1. Welcome to Know How Webinars

2. Actiwatch Analysis Guide

3. Actiwatch analysis guide Use them to view sleep patterns Use them to produce sleep statistics Manually score an actogram for rest intervals Print out data reports We will review actograms and how to:

4. Using actograms

5. Getting started: recommended actogram display properties For optimal viewing, match the settings on the actogram tab to those below Tools menu → options actogram tab Activity scale White light scale

6. Getting started: viewing an actogram An actogram can be viewed at any time by double clicking an analysis icon in the database viewer If you don’t see an analysis icon, double click the Actiwatch or subject icons Analysis icon Subject icon Actiwatch icon

7. What is an actogram? Actograms enable you to view active/rest periods and when they occur during the day Active period Rest period

8. An actogram is created when activity is charted for 24 hours on a single strip chart What’s in an actogram? Midnight The time scale is set by default with midnight in the center to make sleep periods easier to see Noon

9. What’s in an actogram? (Cont.) Activity data are expressed in black Event marker data are expressed as blue wedges Sleep/wake scores are shown below activity Visible light data are shown in yellow (some models) Activity valuesSleep/wake scores Red = wake, White = sleep Event marker

10. Individual 24-hour periods are stacked up What’s in an actogram? (Cont.)

11. Sleep intervals are marked in blue Identifying rest intervals Actograms makes it easy to recognize periods of inactivity or rest. These rest intervals typically indicate time in bed or naps Actiware can indicate data to be excluded, sleep onset latency, and snooze time Off-wrist or excluded periods are dark blue Sleep onset and snooze time are shown in aqua

12. Using actograms to view sleep/wake patterns

13. Assessing sleep/wake patterns using rest intervals Once rest intervals are marked, a sleep/wake pattern can be easily identified using these four characteristics: 1.Circadian rhythmicity: Are there rest intervals occurring during typical sleeping times? 2.Sleep consolidation: Are sleep periods interrupted by activity? –If so, it can indicate either difficulty falling asleep or significant awakenings during the night 3.Regularity: Are rest intervals a relatively consistent length and consistent in their distribution throughout the day? 4.Napping: Do multiple rest intervals occur during the day?

14. How rest interval patterns provide insight Good/poor sleep hygiene Circadian rhythms disorders Compliance with behavioral or schedule-based therapies like sleep restriction or stimulus control Compliance during follow up These patterns can help you understand basic sleep scheduling and provide insight into:

15. Some examples of sleep/wake patterns Insomnia/irregular sleep vs. normal sleep patterns Delayed sleep phase Non-entrained or free running Shift work sleep disorder Remember to review: Rhythmicity Consolidation Regularity Napping Note: The assessments being provided in the next four slides are for example only and the medical professional should use his/her medical judgment in evaluating all Actiwatch 2 and Actiwatch Spectrum data.

16. The patient data on the left demonstrates rhythmicity in a sleep pattern during irregular sleep periods Insomnia patient (68 yr. F) Control subject (78 yr. F) Irregular sleep schedule vs. a normal sleeper Look for rest interval start and end times

17. Delayed sleep phase There are definite issues with rhythmicity Sleep periods are shifted to the right (delayed) Activity during the sleep period also is present indicating that consolidation may be an issue

18. Circadian rhythms - free running Rhythmicity is definitely a problem The periods of rest are similar in length, but they are distributed into hours not typically used for sleep

19. Shift work sleep disorder Shift workers may show issues with multiple charac- teristics Rhythmicity and regularity issues are easy to see Naps and consolidation issues are present Some rest intervals (i.e., day 9) have considerable interruption

20. Using actograms to produce sleep statistics

21. Insight into important sleep parameters Although actigraphy and polysomnography (PSG) share terminology, they are different technologies and are applied under different circumstances For actigraphy, tracking the relative changes of these parameters over time is of primary use. Absolute sleep statistics for a single night are best derived from PSG which is the recognized standard. Some parameters which can be calculated and viewed using Actiwatch include: –Time in bed –Total sleep time –Wake after sleep onset –Sleep efficiency –Number of wake bouts –Sleep onset latency

22. Viewing statistics tables Calculated statistics are tabulated automatically and displayed in the statistics table window Select the view menu statistics table option

23. Viewing statistics tables (Cont.) The actogram shows sleep scheduling issues very well By marking rest periods and nap periods on the actogram as rest intervals, the Actiware software will also automatically produce sleep statistics Statistics are shown for each interval containing sleep Averages are automatically calculated

24. Viewing statistics tables (Cont.) Statistics for the rest period and the sleep period are automatically calculated Many sleep statistics are only available on the sleep tab Sleep interval statistics for “actual sleep time” Rest interval statistics for “time in bed”

25. Recommended statistics Tools menu options actogram tab Select the sleep statistics for display in the statistics tables and on printed reports

26. Manually scoring an actogram for rest intervals

27. How to manually score an actogram 1. Identify and mark rest intervals to match bed time Identify the bed time and set the interval start Identify the get up time and set the interval end Insert the rest interval 2. Identify and mark rest intervals to match naps Identify the nap start and select the interval start Identify the nap end and select the interval end Insert the rest interval

28. Identification and marking of rest intervals to match time in bed Use all available data to determine, for each day, two points of time: (1) The time when the subject went to bed with the intent to sleep, and (2) The last out of bed time - here are some examples –Sleep diary –Event marker –Activity information –Sleep/wake scores –Light information These two points of time will be used by the software to make calculations for each rest period

29. Step 1: Identify bed time Look for a point where activity decreases Event marker, diary, and activity may not match Compare event markers or diary entries to the time where activity decreases Don’t expect a match as patients aren’t as precise as the Actiwatch

30. Identify bed time (Cont.) Click the mouse to view the time, activity, and sleep/wake score Red = wake White = sleep Red or white marks below activity indicate wake or sleep; look for the transition from red to white Click the mouse to view the time, activity, and sleep/wake score at that point

31. Set the rest interval start time to match the bed time Use common sense to identify a bed time considering all of these inputs –Precision isn’t required Right click on the chosen time and select set interval start from the pop-up menu, or press the R key Right click and select set interval start Red flag appears at interval start time

32. Step 2: Identify get up time Compare event markers or diary entries to the time where activity increases; don’t expect a precise match Look for a point where activity increases Event marker, diary, and activity may not match

33. Identify get up time (Cont.) Red or white marks below activity indicate wake or sleep; look for the transition Click the mouse to view the time, activity, and sleep/wake score at any point Red = wake White = sleep Click the mouse to view the time, activity, and sleep/wake score

34. Select the rest interval end time Use common sense to identify a get up time considering all of these inputs; precision isn’t required Right click on the chosen time and select Set interval end from the pop-up menu, or press the Shift-R keys together Select set interval end from pop-up Right click on the end time

35. Select the rest interval end time (Cont.) Red flag appears at interval end time

36. Insert the rest interval Right click and select Insert rest interval from the pop-up menu, or press the CTRL- R keys together Rest intervals appear in blue –If sleep onset is more than a few minutes, you may see a green region at the beginning of the interval –The same is true for snooze time in the morning Repeat for each day

37. Manual identification and marking of naps Like overnight rest intervals, utilize all inputs to identify periods of inactivity/rest during a typical active period that are at most a few hours long Potential naps Sleep logs/diaries Event marks Decreases in activity Sleep/wake scoring (red and white markings)

38. Identify the nap start and select the interval start Use diary and event marker data if available Locate periods of inactivity using activity data or red and white markings on actogram Set interval start and end times, i.e., time in bed, for major sleep periods First, left click to select time Then, right click to set the start flag or type R

39. Identify the nap end and select the interval end Use diary and event marker data if available Locate point of resumed activity using activity data itself or red and white markings on actogram Set interval start and end times as with the time in bed First, left click to select time Then, right click to set the end flag or type Shift-R

40. Insert the rest interval Right click and select insert rest interval from the pop-up menu Rest intervals appear in blue Repeat for other naps Rest interval for a nap

41. Identify and exclude invalid data Excluded intervals remove data from consideration/calculations –Device removal (indicated by no activity) or other concerns Flag interval start and end times and insert an excluded interval This is automatically done if using the Actiwatch Spectrum device No activity Excluded intervals are dark blue

42. Saving actogram analysis settings and results Settings and results for any actogram analysis can be saved at any time by: Right clicking in the actogram Selecting the save analysis Naming the actogram analysis

43. Printing out reports

44. The clinician’s report After setting intervals, press the clinician’s report button for a standard, clinical report Summary statistics for the entire data collection Daily statistics for each day Actogram with sleep start and end

45. Printing a custom report To print a report for a specific analysis: Open the analysis by double clicking on its icon in the database viewer Select the file menu Select the print report option Select the printer you want to use and the properties for that printer You can choose the elements to include in your printed report: Actogram Statistics to include Intervals to include

46. Recommended print report settings Choose from the settings to generate a useful and custom report Tools menu → options print report tab

47. Custom report example from a normal sleeper

48. For additional information Actiware online help: –Help menu; contents option Online tutorials: –http://www.learnactiware.com Actiwatch and Actiware are trademarks of Respironics, Inc. and its affiliates. © 2009 Koninklijke Philips Electronics N.V. All rights are reserved Philips Respironics product support: –1-800-345-6443 –mm.service@respironics.com.

49. Thank you