Low REM during sleep study means?

[wireless]

I'm still confused if I have a REM related disorder. I did get diagnosed with OSA but the doc seemed surprised that study showed I qualified for CPAP. He started to say I was fine, then he looked at the papers for a minute, and said I needed it. I feel like he was assuming I was fine, but realized he better actually look at the report! Anyway, so I'm feeling like he ignored the REM issue I brought up. It shows I had 15.3% REM during my sleep study and normal is 25%. Then in my overnight visit to get fitted, I had 12.2% REM. Should I bring this up or not worry about it? I feel I have memory and learning problems, feel unrested, and sometimes I dream a lot, especially if I nap, like I'm catching up on REM. I don't want to see a different sleep specialist but I was told regular docs don't get educated about sleep disorders much. Thanks.

[cowlypso]

Having OSA can cause you to have little or even no REM sleep, because you keep waking up so much you never get there. Some people see an increase in their REM during their titration study, but many don't, because you're sleeping in a strange place will all those wires and new equipment.

I wouldn't worry about it at this point. Once you get settled into the CPAP and your AHI goes down, then you can evaluate how you feel. I'm betting that your REM will straighten itself out once your OSA is treated effectively.

All of the symptoms you describe can be attributed to OSA.

[JohnBFisher]

Just as an additional note, one reason folks with obstructive sleep apnea often have problems attaining good REM sleep is that during REM sleep normal muscular control is inhibited. This "atonal" (without tone) state is normal and helps prevent us from hurting ourselves if we were to act out our dreams. However, this same atonal state also tends to depress the muscular control of the back of the throat. Thus, during REM sleep most of us normally experience more obstructive sleep apneas. That is why it is important for the sleep study to determine the effective pressure that mostly eliminates obstructive apneas during REM sleep.

Thus, if you have obstructive sleep apnea, you probably have more apneas during REM sleep. The lack of breathing, and our bodies attempt to rouse us enough to start breathing again, tends to shorten REM sleep.

So, as already noted, low REM sleep can be indicative of obstructive sleep apnea.

By the way, this is opposite of the normal situation with central sleep apnea. During REM state, I have very few central apneas. It appears that the reason is that the brain is more active during REM state, which helps support and strengthen the neural networks that support breathing. Think of REM sleep as adding a little more "juice" to the circuitry. Thus, during REM sleep, someone with central sleep apnea will have fewer central apneas.

Of course, if you are lucky - as I am - then if you have both obstructive and central sleep apnea, you get it both in and out of REM sleep! Ouch!!

Hope that helps further explain the WHY a "Low REM during a sleep study" helps confirm obstructive sleep apnea.

[archangle]

I wonder how much REM sleep would vary from home results for a healthy non-apneac taking a PSG, sleeping in a strange bed, hooked up to wires and things, wearing a CPAP mask, nervous about all the medical people and test results, possible noisy environment, without his teddy bear, trying to sleep 8 PM-4AM vs. his normal sleep schedule, etc.?

[JohnBFisher]

... I wonder how much REM sleep would vary from ...

Wonder no more. Few people can sleep soundly in a sleep lab. But I do know - from personal experience - that if you are very REM sleep deprived, you will hit a point where you will dream when you blink! Talk about strange!! Though I had a terrible night during the diagnostic test, the trial of CPAP was *WONDERFUL*!! I could tell the sleep tech was futzing with the pressure, and then she was waking me. I thought something was wrong, but she informed me the study was over and it was morning. No way. I normally awaken several times every night ... Well, not that one.

But you are right. Even under ideal conditions, a sleep study decreases the chance of a *very* good night of sleep.

[wireless]

cowlypso - Thanks.

JohnBFisher - Very interesting about the muscle tone and low REM helping confirm. I like knowing why! Interesting about dreaming when blinking!

archangle - Everyone thought it was funny how I brought 2 pillows from home. Probably helped me sleep more. I should have brought my blanket too, lol! Mine was quiet and the first time without a mask, but with the finger oximeter. The REM was stated as a percentage, so it didn't matter how long it took to fall asleep. Well, if someone only got less than 1 cycle, it would matter.

[2flamingos]

During my Sleep Study I got ZERO Delta and ZERO REM! During Titration I was up to a whole 10% REM, which while below average was much better than nothing! I would love to be able to determine sleep stages at home. I know I am sleeping "better" with PAP because I am not as tired and cranky as before, and I literally cannot go to sleep without my PAP! I try to snooze in the Lazyboy to no avail, but let me crawl in the bed, put on my PAP and I am napping in no time.

[JohnBFisher]

... Very interesting about the muscle tone and low REM helping confirm. I like knowing why! ...

I also like knowing why. That's why I enjoy learning and then passing on what I've learned. It helps me and often helps others.

... Interesting about dreaming when blinking! ...

Of course, while interesting it is NOT something that I recommend!! I would not be surprised if a number of "hallucinations" are in fact dreams due to lack of REM sleep.

Here's hoping your adventures with getting more sleep are happy and full of wonderful dreams!