No REM Sleep? Huh?

[LyricZ]

I just received my report of my initial sleep study. I know what REM sleep is, but I wonder if "no REM sleep" is an indication of anything other than the fact that I didn't dream during the study. Is that significant?
Thanks

[socknitster]

It depends on how long you were asleep. If apneas keep your body aroused and you never get to delta or REM sleep you will suffer a lot of side effects over the long term--pain and depression being number one. THis is not even counting the effects hypoxia (low blood oxygen) can cause.

jen

[ozij]

Yes it is.

REM sleep is a sleep stage the can be identified by a combination of your EEG waves and Rapid Eye Movements. Its a part of every normal night's sleep, and has nothing to do wiht wether you remember dreaming or not. REM sleep is the kind of sleep where most dreams occur. And not having REM sleep means your sleep architechture (its stages) is abnormal - like socknister said - apneas can be something that keeps you from slipping into, and maintaining REM sleep.

So it means much more than "you didn't dream at night".

O.

[LyricZ]

Thank you, Ozij and Socknister.

I didn't know that lack of REM meant so much. Thanks for clearing that up for me.

My report says that I was asleep 341 minutes. My number of arousals was 186 for greater than 15 seconds.

Socknister, I have had severe chronic depression, which was diagnosed 20 years ago. Perhaps I had apnea which has caused what looked like a mental problem. I would love to be off of these psychotropic medications. I am not depressed at this time, for which I credit Lexapro. But at my next psychiatrist's appointment, I'm going to ask whether we can try at least reducing the meds now that my sleep apnea is being treated.

I asked the sleep doc to test me for narcolepsy. She said that I should wait until after the sleep apnea was taken care of. I have some of the symptoms of narc., hallucinations before sleep, sleep paralysis, and of course excessive daytime sleppiness. But now that I see that I had no REM sleep, I think that I may not have narcolepsy. Don't narcoleptics go into REM really fast? Do you know anything about narcolepsy?

Also, do you think that medication could contribute to changing my sleep architecture? Maybe you know some of these med names: Trazodone, Geodon, Trileptal, Lexapro. I've always wondered whether some of these meds were detrimental in some sneaky way.

Thanks again, so much, for your help.

[RiverDave]

I was told that benzodiazapienes can screw up sleep architecture. It was a note on my sleep study.

[LyricZ]

Oh, River Dave, I was on the benzos for maybe 2 years. Had terrible withdrawl when some genius doc snatched me off of them too fast. I had seizures and my blood pressure soared. When I went to see why I was shaking and having crazy symptoms, they rushed me to the hospital in an ambulance. I never want to be on those things again.

Anyway, maybe I was on the benzos long enough for them to have affected my architecture.

[dieselgal]

My sleep study showed that I had very little stage 3 & 4 sleep and almost never hit REM.
Now that I am on CPAP I can tell for sure that I hit REM.

[tuna]

Stage 1 11.3%
Stage 2 63.9%
Stage 3 0.0%
Stage 4 0.0%
Rem 24.8%

Total time in bed 2:24:28
Sleep period 2:23:38
Sleep time 2:13:00
Sleep efficiency 92.1% Normal
Sleep latency 0:00;50 Severely reduced
REM Latency was 1:24:00 Normay

Thats explain why I was so cranky and tired before becoming a hosehead!

[Art Mom]

All four of those medications can effect sleep architecture!

I also have suffered from intermitent depression, and had many mental health diagnosis, and also was on many many meds. I currently am not (yay!) on any meds. It's been about a year off meds and I am doing great. I think I would wait till you are comfortable with cpap therapy before you think about stopping any meds though.

Good luck! When I first started cpap I had tons of crazy dreams, I think I was catching up on lost REM sleep.

[tillymarigold]

I've heard it explained as "stage 3/4 is when your body heals and rebuilds, REM is when your mind heals and rebuilds." In other words you need both to be healthy.

[StillAnotherGuest]

Geodon and Lexapro (ziprasidone and escitalopram) are REM-suppressants, and may be partially or totally responsible for the absence of REM in the sleep study.

So at this point, you can't say with certainty that you don't have Sleep-Onset REM (SOREM), that narcoleptic quality may simply be masked by the medications.

Further, trying to do the daytime diagnostic sleep study (Multiple Sleep Latency Test, or MSLT) looking for SOREMs after you toss down a couple of Lexapro might not be completely diagnostic. A negative test might simply be the REM being suppressed again.

Fiddling with the medications over the short term in order to try to do the MSLT carries it's own host of problems as well, ranging from insomnia and/or sleep fragmentation (now a positive MSLT becomes suspect if you go into it artificially sleep-deprived) or even worse, some withdrawal phenomenon like SSRI Discontinuation Syndrome occurs, and now all the results are junk.

Documenting cataplexy might be an easier way to establish the existence of narcolepsy. If you can show unequivocal cataplexy and EDS, then the whole MSLT thing may be academic.

Or of course, if you were to get off all the medications and get your sleep stabilized over the long term, then the PSG and MSLT results may be a little more clear.

Continuing to wax and wane, it may also be possible that the medication regimen may have beneficial aspects. Trazodone, for example, has some great sleep-enhancing properties.

SAG

[dieselgal]

Your right about Trazadone. My Dr. actually prescribed that to me once in place of a sleeping pill and it does make me sleepy. I still take it very infrequently if I am really having trouble sleeping but in the last 6 weeks I haven't had that kind of trouble.

[socknitster]

Lyric,

I was misdiagnosed with depression for 10 years. I didn't fit the profile of an OSA sufferer when it all began--I was thin, healthy and never knew at the time that all the trouble I had always had with sleep was abnormal.

You may want to hold off on getting off of lexapro until you are doing well on cpap. You may want to google Lexapro Discontinuation to prepare yourself. I tried weaning from lex for years before I finally found a solution. For me, I found a reference in a medical journal where a study had the patients switch to an easier to discontinue drug like Prozac at a comparable dose and then wean off of that. Many doctors are unfamiliar with weaning from lex because 1.) it is relatively new 2.) it works so well, few people are trying to get off of it. The problem with lex is that it has a short half life. Prozac has a very long half life. When you go off lex, even if you wean very slowly over months, eventually you are going to reach a point where your brain is freaking out and you can suffer from some strange sensations. Prozac leaaves the body so slowly that the brain adjusts very easily.

That said, I was on prozac when I had my sleep study and my doctors felt that it contributed to a bunch of spontaneous arousals. Which are arousals with uncertain origin--they are not apnea induced.

So, you have a lot of decisions to make with your doctor about what medications you really should be on. I think I would recommend you see a sleep doctor who is a neurologist and talk about all the issues raised here. DO NOT make radical changes with chemicals that affect the brain.

I was on the verge of being diagnosed with fibromyalgia and I had a host of other weird symptoms when I was diagnosed back in June with apnea. I weaned off of prozac shortly after I started cpap and I found my sleep improved bit by bit and I felt better and better. I never had any discontinuation symptoms and my mood was better than it had been in years. Also the pain I was suffering from evaporated.

Treatment is not easy for everyone, but don't get discouraged. What other ailment can you have for which the treatment is air? It takes a while to adjust. You should see your life improving very soon and maybe you won't need all those drugs that maybe are contributing to the problem.

It was hard for me to accept at first that this diagnosis had been missed. But when I realized that the cpap was only invented in 1982 or something I realized sleep medicine is in its infancy. I can only move forward now with the knowledge I have now and being bitter and looking back at what was missed cannot help me now.

You will find that this is an incredible community and a great place to learn. Welcome and keep us informed on your progress.

Jen

[LyricZ]

Thanks, everyone, for the wealth of info that you have provided here. I just left a message with my doc so that we can discuss this. I'm going to print out these posts and use this information when I speak to him.

You guys are great. You're so smart. I guess that's why I have become so addicted to this forum

[split_city]

I actually learnt the other day that male erections during sleep predominantly occurs in REM. No-one really knows why males experience this (perhaps dream related ). One hypothesis was that these erections during sleep may help maintain or even exercise the neuronal pathway involved in an erection. The saying "use it or lose it" was mentioned i.e. if you don't have these ercetions during sleep, you might suffer from erectile dysfunction. This is perhaps why many untreated male OSA patients have ED because they don't reach REM sleep.