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Normal Sleep EEG: Multimedia

Author: Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Coauthor(s): Diego Rielo, MD, Staff Physician, Department of Neurology, Memorial Hospital West, Memorial Hospital Pembroke, Memorial Healthcare
Contributor Information and Disclosures

Updated: Sep 11, 2008

Multimedia

The earliest indication of transition from wakefu...
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Media file 1: The earliest indication of transition from wakefulness to stage I sleep (drowsiness) is shown here and usually consists of a combination of (1) drop out of alpha activity and (2) slow rolling eye movements.
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The earliest indication of transition from wakefu...

The earliest indication of transition from wakefulness to stage I sleep (drowsiness) is shown here and usually consists of a combination of (1) drop out of alpha activity and (2) slow rolling eye movements.

Slow rolling (lateral) eye movements during stage...
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Media file 2: Slow rolling (lateral) eye movements during stage I sleep. Like faster lateral eye movements, slow ones are best seen at the F7 and F8 electrodes, with the corneal positivity indicating the side of gaze.
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Slow rolling (lateral) eye movements during stage...

Slow rolling (lateral) eye movements during stage I sleep. Like faster lateral eye movements, slow ones are best seen at the F7 and F8 electrodes, with the corneal positivity indicating the side of gaze.

On this transverse montage, typical vertex sharp ...
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Media file 3: On this transverse montage, typical vertex sharp transients are seen. In contrast to K complexes, these are narrow (brief) and more focal, with a maximum negativity at the mid line (Cz and to a lesser degree Fz). These are seen in sleep stages I and II.
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On this transverse montage, typical vertex sharp ...

On this transverse montage, typical vertex sharp transients are seen. In contrast to K complexes, these are narrow (brief) and more focal, with a maximum negativity at the mid line (Cz and to a lesser degree Fz). These are seen in sleep stages I and II.

Vertex waves are focal sharp transients typically...
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Media file 4: Vertex waves are focal sharp transients typically best seen on transverse montages (through the midline) and would be missed on this longitudinal bipolar montage if it did not include midline channels (Fz-Cz-Pz). Vertex waves are seen in sleep stages I and II.
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Vertex waves are focal sharp transients typically...

Vertex waves are focal sharp transients typically best seen on transverse montages (through the midline) and would be missed on this longitudinal bipolar montage if it did not include midline channels (Fz-Cz-Pz). Vertex waves are seen in sleep stages I and II.

Positive occipital sharp transients of sleep (POS...
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Media file 5: Positive occipital sharp transients of sleep (POSTS) are seen in both occipital regions, with their typical characteristics contained in their name. They also have morphology classically described as "reverse check mark" and often occur in consecutive runs of several seconds, as shown here.
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Positive occipital sharp transients of sleep (POS...

Positive occipital sharp transients of sleep (POSTS) are seen in both occipital regions, with their typical characteristics contained in their name. They also have morphology classically described as "reverse check mark" and often occur in consecutive runs of several seconds, as shown here.

This shows a K complex, typically a high-amplitud...
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Media file 6: This shows a K complex, typically a high-amplitude long-duration biphasic waveform with overriding spindle. This is a transverse montage, which shows the typical maximum (manifested by a "phase reversal") at the midline.
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This shows a K complex, typically a high-amplitud...

This shows a K complex, typically a high-amplitude long-duration biphasic waveform with overriding spindle. This is a transverse montage, which shows the typical maximum (manifested by a "phase reversal") at the midline.

Typical sleep spindles with short-lived waxing an...
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Media file 7: Typical sleep spindles with short-lived waxing and waning 15-Hz activity maximum in the frontocentral regions. Note the associated slow (theta) activity that also characterizes stage II sleep.
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Typical sleep spindles with short-lived waxing an...

Typical sleep spindles with short-lived waxing and waning 15-Hz activity maximum in the frontocentral regions. Note the associated slow (theta) activity that also characterizes stage II sleep.

Vertex sharp transients. This transverse montage ...
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Media file 8: Vertex sharp transients. This transverse montage illustrates the maximum negativity (manifested by a negative phase reversal) at the midline. The location is similar to that of K complexes, but these are shorter (narrower) and more localized.
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Vertex sharp transients. This transverse montage ...

Vertex sharp transients. This transverse montage illustrates the maximum negativity (manifested by a negative phase reversal) at the midline. The location is similar to that of K complexes, but these are shorter (narrower) and more localized.

K complex, with its typical characteristics: high...
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Media file 9: K complex, with its typical characteristics: high-amplitude, widespread, broad, diphasic slow transient with overriding spindle. On the longitudinal montage (left), the K complex appears to be generalized. However, the transverse montage clearly shows that the maximum (phase reversal) is at the midline (Fz and Cz).
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K complex, with its typical characteristics: high...

K complex, with its typical characteristics: high-amplitude, widespread, broad, diphasic slow transient with overriding spindle. On the longitudinal montage (left), the K complex appears to be generalized. However, the transverse montage clearly shows that the maximum (phase reversal) is at the midline (Fz and Cz).

A mixture of spindles (ie, bicentral short-lived ...
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Media file 10: A mixture of spindles (ie, bicentral short-lived rhythmic 14 Hz bursts) and positive occipital sharp transients of sleep (POSTS) can be seen. POSTS occur in stage I, but the presence of spindles is "diagnostic" of stage II.
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A mixture of spindles (ie, bicentral short-lived ...

A mixture of spindles (ie, bicentral short-lived rhythmic 14 Hz bursts) and positive occipital sharp transients of sleep (POSTS) can be seen. POSTS occur in stage I, but the presence of spindles is "diagnostic" of stage II.

A mixture of positive occipital sharp transients ...
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Media file 11: A mixture of positive occipital sharp transients of sleep (POSTS) and spindles (fronto-central short-lived rhythmic 14-Hz bursts) can be seen.
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A mixture of positive occipital sharp transients ...

A mixture of positive occipital sharp transients of sleep (POSTS) and spindles (fronto-central short-lived rhythmic 14-Hz bursts) can be seen.

Slow wave sleep with predominantly delta activity...
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Media file 12: Slow wave sleep with predominantly delta activity, especially in the first half.
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Slow wave sleep with predominantly delta activity...

Slow wave sleep with predominantly delta activity, especially in the first half.

Slow wave sleep with predominantly delta activity.
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Media file 13: Slow wave sleep with predominantly delta activity.
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Slow wave sleep with predominantly delta activity.

Slow wave sleep with predominantly delta activity.

Rapid eye movement sleep with rapid (saccadic) ey...
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Media file 14: Rapid eye movement sleep with rapid (saccadic) eye movements. While muscle "atonia" cannot be proven without a dedicated electromyogram (EMG) channel, certainly EMG artifact is absent with a "quiet" recording. Also, no alpha rhythm is present that would suggest wakefulness.
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Rapid eye movement sleep with rapid (saccadic) ey...

Rapid eye movement sleep with rapid (saccadic) eye movements. While muscle "atonia" cannot be proven without a dedicated electromyogram (EMG) channel, certainly EMG artifact is absent with a "quiet" recording. Also, no alpha rhythm is present that would suggest wakefulness.

Typical saccadic eye movements of rapid eye movem...
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Media file 15: Typical saccadic eye movements of rapid eye movement sleep are shown, with lateral rectus "spikes" seen just preceding the lateral abducting eye movements.
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Typical saccadic eye movements of rapid eye movem...

Typical saccadic eye movements of rapid eye movement sleep are shown, with lateral rectus "spikes" seen just preceding the lateral abducting eye movements.

In addition to rapid eye movements, this rapid ey...
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Media file 16: In addition to rapid eye movements, this rapid eye movement sleep record is characterized by brief fragments of alpha rhythm (first half) and central saw tooth waves (second half).
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In addition to rapid eye movements, this rapid ey...

In addition to rapid eye movements, this rapid eye movement sleep record is characterized by brief fragments of alpha rhythm (first half) and central saw tooth waves (second half).

This is a good example of saw tooth waves seen in...
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Media file 17: This is a good example of saw tooth waves seen in rapid eye movement sleep and their "notched" morphology.
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This is a good example of saw tooth waves seen in...

This is a good example of saw tooth waves seen in rapid eye movement sleep and their "notched" morphology.

This is a good example of saw tooth waves seen in...
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Media file 18: This is a good example of saw tooth waves seen in rapid eye movement sleep and their "notched" morphology, best seen here in the Cz-Pz (last) channel.
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This is a good example of saw tooth waves seen in...

This is a good example of saw tooth waves seen in rapid eye movement sleep and their "notched" morphology, best seen here in the Cz-Pz (last) channel.

This illustrates the typical appearance of saw to...
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Media file 19: This illustrates the typical appearance of saw tooth waves on a polysomnogram (PSG) display, equivalent to 1 cm/s.
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This illustrates the typical appearance of saw to...

This illustrates the typical appearance of saw tooth waves on a polysomnogram (PSG) display, equivalent to 1 cm/s.

More on Normal Sleep EEG

References
Further Reading
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References

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  4. Benbadis SR. Introduction to EEG. In: Lee-Chiong T, ed. Sleep: A Comprehensive Handbook. Hoboken, NJ: Wiley & Sons; 2006:989-1024.

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Further Reading

See Medscape's Insomnia and Sleep Health Resource Center.

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Keywords

EEG atlas, normal sleep EEG, stage I sleep, drowsiness, presleep, sleep stages, rapid eye movement sleep, REM sleep, nonrapid eye movement sleep, NREM sleep, slow rolling eye movements, SREMs, attenuation (drop out) of the alpha rhythm, central or frontocentral theta activity, enhanced beta activity, positive occipital sharp transients of sleep, POSTS, vertex sharp transients, hypnagogic hypersynchrony, EEG waveforms, stage II sleep, K complex, sleep spindle, sleep stages, stage II waveforms, delta sleep, delta waves, slow wave sleep, SWS, normal sleep stage III, normal sleep stage IV, sleep cycles, EEG desynchronization, saw tooth wave, sleep-onset REM period, SOREMP, sleep waveforms

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Contributor Information and Disclosures

Author

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Diego Rielo, MD, Staff Physician, Department of Neurology, Memorial Hospital West, Memorial Hospital Pembroke, Memorial Healthcare
Diego Rielo, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Leslie Huszar, MD, Consulting Staff, Department of Neurology, Indian River Memorial Hospital
Leslie Huszar, MD is a member of the following medical societies: American Academy of Neurology, American Association for the Advancement of Science, and American Medical Electroencephalographic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health and Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching; Concentric Medical None Review panel membership; Northstar Neuroscience  Review panel membership; ev3 Consulting fee Review panel membership

 
 
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