No Stage 3 Sleep

I worked at a sleep lab for about a year and a half and it was actually very common not to see stage 3 on a lot of pts. A lot of stage 2 and some REM but stage 3 was missing a lot.

Thanks teachcsgg. At least I'm not the only one with this.

When I had my titration study I was told that the tech could not get me into stage 3 sleep at all. For me I'm sure this is pretty normal because I never feel rested when I wake up.

I hope your CPAP helps you Ladyflower. I never feel rested when I wake up either.

My untreated AHI was 131 and I never got into REM or Stage 3 sleep either.

Thanks Kenwood - It seems to be a lot more common than I first thought.

When I had my 1st sleep study in 2008 I had ZERO stage 3 and ZERO REM. I don't remember how much 3 or REM I got during titration, but it was more than 0. My second study (a little over a year ago) was with my PAP, and while not ideal levels of 3 and REM, it was enough that sleep dr was satisfied. I guess I am saying all that to say this - it does get better.

How do you know your sleep stage? I had an at-home study ...

Jeannh wrote:How do you know your sleep stage? I had an at-home study ...

You need to look at the sleep report.

However, a lot of HSTs do not measure "sleep", or use alternate technologies to simply differentiate REM from NREM, etc.

newpapper wrote:I had my titration last night. The plan is to try to improve the sleep first and then see how the PLMD is.

Hi. Just wondering if you posted the results of your titration in another thread and I missed it or how that turned out. Particularly wondering how those limb movements looked. Was it the doctor's plan to try to improve sleep 1st then look at your PLMD? Just asking because if your PLMD causes sleep disruption and is unaddressed, good sleep may continue to elude you. If you did post about your study elsewhere, can you direct me to it? Thanks.

Thank you for the follow up. I had 2 minutes of Stage 3 sleep and they did not mention PLMD on the report this time. I don't see the Sleep Dr until the one month follow up. Is it usual to have good nights and bad nights with PLMD? Thanks again for your thoughts.

Here's another chart illustrating the point sludge was trying to make:

Thanks Sir.
kteague - I apologize that I did not address all your questions. I'm baffled that they put it as a diagnosis on the first sleep study and did not even mention it on the titration study report. I find it hard to believe that it could be a diagnosis on the first and not even get a mention on the titration study. Unless the CPAP eliminated it? I did not post the study elsewhere so you did not miss it.
The study recommended a pressure of 8. My AHI was still slightly over 10 at this pressure, which was the lowest they got as it increased at higher pressures. I am frankly disappointed that they could not get it lower and did not try anything but straight CPAP with no EPR, or bilevel. The sleep tech said to address the apnea first and then the PLMD when I asked him about the PLMD before the titration study. You make a very good point that unaddressed PLMD will still be a problem. The last I saw the Sleep Dr was before the titration. When I see him I'll ask him why the PLMD was diagnosed and then no mention was made on the titration report. Thank you sincerely for your concern. Are you a PLMD sufferer? My gut feeling is that my legs are thrashing in the night as the sheet and blanket are always a complete mess in the morning.

newpapper wrote:Thanks Sir.
kteague - I apologize that I did not address all your questions. I'm baffled that they put it as a diagnosis on the first sleep study and did not even mention it on the titration study report. I find it hard to believe that it could be a diagnosis on the first and not even get a mention on the titration study. Unless the CPAP eliminated it? I did not post the study elsewhere so you did not miss it.
The study recommended a pressure of 8. My AHI was still slightly over 10 at this pressure, which was the lowest they got as it increased at higher pressures. I am frankly disappointed that they could not get it lower and did not try anything but straight CPAP with no EPR, or bilevel. The sleep tech said to address the apnea first and then the PLMD when I asked him about the PLMD before the titration study. You make a very good point that unaddressed PLMD will still be a problem. The last I saw the Sleep Dr was before the titration. When I see him I'll ask him why the PLMD was diagnosed and then no mention was made on the titration report. Thank you sincerely for your concern. Are you a PLMD sufferer? My gut feeling is that my legs are thrashing in the night as the sheet and blanket are always a complete mess in the morning.

Limb Movements can be tricky. Having limb movements show up on a study is not always a concern or an indicator of a future problem. Sometimes those movements are a part of the effort to begin breathing again with apneas and will resolve with CPAP treatment. A report might show LMs or PLMs. That small "s" should be for plural, indicating their presence more so than a diagnosis of a disorder. If it says PLMS, with a capital "S", that's for Periodic Limb Movements of Sleep and must meet a level of diagnostic criteria. PLMD, "D" for Disorder, is also a diagnosis meeting specific criteria. I have PLMD. Seldom do I read that actual PLMD resolves with CPAP - but I have read of it, just not sure of the exact terminology on their report. EDIT: Anyone more in the know please step in here and correct me if needed.

I agree with your doctor on getting the OSA treatment in order first. In my opinion it's a more critical health matter. That's really the only way to see how bad the movements actually are when there is no interference or awakenings from the apneas. If the limb movements end up needing treatment, once they are resolved one should be in tune that their apneas may increase once there is no more interference or awakenings from the limb movements. - It can be a cat and mouse kind of game, but is doable. For me there was a lot of breath holding with my movements so I'm guessing that would have made my machine data's accuracy suspect. And there can be variability with limb movements from night to night. If it turns out you have PLMD, I would suggest you get your OSA treatment stabilized then get retested while using your therapeutic pressure to see how your limb movements are doing. Or video yourself at home. Your bedding being in disarray could be a sign of trouble, but some people thrash about with apnea events so it's hard to say without evidence.

BTW, titration with a bi-level is generally reserved for high pressure needs or maybe other extenuating circumstances. You did not max out the potential for a CPAP to effectively treat your apneas, even though this particular night may not have successfully honed in on it. While an autopap machine at home will seek a therapeutic pressure, it's not conducive to the very structured diagnostic process used in a sleep lab.

Thanks for all the additional information. The original sleep study did specifically list PLMD and it's diagnostic code along with Moderate Sleep Apnea and Hypoxia. A video seems like a great idea and a lot cheaper than another sleep study. I wish you the best in dealing with your PLMD.