On your sleeping patient's 12-lead EKG,Lead I's waves and complexes are extremely jittery-completely unreadable-as are aVR's.The most likely cause of this is

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The most likely cause of jittery and unreadable waves in Lead I and aVR is a loose or off electrode or patch on the right arm. This would result in poor conduction of electrical signals from the right arm and affect the recordings of those leads on the EKG. Checking and fixing the electrode or patch would likely resolve the issue. A heart being on the right side of the body instead of the left, gain being set too low, or the patient having an arrhythmia are less likely explanations for this particular EKG finding.

On Your Sleeping Patient's 12-Lead EKG,Lead I's Waves and Complexes