0% REM isn't a bad thing?

[kalatraza]

Hi Folks,

After about a year and half of CPAP and not feeling any more rested, I threw in the towel. Turned out I had a largish hole in my septum, probably from endonasal surgery and radiation for Cushing's Disease. Got that patched up and no longer snored, which is cool. Since I'm still sleepy all the time, my internist convinced me to do another sleepy study. I had to switch insurance a while back and had to go to a different center and doctor.

The good news (I guess) was that I now only have mild apnea (AHI 7.. No central or obstructive apneas. 8 obstructive hypopneas while on my side, 50 while on my back. Guess that means I should stay on my side, which is my tendency anyway. . . .

The doctor told me that my sleep architecture wasn't something to be super concerned about. . . but with 0% REM, I'm concerned. This is the same result I have had on 3 different sleep studies. He said that sleepiness isn't associated with REM sleep but rather with N2 stage sleep. Can someone help me understand that? I know there's a lot of hype about REM sleep but it seems like you need it. (It's possible that I just don't sleep well during sleep studies, but I had plenty of sleep time and felt like I was sleeping normally.) If it is something I should be concerned about, what can I do?

Oh, the numbers:
N1 - 29 minutes - 6.5%
N2 - 344 minutes - 76.8%
N3 - 75 minutes - 16.7%
Stage REM - 0 minutes - 0%

AHI 7.8
RDI 31.6
Lowest SaO2 - 83%

Thanks for any help you provide. I'm confused. Which isn't a new thing, but anyway., . . .

[xenablue]

You might try doing some reading at http://www.myzeo.com. You don't need to register, and in fact can't unless you have a Zeo machine. There is a lot of great information about the sleep stages and their importance.

From what I understand we need a certain amount of REM as it's the restorative stage and is indeed what causes a lack of energy and tiredness if it's low. I've been on CPAP now for over 2 years, and still don't feel like leaping out of bed every morning. Having a new Zeo for just 3 nights has shown me why - instead of having the recommended REM sleep, I'm having about one tenth of that time. All other stages of sleep are within the recommended range and my CPAP therapy is working very well, so it makes sense where the problem is - now I just have to find a way to work on improving the REM sleep.

In answer to your question - YES, I think 0% REM IS a bad thing - I'm not a doctor, but have read enough about sleep stages to be convinced we need REM sleep.

Cheers,
xena

[archangle]

Don't rule out the possibility that you just don't REM when you're doing one night in a strange environment.

[fishy]

Agree that it might be just a "one time" or occasional occurance. Also, there are many medications that will suppress REM. In particular, benzodiazepines and anti-depressants will greatly reduce REM. If you don't mind me asking, are you on any medications? If you don't want to reveal that on this board, just ask your Dr. and they should be able to let you know (IF you are taking meds) whether they affect REM.

[kalatraza]

Thanks, all, for your thoughts on this. I should have said (sorry, was all obsessed with the sleep study results this morning!) that I have a Zeo and it keeps telling me I'm not getting REM either. I just assumed it wasn't working. Not the smartest assumption, but, there I am today.

I am on a number of medications because I'm panhypopituitary, ADHD, and have fought depression since high school. Reviewed my list of medications with the sleep doctor today and he pointed out that stimulant medications (Adderall and Nuvigil) didn't help. I've been on Adderall for a long time, since before I was tired, and was put on the Nuvigil so I could make it through the day. I'm also on temezepam and cymblata, and he said that pretty much every antidepressant and sleep aid had at least 10% of the people having sleep problems. . . . just did some google work, though, and both of these seem to be bad news when it comes to sleep. It's not likely that I can just not take an anti-depressant, but hopefully I can find something that has less effect? Anyone have any expertise there?

One last question. Is there a different kind of doctor that deals with "this" kind of sleep problem? Or someone I can consult with long distance? I think I'm at the end of the line with this doc -- he'll help me either get back on CPAP or a dental device and thinks that will help but I don't see how it will since I tried that -- and said he doesn't have anything else to offer. . . .

Best,
K

[jencat824]

K,
Could you fill in your machine, mask & humidifier type in your User Profile. See the below blue type under all our posts. That helps us to know what your equipment and how we may best help you. In your signature line it would be helpful to say you use a Zeo.

As for antidepressants, I'm on clonazepam & cymbalta, they do not affect my REM sleep according to my sleep studies. I don't have a Zeo (yet) so cannot monitor what my REM is. If you use the search function you will see all kinds of opposing opinions about benzodiazepams, all the benzos are generally a class of drugs, example: clonazepam, diazepam etc. These have some nasty side effects for many people, but stopping taking them is a process, and you SHOULD NOT just stop taking them cold turkey. As for cymbalta, I take the lowest dose, in the afternoon. If I took it during the day, I'd sleep all day, if I took at nite, I'd sleep all nite AND all day too. As it is, I don't like this drug, but it is the better of those on the list my PM dr requires ALL his patients to take. My sleep dr thinks its crappy of PM dr to require that, and has told him so, but we've worked together to come up with the less of those evils (cymbalta, lyrica and a few more I can't remember).

The whole benzo's & antidepressant controversy is complicated, and ultimately your choice in working with your dr to either take another drug in that class, or to be weaned off them altogether. I chose to compromise with my PM dr, so my sleep dr (my neuro) agreed to the compromise and my primary care dr kind of bowed out and deferred to the neuro & PM drs to help me decide.

Good luck on these complex issues.
Jen

Edit to add: I'm also on anitriptyline at nite. If I published my med list, I'd scare everyone.

[cosmo]

Even on my worst nights I still get REM. Care to post a screen shot of your Zeo?

[Denial Dave]

My understanding is that we typically go in and out of REM every 90 minutes.

But apnea obstructions, colds, mask leaks, over the counter drugs, etc...can prevent us from reaching REM or only staying in REM for a very short period of time.

IMHO Zeo may help show you if you reach REM, but keeping track of how you feel in the mornings will also guide you.

Unless I'm in a hospital, wearing a mask with a hose connected to it is as much equipment that I'm willing to sleep with.

[old64mb]

Hi kalatraza -

He said that sleepiness isn't associated with REM sleep but rather with N2 stage sleep.

That's possible, but it's not just that. Fragmented sleep, arousals, not getting enough overall sleep...it's a bunch of things. If you are indeed not getting any REM sleep, it's a potential source for EDS.

I'm also on temezepam and cymblata, and he said that pretty much every antidepressant and sleep aid had at least 10% of the people having sleep problems. . . .

That's also not entirely true as different meds do very different things. The benzos like temazepam often do numbers on deep sleep. Something like An SSRI like Cymbalta might have a some effect on REM sleep, but it's not something like klonopin, where it will definitely affect it. There's also an issue with drug interaction; the Cymbalta may have a greater effect because of the temazepam.

One last question. Is there a different kind of doctor that deals with "this" kind of sleep problem?

Well, a few suggestions for you.

First, if your Zeo is showing the same results as your studies regarding REM, that's something to definitely be concerned about. Zeos may not match a PSG on a night-by-night basis, but they are extremely helpful on long-term trends. As has been requested, could you post a result or two of a typical night?

Second, the problem is you're on a bunch of psychopharmacologicals with what sounds like nobody overseeing how they interact. I'm most concerned about continued use of temazepam; taking a benzo for sleep onset over a long period of time is generally not a wise idea.

However, trying to figure out the right drug cocktail is beyond the expertise of people on this board. That's why a psychiatrist - who has expertise in the meds you're on - might be a better option than a sleep doctor. Unfortunately most psychiatrists tend not to know much about sleep and sleep interaction. However, it might give you someone to search for, since if it's true you're getting almost no REM sleep there's going to need to be some supervised experimentation on what you're taking.

Finally, regarding sleep AHI overall, you sound like you're actually a candidate for a dental device and/or tennis balls in the back of a shirt to keep you on your side. A 7 AHI isn't going to be helpful for feeling tired, but it's probably not the cause of what's going on by itself.

[sylvie]

Instead of the prescription antidepressants, have you tried 5-HTP? Before I figured out I had sleep apnea and was getting progressively more depressed, I tried 5-HTP and it helped immensely and is a very natural supplement. I read that people on hardcore antidepressants actually found 5-HTP to be of more benefit. Just be careful with the beginning dosage. You should break a 100 mg capsule and take about 30mg to start with until you get used to it.

[Sir NoddinOff]

I am on a number of medications because I'm panhypopituitary, ADHD, and have fought depression since high school. Reviewed my list of medications with the sleep doctor today and he pointed out that stimulant medications (Adderall and Nuvigil) didn't help. I've been on Adderall for a long time, since before I was tired, and was put on the Nuvigil so I could make it through the day. I'm also on temezepam and cymblata, and he said that pretty much every antidepressant and sleep aid had at least 10% of the people having sleep problems.

Having some experience with some of the drugs you mentioned, I'd have to say "Yes, the drugs are probably the source of most of your REM and tiredness problems. Sorry to be the bearer of bad news, but that's my opinion. I got off benzos successfully in six weeks, as for all the rest, it sounds like you'd have to consult a doctor to work out a withdrawal plan that'll fit your health concerns. Maybe get a second opinion from a doctor who is not so prone to prescribe the latest wonder drugs, just to hurry you out the door. Yes, I agree, a tough pill to swallow... no pun intended.

[BlackSpinner]

REM is associated with memory retention and learning new things.
Lack of REM is also associated with hallucinations, one will drop into REM at random times during the day. Before my sleep apnea got treated I always felt that there was another reality "just around the corner" in the back of that wardrobe maybe?

[Diablode1]

temezepam and cymblata is probably the cause of loss of rem. Rem sleep is NOT the restorative part of sleep, stage 3 is. Are you doing any harm by lack of rem sleep? There isn't a definitive answer but probably nothing serious. Long term temezapam use could potentially cause tiredness as it builds up but it is specifically used for sleep because of it's tendency to not build up and affect you by the time you wake up.

Why is everyone ignoring the fact that his RDI of 30 means a diagnoses of Upper airway resistance syndrome is warranted and is a possible cause of his sleepiness, and potentially the depression. My guess is the septum was not the only thing wrong with the nasal cavity. Sinus issues, enlarged turbinates, allergies or some other cause for nasal issues perhaps.