No REM Sleep? Please help!

[kaiasgram]

Thanks everyone for the advice. I just wonder what happens next time if I don't get any REM sleep. I slept a solid four hours. At least I thought I did. I took my usual medication plus a sleeping pill, which I was told was fine. Wouldn't failing to get REM sleep be a sleep disorder itself?

Failing to achieve REM is definitely a problem in need of investigation. That's why we want you to get the repeat sleep study. (And this time make sure the tech doesn't wake you up after 4 hours for no good reason!)

The reason I asked Krelvin about flow limitation and RERA's during sleep studies is because one reason for not reaching REM is partial airway compromise that doesn't turn into full-on apneas, but does restrict breathing and make it very effortful causing lots of little arousals -- not necessarily waking the sleeper up but constantly pulling them out of deeper stages of sleep. I wonder if there will be evidence in your sleep study report of this kind of situation.

Try not to stress about the next steps. There is still a lot of hope for you to feel better and it's actually quite positive that you've been offered a repeat study at no charge. I don't know if I've ever heard of that -- it makes me wonder if they did see some problems but just couldn't officially start the titration because of strict criteria that you didn't meet last night.

[kteague]

Maybe a full night diagnostic study would be best for you, with a titration to be scheduled for another night if OSA is diagnosed. Ask your doctor about doing it that way. Not reaching REM, while not unusual with untreated sleep apnea, does mean the criteria for diagnosis has to be met with data from non REM sleep. I thought every scheduled split night study would proceed with the data gathering the full night if the first few hours didn't garner a result. Was information gathered for the rest of your night? Seeing your actual results will hopefully answer some questions for you.

[zoocrewphoto]

When I did my sleep study, I was told that it *might* be a split night study *if* I met the criteria early enough in the night. I did so within 2 1/2 hours, and I did NOT reach REM sleep at all. I did the titration and did reach REM sleep then. I know at home, even with cpap, that I do reach REM sleep, but without cpap, I probably get a lot less than normal people do.

It sounds to me like you slept enough hours, but did not meet the full criteria for a split study. Perhaps REM sleep would have helped, but that is only because most people have more events during REM sleep. You still could have shown mild or moderate sleep apnea. I think they only go to a split night if you are severe since they need to be able to telkl you if you are mild, moderate, or severe. If you reach the level of mild in 4 hours without REM, and they don't give it a full night, they won't know if you are truly mild, and if you are really severe. It could be that you wake up before the events fully register, making it difficult to get deep sleep and REM.

[rockncountry101]

I wonder if my severe nasal obstruction has anything to do with it. I just can't breathe out of my nose and I'm working on getting that fixed.

[zoocrewphoto]

My nose can be completely clear, and I do not breathe through it when lying down. I have a narrow airway all the way down my throat. Doesn't take much to close it.

It doesn't matter whether you breathe through your nose or your mouth. If your airway collapses further down, you can't breathe very well.

[rockncountry101]

Okay, here are the numbers...

Sleep efficiency 66%
Sleep Latency 97.5
25.8% Stage 1
74.2% Stage 2
0 % Stage 3
0 % REM
AHI 4.7
RDI 9.5

The total arousal index was increased at 39.3.
Respiratory arousal index was 5.6

Diagnosis was mild obstructive sleep apnea, mild snoring, and he also said that I had poor sleep architecture and efficiency that might lead to under/over estimation of the sleep related breathing disorder.

I was told that I needed a CPAP. What concerns me is no REM sleep. Could this be happening frequently and would CPAP help? The technologist said that the test was a false negative because I didn't achieve REM sleep. She said that apnea episodes are greater in REM sleep and the doctor said that I had poor sleep architecture which I don't even understand. I'm new to this so thank you for any responses.

[kaiasgram]

Sleep architecture is a way to describe how intact a person's sleep patterns are. That includes sleeping an expected (average) amount of time in all stages of sleep. You have poor sleep architecture because you did not have normal N3 (deep stage) or REM sleep. That's the summary version.

I'm not surprised at the outcome of your sleep study -- you demonstrated respiratory problems, just not in time to start a titration that night. But enough to qualify you for a diagnosis and CPAP. As for not getting REM, don't be concerned yet. It's likely because of all the interruptions to your sleep from respiratory disturbances/arousals. If you peruse the forum for a while you'll see people posting that they started CPAP and are finally starting to have dreams (REM sleep). Likely you will too.

I'm glad things are moving forward for you now.

[Papit]

From what your doc told you, as kaiasgram points out, he saw enough to qualify you for a diagnosis and CPAP. You have arrived, rockncountry101! You're through the "door" and according to your doc into CPAP therapy now. Like kteague said below, a full night diagnostic study would likely have been best for you, with a titration to be scheduled for another night. But that's history. Your doc says you're in.

Please don't get fixated on REM. It's but one of many indicators and other sleep measurements you'll be learning about. At this point in your shoes, I'd be interested in getting the message to your doc to please be sure that he prescribes a machine that will capture your sleep data on an SD card so he (and perhaps you needn't mention right now, so you and others here) can help evaluate how you are progressing. You can read more specific guidance about that, and much, much more from robysue's http://adventures-in-hosehead-land.blog ... -with.html
Welcome to hoseland. All the best! Read, read, read and don't be afraid to ask more questions as you go.