What should be done if a patient has completed 5 naps during an MSLT without REM onset?

If a patient has completed five naps during a Multiple Sleep Latency Test (MSLT) without any onset of REM sleep, it is appropriate to have the patient take a sixth nap. The primary purpose of the MSLT is to assess the patient's tendency to fall asleep and to determine the presence of REM sleep, which is a key indicator of certain sleep disorders, particularly narcolepsy.

Having the patient take an additional nap allows for the possibility of REM sleep to occur, especially since REM can sometimes take longer to manifest, particularly in certain populations or under specific circumstances. The MSLT is designed to provide a comprehensive analysis of the patient's sleep patterns, and therefore, extending the testing to include another opportunity for sleep can yield more accurate and informative results.

Ending the study after five naps without REM could prematurely conclude the evaluation without giving the patient a fair chance to demonstrate their sleep patterns. Similarly, changing to a different study type or initiating longer wake periods may not be necessary without first exhausting the existing parameters of the MSLT. Thus, allowing for a sixth nap is the most logical step in obtaining a complete assessment.