Anyone know why this might happen?   The last time it happened My daughter's Sleep Specialist said that my daughter's Stage 1 sleep is probably being recorded as Awake or Stage 2...that is, for the specific recording interval if 55 percent of that interval is Awake and 45 percent is Stage 1 it will be recorded as Awake.  It happened again in her last sleep study so I'm wondering if there is something else going on.

My daughter is 3 3/4 years old and has a complicated medical history including severe brain damage, cerebral palsy, seizure disorder (on Topamax now but was on Depakote during the sleep study), sleep apnea (mostly hypopneas = uses Bipap at night), reflux (Gtube fed with overnight hydration)...among other things.

TIA


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Erin
Mom to 3 children 4 and under!! including a sweet 2 year old who has chronic kidney failure with severe cystic encephalomalacia, cortically blind, mixed cerebral palsy, severe global delays, Sleep Apnea, possible RLS, reflux, G tube

What does your sleep specialist make of this?
My understanding (and I am not a medical expert or sleep expert and my knowledge on pediatric sleep is even more limited than my understanding of adult sleep) would suggest that this may not be a significant issue. In normal adult sleep, stage I sleep is generelly brief and that it is less important than slow wave (stage 3 & 4) sleep and REM sleep.
If your daughter is getting adequate total sleep and adequate slow wave and REM sleep and not having an abnormal level of arousals, I am not sure whether the absence of stage I sleep would be a significant problem.
If she has trouble falling asleep, I can imagine that the apparent absence of stage I sleep might reflect an effect from either the possible RLS (which the sleep specialist might help confirm, but that question may have been resolved by now) or some effect from the severe brain damage (and perhaps a pediatric neurologist could help answer this). This might mean that her body is somehow resisting sleep until it is to tired to resist and might appear on a sleep study as an extremely short or absent stage I sleep. However, this is pretty much sheer conjecture on my part.
Others may have more knowledge or insight and I hope they will chime in also. I would also encourage you to discuss this concern with your child's medical team to help place the data in perspective.

Best wishes to you and all your family,
Bill

Thanks Bill for your input.  She had an awful night's sleep that night...Sleep Efficiency was 78.3%, Respiratory Disturbance Index was 31.4, Number of Awakenings was 51 in a 416.8 minute sleep time.  She had no PLMs but 208 obstructive hypopneas, 7 central apneas, and 3 obstructive apneas.  It was a diagnostic study with a seizure montage that indicated her repeated painful stiffening/screaming were not seizure related or RLS (731 PLMs in a 2nd titration study initially seemed to respond to Mirapex but it suddenly stopped working a year into treatment) but startle reflexes during sleep.  Oddly enough switching her to Topamax has changed her sleep so we can't help but wonder if she was having subcortical seizures that weren't being picked up by the EEG leads.  Of course the Topamax is so sedating it could be she doesn't wake as easily anymore---unfortunately she doesn't wake even if her Bipap mask is off and blowing air in her hair!   So she's not getting great sleep even with her Bipap mask "in use" at night.  Our Sleep Specialist thinks she needs a T & A but no ENT will touch her because she has small tonsils and adenoids and is an anesthesia risk.  She may actually be resisting sleep knowing that a painful event will wake her from her sleep.  Quite frankly no one really knows what is going on with her, we're still investigating because she's now screaming when tired during the day instead of at night and she's so complicated getting her specialists to chat is really difficult.  We just want her to sleep better than she currently does (from 2am-10am and still needs 2-3 naps a day).


_________________
Erin
Mom to 3 children 4 and under!! including a sweet 2 year old who has chronic kidney failure with severe cystic encephalomalacia, cortically blind, mixed cerebral palsy, severe global delays, Sleep Apnea, possible RLS, reflux, G tube

I don't know anything about the issues that  you're facing, but I wanted to at least send you hugs.  It's hard when you've got a little one who's already having problems and then who has to deal with sleep issues on top of everything else.  Hang in there.  Keep asking questions and keep trying to get her doctors (at least the most important ones such as the ENT and the sleep specialist) to communicate with each other.