MSLT Scoring

I'm reading the wikipedia description of MSLT. https://en.wikipedia.org/wiki/Multiple_ ... tency_Test

Is this really correct?

"The patient is asked to nap for 20 minutes, and then is awakened."

If you fall asleep within 0-5 minutes, you are considered to be "severe."

Really, the patient is asked to nap, and is failed if they fall asleep quickly? What about people who can fall asleep easily but don't have a problem falling asleep when they don't want to?

Is the patient warned that falling asleep quickly generates a failing grade?

Shouldn't the instructions be to lie there quietly and try to NOT fall asleep?

If you can figure out something that will keep you awake, such as sleeping in the wrong position, do you beat the MSLT?

I was wondering the same thing. I looked up MSLT a few hours ago as I wasn't sure what the test entailed. I assumed you sat in a dark room to see if you doze off easily. It doesn't make sense to encourage somebody to take a nap and then fail them for taking a nap. On my days off, I often fall asleep while watching tv in the evening. I am not sleepy at all on my work days at the same time.

I thought to be diagnosed with narcolepsy, not only do you have to be able to fall asleep quickly when you don't want to but you have enter a certain stage of sleep. I thought it was REM but I am not sure.

Your point is well taken about trying not to fall asleep. Many times when I have desperately tried not to fall asleep at the wrong time and have tried all the usual remedies to no avail, I will lay down and wear a mask that massively leaks and that noisily farts. Unfortunately, it never works.

So maybe when testing someone for narcolepsy, you should make the things as noisy as possible to prevent them from falling asleep. Of course, I have no idea what is appropriate clinically and am just spouting things off at the top of my brain.

49er

archangle wrote:I'm reading the wikipedia description of MSLT. https://en.wikipedia.org/wiki/Multiple_ ... tency_Test

Is this really correct?

"The patient is asked to nap for 20 minutes, and then is awakened."

If you fall asleep within 0-5 minutes, you are considered to be "severe."

Really, the patient is asked to nap, and is failed if they fall asleep quickly? What about people who can fall asleep easily but don't have a problem falling asleep when they don't want to?

Is the patient warned that falling asleep quickly generates a failing grade?

Shouldn't the instructions be to lie there quietly and try to NOT fall asleep?

If you can figure out something that will keep you awake, such as sleeping in the wrong position, do you beat the MSLT?

Agreed that I have read it is quickly reaching REM that is what counts for the narcolepsy diagnosis, in addition to napping within the time frame in a certain percentage of opportunities. I don't get why the tests typically require the patient to have a sleep study the night before. I assume to rule out other potential causes of their sleep disturbance? However, that means they will likely be more sleep deprived then usual, then you have them sit around quietly all day between nap sessions. I am very likely to fall asleep if lounging doing nothing, but very unlikely to fall asleep if I lie down in bed and try to lol. Best wishes.

None of this makes the least bit of sense to me. There is no way, I repeat - no way - that I would be able to fall asleep under the circumstances described. I don't fall asleep watching TV, in a car, airplane, couch, recliner or anywhere else except my bed. The sleep study was the exception and that was in a bed at night. It still took me nearly three hours (taking a .5 xanax) to finally fall asleep.

If they hooked me up and I just sat there... what would they make of that? Could be I'm missing something.

ems wrote:None of this makes the least bit of sense to me. There is no way, I repeat - no way - that I would be able to fall asleep under the circumstances described. I don't fall asleep watching TV, in a car, airplane, couch, recliner or anywhere else except my bed. The sleep study was the exception and that was in a bed at night. It still took me nearly three hours (taking a .5 xanax) to finally fall asleep.

If they hooked me up and I just sat there... what would they make of that? Could be I'm missing something.

As I read it, if you can't sleep, you pass the MSLT.

I've had at least 2 MSLT tests. For some reason I'm thinking maybe 3 but my memory is hazy. In between naps I watched TV and whatever else I wanted to do in my room. The hardest part for me was staying awake between naps. falling asleep with each nap was no problem as all I had to do was give myself opportunity and I would sleep. The test does look at time till sleep onset in each nap and how many naps included REM sleep. Seems to me the MWT would be the more useful of the two daytime tests in determining one's safety in situations requiring alertness. But hey, who am I to say? There's some links below that get into more detail on diagnosis criteria for anyone so inclined.

https://online.epocrates.com/u/2936428/Narcolepsy
http://www.aasmnet.org/Resources/Practi ... SLTMWT.pdf
http://www.healthcommunities.com/narcol ... osis.shtml

But seriously, yay! And do see if you can persuade our friend Roger to come -- I'm dying to know if he walks around carrying that "HELP" sign all the time...

I think part of the problem is the idea of using MSLT as a way to, for instance, test truck drivers for sleep problems.

You ask them to try to sleep, but if they succeed, they fail the test. Obviously, a smart truck driver is going to try to stay awake.

I still question the part where you're graded badly if you fall asleep quickly. I've always thought there were a lot of people who were blessed with being able to fall asleep quickly, even if they're not tired or about to fall asleep. Me, I've always been the other way, often having difficulty falling asleep, even if I'm tired and often even if I'm sleepy.

MSLT sounds like "sleep theater" in the same way that the TSA and homeland security are "security theater." Is it something that's just for show to give the appearance of doing something for legal and CYA reasons?

What's in question for me is how this test for narcolepsy is going to be relevant in the context of testing for drivers to maintain their CDL licenses. Been reading quite a bit about that coming into play.

kteague wrote:What's in question for me is how this test for narcolepsy is going to be relevant in the context of testing for drivers to maintain their CDL licenses. Been reading quite a bit about that coming into play.

That's why I mentioned "sleep theater" like the "security theater" we go through all the time these days.

Assuming for the moment that MSLT is "wrong," it does a CYA where the people involved can say "look, we ran this test, it's not my fault." The doctors, the politicians, the trucking companies, etc. all get to pretend it works.

However, MSLT probably has some value. If the truck driver is trying to stay awake and can't, that probably means something.

It does sound to me like their trying to trick the truck drivers by telling them to try to go to sleep when the smart driver should be trying to stay awake.

It also sounds to me like MSLT is designed for people who know they have sleep problems and are trying to find out what's wrong of their own free will, not for testing someone who doesn't want to be tested. There appears to be a MWT test where you are supposed to try and stay awake that might be better for sleep safety testing.