How important is stage 3 sleep?

[Catnapper]

I just had another sleep test, a follow-up to the one I had originally over a year ago.

One result that I am wondering about is that I had no stage 3 sleep. I was told that typically a person will have about 20% of the time asleep in stage 3. My stage 1 was 22.8% rather than the 5% that is typical. Stage 2 was 53.4% compared to normal 50% and REM was 23.8% compared to the normal 25%.

Sleep efficiency was 77.7%.

The sleep tech said that my machine (Respironics M series Auto Bi-Pap) has done an excellent job and has the titration exactly right! He was surprised, and said he does not have that experience very often if ever. Hmmm.

I will see the doctor tomorrow afternoon, but I was hoping to get the real scoop here so I will be prepared when I have a chance to ask him for help.

My complaint is that I have trouble with insomnia in the middle of the night and that I am a very light sleeper. I wake up very easily. The sleep study supports my claim there, apparently. I never seem to get enough sleep.

There were no leaks with my Aura/Headrest mask, by the way, and I obviously sleep with my mouth closed.

They used a ResMed machine (industrial type, not the home version) and that sucker moaned all night long. It had a moan/groan sound for inhalation and exhalation that was annoying at first and then really boring. My machine (Yes, I know I am lucky) is silent, certainly in comparison.

I appreciate any help with this. Thanks in advance.

Catnapper - Joanie

[kteague]

Joanie,

If I'm looking at those numbers right, you have no stage 3 or 4, right? Big ouch. Can you ask at your appointment if they will go over the test and maybe pinpoint what happened right before you woke up each time and see if there's a pattern? If you had those portions of the study to post on here, I bet some astute folks could make some insightful observations at least.

Do you have any issues with limb movements?

Let us know how the appointment goes. Good luck.

Kathy

[floppysleeper]

My sleep study was 87% stage one, 13% stage 2 and no 3 4 or rem. I was wondering the same thing. The lady at the sleep lab told me all the sleep I was getting was basically useless.

[rested gal]

sleepydave (aka StillAnotherGuest on cpaptalk) posted this on the ASAA message board:
http://www.apneasupport.org/viewtopic.php?p=1828

And...

Some interesting links to articles about sleep stages:

web.umr.edu

nettips.com sleep doctor

sleep changes with age

The last link is very interesting to an "older" person like me (will be 63 in Dec.) There was just a very few minutes of stage 3 during each of the three nights I was wired for a PSG...two of those nights while using CPAP. I always feel very rested each morning. I suppose that getting plenty of stage 2 and REM (plus a smidgen of stage 3) is sufficient for me at my age.

Edited to take out a couple of links that no longer work.

[Guest]

I assume we're talking about Delta sleep (stage3 + stage4) and not the new designation N3, right? Having said that, how much stage3 one needs is a bit of a trick answer. You don't need very much stage3 sleep per se (it usually only makes up 3-8% of total sleep time), but you DO need Delta sleep (which stage3 is a part of) because that's when a lot of cellular repair / regrowth takes place.

I can maybe get more specific, if anybody wants (I just don't want to bore everybody with technical stuff..... ).

[Snoredog]

I assume we're talking about Delta sleep (stage3 + stage4) and not the new designation N3, right? Having said that, how much stage3 one needs is a bit of a trick answer. You don't need very much stage3 sleep per se (it usually only makes up 3-8% of total sleep time), but you DO need Delta sleep (which stage3 is a part of) because that's when a lot of cellular repair / regrowth takes place.

I can maybe get more specific, if anybody wants (I just don't want to bore everybody with technical stuff..... ).

go ahead and bore us, I want to hear about the stage that restores libido

If that ain't in stage 3/4 then we don't need it as far as I'm concerned.

[Catnapper]

Hi Guest

I am interested in more information. Please continue.

People who are not interested will not read it. However, if Snoredog is right and it restores libido, you will have a standing ovation! (so to speak!!)

At my age, restoration is really important. I am rapidly becoming an antique. I still have the original finish however, so according to Antiques Roadshow, that makes me more valuable unless you prefer the newer model.

Some of RG's links didn't work for me. I will try again on another computer another day.

Joanie - Catnapper

[RosemaryB]

I assume we're talking about Delta sleep (stage3 + stage4) and not the new designation N3, right? Having said that, how much stage3 one needs is a bit of a trick answer. You don't need very much stage3 sleep per se (it usually only makes up 3-8% of total sleep time), but you DO need Delta sleep (which stage3 is a part of) because that's when a lot of cellular repair / regrowth takes place.

I can maybe get more specific, if anybody wants (I just don't want to bore everybody with technical stuff..... ).

Very timely topic. One of the people that I'm helping get going on cpap just sent me her complete sleep study. She had zero stage 3 and 4 in the first study and very little REM. During titration she had more REM and better quality REM but still no stages 3 and 4. She's in her early 80's, so is an older adult.

However, I'm thinking that this can't be good. A decrease is one thing, but none is another. Is this REALLY normal, or is it just common. The picture we have of aging is often a distorted one, where we figure that things that are common, but are really diseases, are "normal." Having a disease isn't normal.

Anyone know what medications or classes of meds interfere with Delta Sleep?

I'm going to help her find out what to say to her doctor, so any info about what causes these decreases with age would be useful.

BTW, I'm 62 and had 32% of my sleep in stage 4, 3% in stage 3. I only had about 14% in REM. This was about the same for both the original and titration studies. (But then I was mistitrated, so who knows what it is now with correct pressure). That's too much delta and not enough REM. But at least the REM is not all chopped up by apneas. All stages are somewhat chopped up by spontaneous arousals in both studies, but apparently I still get enough Delta.

FYI, here are normal values

Stage 1: 5%
Stage 2: 50%
Stage 3: 10%
Stage 4: 10%
REM: 25%

[Catnapper]

Back to the question of stage 3 or the new N3 - I am going to guess it is the new N3 because there was no mention of a stage 4, only 1, 2, 3, and REM.

My doctor is really nice. I like him a lot and I have to admire a doctor who is willing to admit he doesn't have an answer. I asked him my question about stage 3 and what could be done to help me be able to have stage 3 sleep. He went to get his book to see if answers were there, and finally said he will do some research for me. He checked my previous study from a year ago and I had some stage 3 in both parts of my split study. He suggested that the study Sunday night may not be representative of my normal sleep at home in my familiar situation. People my age typically have less of the stage 3 sleep, he said. I acknowledged that I had read that but what about NONE???

His final verdict is to change my auto bi-pap to regular bi-pap to see if that allows me to sleep more soundly. He suspects that the changes of the auto may be bothering me. The machine in the study was not auto, and he showed me the results of the study that showed I was sleeping fairly well, if not deeply. He told me to try that for 2 weeks and then let him know how it goes. We will go from there.

He offered to put the prescription on a card for me but I told him I knew how to do it myself. He laughed and said he loves self-sufficient people, and people who are involved in their therapy. He said he has about 5 patients who have the software and card readers.

I am not really satisfied, but the study at least showed that my apnea is well controlled by the therapy. O2 levels were excellent, no leaks, and 90% pressure from the auto was right on the money. He bumped up the epap 1CM to cover that 1 apnea I had.

I still need more sleep and to feel more rested. It has been over a year now of 100% all night compliance, even if I was lying there awake, hoping to go back to sleep. I am doing my best but my results are not optimal. There has to be some small thing I am missing.

Any suggestions?

Catnapper - Joanie

[rested gal]

Some of RG's links didn't work for me. I will try again on another computer another day.

Joanie - Catnapper

Thanks for mentioning that, Joanie. I should have tried them again before posting them, as they're pretty old. I've edited the post to take out the two that don't work. Appreciate it!

[StillAnotherGuest]

I assume we're talking about Delta sleep (stage3 + stage4) and not the new designation N3, right? Having said that, how much stage3 one needs is a bit of a trick answer. You don't need very much stage3 sleep per se (it usually only makes up 3-8% of total sleep time), but you DO need Delta sleep (which stage3 is a part of) because that's when a lot of cellular repair / regrowth takes place.

I can maybe get more specific, if anybody wants (I just don't want to bore everybody with technical stuff..... ).

Personally, I am boycotting the N3 designation in protest for their failing to adequately address the 75 uV rule.

SAG

[RosemaryB]

I assume we're talking about Delta sleep (stage3 + stage4) and not the new designation N3, right? Having said that, how much stage3 one needs is a bit of a trick answer. You don't need very much stage3 sleep per se (it usually only makes up 3-8% of total sleep time), but you DO need Delta sleep (which stage3 is a part of) because that's when a lot of cellular repair / regrowth takes place.

I can maybe get more specific, if anybody wants (I just don't want to bore everybody with technical stuff..... ).

Personally, I am boycotting the N3 designation in protest for their failing to adequately address the 75 uV rule.

SAG

I'm very curious about what all this means, since I'm interested in sleep stages in general and also in particular. What's N3 and whats the 75 uV rule and why is it bad not to address it?

[StillAnotherGuest]

EEG waveform identification is based on frequency (how wide the waves are, so consequently how many you can pack into a second) and amplitude (how tall they are). There are rules to score the 30 second pages, or "epochs" of sleep, like for SWS:

Stage 3 sleep contains at least 20% but less than 50% delta waves, while stage 4 is indicated by more than 50% delta. Delta waves are high-amplitude, slow-frequency waveforms ranging from 0.5 to 2 Hz that have amplitudes of more than 75 mV from peak to peak..

but now Stage 3 and 4 will be lumped together by everybody. Well, almost.

Anyway, SWS is the only stage that has amplitude criteria, and EEG amplitude often diminishes naturally as a function of age. The original criteria were based on healthy young adults (good thing they didn't use kids!). So while some older adults may have waves that meet frequency criteria, if they aren't high enough, the epochs get scored as Stage 2 or N2, and then "No SWS". It may have made more sense to lower the amplitude a little, to maybe 50 uV for older adults.

Moving the analysis leads to the front may pick up a uV or two, but age criteria for say > 40 years would have been better.
SAG

[Slinky]

Speaking of Delta sleep: My original sleep study back in 1998 or so I had quite a few Alpha intrusions in Delta sleep.

Sleep evaluation in 1999 reported virtually no OSA but lots and lots of PLM or RLS (I've forgotten which), no mention of Alpha/Delta sleep. Different lab, sleep neuro, this chain lab now under Federal indictment in Nevada.

Recent sleep evaluation that put me back on CPAP (returned the one scripted in 1998 after 2 1/2 months of compliance, never followed up on the 1999 evaluation) done at a different sleep lab, same sleep doc as first evaluation, a pulmo, and absolutely NO MENTION of Alpha waves or Delta sleep.

What is it? Alpha waves indicate awake or arousals and Delta waves indicate sleeping?

[RosemaryB]

EEG waveform identification is based on frequency (how wide the waves are, so consequently how many you can pack into a second) and amplitude (how tall they are). There are rules to score the 30 second pages, or "epochs" of sleep, like for SWS:

Stage 3 sleep contains at least 20% but less than 50% delta waves, while stage 4 is indicated by more than 50% delta. Delta waves are high-amplitude, slow-frequency waveforms ranging from 0.5 to 2 Hz that have amplitudes of more than 75 mV from peak to peak..

but now Stage 3 and 4 will be lumped together by everybody. Well, almost.

Anyway, SWS is the only stage that has amplitude criteria, and EEG amplitude often diminishes naturally as a function of age. The original criteria were based on healthy young adults (good thing they didn't use kids!). So while some older adults may have waves that meet frequency criteria, if they aren't high enough, the epochs get scored as Stage 2 or N2, and then "No SWS". It may have made more sense to lower the amplitude a little, to maybe 50 uV for older adults.

Moving the analysis leads to the front may pick up a uV or two, but age criteria for say > 40 years would have been better.
SAG

Thank you, SAG. That fills in the picture for me. Given what you have written, I would agree with you about the new criteria. It sounds like the traditional scoring gives more information about what is actually going on.

If an older adult (like the person I'm helping) has no stage 3 or stage 4, even on titration that takes her AHI down to zero. Might that have any relationship with the fact that she has shrinkage of the white matter in her brain? That shrinkage is associated with serious hearing loss for her and I'm wondering if this might be associated. If not, we can go over her meds, but I think all she's taking is a statin, BP meds, and a PPI.