signal may be used for staging artifact is extensive in all three channels the epic is staged invalid.a percentage of good signal quality for each channel is provided at the bottom of the report next we will demonstrate the most efficient means to apply these rules to technical.editing of the auto scored records a number of features are provided to speed up the editing process the page down key.will change the presentation to a ten minute scene,a page up key will return a thirty second epic that appears at the left edge of the ten minutes screen.alternatively,double left click any point on the entire night hypno Graham，open a thirty second screen，left and right arrow on the keyboard are the functions at the bottom of the screen，scrolling throughout the study，signals are defaulted to a plus or minus seventy five micro volts for the， and plus your minus fifty micro volts for the EEG signal with a zero hurts hi pass bill to reply when more than three seconds in a thirty second epic staged into in three exceeds the presentation range the sweat are breathing artifact is removed with the stop filter applied to all three channels this filter can be manually applied using the down arrow are removed using the a pair alternatively the filter and unfiltered buttons at the bottom of the screen can be you impedance values presented at the top of the screen can assist an interpretation of contaminated with artifact and identify when the sensors are not properly fed o'clock time an elapsed time based on the left edge of the screen and the elapsed time associated with the location of the mouse are presented at the bottom of the screen to assist with navigation when the left click and drag feature is used the elapsed time are distance of the region is presented at the bottom of the screen sleep stage can be edited by multiple means and in all cases a team will be placed in front of the stage label and a Redbox will identify when the stage was edited the stage can be edited using the designated keypad entry went on a thirty second screen once changed the presentation will automatically advance to the next thirty epic multiple epochs can be edited using the left click and drag feature alternatively right click on any stage strike to edit the stage we are now going edit two studies climb the techniques where the auto staging is confirmed by view of the power spectral density characteristics on a ten minute screen with selective a thirty second epics our goal is to present this information fairly rapidly and to provide you the opportunity to review the same records at your convenience.www.Sleep profiler.Com just click on the guest exploration icon you will need to install the latest version of Java to review signals and any edits that you attempt to make will not be saved the first study were going to edit is named sleep state misperception left click let me actions and reports and you'll see there are options for entering or editing a sleep profiler questionnaire，diary editing patient information interpreting physicians they wished to review the sleep profile er questionnaire the bottom of the second page lists occasions that the patient is taking that may have an impact on the eeg .next we're going to review the sleep profile are report I always select the top report as that is the most recent one generated the clinical history at the top of the narrative report captures information including the insomnia severity index that poor sleeping a score measures of depression using the PHP nine questionnaire and measures of using the seven questionnaire.the tabular report focuses primarily on sleep architecture sleep and sleep continuity information we've included the normative ranges from home Polly sonography underlying values so that if the patient is below the low value or above the high value that is underlying then that indicates a level of abnormality when the sleep diary is completed by the patient and comparison report will show the differences between what the patient thought happened and what actually occurred in this example the patient thought that it took them one hundred and twenty minutes or two hours to fall asleep when in fact they fell asleep in thirty eight minutes clinicians find this report useful when they're having a consultation with we're now going to open the study for editing.study opens on a thirty second screen .this is the overnight hitting a gram showing the first the second and the third sleep cycle, by hitting page down I will transition to a ten minutes screen, as we begin to transition through the record see a lot of movement and the black emg lying in the power spec is quite high indicating that the patient is still awake here the auto scoring identifies that the patient has transitioned to sleep and we see an increase in the green sigma activity suggesting the patient is be getting the transition to non REM sleep.I'm gonna open this epic by left double clicking and confirmed sleep on.I'm going to use the left arrow going back in the file towards the beginning of the night.I see some emg activity and beta activity suggesting the patient, likely awake here again here get here so I'm gonna left drag and click select wake the staging of these epics have now been changed so now I'm going to begin transitioning through the record using the right arrow key I'm going to move forward into the record and I see an intermittent pattern of and wake and in one and wake questionable whether these periods of n one are correctly called so I'm gonna left double click on this epic and I'm gonna go back through the record using the left arrow key and from this point I'm gonna stage these epics as awake left double click and confirmed.I'm gonna press page down .and with the left arrow key go back and convert to wake from the sigma power  so I'm gonna continue through the record and now they're in slow wave sleep and I'm gonna check by left double clicking confirmed that the amplitude is within the plus or minus thirty micro range in a sufficient portion of the epic to confirm that it was properly staged it is so I'm gonna press page down and rather than check all of these epics I'm going to assume that the auto state.will be scoring them all consistently here is the first transition from NREM sleep note that the difference of signal power that green activity ,much much lower during REM sleep and the beta activity increases you should always confirm transitions between rem.NREM by simply left double clicking on a rem epic and confirm that the sharp ocular changes associated with phase are in at least one epic within the rem block.now I'm going to hit page down，here the patient awakens you can see the movement，and they begin to transition back to non REM sleep，transition again to end three sleep。and here is the Delta activity confirming the appropriate stage press page down and the right arrow，you're the patient awakens and begins to transition back to sleep，I expect that these two epics should be staged awake because of the large emg activity,occurs in both so I would left quick,you can see the micro arousal here and there is some snoring given the snoring pattern I'm gonna leave these two epics as they are press the right arrow key and again transitioning through the record and we begin another transition from NREM.there is the basic ocular activity press page down and continue again the transition to non REM sleep, after the patient awakens you can see a distinctive pattern he began to transition to sleep where there's increase emg activity associated with breathing in stability, funding a left click ,you can see the arousal here and the arousal here and I'm gonna leave those stages as they are .we have now finished editing the first four hours of the record pressing the right arrow key I'm continuing to review the signals quite quickly because the power spectral, are suggesting that there is no need to inspect thirty seconds, after the wakening I see the sigma activity suggesting correct assignment NREM sleep.now the patient is transitioning again I'm gonna left click as there is the phase ik ocular activity press page down and because of this awakening I'm going to check again this REM block there is the basic activity so I can press page down as the patient transitions back to non REM sleep with the blue stripes identifying spindles and now the patient awakens and we will need to identify sleep on set again pressing the right arrow key go forward through the record just point the auto staging is indicating that the patient has fallen asleep to be conservative I'm gonna convert this epic to wait I'll inspect the epic you can see the small spindle like activity confirming that the staging is correct here's another example of an isolated epic amongst wake check go to the left one epic .I'm gonna leave this as it is three rem ethics look a little out of place.I'll go in and confirm and you can see the dense ocular activity the phase of activity,our press page down.in one stage looks a little out of place I'll check it to be conservative I'm gonna edit this to wake by pressing zero and the software automatically advances me to the next epic .using the left arrow key and going back I can see that this epic is now identified awake meaning the technician has staged this to wake pressing page down and the right arrow key and we're approaching the end of the record this blue box identifies the pation within the record it's being presented on the screen pressing the right arrow，I now reach the end of the study.I'm going to press save confirmed that the edits were successfully saved and if you required a tonight's study now you can go in and edit the second night.this case I'm gonna close the screen now I'm going to review a study the subject labelled undetected press page down and we could see that the patient fell asleep within five minutes so will go and and sleep on it,you can see the slow rollers and alpha activity.pressing page down,in the next ten minute period we see an increase in sigma the green activity dark blue stripes that his spindle activity as the patient transitions into deeper .here we see a large crescendo snore autonomic activation.we can see a cortical arousal occurring here.I see that pattern occurring again here leading to a large arousal falls back to sleep and now they transition from slow wave sleep and awakened with the same pattern I see a single Reb event I'm gonna press one when I press page down I can see that there's a t in front of it to indicate that it was tech he edited and now it appears that the patient is transitioning to ram so I'm going to left click and there is the basic activity I'm going to leave the staging like it is arousal makes sense to call them in one this is a micro arousal where,combines both emg and increased alpha activity press page down.continue reviewing the record.here are a couple of more patterns that will likely be high basic activity.the basic activity is plus or minus a hundred micro volts with sharp edges gets detected as artifact and is marked red the balance is used for stage the first epic after a wait is always staged in one unless there's a spill and we see in arousal and a high peak and alpha activity so this epic is properly staged these two epics look a little out of place so I would let click we have movement again in the transition back to sleep I'll press one and we see the transition here to REM sleep, basic activity going back and I'm gonna leave these ethics as they are at the end of the record from a signal quality standpoint this was a very good, and this is confirmed by the impedance values presented at the top of the screen conducting the review press save and as an option you can go in status to interpretation required this will automatically send an email to the clinician to let them know this study is ready for them to review clinicians there's the option to automatically insert messages into the bottom porch of the narrative report the exact wording of these messages is provided in the technical match eternally I could press clinician comments and type in a message are copy message from a word file to insert into this section that will appear above the nature on the report the last step for clinicians is to save the final report the message will remind you.only one report can be generated as a final report for each study I'm going to select yes and it provides me the opportunity to insert a signature that will on the narrative report saw press ok the final report is saved.and when I press refresh I will see that it says that the final report is now available.this concludes the training video on the application and editing asleep staging with.We profile we recommend that you review these techniques using the same records available on guest exploration at www.sleep profile.com