Aktiviteettikäyrät ja niiden hyötykäyttö
Contents
1. Ci ug _______ Fagl Sec d ini Codi PE Enh 1 Case repart 1 Preview Microsoft Word Ele Edt View Insert Format Jools Table Window gyae a8 ROB ess NW eee T Dro Dra s How ga 17 Z2 23 00 GE D 4 ee DB DM JD i Figure 4 in Wide E B4 rr EE Jj bef soj bai gu tl Sec 1 AaS ini Col SEC ET O6 Figure 21 Activity case report 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 28 10 REFERENCES The sleep and circadian rhythm of elderly people and its significance in care has been actively researched Results indicate that circadian rhythm and sleep represent the well being of elderly people in many ways By taking this into consideration the well being and more independent living of individuals both at home and in facilities can be greatly improved The IST Vivago system s activity measurement has been scientifically validated 9 and 10 to be equivalent to actigraphs in observing circadian rhythm The actigraph which has been in clinical use for a long time is an established method for studying sleep and circadian rhythm The references listed below are only a small part of the studies that have been done but give a good overview of th2. Open A S Close E Refresh Settings ucc WE M REEL Transfer OFF Curve settings Screen layout Sleep analysis VEN EE TE Normal Passive cup Sensitive C Own setti j Sleep analysis parame Limit Far sleep gt Fall asleep delay Cl 5 mis i Wake up delay wm mns 60 Cancel Figure 10 Sleep analysis settings 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 16 6 3 Accuracy of sleep analysis and adjustment Automatic sleep analysis is an estimate and its accuracy is 80 Typically the analysis gives sleep times 30 70 minutes longer than actual times because situations during which a person is awake but does not move for some other reason are also interpreted as sleep Elderly people having poor functional ability may have very low daytime activity In this case the sleep analysis interprets wakefulness but low activity as sleep The calculated and displayed sleep times are markedly longer than in actuality There are also people suffering from different types of sleep disorders for whom the analysis will produce shorter than actual sleep time because they may move about restlessly during sleep and this is interpreted as wakefulness The sleep limit estimated on the basis of movement activity is unique to the individual but for most people who have normal functional ability and who don t suffer fr
3. Include header information Printer MisEserverYcanan iR 3300 Properties time 11pm 5am Add comment Calendar s 2 Case report 1 doc Microsoft Word tA Ele Edit Yew jirmert Format Tools Window iib oco eM 0 os 3 P D Ur ER ob Headrest Tom jg um dd m Pe Cul4F Cri G 19 i ee DE GO G8 4 8 i L PO tee pet coe Engle ey Figure 20 Transferring curve information to MS Word using the clipboard If you want to transfer curve information to other programs this can be done with the clipboard or by first saving the information as a picture file jpg format in the desired file and then attaching this picture file to another document made using MS Word for example Figure 20 shows an example of using the clipping table You can chose either to copy onto the clipboard or to a separate file from the Export menu in the Vista program 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 27 9 4 Activity report By using a separate word processing program you can make for example an activity case report as shown in
4. Colour codes Sleep Week analysis window 14 days view Midnight in the middle Normal smoothing Show on screen Colour codes Sleep CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy General circadian rhythm Average daytime activity nighttime activity 24 hour patterns awakenings sleep time situation of sleep in night time phases of deep sleep maximum day time activity low activity periods during day time Circadian rhythm and its changes average value fluctuation Recurring events moving out of range walking outside wrist unit usage rate Sleep and changes in sleep pattern regularity of sleep sleep time number of sleep periods situation of sleep in the day Slow and fast changes in the circadian patterns 14 6 SLEEP ANALYSIS 6 1 The normal structure of sleep There are five stages of sleep four of which form a continuum towards deep sleep The first and second stages are light sleep and the third and fourth are deep sleep during which a person is normally quite motionless The fifth stage is REM Rapid Eye Movement which usually appears after the first period of deep sleep about 1 hour after falling asleep It is typically accompanied by dreaming Figure 9 is an example of the activity curve s depiction of normal sleep Upon falling asleep the activity curve drops steeply indicating the beginning of sleep 1 If sleep quality is good
5. m gt vis29 Selected day Thu 10 10 2002 7 File 21 22 23 24 28 29 30 31 4 Modify Add Remove Alarms Curve information 2 2001 Tue 11 03 2003 leep analysis 5 period s time 07 52 Mus Tue Wed the Late cal Circadian rhythm 0 23 E 30 1 2 3 Additional info Debug 4 m T vista 2 Midnights Meter 46 Middays Time stamps Color codes Comments Instructions For analysis screen se 2002 _ Fri Sat 4 5 11 12 18 19 25 2b 1 2 Curve color codes No curve available WristCare off wrist i Sleep Night time 1 ipm Sam Transfer OFF Figure 6 Post analysis of curves Y Screen size 4 days Y 1 Smoothing Maximum 15x Zooming Hold down the Ctrl key and the left mouse button move mouse From left to right Scrolling Hold down the right mouse button and move the mouse left or right 6 13 20 27 3 5 6 7 8 9 10 10 10 2002 _ You can scroll the curve visible on your screen by using the scroll bar underneath it and by using the calendar 4 on the right side of the screen The curve screen always contains a maximum of nine days of data that can be viewed with the scroll bar The blue coloured days on the calendar indicate which days have been selected for viewing The red day indicates the day that is currently showing in
6. IST International Security Technology Oy The efficient use of the activity curve in health care includes the following work stages e Observation see chapter 4 o familiarization with customer and curve e Activity curve SWR analysis see chapters 5 7 o examination of curve patterns and conclusions e Reporting see chapter 8 o notes and documentation e Action o actual care CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 4 REASONS FOR CHANGES IN SLEEP WAKE RHYTHM The activity signal depicts changes in the health and well being of elderly people because these often cause a decrease in the level of daytime physical activity and otherwise restlessness confusion disruptions in night time sleep and changes in daytime rhythm which can be seen on the activity curve Examples of reasons which cause changes in circadian rhythm are Sleep disorders e fragmented sleep e problems falling asleep e morning awakenings e sleep apnea e restless legs e delayed or advanced sleep period e Symptoms and illnesses that have an adverse effect on circadian rhythm and sleep e confusion e blood circulation problems of the brain and limbs Parkinson s disease Alzheimer s disease and other dementia e other neurological disorders e back and joint pain and other skeletal or muscular illnesses and symptoms heartburn and other stomach symptoms e night time chest pain e cardiac insufficiency e asthma or chronic
7. Based on the graph we can make conclusions about the state and well being of the user The wrist unit measures macro movement The signal measured by the wrist unit is the i e hand and body movements that move sum of macro and micro movements the wrist unit F1 In addition it measures S F1 F2 micro movements of the wrist muscles and ligaments detected as forces at the base of the wrist unit F2 Hand at rest Movements One value A is formed from the signal every minute to represent movement activity during one minute The calculated values are presented on the screen as a graph 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 Figure 1 Movement activity CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 2 ACTIVITY CURVES IN THE ANALYSIS OF CIRCADIAN RHYTHM AND SLEEP Circadian rhythm and sleep can be analysed with the aid of activity curves derived from activity measurement figure 2 A person s circadian rhythm and sleep quality as well as daily activity reflect their state of health and well being In poor health a person sleeps restlessly and is tired during the day Many changes in state of health or functional ability can be detected from changes in circadian rhythm and sleep and thus also on the measured a
8. Security Technology Oy 24 9 REPORTING After viewing a person s activity curve analysis conclusions and appropriate actions it is beneficial to also record observations and completed actions In the long range a great deal of curve information amounting to months or even years can be accumulated Often only a part of this accumulated information contains changes or events of interest that are necessary to report separately to for example the client or to care giving personnel or the residing doctor The Vista program allows for the recording of comments and supplementary information as a part of the curve database Curve information can be exported from the program and be attached as part of other customer documentation in various ways or can for example be made into a separate report using a regular word processing program 9 1 Comments and additional information The Vista program automatically records each customer s curves and resulting alarms Comments added to the curve and observations written in the additional information field can also be recorded in the same database When transferring or copying curve information this information will also be transferred Views Activity Curves 09 22 Vivago Realtime curves Curve post analysis Week analysis Customers Mon 02 08 2004 21 21 Tue 03 08 2004 21 21 Tue 03 08 gt Screen size 1 day l 50 4 Tue 03 08 2004 02 314 Smoo
9. condition should be checked to find the source of the problem 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 22 8 ANALYSIS OF WAKEFULNESS With the aid of the activity curve we can observe a customer s physical activeness during wakeful hours The higher the values on the activity curve the more actively the person is moving For the activity curve to reach its maximum value 100 the user must be vigorously active for example doing an active sport activity or demanding physical labour It is also beneficial to observe variation in activity level Generally a person will be active for short periods at a time followed by rest periods during which calculated activity will have low values A person has good wakeful activity if his her average value is markedly greater than the normal sleep limit 26 In addition activity should periodically have large values gt 50 which are then followed by a period of lesser activity Variation in activity during wakeful hours is usually a good characteristic Because the activity curve depicts physical performance during wakeful hours by observing this pattern changes in well being that have an effect on daytime vitality and energy level can be detected CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 23 2003 Circadian rhythm Sat 09 08 Sun 10 08 Sleep time 08 52 Sleep periods 3 Weal Sun 10 08 Mon 11 0
10. own adjustment Calculated sleep time is displayed under the curve with the blue bar 3 The information screen 4 allows you to view the calculated number of sleep periods that is the number of separate blue bars within the selected day and total sleep time as a sum of these In addition the information screen shows the calculated circadian rhythm for the selected 24 hour period see the chapter on circadian rhythm Activity Curves IS Vivaco Realtime curves Curve post analysis Week analysis Wed 09 10 2002 18 00 Thu 10 10 2002 00 00 Customers Screen size 6 hours Smoothing Normal 4x v Alarms Show on screen Midnights Meter Middays Time stamps Color codes Comments Perm bran Sleep Alarms Add comment Activity Curves NT TE Instructions For analysis screen Zooming Hold down the Ctrl key and the left mouse button move mouse From left to right Scrolling Hold down the right mouse button and move the mouse left or right Settings Wed 09 10 2002 3 period s time 09 21 File vis29 Curve inFormation Wed 12 12 2001 Tue 11 03 2p03 Latest all N October 2002 LLLA Mon Tue Wed Thu Fri Sat Sun 30 1 2 5 6 ENEEN S GH 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 9 10 09 10 2002 Additional info Debug A
11. sleep wake rhythm One of a person s most important circadian rhythms is the variation of sleep and wakeful states in other words the sleep wake rhythm A healthy person should naturally move sufficiently during the day and sleep peacefully during the night Daytime activity curve values are large and activity levels also fluctuate greatly 1 During the night while the wrist unit s user is asleep and moves little because of this the curve has markedly CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy smaller values than during the daytime 2 Activity levels also fluctuate little during sleep Sleep time differs for this reason clearly from the daytime wakeful state With a glance then we can determine when a person is asleep or awake based on the amount of their movement Regular events during the 24 hour period can also be observed with the help of the activity curve For example a nap can be noticed as a short period of little movement in the afternoon 3 The user may be in the habit of taking a daily stroll at a certain time of day during which the wrist unit is out of signal range There is a break in the activity curve at this time 4 During sleep time a person also moves a little from time to time Sleep time movement can be seen as low activity 5 which is however markedly smaller than that during this person s wakeful time During deep sleep a person is usually still and their activity curve can s
12. 21 Mum Tus Wed Thu FH Set man Circadian rhythm 0 12 30 1 2 3 4 5 6 oF 8 9 11 12 13 14 15 16 17 18 19 20 Modify Add Remove 21 22 23 24 25 26 27 28 29 30 31 7 3 4 5 5 1 8 9 10 09 10 2002 Goa amp Customer zr Open g Close Refresh Export j Settings Curve color codes No curve available WristCare off wrist E Sleep Night time 11 pm Sam Application guide activity curve v1 2 doc Microsoft Word Additional info Debug Figure 7 Observing one 24 hour period CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 11 Choose for observation those 24 hour periods which you have determined to be typical poor and good for your customer Observe the following patterns e he placement of sleep time within the 24 hour period falling asleep and waking up times e duration of sleep and number of sleep periods e he number of awakenings their duration and their position during night time e Movement during sleep are there periods of deep sleep e Daytime activity variation maximum value for activity e Daytime rest periods their position and duration oee the separate chapter on sleep analysis for instructions on how to use the program for observing sleep patterns Make a record of a typical time period obvious changes and other known events that have had an effect on the activity curve See the chapter on reporting fo
13. 27 28 11 is also more restless than normal and the circadian rhythm value is 0 54 7 2 Intended use of circadian rhythm By observing circadian rhythm and the curve depicting it we can detect changes in a person s well being With the help of a graphic presentation it is easy to notice deviations from a normal state as well as slowly developing long term changes Normally when a person is well she he is physically active during the day and sleeps regularly during the night The circadian rhythm is then close to 0 and the curve moves along the left edge of the scale When a person s condition deteriorates it may be seen as sleeplessness nighttime awakening sleep time deviating from night time hours a decrease in daytime activity or a combination of all of these simultaneously Changes in a poor direction increase the calculated value of circadian rhythm and move its depicting CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 21 curve towards the right edge of the scale Accordingly when a person s condition improves we can see that the circadian rhythm returns to normal and the curve moves back towards the left edge of the scale 2004 Tue 03 08 Wed 04 08 Sleep time 13 31 Sleep periods 10 Wed 04 08 Thu 05 08 Sleep time 10 16 i i Sleep periods 10 Thu 05 08 Fri 06 08 Sleep time 12 58 Sleep periods 9 Fri 06 08 Sat 0708 S
14. 8 Sleep time 02 09 Sleep periods 4 Mon 11 08 Tue 12 08 Sleep time 05 18 Sleep periods 3 Tue 12 08 Wed 13 08 Sleep time 06 43 Sleep periods 2 Wed 13 08 Thu 14 08 Sleep 06 41 Sleep periods 3 Thu 14 08 Fri 15 08 Sleep time 05 53 Sleep periods Fri 15 08 Sat 16 08 Sleep time 02 07 Sleep periods 3 2004 13 14 15 16 17 18 19 20 21 22 23 01 Of 03 04 n5 6 OF as ge 10 Circadian rhythm Sleep time 09 22 Sleep periods 6 Sun 11 01 Mon 12 01 Mon 12 01 Tue 13 01 Sleep time 10 45 Sleep periods 5 Tue 13 01 Wed 14 01 Sleep time 08 28 Sleep periads 3 Wed 14 01 Thu 15 01 Sleep time 08 43 Sleep periods 4 Thu 15 01 Fri 16 01 Sleep time 06 22 Sleep periods 2 Fri 16 01 Sat 17 01 Sleep time 08 18 Sleep periods 4 Sat 17 01 Sun 18 01 Sleep time 08 56 Sleep periods 3 Figure 17 The gradual change of daytime activity in an adverse direction The top figure shows the person s 7 day activity for August and the lower six months later for February The most prominent change is the marked decline in daytime activity which is also reflected in the circadian rhythm There has been no sudden change in the person s state of health but rather a gradual deterioration of his her physical performance 0120 ENG v 1 2 April 2005 IST International
15. ACTIVITY CURVES AND THEIR PRACTICAL USE CONTENTS MOVEMENT fec 3 2 ACTIVITY CURVES IN THE ANALYSIS OF CIRCADIAN RHYTHM AND SLEEP 4 3 USE OF THE ACTITITY CURVE IN CARE WORK rennen nnne 5 4 REASONS FOR CHANGES IN SLEEP WAKE 8 5 GETTING TO KNOW THE ACTIVITY CURVE 9 0 ATE essen 14 6 1 Thenorm lstr cture of 14 6 2 Method SELLINGS NN CH ERN ESPERE Na oa PUES PES aia 15 6 3 Accuracy of sleep analysis and adjustment 1 eee e eee e eee eee eee eee e eee ee eese eee 16 6 4 analysls TU 16 Ts oe 19 rm Eme i a E aa Oa aE aaa aE ENE 19 7 4 Intended Use of circadian Ep e aee ene PE EE 20 6 ANAEYSISOF WAKEFULNESS a eo ue ccn 22 icuelnlicpe cR 24 9 1 Comments and additional Inforniatioh ooo oue ey vo ee ERN VER SEE RES ENSURE S ERE R RYE ER PERF e ERIS 24 92 Printing of curve informatio Mses ressos ana AEE UE IS E i aene 25 9 3 Adding curve
16. April 2005 IST International Security Technology Oy The following diagrams depict good and poor situations for each pattern 1 SLEEP awakenings sleep time regularity and the time where sleep situates during a 24 hour period The blue line depicts sleep time estimated on the basis of the curve 100 100 a 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 Good sleep sufficient in length Poor sleep several awakenings occurs during night hours no long periods of wakeful time awakenings several periods of during night hours the duration of deep sleep sleep is short and fragmented 2 WAKE the level of daytime activity 100 100 0 0 01 02 03 04 05 06 07 08 09 10 H 12 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 49 20 21 22 23 00 Poor daytime activity low physical activity and also rests frequently during the day Good daytime activity physically active with periodic rest breaks outside in the afternoon red line 3 RHYTHM The relationship between night and daytime activity In these diagrams the blue line depicts average nighttime activity and the red line average daytime activity EN Good rhythm night and daytime Poor rhythm night and daytime activity levels differ markedly activity levels are similar CFI0120 ENG v 1 2 April 2005
17. Rhythm in Demented and Non demented Nursing Home Inhabitants Measured by IST Vivago WristCare Activity Signal The International Conference on Aging Disability and Independence 4 6 December 2003 Washington DC USA CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy
18. Transfer OFF 1 2 3 4 6 Figure 8 Week analysis First choose the 14 day display 1 and place midnight in the middle of the screen 2 Use normal smoothing 3 Choose the colour codes and sleep display hide comments and alarms from the screen 4 You can scroll the curve using the scroll bar at the right hand side of the screen 5 The double arrow moves you one full screen back or CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 12 forward in this case 14 days You can also use the calendar to move around in time 6 just as in the post analysis window By double clicking your mouse on a curve on the display you can switch to the post analysis mode for more detail of the chosen period The purpose of this display is to aid in the comparison of 24 hour periods so that changes can be detected Consecutive 24 hour periods are one below the other the top one being the oldest The screen will display 7 10 or 14 days according to your choice 1 Each row shows 24 hours of data so that your choice of either midnight or midday is in the middle 2 When you want to compare nights to one another it is easier to place midnight in to middle and when you want to compare days place midday in to middle It is especially beneficial to use colour codes on the weekly analysis display With their help you can see regularly occurring events that stem from the user s lifestyle For example if the user often remo
19. bronchitis e urinary tract infections incontinency e Other temporary factors e excessive use of coffee tea or alcohol e medication especially sleeping pills others some heart and blood pressure medication as well as asthma medication and cortisone treatment e excessive smoking e excessively long daytime naps e lying in bed waiting for sleep e lighted sleeping environment noise e insufficient physical activity during the daytime e emotional reasons e anxiety e sadness and depression The circadian rhythm of elderly people has characteristics common to older age The necessary duration of sleep changes little with age but sleep becomes lighter fragmented and diverse in quality as a person ages Older people awaken more frequently than younger people This results in decreased daytime vitality and fatigue Elderly people also take more frequent naps Elderly people retire to bed at an early hour and thus awaken at an early hour Sleep difficulties increase with age so sleep medication is common CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 5 GETTING TO KNOW THE ACTIVITY CURVE Prior to familiarization with the activity curve itself it is important to understand the customer s general information state of health functional ability as well as other details which can have an effect on the customer s activity curve Familiarization general Choose your preferred customer s activity curve p
20. ctivity curve Continuous observation is important because it enables the detection of changes in the activity curve Necessary care can then be given immediately and its effectiveness can be evaluated Activity curve observation cannot render a specific diagnosis because many ailments appear similarly on the curve as for example nighttime awakenings It is not very often possible to say that a certain ailment would appear on the graph in its own particular way Sometimes a certain change in the state of health such as back pains may induce individual changes in circadian rhythm and sleep One may wake up during the night another is tired during the day The activity curve is effective in 1 detecting general problem states 2 evaluating the effectiveness of care when the ailment has already been identified The Vista program has several features that aid in the analysis of circadian rhythm and sleep The activity curves chapter in the Vista user s manual includes a detailed description of these features Practical instructions and examples of the effective use of available features are provided in this application guide The pictures and curves presented in this guide have been made using Vista program version 3 0 In version 2 0 or those older the curve is drawn and presented in a different way and they do not contain all of the features introduced in this manual 09 10 if 12 13 1 Figure 2 Activity curve depiction of a healthy person s
21. e topic 1 Ancoli Israel S Cole R Alessi C Chambers M Moorcroft W Pollak CP The role of actigraphy in the study of sleep and circadian rhythms Sleep 2003 26 3 342 392 2 van Someren E J W Circadian and sleep disturbances in the elderly Exp Gerontology 2000 35 1229 1237 3 Bliwise DL Sleep in normal aging and dementia Review Sleep 1993 16 1 40 81 4 Phillips B Ancoli Israel S Sleep disorders in the elderly Review Sleep Medicine 2001 2 99 114 5 Brassington GS King AC Bliwise DL Sleep problem as a risk factor for falls in a sample of community dwelling adults aged 64 99 years JAGS 2002 48 10 1234 1240 6 Foley D Monjan A Masaki K et al Daytime sleepiness is associated with 3 year incident dementia and cognitive decline in older Japanese American men JAGS 2001 49 12 1628 1632 7 Pollak CP Perlick D Linsner JP Wenston J Hsieh F Sleep problems in the community elderly as predictors of death and nursing home placement J Community Health 1990 15 2 123 135 8 Chenier MC Review and analysis of caregiver burden and nursing home placement Geriatric Nursing 1997 18 3 121 126 9 L tj nen J Korhonen I Hirvonen K Eskelinen S Myllymaki M Partinen M Automatic sleep wake and nap analysis with a new wrist worn online activity monitoring device Vivago WristCare Sleep 2003 26 1 86 90 10 Paavilainen P Korhonen I Cluitmans L L tj nen J Sarela A amp Partinen M Circadian
22. figure 21 for each customer 1 Case report 1 doc Preview Microsoft Word 3 Rive ice _ vis Ezio 1 p ACTIVITY CASE REPORT ORGANISATION Prale honie svstem user DATE OF REPORT 27 8 2004 AUTHOR NN CONTACT INFO tel 010 1234456 e mail nn irem eom GENERAL CUSTOMER INFORMATION m tel 050 2345078 1 Hone General physical condition Fairly good does louse work exercises daily by walking in the neighborhood 34 R4 r7 T EE CASE Description Circadian rhythm haz rapidly changed from normal average 0 2 to 0 5 on Monday 09 08 04 and up to LA on Tuesday fig L Monday malt ic restless aad on Tuesday there t almost no sleep at all circadian rhythm is reversed Daytime activity is very low on Monday fig 2 When interviewed ou Tuesday customer is feeling bad complains headache and is very tired his Actions Customer visited his doctor and a urinary tract infection was diagnosed after examination and laboratory teste Infection waz treated with antibiotics idi remm preme Follow up The customer s condition returned to alinost normal aud the circ adian rhythm has been normalized after one week fies 3 and 4 Some fatigue stall visible a littl lower activity before and longer sleep times than normal AES Late ir mk pb 07 JB 18 GO IP 23 73 DO ST SE
23. gy Oy 7 CIRCADIAN RHYTHM 7 1 Method With the help of the activity curve it is possible to observe a person s circadian i e sleep wake rhythm Circadian rhythm refers to the relationship between daytime and nighttime activity Vista calculates and presents a value representing circadian rhythm for each 24 hour period figure 14 The value is calculated from the curve by dividing average nighttime activity NightActivity by average daytime activity DayActivity CircadianRhythm DayActivity Nighttime from which average activity vale is calculated is between 23 00 5 00 and it appears as the light blue area on the screen Daytime is between 8 00 20 00 Circadian rhythm is always calculated by dividing nighttime activity by the activity of the previous day Mews Activity Curves 39 3 Vivago Realtime curves Curve post analysis Week analysis Customers Sun 05 01 2003 12 14 Mon 06 01 2003 12 14 Screen size 1 day 50 EE i oP 5 Smoothing Normal 4x 43 Pc Me 4 i Alarms T E Bo Show on screen 37 Day Activity 1 0 eem Midnights Meter Middays Time stamps i i i i m Color codes Comments Night Activity 1 Sleep Alarms Activity Curves Dp i i Instructions For analysis screen Zooming Hold down the Ctrl key and the left mouse butt
24. h Long term changes are easily observed with the help of the week analysis screen Figures 12 and 13 show examples of change in sleep duration 0120 ENG v 1 2 April 2005 IST International Security Technology Oy Customers Alarms Alarm History Activity Curves Settings Color codes Comments A Add comment File visa 151 C 7 days Customer Open file Close Inthe middle Smoothing vista 10 days Midnight 0 14 days C Midday Normal 4x n Alarms Calendar E Refresh Export i Curve color codes W curve available WristCare off wrist Bl Sleep Night time 11pm Sam Transfer OFF Figure 12 Increase in sleep duration and a single daytime rhythm change 14 3 15 3 Figure 12 shows that sleep duration has markedly increased beginning 12 3 This is particularly evident during afternoon hours Prior to 12 3 the person slept in the afternoon only on 8 3 and 11 3 Starting on 12 3 however s he sleeps every afternoon for several hours Calculated sleep time increases by an average of about two hours This may be a sign of increased fatigue the reason for which should be investigated The increase of fatigue can also be seen as a decrease in daytime activity level beginning on12 3 CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy Views O Activity Curves Real time curves C
25. hm is reversed that is the person is more active during the nighttime than the daytime 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 20 Circadian rhythm and changes in it are easier to observe on the week analysis screen figure 15 There is a curve on the right edge of the screen the points of which represent the circadian rhythm values for each day By pointing to a curve point with your mouse Vista will show the numerical value for circadian rhythm on that day e g 0 23 If circadian rhythm is reversed that is nighttime activity 2 is greater than that in the daytime 3 then the corresponding point will be red If several hours of activity data are missing for either night or daytime for example if the user neglected to wear his her wrist unit 4 or has been out of transmission range then that days circadian rhythm cannot be reliably calculated In this case the circadian rhythm curve has a gap 5 vista vens TETTE Vivago Real time curves Curve post analysis Week analysis _ 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 Circadianrhythm Customers 2003 Wed 19 11 Thu 20 11 Sleep time 07 35 Sleep periods 5 Thu 20 11 Fri 21 11 Sleep time 06 31 Sleep periods 4 Alarms i Fri 21 11 Sat 22 11 Sleeptime 08 20 Alarm History Sleep periods 3 T T Sat 22 11 Sun 23 111 a ub Sleep time 00 41 S
26. how zero 6 Nighttime awakenings can be seen as periods of high activity during night hours 7 Good sleep should be sufficiently long regular continuous and should include periods of deep sleep 3 USE OF THE ACTITITY CURVE IN CARE WORK Many changes in a person s well being functional ability and state of health are reflected onto their sleep wake patterns sleep or wakeful time movement activity Activity curves are useful in health care for two purposes 1 Evaluating changes and probable developments in well being as well as 2 Follow up of treatment Changes in well being can be seen and effects of treatment can be evaluated by observing and analysing SWR patterns Sleep Wake and Rhythm 1 SLEEP Characterised by awakenings length of sleep regularity sleep quality and where sleep time is situated during a 24 hour period 2 WAKE Characterised by the level of activity during daytime hours 3 RYTHM i e the alteration of sleep and wakefulness Characterised by the ratio of day and night time activity WELL BEING SWR patterns are significantly related to one s health Sleep wakefulness and the alteration of these two i e circadian rhythm depict health independently but are also closely connected to each other A change in sleep often affects circadian rhythm as well as the wakeful state A poorly slept night for example may cause sleepiness during the day and thus also a change in rhythm CFI0120 ENG v 1 2
27. information to other programMS sscssssscececccsssssecococsssssececoosssssececocossssceccoossssseceesossssssee 26 LU MEE vidua NALLE E EELA EENES ELLES T 27 10 REFERENCES isie EE IMEEM IM MILI LL 28 CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 1 MOVEMENT ACTIVITY The Vivago system measures the movement activity of the wrist unit s user Measurement is made with the wrist unit s sensitive movement sensor Both the amount and strength of movements have an affect on measurement results A value representing activity ranging from 0 100 is calculated for each minute This value tells us the amount of the user s activity during the period of one minute An activity value of 0 shows that the wrist unit has not registered any movement from its user that is s he has been completely motionless A value of 100 represents the greatest amount of movement measurable by the wrist unit This type of activity requires vigorous movements from the user Measurement results are transferred through a base station to a computer with the Vista program The computer stores each user s measurement information which can be viewed and analysed with the help of the Vista program The program produces an activity curve for each user based on the measurements provided by the wrist unit where one point represents one minute of activity The activity curve shows the users average movement activity
28. leep periods 1 ae Ee T Sun 23 11 Mon 24 11 Sleep time 05 47 Sleep periods 5 Mon 24 11 Tue 25 11 Sleep time 08 09 Sleep periods 4 Tue 25 11 Wed 26 11 Sleep time 03 07 Sleep periods 4 Wed 26 11 Thu 27 11 time 10 53 Sleep periods 9 Thu 27 11 Fri 28 11 Sleep time 06 23 Sleep periods 8 Activity Curves Settings Fri 28 11 5at 29 11 Sleep time 12 10 Sleep periods 7 File vis3 C 7 days Inthe middle Smoothing Colorcodes Comments Add comment customer Gar Open 7 10 days Midnight Normal 4x v WV Slee Alarms A rus C Mdday Calendar Refresh Export Settings Curve color codes No curve available 8 WristCare off wrist Sleep Night time 11 pm Sam Application quide activity curve v1 2 doc Microsoft Word Figure 15 Circadian rhythm on the week analysis screen In figure 15 the person has haraly slept at all on the night between 22 11 and 23 11 His her daytime activity is even greater than that of the nighttime Because of this the calculated circadian rhythm has a large value 1 36 and the curve moves toward the right edge during this period of 24 hours Normally his her circadian rhythm is an average of 0 2 The deviating period is easily noticeable as a sharp turn to the right A similar situation can be seen on 25 26 11 when the user has taken off the wrist unit for the night The night between
29. leep time 10 07 Sleep periods 13 Sat 07 08 Sun 08 08 Sleep time 11 45 Sleep periods 12 Sun 08 08 Mon 09 08 Sleep time 15 02 Sleep periods 18 e Mon 09 08 Tue 10 08 Sleep time 13 43 Sleep periods 16 50 50 fe 43 43 i V i i 37 ma mm mE NND ON I8 ee eee 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 Figure 16 A rapid deterioration of circadian rhythm Figure 16 shows an example of the rapid deterioration of circadian rhythm The user usually has a good circadian rhythm 0 13 on Thursday 4 8 She he sleeps well over 8 hours during the night 1 This person is physically active and outdoors often during the daytime and for this reason the wrist unit it out of signal range a few times every day 2 She he usually has an afternoon nap 3 Beginning on Sunday 8 8 this person s circadian rhythm deteriorates markedly Daytime activity level drops outdoor activity halts daytime naps increase in number and duration and nighttime sleep deteriorates or becomes virtually nonexistent On Monday and Tuesday this person s circadian rhythm is already reversed that is she he is more active during Tuesday night than during the preceding day 4 The circadian rhythm value is 1 5 The change is obvious on the circadian rhythm curve 5 Dramatic deterioration of circadian rhythm can be a sign of a problem in well being The user s
30. mation field 2 Comments are added to the point indicated by the meter by using the Add comment button The meter 3 can be moved by dragging your mouse or by clicking on the picture at the desired point The comment can be seen on the curve as a green note The complete comment can be viewed by bringing the mouse on top of the green note The note can be modified or removed by double clicking Short general information about a client s condition events or other relevant information can be written in the additional information field at the bottom of the screen Additional information can be modified or removed CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 25 9 2 Printing of curve information The simplest way of reporting events is to print curve information for a specific time period on paper from either the post or weekly analysis window Figure 19 shows an example of a print out taken from a situation where there was a rapid change in circadian rhythm due to the poor health of the user vista Activity Curves Vivago Real time curves Curve post analysis Week analysis Views Customers 2004 Tue 03 08 Wed 04 08 Alarms Wed 04 08 Thu 05 08 Alarm History Thu 05 08 Fri 06 08 Activity Curves Fri 06 08 Sat 07 08 Export Activity curves xport in the Following Form Copy to clipboard as image Save as image JPG Save curve in numeric Forma
31. oint curve for two to three hours During a normal eight hour sleep period a person only requires one generous hour of deep sleep and two hours of REM to stay alert and functional Three hours of sleep is insufficient for even a very efficient sleeper because the other phases of sleep around deep sleep are also necessary to complete sleep stages There are people who successfully manage this in six hours Various disturbances and individual characteristics however can greatly increase the necessary duration of sleep The rising of the activity curve to a level close to daytime activity for several minutes is a sign of awakening If a person experiences significant daytime fatigue there is reason to evaluate the quality of sleep with the help of the curve and try to isolate disturbing factors CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 15 6 2 Method and settings The Vista program can automatically calculate and show an estimate of the customer s sleep time The calculation of sleep time is based on the threshold value method figure 10 When the measured activity is below the adjusted threshold value 6 00 in example for a set time 15 min the program assumes the person is asleep Correspondingly awakening is assumed when activity is above the same threshold value for a sufficient time 5 min The settings can be changed using the Settings button 1 You can use either predefined settings 2 or make your
32. om sleep disorders default values for settings limit for sleep 6 00 fall asleep delay 15min and wake up delay 3min render good accuracy For elderly people who have low functional ability and who s default values produce markedly higher values than in actual experience the sleep limit should be decreased e g 3 00 and the fall asleep delay increased to e g 20 min If a person has a sleep disorder and sleeps restlessly the sleep limit can be increased e g 10 00 and the wake up delay can be increased e g 6min 6 4 Use of sleep analysis The purpose of the automatic sleep analysis is to help to observe the states of sleep and wakefulness Graphic presentation makes it easier to notice abnormal sleep and observe long term changes in sleep patterns 100 100 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 Figure 11 A normal sleep b disturbed sleep The ideal situation is shown in figure11 A where there is one consecutive sleep period of about 9 hours Sleep takes place during nighttime hours between 23 00 8 00 and the user is awake during the daytime The blue bar depicting sleep is continuous and sufficiently long Figure 11 B depicts an abnormal situation Sleep time is broken into several phases due to frequent awakenings The deviation from normal sleep is easily detected from the broken blue bar under the grap
33. on move mouse from left to right Settings B i pu Scrnllina Hold dawn the right mouse button BUONO E NONE URN 0 left or right 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 07 rhythm Ls i 1 10 20 10 File Selected day Mon ubju1 zuu3 8441 4 January 2003 i Curve information Wed 12 12 2001 Wed 08 01 2003 analysis 2 periods time 05145 Ms mE Wed hu PH sb Sen Latest il Mo call Circadian rhythm 30 1 2c cw Additional info Debug 6 8 Modify Remove 06 01 2003 Go 3 amp Customer z Open file 2 Close Refresh Export settings Curve color codes Bi No curve available WristCare off wrist NI Sleep Night time 11 pm Sam Transfer OFF Figure 14 Circadian rhythm Average nighttime activity 1 blue dotted line and average daytime activity 10 red dotted line so circadian rhythm 1 10 0 1 This 15 strong rhythm The calculated value for circadian rhythm represents the quality of sleep wake rhythm When the rhythm is strong nighttime activity is minimal and daytime activity is great In this case the circadian rhythm value is close to zero When the rhythm is weak nighttime activity is close to daytime activity In this case the calculated value is close to or greater than 1 00 If the value is greater than one the rhyt
34. ost analysis window figure 6 Initially a 4 days screen size can be chosen 1 to gain a general conception of the person s circadian rhythm You can adjust the smoothing to its maximum value 2 and graph settings can be chosen so that only the line depicting midnight can be seen on the graph 3 This simplifies perception of the overview of a customer s activity curve Additional information Curve smoothing is done by calculating the average of several surrounding points each depicting one minute of activity The stronger the smoothing the more the adjacent surrounding activity affects the activity value of the moment in question The smoothing only affects the displayed curve Information is always stored in its most accurate form without smoothing Smoothing eliminates details from the graph but can clarify its main characteristics The longer the duration of the graph being viewed on screen the bigger the smoothing value should be used When viewing a graph of shorter duration e g 6hr 1 day it is good to use a small smoothing value so that details will still be discernable n Activity Curves Realtime curves Curve post analysis eek analysis Tue 08 10 2002 Sat 12 10 2002 05 16 Sat 12 10 gt Customers Wed 09 10 gt Thu 10 10 gt Fri 11 10 gt Alarms Alarm History 3 i E Add comment Activity Curves Settings ie i da 0 46 l2 d a te d d5 12 ABS OE 5b
35. r more detailed instructions on how to make a report from the curves Familiarization long term analysis When you have become familiar with individual days you can observe typical characteristics of a longer time period by choosing the week analysis sheet figure 8 Vivaco vista Views Activity Curves Real time curves Curve post analysis Week analysis Customers 2002 Tue 15 10 Wed 16 10 nu E Sleep time 05 3 eb wed 16 Thu A 8 Alarms Alarm History Sat 19 1 10 cun 20 10 Sat 19 10 2002 15 15 Sleep time 05 29 Sleep periods 4 Sun 20 10 Mon 21 10 Activity Curves Sleep time 06 41 Sleep periods 7 Mon 21 10 Tue 22 10 ae Tue 22 10 Wed 23 10 Settings Sleep time 06 48 Sleep deridet 8 Wed 23 10 Thu 24 10 Sleep time 06 15 Sleep periods 7 Thu 24 10 Fri 25 10 Sleep time 09 2 Sleep periods ss Fri 25 10 Sat 26 10 Sleep time 07 45 Sleep periods 5 Sat 26 10 Sun 27 10 Sleep time 05 43 Sleep periods 8 Sun 27 10 Mon 28 10 Sleep time 09 3 Sleep periods 8 Mon 28 10 Tue 29 10 Sleep iss 02 In the middle Midnight Midday Color codes Comments v Sleep Alarms Curve color codes No curve available WristCare off wrist NI Sleep Night ti time a 1pm Sam
36. rves on the weekly analysis display take special note of the following things Whatis the average circadian rhythm value does it vary Are certain days like weekends better than others Are there regularly recurring events such as walking outdoors and does the user keep the wrist unit on Sleep and its regularity Is calculated sleep time short or is it especially abundant is average sleep time normal does it situate in night time hours are there many sleep periods is the sleep pattern regular or is there a lot of diversity is there sleep during the daytime e Are there abrupt changes taking place within one or two days to circadian rhythm or sleep characteristics Are there gradual changes taking place over the period of several days or weeks to circadian rhythm or sleep characteristics Make a record of a typical time period obvious changes and other known events that have had an effect on the activity curve See the chapter on reporting for more detailed instructions on how to make a report from the curves CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy Summary 13 2 l Screen settings Observable patterns General view Detailed analysis Long term analysis Curve post analysis window Screen size 4 days Maximum smoothing Show on screen Midnights Curve post analysis window Screen size 1 day Normal smoothing Show on screen Midnights Middays Meter
37. t to a text File TXT Save as IST curve database YDB ettings Include header information Printer istserver Canon iR3300 Properties g x EDT Comments A 4dd comment Customer 2 Open file ge Close C 14 days C Midday Alarms Calendar 28 Refr sh Export Sbttings LJ Curve color codes No curve available WristCare off wrist Sleep Night time 11pm Sam rame e fil Print B Wu M P ae zi 9 e e o e o IT eS ld FE id Figure 19 Printing curve information on paper from the Vista program The print out can be kept as part of client records or can be attached to other documents and given to the appropriate recipient as normal 0120 ENG v 1 2 April 2005 IST International Security Technology Oy 9 3 Adding curve information to other programs vista Activity Curves Real time curves Curve post analysis Week analysis Customers Tue 03 08 Wed 04 08 Alarms Wed 04 08 Thu 05 08 Alarm History Thu 05 08 Fri 06 08 Activity Curves 1 Fri 06 08 Sat 07 08 Export Activity curves xpart in the Following Form C to clipboard as image Save curve in numeric Format to a text File Save as 157 curve database t YDE ectings
38. the curve remains at a very low value for one or two hours and the first period of deep sleep has been successful 2 Accumulated sleep deprivation accelerates the appearance of deep sleep During the following REM sleep occasional slight awakenings or movements can render higher activity within an otherwise low curve 3 Approaching twilight the amount of deep sleep usually decreases and restlessness associated with REM increases This is apparent on the curve 4 The fluctuation between shallow and deep sleep becomes slower towards morning gt possible deep 5 ep en ie zs a am _ vc MEM num m NM 2 ax wink RR CC ET A rer T E E BANT ERE wink TES RM i ET B TT TUM jj Tem aa ez e3 01 r3 04 05 D oF 09 Figure 9 The structure of sleep The sufficiency of deep sleep can often be determined from the activity curve Evaluation should be made by observing several consecutive nights An isolated night may contain disturbances and does not necessarily reflect the typical situation The amount of deep sleep can be considered sufficient if especially during the first hours of the night there is a very low almost zero p
39. the middle of the screen First choose the time period from the calendar and scroll back and forth with the help of the CFI0120 ENG v 1 2 April 2005 IST International Security Technology Oy 10 scroll bar When you are viewing a customer s curve for the first time you can go to the beginning of his her data by pressing the double arrow button on the calendar 5 Go to the end of the data by pressing the double arrow to the right 6 The arrow button 7 enables you to change calendar months The blue field in the background of the activity curve analysis window is always between 11pm and 5am This coloured field helps to easily distinguish the position of nighttime on the screen and where the person s own sleep rhythm situates during a 24 hour period Begin by viewing curves from a time period that you want to compare to the current situation Always observe a period of at least one week preferably several weeks While browsing through the curves note the following factors General circadian rhythm can you differentiate daytime from night is sleep time taking place during nighttime hours and is rhythm regular e he average level of daytime activity e average level of night time activity Make a record of a typical time period obvious changes and other known events that have had an effect on the activity curve See the chapter on reporting for more detailed instructions on how to make a report from the curves Familiari
40. thing Normal 4 Alarms Show on screen 37 1 Midnights Meter Middays Time stamps ah Color codes Comments Alarm History wo Add comment Activity Curves 1 I X X NE Instructions For analysis screen Zooming Hold down the Ctrl key and the left Bi d 1 mouse button move mouse from left to right Settings Q MX QU Scrolling Hold down the right mouse button m um and move the mouse left or right 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 a p gt File 05 Selected day Tue 03 08 2004 44 August 2004 bb Curve information Mon 02 08 2004 Thu 26 08 2004 Sleep analysis 2 period s time 08 46 Mk Tue Wed Thus PH mem ites call ircadian rhythm Unavailable Additional info Debug 2 2 3 4 5 6 7 8 9 10 15 Modify Add Remove 16 17 18 19 20 21 22 Wed 04 05 2004 Sat07 08 2004 Feels good goes out normal rhythm 23 24 25 26 Tue 10 08 2004 Headache tired 03 08 2004 _ Go amp Customer zr Open Close 1 Refresh Export Sj Settings Curve color codes No curve available WristCare off wrist Sleep Night time 11 pm Sam Transfer OFF Figure 18 Adding comments and additional information to curve data Figure 18 shows an example of adding comments 1 as well as the additional infor
41. urve post analysis Week analysis 2003 Customers 2003 02 Fri 21 02 Alarms Alarm History Activity Curves Tue 25 02 Wed 26 02 Settings Sleep time 04 55 A g Thu 27 02 Sleep time 03 07 Thu 27 02 Fri 28 02 Sun 02 03 File vis30 151 C 7 days In the middle Smoothing Color codes Comments Add comment Customer Open 52 Close vista 10 days Midnight 4x v Wseo Alarms lt C 14 days C Midday Calendar Refresh Export Settings Curve color codes W No curve available 88 WristCare off wrist Bl Sleep Night time 11pm Sam Transfer OFF Figure 13 The deterioration and fragmentation of sleep also the weakening of circadian rhythm Sleep duration of the person in figure 13 decreases markedly and nighttime wakefulness increases markedly beginning on 25 2 Earlier sleep time has been fairly tied to nighttime hours and has been quite consecutive On 25 2 calculated sleep duration decreases by about two hours the user seems to sleep only at the beginning of the night and on 26 2 not even that An obvious deterioration in sleep can be the sign of a problem in well being The person s physical condition should be reviewed to find the underlying reason Deterioration in condition can also be seen as the weakening of circadian rhythm see next chapter CFI0120 ENG v 1 2 April 2005 IST International Security Technolo
42. ves the wrist unit during the night it can be seen as a recurring yellow bar during the night under the curve Similarly the user s moving out of signal range for example during walks outside would be seen as a red bar When necessary the situation can be commented on by for example asking the customer to keep the wrist unit on during the night as well On the right hand side of the display there is a curve which depicts the user s circadian rhythm 7 The curve has been calculated for each day by dividing average daytime activity by average nighttime activity The better a person s circadian rhythm is the closer to zero and to the left side of the scale the curve is If nighttime activity is the same or even greater than daytime activity the circadian rhythm will have a value of one or more The curve will then be close to the right hand side of the scale and rhythm is obviously poor When you move the mouse pointer on top of a point on the curve the calculated numerical value for circadian rhythm will be shown See the separate chapter on circadian rhythm In the field 8 on the left hand side of the display calculated sleep time and the number of sleep periods for the 24 hour period in question can be seen See the separate chapter on sleep analysis for instructions on how to use the program for observing sleep Begin by viewing curves from a time period that you want to compare to the current situation While browsing through the cu
43. zation a more detailed analysis When you have a general conception of the person s circadian rhythm choose a shorter time window for your screen figure 7 by setting one day for the size of your display Choose normal 1 for the smoothing value so that you can more easily differentiate details Select midnight midday and the meter on your screen Choose the colour codes and the sleep display 2 vista Activity Curves Real time curves Curve post analysis analysis Tue 08 10 200242 43 Wed 09 10 2002 12 43 1 Wed 09 10 gt 50 Wed 09 10 2002 05 24 43 i i Alarms Show on screen 37 4 Midnights Meter Middays Time stamps 2 5 f Color codes Comments Alarm History i ee MM alarms 25 Activity Curves Instructions For analysis screen Zooming Hold down the Ctrl key and the left P 35 mouse button move mouse from left to right Settings 4 Scrolling Hold down the right mouse button E E EN EE o and move the mouse left or right 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 OF 08 09 10 11 12 n gt File is29 Selected day Wed 09 10 2002 44 October 2002 Curve information Wed 12 12 2001 Tue 11 03 2003 Sleep analysis 3 period s time 09
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