Absence of Delta Sleep

[Cranberry Ray]

Looking for some input on a problem noted on my titration study. Apparently I didn't get into stage 3/4 sleep (also know as deep sleep, delta sleep, N3). Here's the breakdown that has me concerned.

The patient slept for a total of 374 minutes out of 418 minutes in bed for a sleep efficiency of 90%. This consisted of
9% stage I, 72% stage II, 0% stage III, 0% stage IV, and 19% stage REM sleep. The sleep architecture was abnormal
with the absence of delta sleep. The onset of sleep was at 3 minutes and the REM latency was at 71 minutes.

I've been trying to do some research on the effects of not attaining deep sleep and found this definition.

• Stage N3 delta slow-wave sleep is physiologically restorative and produces, releases, or balances important hormones, blood sugar, metabolism, and energy.
  
  
• Stage REM sleep is cognitively restorative and assists in the consolidation of memories and stabilizing of mood and temperament. 
  
  

Have now been on APAP for about 12 weeks and definitely notice an improvement in energy and mental function and thinking I have probably been getting more and more delta sleep. Obviously without a new polysomnography I can't confirm it but was wondering what others think about this. I never realized that stage 3 sleep was just as, if not more important than REM. I'm not complaining, as I said have been feeling much better lately. But I truly believe xPAP therapy has helped to change my sleep cycles. Interested to hear others views.

[ppca]

Cranberry Ray,

Your post made me look deeper into my latest sleep study report. Yours doesn't look as bad as mine.

In my case, it was only 55% sleep efficiency, with complete absence of N3 sleep, and only 4.4% REM sleep. No wonder I was always feeling tired.

I've only been on my CPAP therapy for a month, after this study, so I guess it is too early to expect a huge improvement, but I am under the impression that is already helping slowly. In the last few nights, I haven't been waking up as frequently as before, so I'm assuming that I'm getting a bit more of deeper sleep, hopefully including both N3 and REM.

Glad to hear that you are already feeling better. It gives a lot of hope to all of us new hosers.

[woozie38]

Looking for some input on a problem noted on my titration study. Apparently I didn't get into stage 3/4 sleep (also know as deep sleep, delta sleep, N3). Here's the breakdown that has me concerned.

The patient slept for a total of 374 minutes out of 418 minutes in bed for a sleep efficiency of 90%. This consisted of
9% stage I, 72% stage II, 0% stage III, 0% stage IV, and 19% stage REM sleep. The sleep architecture was abnormal
with the absence of delta sleep. The onset of sleep was at 3 minutes and the REM latency was at 71 minutes.

I've been trying to do some research on the effects of not attaining deep sleep and found this definition.

• Stage N3 delta slow-wave sleep is physiologically restorative and produces, releases, or balances important hormones, blood sugar, metabolism, and energy.
  
  
• Stage REM sleep is cognitively restorative and assists in the consolidation of memories and stabilizing of mood and temperament. 
  
  

Have now been on APAP for about 12 weeks and definitely notice an improvement in energy and mental function and thinking I have probably been getting more and more delta sleep. Obviously without a new polysomnography I can't confirm it but was wondering what others think about this. I never realized that stage 3 sleep was just as, if not more important than REM. I'm not complaining, as I said have been feeling much better lately. But I truly believe xPAP therapy has helped to change my sleep cycles. Interested to hear others views.

G'day Ray, Most members on this board would agree sleep structure is the domain of the specialists of the medical profession. Access to these people & their laboratories is perhaps limited to folk like us, given the hoops we must jump though to land in a specialist's consulting room.
Everyone here would also agree, the amount of stage 3 & stage 4 sleep we have  is very relative to the way we feel next day. That said though, the ways these sleep stages might be lengthened or improved is something of a mystery to everyone. There are, as it were, too many governing factors to be able to nail down specific causes & effects.
However in my opinion PAP has a definite effect on sleep structure & when we don the mask & turn our machine on, we enter a sleep world that is different to the ordinary sleeper.
For the most part SDB sufferers are concerned more about O2 desats, daytime sleepiness & fatigue. Factors that affect their everyday performance. Little is said about the loss of cognition & memory, & these are the two major effects of insufficient stage 3 & stage 4 sleep. We can't function well without these sleep stages & I for one can attest to that. So your efforts, after SDB is successfully treated,  perhaps should be directed towards solving your stage sleep problem.
Much has been written about "sleep hygiene", preparing the bedroom, what to include in your bedroom & what not to have in there. Eating, or drinking beverages prior to retiring is also frowned upon. Body temperature in my opinion is of ultra importance too. Overheating whilst asleep is not good. I believe it's better to sleep a little on the cold side, rather than be hot.
Looking to these things will help. Do a little analyses of what you do before going to bed each evening, & good luck

[Ghost1958]

I also did not enter Delta phase at all until put on therapy.

Once they reached theraputic pressure I went thru a complete normal sleep cycle, and felt 20 yes younger the next morning
Pap, done correctly will usually rectify sleep phase problems.

[Rcgop]

Thanks for the post. My problem was not so much being tired but a waking to a racing heart that scared me. Had the home study so I didn't get the detail but the pap has fixed all problems.

[HZone]

Hi,

I'm no expert, but would also imagine that for many people there is a significant distortion/monitoring effect that will reduce the amount of time spent in the restorative sleep (deep and REM) states when you go for a sleep study? For most people it is not natural to go to sleep with multiple wires attached to your head and other parts of your body and/or when you know that you are been observed by people you do not know well. This will result in a (possibly unconscious) reluctance for the brain to enter a sleep state in which it is has significantly reduced ability to monitor the surroundings and wake you should danger occur.

Of cause untreated sleep disorders such as OSA will reduce the quality of sleep, including the likelihood of entering the deep restorative sleep states and increasing the likelihood of an arousal that takes you prematually out of these sleep states when you are in them. However, it is likely that the conditions of a sleep study (particularly if this is you first and therefore a new and strange experience) will further reduce the time taken in the REM and deep sleep states.

While I'm sure they are not as accurate as a true sleep study there are many consumer cadgets for monitoring sleep state. I use a ResMed S+ which has the advantage of been contactless, therefore significantly reducing/eliminating any 'monitoring effect', it identifies light, deep and REM sleep states and together with 02 saturation data and the data collected from CPAP machines provides a good picture of the amount and quality of sleep.

[Cranberry Ray]

In my case, it was only 55% sleep efficiency, with complete absence of N3 sleep, and only 4.4% REM sleep. No wonder I was always feeling tired.

Wow! With those numbers I don't know how you were able to function during the day. As others have stated, once on PAP you will begin to see a difference. I feel lucky that after less than 3 months it has made a huge difference for me. Hopefully you'll have a similar experience. While trying to find out more about delta sleep came across some articles that talked about a "sleep bank". They weren't referring to making up for a night or two where you didn't get enough sleep but rather the effects long term of sleep deprivation or lack of delta and REM sleep. There are apparently a number of hormones that the body produces during delta/REM that take time to replenish in the body once you get on a normal sleep pattern.

Good luck and stay with it, you'll feel the difference before long!

[mrkdilkington]

I also had 0% N3 on my sleep study as well as my CPAP titration study! CPAP increased my my sleep efficiency from 44% to 66% but did very little for REM and nothing for N3. After getting corrective jaw surgery last year I finally feel like I'm getting N3 sleep consistently. Sleep without N3 shouldn't even be called sleep because it exhausts you rather than refreshing you. My post-op sleep study is in June at Stanford so I'll know then what the exact %'s are. In my opinion, UARS (distinct from OSA but related) is responsible for preventing delta wave sleep.

Regular study:
   

Titration study:
   

[Cranberry Ray]

I also had 0% N3 on my sleep study as well as my CPAP titration study! CPAP increased my my sleep efficiency from 44% to 66% but did very little for REM and nothing for N3. After getting corrective jaw surgery last year I finally feel like I'm getting N3 sleep consistently. Sleep without N3 shouldn't even be called sleep because it exhausts you rather than refreshing you. My post-op sleep study is in June at Stanford so I'll know then what the exact %'s are. In my opinion, UARS (distinct from OSA but related) is responsible for preventing delta wave sleep.

Regular study:


Titration study:

Thanks for sharing your results, they are very similar. Did your surgeon that performed your jaw surgery think there was any correlation between your jaw problem and the absence of deep sleep? Would be interested to see what your new results are although probably won't be able to confirm if it's the result of the surgery or the effects of PAP use and correcting your OSA. I personally feel my sleep patterns have improved substantially because of my APAP use. Entire body just feels different in a good way and definitely more strength and stamina for workouts and daily activities. Had always been under the impression this was a result of better oxygen levels which now average about 95% every night, but now think deep sleep has a lot to do with it too.