Sleep Stages Question

With REM sleep periods lengthening and NonREM periods getting shorter as the night progresses, do brief wakeups interfere with that pattern? I mean, is it like starting over after a wakeup, or do we resume where we left off in the pattern?

I'm trying to better understand my Periodic Limb Movement Disorder, which is horrid during NonREM but stops during REM. While PLMD is considered neurological, I'm starting to think the glitch isn't always in the brain with me. I think there is something positional that changes how signals are transmitted to my legs. I do have back issues. But, I digress. Most times if I fall asleep in my recliner with the footrest up and me sitting nearly upright, I will sleep soundly for 3 to 4 hours without waking or feeling any misery in my legs. However, if I had got in the bed to go to sleep, I would look like I'm auditioning for So You Think You Can Dance, legs moving all over and me thrashing wildly from side to side pretty much the whole night. Seems like I can't get past NonREM to find relief in REM. Now, here's what I've noticed though. If I start my night in the chair, sleeping well for a few hours, when I move to the bed, those last 2 or 3 hours are usually decent sleep. Almost as if the NonREM sleep was so short my legs didn't have time to get revved up, and the REM was lengthy enough to let me get substantial restful sleep. I'm considering just making the split night a plan, at least for a while to see if the trend continues.

We'll see if the answer to my original question blows my theory out of the water, and those nights were just a fluke.

Hi Kathy

You may well be onto something there.

Is there any difference in your AHi during the time you are sleeping on the recliner and the time you are sleeping on your bed?

When I tried something similar I found that my AHi went up by 2 to 4 points during the recliner time.

I also was diagnosed with PLMD, and all I know is that it has now stopped prior to falling asleep, whereas it used to kick in just as I was going off, and keep me awake. If it still happens at night during sleep I am unaware of it.

The other thing is that on the recliner during the day, I sometimes sleep for an hour without desaturation, which either means no events, or no clusters of events. Again , I guess this would be positional.

I hope you keep us up to date as your experimenting progresses.

cheers

Mars

I'll try to answer your question from the lab side of things.
As most of you know you enter sleep through stage 1, which lasts approx. 1-7 min. Then its into stage 2, where you spend most of your sleep, then into stage 3, then into REM. Now they say you cycle through NonREM and REM every 90 min. I honestly don't see the NON REM getting shorter as the night goes on. I usually see the cycle I mentioned above with the only thing different is REM usually starts around 3-4am, not in 90 min. 90% of my patients don't hit REM until 5 am.

So anytime you have a brief wake up, or arousal it does break the cycle. If you are in stage 3, wake, fall asleep, you usually hit stage 2 for a bit then back into 3. Or you may just stay into 2 for a while. If you in stage 2 and wake, you may hit stage 1, then back into 2. No two people do the same cycle when they sleep and wake, it is truly amazing to watch.

Now here is what is interesting about REM sleep. When you are in REM, your body is paralyzed. The breathing slows, heart rate slows, your temp. will drop. This may be why your leg movements stop, although I have seen legs move while in REM. Stages 1-3 is where the brain gets rested. REM is where the body gets rested. If you are not getting enough or any REM sleep, that is why you may feel like a truck ran you over during the night.

Well not sure if this info helped at all, but hopefully some did!

Mars, the times I have used my cpap while sleeping in the recliner my AHI was zilch, so I generally don't use it. As long as I stay nearly upright and keep my head from tilting back or chin from falling forward, sleep apnea and snoring aren't apparent. My recliner sleep has been observed for extended periods many times by my daughter and she has never observed any hints of a problem. When I lie down, everyone within earshot knows I have a problem. To be on the safe side, I am going to use the machine again at a lower pressure just to see if I still show a zero AHI. I will report back if I see a trend on split night sleeping with the leg movements.

Montana User, are you saying that a person who wakes a few times during the night isn't going to get that lengthened REM due to the fractured sleep? I was hoping somehow the sleep brain might know it is in the later hours of sleep and still lengthen the REM. I just know that my last couple hours of sleep are usually my best. I used to just get up when my sleep is miserable, although it meant most nights with only a couple hours in bed. Now I suffer through in hopes of grasping the dangling carrot of REM just out of reach. One of my sleep studies said about my limb movements, "REM sleep was spared." Not sure if it was the same in my other studies. My father had a REM behavior disorder. He acted out his dreams and sleepwalked. It just crossed my mind that in a sleep study setting, with the clientele likely to have some variation of abnormal sleep, the only consistency might be inconsistency.

Now I am even more confused......

Kathy, I would be interested in any method of outsmarting fractured sleep. I have don't have a recliner, but if it meant getting good sleep and feeling better, I would get one and chuck my bed in a heartbeat. I had leg movement related arousals during REM, although fewer than in non-REM.

I find that I have a much better chance of maintaining sleep if I fall asleep in the first half hour or so of going to bed (At least my awareness of maintaining sleep). If, and I mean if, I feel sleepy in the evening before bedtime, no matter what I am doing, I stop and go to bed, right away. If I wait the night is usually ruined. If something wakes me in the first hour or two, the night is also ruined.

Patrick why are you confused? You still have your tin foil hat don't you?

r

kteague wrote:Mars, the times I have used my cpap while sleeping in the recliner my AHI was zilch, so I generally don't use it. As long as I stay nearly upright and keep my head from tilting back or chin from falling forward, sleep apnea and snoring aren't apparent. My recliner sleep has been observed for extended periods many times by my daughter and she has never observed any hints of a problem. When I lie down, everyone within earshot knows I have a problem. To be on the safe side, I am going to use the machine again at a lower pressure just to see if I still show a zero AHI. I will report back if I see a trend on split night sleeping with the leg movements.

Montana User, are you saying that a person who wakes a few times during the night isn't going to get that lengthened REM due to the fractured sleep? I was hoping somehow the sleep brain might know it is in the later hours of sleep and still lengthen the REM. I just know that my last couple hours of sleep are usually my best. I used to just get up when my sleep is miserable, although it meant most nights with only a couple hours in bed. Now I suffer through in hopes of grasping the dangling carrot of REM just out of reach. One of my sleep studies said about my limb movements, "REM sleep was spared." Not sure if it was the same in my other studies. My father had a REM behavior disorder. He acted out his dreams and sleepwalked. It just crossed my mind that in a sleep study setting, with the clientele likely to have some variation of abnormal sleep, the only consistency might be inconsistency.

As I see in the lab ( as most things real life and what the book says are different..lol) frequent wakings does not get the lengthened REM. In fact some people never get to REM due to all the wakings. Or they get about 5 min. of REm and wake and have hard time getting back in. Here is a perfect example!

One of our sleep doctors wanted us to wake a patient during REM if they were on there side, and ask them to sleep supine. He stated they would probably go right back into REM so no problem. ( he was a brand new sleep doctor and had nothing to back this up). We did this on 25 patients and not 1 of them went right back to REM after being woke up. In fact probabaly 10% of them never got back to sleep at all and left the lab early. Needless to say the doctor changed his idea on this and we never woke a patient again to change postions.

Kathy, this is not an answer to your question, as I don't have one. But do you take medication for your PLMS? Seems like that might help you.

@ Montana User, thanks for posting this! I still have nights with awakenings, seems they follow an event as I'm almost always breathing faster & deeper but that's a guess as I don't have a way to read the detailed reports (no card reader or USB cable). My numbers are good, often AI=0 or <.4 & low leak. In my PSG, no SWS and no REM. Took awhile for memory of dreaming to occur regularly; I'm just now getting those memories again after my 6-month backslide into apnea last yr. I've often thought I still have fragmented sleep as it's not as refreshing as it once was, better but not there yet. My brain is just plain slow to adjust to change. Helps to understand more about sleep stages...makes me more patient.

Your welcome Muse-inc! There is so much on the lab side of things that I believe would help people on the CPAP side of things! I have always believed when I started doing this, that education is going to be a huge factor! As I have said in other posts, if the doctors/DME would take the time to educate and follow up, I think this wouldn't be such a struggle for allot of people! I would encourage (most labs will allow this) people to go and sit with a sleep tech one night. You will be amazed at what the patient ( and you) do when your asleep. If you could watch someone with apnea shake and shutter, watch their O2 saturations drop, go in and out of sleep (even though they think they slept all night) I think most people would really appreciate their CPAP ( if you already don't). Might even close some gaps in the "cash cow" discussion.. . I love the fact I can see both sides and try my best not to come off like a know it all, but there are things we see in the lab that the general public has no clue of ( education issue!!).

I can not tell you how much I love this forum and the education I get from everyone on here -every time I log on!!!
Hell maybe I should start my own cash cow and start traveling all over and put on some classes! pm me for booking dates and prices! just kidding

I've been on various meds for the limb movements for over 10 years. Running out of non-narcotic options. The pattern has been that they help for a while then they stop working. Increase dose until they are causing more trouble than they are fixing. Try another med. I'm at the cross-the-line point with the current med.

Katie

I read my sleep study this evening and they had all kinds of Sleep Stages on it. I am more confused now than I was this morning when I jokingly repied to your post.

On Tuesday I am taking my machine over to the sleep center so the RT can turn on a couple of things....also I am going to ask him to explain some of the items in the report he already said that he would. I am going to print your post and ask him about some of your questions too.
Pat

Here's looking at you kid.

So you've tried dopaminergics, and you've tried things like Neurontin?

Do you have PLMS and RLS, or just PLMS?

kteague wrote:I've been on various meds for the limb movements for over 10 years. Running out of non-narcotic options. The pattern has been that they help for a while then they stop working. Increase dose until they are causing more trouble than they are fixing. Try another med. I'm at the cross-the-line point with the current med.

SleepingUgly wrote:So you've tried dopaminergics, and you've tried things like Neurontin?

Do you have PLMS and RLS, or just PLMS?

kteague wrote:I've been on various meds for the limb movements for over 10 years. Running out of non-narcotic options. The pattern has been that they help for a while then they stop working. Increase dose until they are causing more trouble than they are fixing. Try another med. I'm at the cross-the-line point with the current med.

One of my doctors put me on Neutrontin I was so tired all the time that I could not function at all.

Patrick A wrote:One of my doctors put me on Neutrontin I was so tired all the time that I could not function at all.

As far as I know, Neurontin for PLMS is used at night, not during the day.