sleep stages

On the sleep study it indicated no stage 3 or 4 levels were recorded, but there was slight REM time and solid stages 1 and 2. Could someone please explain how stages could be skipped? With therapy REM was noted but still not 3 or 4. I thought sleep was progressive thru the 5 levels.

According to my sleep doc,when the body is very sleep deprived,it will skip stages 3 and 4 and go straight to REM. The time in
REM is very short when this happens. Sleep stages 3 & 4 is called delta sleep and allows the body to recover. When the body does not reach delta sleep, one awakens with a feeling of malaise.

At least that is the way he explained it to me.

amos

There is the expected progression of sleep stages and cycles, but when sleep disorders come into play, all bets are off. Come to think of it, I guess they're called sleep disorders because our normal patterns of sleep are out of order. I've had several sleep studies, and skipped or nearly skipped deep sleep in several of those tests, and REM in some. Although I still have some sleep issues, I know I get periods of stage 3 & 4 because I crash hard for at least a while each night to the point I can't easily be awakened. Before cpap, it had been many years since I had the sensation of having been deep asleep.

Thanks for both responses. Disorder kinda explained it, didn't it! Seems if you're deprived of sleep your body would go to where it can recover the fastest but apparently that's not the way it is. Hard to think outside of the box sometimes!

on a quest wrote:On the sleep study it indicated no stage 3 or 4 levels were recorded, but there was slight REM time and solid stages 1 and 2. Could someone please explain how stages could be skipped? With therapy REM was noted but still not 3 or 4. I thought sleep was progressive thru the 5 levels.

I think you will find there are many variables to sleep disorder. I'm sure that many people here miss 3, 4, and REM time.
In two sleep studies (PSG's) I had zero Stage 3 and 4 (Slow Wave Sleep) and in one I had a little REM and none in the other.

Doesn't mean that I don't get the same every night... in fact its normal for Stages to vary.
But, in my case, it is an indication that there are problems achieving deep sleep that you have to work on.
Months into therapy, I am still working on it.
I need to sleep extra amounts every day, if I can...
but, not everybody needs the same.

Nord

So how do you work toward deep sleep stages? Does it just improve with use of therapy? Does it improve as you reduce sleep debt? Thanks!

on a quest wrote:So how do you work toward deep sleep stages? Does it just improve with use of therapy? Does it improve as you reduce sleep debt? Thanks!

The only proof positive towards Sleep Stages is through PSG... so you will get very little feedback.
So...
1. "how you feel"
2. Therapy to reduce AI and HI
3. CPAP Pressure levels will affect REM and perhaps SWS... but that is experimental
(they say that pressure increase can cause REM to happen but there are other problems associated... including causing Centrals)
4. Therapy will increase oxygen levels during sleep and hopefully will promote REM and SWS

Nord

Thanks for the info.....SWS? Another question lurking in this brain......the sleep ctr said they like to see 70% usage compliance. She said 70% usage per night displays good therapy along with seeing the reduction of AHI/AI during that time. So if I'm doing this observation correctly: 8 hrs X 70% =5.6 hrs. I'm using 8 hrs because that is time available for sleep that the mask is either on or off. He seems to hit the 4 hr mark more frequently but once a week or so hits 6 hrs. Some nights only 1 to 2. Am I headed in the right direction? Should I be keeping a log of his available sleep time along with the usage?

(We do not have insuerance compliance issues.)

Anyone also dealing with PLM? Anyone have any suggestions how to calm those busy legs besides dr prescrip? I read that some consider this leg movement an attempt by the body to "kick start" the breathing. I would think that they would reduce with productive cpap therapy as it would reduce the number of events and thus reduce the leg movement which would have no "kick starting" to do. Any thoughts?

It is not unusual early on to have trouble getting consolidated sleep. So many new sensations to get used to. About PLM's - how does the reports break them down? That may give you a better idea what you are up against. Just in general, if using cpap does not help you sleep less restlessly and the legs are the issue, making sure one is not nutritionally deficient usually comes up in dicsussion, particularly in magnesium. Iron issues are seen in a lot of those with leg movements during sleep. My doc recommends hot foot soaks near bedtime, or a warm bath. Also, avoid caffeine. I think it's important for those with limb movements to have data on their cpap treatment so they can see that it is effective and not feeling negatively toward their cpap treatment residual sleep issues remain.

on a quest wrote:Thanks for the info.....SWS? Another question lurking in this brain......the sleep ctr said they like to see 70% usage compliance. She said 70% usage per night displays good therapy along with seeing the reduction of AHI/AI during that time. So if I'm doing this observation correctly: 8 hrs X 70% =5.6 hrs. I'm using 8 hrs because that is time available for sleep that the mask is either on or off. He seems to hit the 4 hr mark more frequently but once a week or so hits 6 hrs. Some nights only 1 to 2. Am I headed in the right direction? Should I be keeping a log of his available sleep time along with the usage?

(We do not have insuerance compliance issues.)

SWS... Slow Wave Sleep... as in my previous post to you.
Compliance... your machine keeps a log of compliance since beginning.
You don't list a machine but compliance is a matrix that all medical staff and insurance company's are interested.

You also seem to suggest that 70% compliance will reduce AHI/AI during that time.
You can have, and likely will have, apneas for most of the time that you are asleep.
Ideally, CPAP applied with "correct" pressure will eliminate ALL Obstructive Apneas and Hypopneas... while it is applied.
Once you take it away... apneas return

Nord

Ideally the machine is most productive 100% of the time. When the sleep center they look for minimum 70% time, knowing we did not have insurance compliance issues, I was just trying to figure out if that's like a bottom cutoff they would use to know about the treatment program. I just wasn't sure why the 70% came into focus. I wasn't thinking 70% was the magic space to remove events.

VPAP S with H4i Heated Huidifer Mirage Quattro mask

on a quest wrote:Ideally the machine is most productive 100% of the time. When the sleep center they look for minimum 70% time, knowing we did not have insurance compliance issues, I was just trying to figure out if that's like a bottom cutoff they would use to know about the treatment program. I just wasn't sure why the 70% came into focus. I wasn't thinking 70% was the magic space to remove events.

VPAP S with H4i Heated Huidifer Mirage Quattro mask

They are probably taking into consideration what your Sleep Dr. has concerns about.
Your Dr. will likely be very interested in Compliance as the most important metric as some do not look beyond that.
Most Dr's agree that success is guaranteed by 100% compliance...

Nord

As we age we have less and less Delta Sleep (Slow wave sleep). Most people with untreated sleep apnea have a respiartory disturbance before they even try to get to Delta sleep.

Although it makes sense...progressing down the line Stage 1,2,3,4 then REM this is not how sleep necessarily works. If your gonna have delta it's usually early in the night rather than late, in general. Elderly people with "normal" sleep may not have any, teenagers may have lots of it. You can start the night, skip Stage 1 and go right into Stage 2 and then REM depending on how tired you are. Then arouse to Stage 1 briefly, stage 2 and then later back to REM (3 or 4 times a night) or maybe have have Stage 1, 2 then 3 then REM. Or even 1,2,3,4, REM. Everyone is a little different. Meds, stress, fatigue, age, all can effect Delta sleep.

If fact you can have a beautuful (OSA free) night of sleep and never have any Delta sleep even if you are younger. So don't sweat the lack of Delta. How you feel/sleep is more important than a sleep report (although they can be related).

As for the "70%" rule. This is a Medicare requirement, 4 hours per night at least 70% of nights or they won't pay for your PAP unit. How they arrived at this threshhold? Who knows...it's government insurance. Do it or else! The point being they no longer want to pay for expensive un-used medical equipment.

Is 70% the amount of usage that will lower your health risks and make you feel well rested? As for health risk, a little choking in your sleep compared to a lot of choking in your sleep? As for how you feel...Just ask the Forum...4 hours a night, 70% of nights?...Not for me. I need it all night every night or I feel/sleep like crap!

Thanks again for the responses! Read, learn and ask questions....advice given in this forum...and good advice it has been! Biting off little pieces of the unknown of sleep apnea is so helping us to understand it and take ownership of it. It's getting easier to let go of some of the fears by getting support for all those beginner questions. To know what is important is the flood of statistics, therapy, acceptance, denial, experiments has helped us to move forward and begin to be a true part of his therapy.