Multiple Awake Test: Treatment, Effect & Risks

The multiple wakefulness test is an apparative procedure of sleep medicine, which can be used for the diagnosis of sleep disorders as well as assessment of therapeutic measures for daytime sleepiness. In this test, the patient is asked to defy falling asleep for as long as possible at various intervals in a low-stimulus and dim environment. The recommendations for performing the test, which are currently being used more frequently, originate from Karl Doghramji and are intended to provide more uniform test results that are easier to assess.

What is the multiple wakefulness test?

The multiple wakefulness test is an instrumental sleep medicine procedure that can be used to diagnose sleep disorders as well as assess therapeutic measures for daytime sleepiness. The multiple wakefulness test is one of the world’s leading methods of sleep medicine performance diagnostics. In the course of the test, the patient is examined for tonic activation as well as wakefulness. The test participants are transferred to a low-stimulus environment without distraction by external influences. There they are supposed to defy falling asleep in the twilight for as long as possible. The individual runs of the procedure are repeated at set intervals. The test differs fundamentally from other apparative procedures of sleep diagnostics. For example, the multiple sleep latency test is performed in a lying position with eyes closed in total darkness, while the multiple wakefulness test is performed in a sitting position with eyes open in dim light.

Function, effect, and objectives

In particular, narcolepsy and hypersomnia are two diagnoses of sleep medicine that can be confirmed or objectified with the Multiple Stay Awake Test. Especially for hypersomnia, the test can provide objectification. The test cannot be used for exclusion diagnosis, but it can be used for classification of the severity of previously made diagnoses. The tendency to fall asleep at the wheel can also be successfully examined with the test. The basis of the test procedure is the collection of various values, which the laboratory compares with the previously collected standard values of sleep disorder patients and healthy persons. Since special measurement techniques are required to perform the test, multiple wakefulness tests are performed exclusively in sleep laboratories. Under certain circumstances, sleep diaries and polysomnographies supplement the test results. Whether and which supplements are useful in individual cases is decided by the respective sleep laboratory depending on the test objectives. According to the recommendations of Karl Dogrhamji, the test now takes place independently of the laboratory conducting the test in four rounds, which run according to a 40-minute protocol and take place in a two-hour interval starting at 9 or 10 am. At least one hour before the test, the supervisors serve the patient a light breakfast. After the second interval, a light lunch takes place.Medication, alcohol, cola, caffeine, and tobacco are not allowed before or during the procedure, as they can influence sleep patterns. During the test, the patient is in a darkened room with comfortable temperatures. The staff regularly inquires about the comfort of the participants and initiates measures to improve comfort if necessary. A single light source is located behind the subject’s head. The subject spends the entire test session seated on the bed and uses a bolster as a headrest. Distractions, such as singing or standing up, are completely prohibited and sensors permanently determine whether the test subject is still awake. Before each interval, the patient moves his or her eyes as instructed by the staff, and electroencephalographs, electrooculographs, electromyographs, and electrocardiograms are used to collect values. Sleep onset is when the sensors have registered more than 15 seconds of sleep. An interval ends either when the patient falls asleep or at the latest after 40 minutes. For each run, the exact time of onset and end is recorded. In addition, fall asleep latencies as well as sleep duration are determined. The respective sleep stages are also included in the test results and are recorded. At the end of the test, the laboratory compares the data collected during the test phase with the previously determined standard data of people with and without sleep disorders.Based on this comparison, the staff determines the patient’s general daytime sleepiness and can thus make statements about the risks of microsleep at the wheel, among other things.

Risks, side effects, and hazards

The multiple wakefulness test goes back to the multiple sleep latency test and has existed since the 1980s. Over time, various sub-procedures developed from the test procedure, so that a uniform assessment of the respective results was soon no longer possible. Anyone taking the test today should make sure that the laboratory follows Dogrhamji’s recommendations in its procedure. If this is not the case, it is difficult to actually classify the data collected. In addition, if the patient must take medication regularly, he or she should discuss this restriction with the laboratory in advance. While some medications have little effect on sleep patterns, participation while under the influence of other medications is not recommended, as the medication influence will skew the results. Unlike the Multiple Sleep Latency Test, the Multiple Wakefulness Test is also suitable for patients who are undergoing therapy for increased daytime sleepiness. The success of the therapy can be assessed by the test, because during the procedure especially the ability to resist sleep when instructed is examined. It is mandatory to perform polysomnography before both the Multiple Sleep Latency Test and the Stay Awake Test, as sleep quality can be of considerable importance for both procedures.