According to my sleep physician, I spend the majority of time in stages 1 (16%) and 2 (55%) with only a small part of the time in stage 3 (13%), nothing in stage 4 and very little REM (16%) when using Auto CPAP. My sleep physician is fine with these values. However, I never feel like I am refreshed or rested and I easily awaken in the middle night. I can't help wonder if my sleep physician is missing something.
Sleep Stages Clarification
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Here's some stuff that Snoredog has posted in the past......maybe it'll help.
Den
DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.
Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%
Stage3&4, REM decrease as we age.
Stuff seen on a PSG Report:
Arousal: An interruption of sleep lasting greater than 3 seconds.
BR Arousal index: The number of breathing related arousals(apnea, hypopnea, snoring & RERAs)multiplied by the # hours of sleep.
Bruxism: Grinding of the teeth.
Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.
EEG/EOG: Comments about sleep stages, brain waves (EEG), or eye movements (EOG)
EKG/ECG: Comments about heart rate, abnormal heart beats, etc.
EMG: Comments about leg movements and or teeth grinding (bruxism).
Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.
Non-supine: Sleeping in any position other than on the back.
NSR: Normal sinus rhythm.
NPSG: Nocturnal Polysomnogram, or sleep study.
(#)Number of Awakenings: The number of pages scored as wake after sleep onset.
Obstructive apnea: A respiratory episode where there is a complete cessation of airflow lasting greater than 10 seconds.
PLMs: Periodic limb movements.
PLM arousal index: The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.
PSGT: Polysomnographic technologist.
REM latency: Latency to REM(dreaming) from sleep onset.
RERAs: Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.
Respiratory: Any specific comments about respiratory events.
RPSGT: Registered polysomnographic technologist.
Sleep efficiency: Total sleep time multiplied by time in bed.
Sleep latency: The first 30 seconds (one `epoch' of recording time) of sleep.
Sleep onset: The first 90 seconds (3 `epochs) of uninterrupted sleep.
Sleep stage shifts: The number of incidents of sleep stage changes.
Snoring intensity: Level of snoring loudness determined by the sleep technologist. Ranging in degrees from mild to very loud snoring.
Spontaneous arousal index: The number of spontaneous arousals (e.g. arousals not related to respiratory events, limb movements, snoring, etc) multiplied by the number of hours of sleep.
Stage 1: The lightest stage of sleep. Transitional stage from wake. top
Stage 1 shifts: The number of times the sleep stage changed to stage 1.
Stage 2: The first true stage of sleep.
Stages 3/4: The deepest, most restorative sleep.
Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.
Supine: Sleeping on back.
Time in bed: The time in the study from `Lights Out' to `Lights On'.
Total arousal index: Total number of all arousals multiplied by the number of hours of sleep.
Total # of PLMs: The number of leg movements in sleep that last greater than 0.5 seconds.
Total sleep time: Total time asleep.
WASO: Wakefulness after sleep onset.
WNL: Within normal limits.
Den
DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.
Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%
Stage3&4, REM decrease as we age.
Stuff seen on a PSG Report:
Arousal: An interruption of sleep lasting greater than 3 seconds.
BR Arousal index: The number of breathing related arousals(apnea, hypopnea, snoring & RERAs)multiplied by the # hours of sleep.
Bruxism: Grinding of the teeth.
Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.
EEG/EOG: Comments about sleep stages, brain waves (EEG), or eye movements (EOG)
EKG/ECG: Comments about heart rate, abnormal heart beats, etc.
EMG: Comments about leg movements and or teeth grinding (bruxism).
Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.
Non-supine: Sleeping in any position other than on the back.
NSR: Normal sinus rhythm.
NPSG: Nocturnal Polysomnogram, or sleep study.
(#)Number of Awakenings: The number of pages scored as wake after sleep onset.
Obstructive apnea: A respiratory episode where there is a complete cessation of airflow lasting greater than 10 seconds.
PLMs: Periodic limb movements.
PLM arousal index: The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.
PSGT: Polysomnographic technologist.
REM latency: Latency to REM(dreaming) from sleep onset.
RERAs: Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.
Respiratory: Any specific comments about respiratory events.
RPSGT: Registered polysomnographic technologist.
Sleep efficiency: Total sleep time multiplied by time in bed.
Sleep latency: The first 30 seconds (one `epoch' of recording time) of sleep.
Sleep onset: The first 90 seconds (3 `epochs) of uninterrupted sleep.
Sleep stage shifts: The number of incidents of sleep stage changes.
Snoring intensity: Level of snoring loudness determined by the sleep technologist. Ranging in degrees from mild to very loud snoring.
Spontaneous arousal index: The number of spontaneous arousals (e.g. arousals not related to respiratory events, limb movements, snoring, etc) multiplied by the number of hours of sleep.
Stage 1: The lightest stage of sleep. Transitional stage from wake. top
Stage 1 shifts: The number of times the sleep stage changed to stage 1.
Stage 2: The first true stage of sleep.
Stages 3/4: The deepest, most restorative sleep.
Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.
Supine: Sleeping on back.
Time in bed: The time in the study from `Lights Out' to `Lights On'.
Total arousal index: Total number of all arousals multiplied by the number of hours of sleep.
Total # of PLMs: The number of leg movements in sleep that last greater than 0.5 seconds.
Total sleep time: Total time asleep.
WASO: Wakefulness after sleep onset.
WNL: Within normal limits.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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User since 05/14/05
Stage 3 & 4 are often times considered the same, below are normal values, I don't think your sleep architecture is all that bad, most people with untreated OSA don't get any 3/4 or REM. Your Stage 2 is 55%, that is near normal, many times if you are short-changed in the other stages of sleep you land back in Stage 2 so it obviously climbs higher as a result.
You appear to be spending more time at Stage 1, which would indicate some insomnia to me. Those values below all change as we get older,
DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.
Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%
You appear to be spending more time at Stage 1, which would indicate some insomnia to me. Those values below all change as we get older,
DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.
Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%
someday science will catch up to what I'm saying...
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justplainbill
- Posts: 60
- Joined: Sat Sep 09, 2006 10:38 am
It would be helpful to place these results in some kind of context.
Presumably the sleep architecture results you are posting were the results of a sleep study done with your APAP or CPAP machine. How long have you been on APAP/CPAP? If this was your initial titration study, then I wouldn't worry at all since there is so much going on with getting adjusted to the mask and the machine that many people don't have very good sleep architecture then. And in this case, your results are good (under the circumstances) and should be getting better over time.
If you have been using your machine for a while, then I would urge you to go back to your initial sleep study and even your initial titration study (and any other previous studies you might have had). How does your current sleep architecture compare with your initial sleep study? Better? Worse? About the same? What about your oxygen levels and your overall number of arousals? Do you have anything going on with arousals related to limb movements or a high number of spontaneous arousals? How about your AHI?
I would hesitate to make any recommendations without having this other information. It could be that you are doing just fine and will do even better in the future, it could be that you are doing ok and will not get much better results than these, you could be doing ok and could do better with a little tweaking of your treatment (which I would count on your doctor to recommend) or you are doing ok but there might (as Snoredog suggested) be something else affecting your sleep that can maybe be addressed or maybe not.
Best wishes,
Bill
Presumably the sleep architecture results you are posting were the results of a sleep study done with your APAP or CPAP machine. How long have you been on APAP/CPAP? If this was your initial titration study, then I wouldn't worry at all since there is so much going on with getting adjusted to the mask and the machine that many people don't have very good sleep architecture then. And in this case, your results are good (under the circumstances) and should be getting better over time.
If you have been using your machine for a while, then I would urge you to go back to your initial sleep study and even your initial titration study (and any other previous studies you might have had). How does your current sleep architecture compare with your initial sleep study? Better? Worse? About the same? What about your oxygen levels and your overall number of arousals? Do you have anything going on with arousals related to limb movements or a high number of spontaneous arousals? How about your AHI?
I would hesitate to make any recommendations without having this other information. It could be that you are doing just fine and will do even better in the future, it could be that you are doing ok and will not get much better results than these, you could be doing ok and could do better with a little tweaking of your treatment (which I would count on your doctor to recommend) or you are doing ok but there might (as Snoredog suggested) be something else affecting your sleep that can maybe be addressed or maybe not.
Best wishes,
Bill
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Guest
justplainbill, I have been using CPAP for several years now. I lack continuity in my sleep and that sleep study data is quite comparable in general of my sleep cycle. I feel only slightly better with CPAP than without.
This is all new to me. I have been listening to my doctor and I am just now starting to question things. Just googling the key words I was able to get a bit of variance on the data:
Stage 1 (5%), Stage 2 (50%), Stages 3 and 4 (AKA Delta sleep: 20-25%), REM sleep (20-25%): California Sleep Disorder Clinic data.
Based on the Stage 3 and 4 sleep (13% in Stage3 and 0 % in Stage 4), on the surface it appears that I am not going enough Delta Sleep.
This is all new to me. I have been listening to my doctor and I am just now starting to question things. Just googling the key words I was able to get a bit of variance on the data:
Stage 1 (5%), Stage 2 (50%), Stages 3 and 4 (AKA Delta sleep: 20-25%), REM sleep (20-25%): California Sleep Disorder Clinic data.
Based on the Stage 3 and 4 sleep (13% in Stage3 and 0 % in Stage 4), on the surface it appears that I am not going enough Delta Sleep.
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DreamStalker
- Posts: 7509
- Joined: Mon Aug 07, 2006 9:58 am
- Location: Nowhere & Everywhere At Once
Have you tried brainwave entrainment? There CD's as well as software that you play as ambient background sounds to entice your brain into Delta (stage 3 & 4) sleep patterns.
Google "brainwave entrainment delta" and you will come up with some interesting stuff.
I found some free software a while back for generating your own sounds if you have a good soundcard and speaker set up for your PC. I also have a couple of Dr. Thompson's CD's.
Google "brainwave entrainment delta" and you will come up with some interesting stuff.
I found some free software a while back for generating your own sounds if you have a good soundcard and speaker set up for your PC. I also have a couple of Dr. Thompson's CD's.
President-pretender, J. Biden, said "the DNC has built the largest voter fraud organization in US history". Too bad they didn’t build the smartest voter fraud organization and got caught.
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Guest
I know how you feel! So, it's not uncommon and not in our head that we fell sleepy. I just read in a medical book that older people are more likely too get ill and have other ailments because their Delta sleep is minimal. So, this "normal" range may in fact not be normal, just common.eblingus wrote:I have the same problem -minimal Deep Sleep, using CPAP, still very sleepy. I have tried two doctors so far, and neither have a clue. I wish I knew what the answer was, but I don't.
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Guest
Interesting info DreamStalker, I will look that up. Are you into psychoneurotherapy by chance?DreamStalker wrote:Have you tried brainwave entrainment? There CD's as well as software that you play as ambient background sounds to entice your brain into Delta (stage 3 & 4) sleep patterns.
Google "brainwave entrainment delta" and you will come up with some interesting stuff.
I found some free software a while back for generating your own sounds if you have a good soundcard and speaker set up for your PC. I also have a couple of Dr. Thompson's CD's.
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DreamStalker
- Posts: 7509
- Joined: Mon Aug 07, 2006 9:58 am
- Location: Nowhere & Everywhere At Once
Psychoneurotherapy? Uhh, no … but I do deep delta sleep with my PAP machine every night. Hmm, well I guess I also experimented with psycoactive/hallucinogenic substances and loud rock-n-roll music in my late teens and early twenties but I don’t know if that counts … and I practiced yoga meditation during my early thirties.Anonymous wrote:Interesting info DreamStalker, I will look that up. Are you into psychoneurotherapy by chance?DreamStalker wrote:Have you tried brainwave entrainment? There CD's as well as software that you play as ambient background sounds to entice your brain into Delta (stage 3 & 4) sleep patterns.
Google "brainwave entrainment delta" and you will come up with some interesting stuff.
I found some free software a while back for generating your own sounds if you have a good soundcard and speaker set up for your PC. I also have a couple of Dr. Thompson's CD's.
Actually, I got interested in the brainwave entrainment stuff while researching self hypnosis about a year ago. The human body is an amazing piece of biological equipment … the human brain is even more remarkable.
President-pretender, J. Biden, said "the DNC has built the largest voter fraud organization in US history". Too bad they didn’t build the smartest voter fraud organization and got caught.
11 posts
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