REM vs. Deep Sleep

[SCW]

Hi,

My AHI in the sleep study was 66 - that means I had an event every minute! It was worse on my back ... something like 90. That's an event every forty seconds!

Since my events are numerous they are by definition short - generally 20 seconds according to the sleep study.

Also according to the sleep study I got no deep sleep! Zero. But about 18% REM sleep, even with all those apnea events going on.

Once I was put on CPAP I was expecting a miracle cure and that I would be a very spritely person!

In fact, I had more physical energy - I finally started getting deep sleep, I think. My wife was impressed when I tore out all the ivy!

But my mental facilities went way down! I am a programmer so you can imagine it is important to keep the brain working. I was a zombie. It was awful.

I finally decided to split my night between CPAP for deep sleep and then sleeping sitting up on the couch to get my old "cruddy" REM sleep which at least worked.

My doctor told me that your body will favor deep sleep over REM sleep. One idea was that my body was getting more deep sleep and so whatever REM sleep I used to get in during all those apnea events was getting pushed out, and so I would get very little REM sleep while on CPAP.

But nobody really seems to know what goes on when your AHI rating is super high. The biggest problem I have had is setting my expectations. I can easily wear my nasal pillow all night - compliance is not a problem. The problem is that the more I comply the more zombie like I become (it's not as bad as it was but it's still not good).

Now, it has been almost a year since I started, and things are evening out, but it still seems like my brain doesn't work as well as it used to before CPAP. I still split my sleep, where once I wake up in the AM (between 5:00 and 7:00 a.m.) I switched to my couch and finish off my sleep sitting up at an angle. Then I have glorious dreams and feel much better!

Just so you know, my cholestral was a little high before CPAP (LDL 265 but the HDL/LDL ratio was okay), and my blood pressure was 120/80 (now it is down to 111/57!), so I wasn't having a huge number of physical side effects from sleep apnea.

Anyway, much internet searching has resulted in NO information on people like me - people who have very high AHI numbers, so I am looking for some support here. I have seen some posts where people get 'used' to CPAP after a year. I think at my rate it will take a year and a half to two years - that is okay with me - I would just like to know that I will get to where I need to be. (I just wish my doctor had told me it might take over a year for my body to adapt.)

Thanks in advance,

-- SCW

[SCW]

Oops - I made an error above - my LDL was 220 before CPAP - now it is higher at 256! But the ratio is still okay.

[frequenseeker]

I'm like you, I get alot of REM between 5 and 7am. I have often taken off my mask at 5 because I can't get back to sleep and then I do go back to sleep and then get all the dreams. My events are closely associated with REM, I get most of them then. If I get all these dreams I can feel quite bad. I feel better if I get up earlier and avoid them, if otherwise I would have them without pap. OR, if I can keep my mask on and keep the bipap going, and get back to sleep, in which case I dream and I feel better.

I wonder if your cpap is allowing you to really get deep sleep - have you had a second study that showed it? You might be getting better or longer sleep in general, or just not having the oxygen deficit and apnea effort, and this has given you more physical energy. You might not be doing well mentally because you might not really be getting "deep" sleep after all, let alone REM. And you might still be having events.
Can you download your data from your machine? Get an autopap on loan and get your data that way? You need to know what you are really having for results. You might have zero apnea but bad hypopnea still. Maybe not 66, but I feel bad if I am over 3-5 AHI, despite nearly zero apnea, and a number of other people here have said the same.
Let us know!

[ozij]

This -posted on another board - might be relevant to your problem

Janelle on Xyrem's beneficial effects effects

O.


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[SCW]

My second study (the titration study) showed no deep sleep at all, even with CPAP, and reduced REM, which the doctor attributed to "first night CPAP jitters" or some such.

I have an Autopap machine and I bought the Autoscan software so I can download every day if I want. I download every four days now (because if I wait past noon I will lose a day, since the machine only holds five days, and a new day starts at noon).

What should I look for in the reports? My AHI is generally 5-6 (although last night was about 3.5) and my AI is usually .5 - 1.2. A long time ago I set the machine to CPAP 12 (doctor prescribed 10 originally) and eliminated all events but even then I woke up a zombie. But I could try that again. My pressure on AutoPap (S7 Spirit) is generally about 10.5 average for the night. I start the pressure at 9 because I have a narrow nose and at much less than that I feel like I can't breathe enough. I fall asleep within 10 minutes generally, wake up at 2:00 a.m. to, ah, pee, and then wake up again between 5:00 a.m. and 7:00 a.m.

I will ask about the drug Xyrem. I have a doctor appointment at the end of August (the doctor is very busy!).

I thought about buying a portable EEG but they are expensive ($1000) and I don't know if a consumer EEG would really work. That would be interesting. As it is, I kind of have to guess what the AHI results mean in terms of deep/REM sleep.

I've seen on the boards here that some people relax more during REM sleep and have more events - it doesn't seem that way for me, but I could be wrong about that. I always thought deep sleep produced deeper relaxation than REM, whereas REM paralyzes your muscles (so you don't run around in your dreams!). It might be the same for me, though, because while my HI is pretty consistent through the night, I do have more AI events in the morning hours.

Thanks again - all ideas are welcome.

-- SCW

[SCW]

I offer the FDA page on Xyrem without comment:

http://www.fda.gov/cder/drug/infopage/xyrem/xyrem_qa.htm

[HisServ]

I am by no means an expert, but you also might want to consider that if your body HAS been getting REM and HAS NOT been getting deep sleep, maybe your body is trying to catch up on your deep sleep. Once you have caught up on that, you might have a more normal sleep pattern with both deep sleep and REM and everything well even out. Best of luck to you.

[SCW]

Yes, that's what I think... I'm just looking for support, because it's taking such a long time to catch up!

What is the longest anyone has gone before they felt 'better'?

[SCW]

Last night I set my S7 Spirit to CPAP and a pressure of 12. It hurt! The air flow somehow scraped up the inside of my nasal passages toward the back.

I downloaded the data and it looks like the night before was much better on Auto: 2.3 events/hour, with 0 apnea events all night. On CPAP 12, I had 3.7 events/hour and 0.3 apnea/hour, and it hurt. And the leak was a lot higher on higher pressure.

So I think I'll stick with Auto mode ...

If anyone else has any more infor about REM vs. deep sleep, please post!

Thanks in advance,

-- SCW

[Dragonlady]

SWC, Were your oxygen levels tested? I found out that even with my bipap I was only getting 80% of oxygen at night so ended up having to use an oxygen concentrator to add more to my air intake. Now I wake up with mind alert and raring to go. I can think and plan, its amazing to recall the difference in alertness and thinking before and after.

[pinetree]

REM sleep leaves you MORE relaxed than deep sleep, so you would have more apneas usually in REM. Research on REM deprivation (which they once thought caused insanity-- 'don't dream and you'll go crazy') showed no effect. They don't know why you need to dream and why people who don't dream due to apnea have REM rebound for a few nights.

New, successfully treated CPAP users often have longer episodes of deep sleep, but only for a few days. If your PAP is working (letting you sleep), you should be sleeping normally after a few weeks. It can take 3 months to a year, however, to get back to feeling normal and fully functioning. (Perhaps the brain's circuits are healing, and all those years of sleep deprivation have messed up the wiring?)

The above 2 paragraphs are things I have read in books - Dement's The Promise of Sleep in particular. I have read something recently on www.myresmed.com about REM sleep saying that it does do something good. Can't recall what. (Must be my apnea...)

It sounds to me (a layman) like your PAP is not doing its job. It could be the AHI you still have with treatment is high enough to disrupt sleep. Or you may have UARS, which don't show up with PAP software, but disrupt sleep. You might want to look into having a follow-up sleep study to see if you are sleeping normally, and have them use the special equipment needed to check for UARS to see if that is the cause.

At any rate, something is not right. You should be able to use your PAP all night and get the right sleep. Are you on any meds that could otherwise disrupt sleep? If so, look into that.

[/i]

[pinetree]

The myresmed site says :

"REM sleep contributes to psychological rest and long-term emotional well-being. It may also bolster memory."

after you register, click on about sleep, sleep architechture.

[SCW]

So if I look at the detail output from my Autoscan software, increasing apneas is more likely to signal REM sleep than deep sleep. Is that right? Is there really any way to know what's going on, brain-wise, by looking at the night time occurance and duration of apnea and hyponea events?

Thanks in advance,

-- SCW

[scw]

pinetree - I have Dement's book so I'll look up REM references. I'm not sure being relaxed during the day is the same as muscles relaxing during sleep.

Thanks for the pointer to myresmed. I registered there and I'm digging around.

dragonlady - My oxygen was about 88% I think - borderline for concern. My oxygen level during regular waking life is only 92%! I think my nose is narrow and I've learned to breathe shallowly all day long.

[frequenseeker]

duration of apnea and hyponea events?