A little hisotry: Cassidy has Epilepsy and some other health issues and is being monitored for Autism.  She was recently diagnosed with an IGA deficiency after allergy testing (nothing severe, some minor), she also recently had a sleep study done after my complaining about her sleep for as long as I can remember!  She is being treated by an ENT who says her tonsils and adnoids look fine, there is plenty of room - we tried some different allergy meds. that didn't help her sleep issues at all.  & With her Epilepsy med. she's not allowed to take any antihistimine's, only nasal spray, which she takes daily.

Her sleep issues include: talking, walking, crying in her sleep - she wakes up a lot (not necessarily gets up, but wakes up), I can hear her gasp & choke sometimes, not much of a loud snorer, but has always had a difficult time with sleep.  I still have to help her sometimes, she asks to be swaddled still, sometimes she takes a couple hours to fall asleep... just a lot of different things...

Anyway - here is some of what the sleep study showed: (Only have a 2pg. report, no graphs...) (I bolded my thoughts...)

Sleep architecture: Lights out was recorded at 10:58pm and sleep onset recorded at 11:33pm showing a sleep latency of 35min. which is slightly prolonged (which makes me laugh, because this is the fastest she's went to sleep in as long as I can remember :)).  A total recording time of 427 minutes was noted of which the patient spent 370 minutes in sleep indicating a sleep efficiency of 87% which is slightly low.  In terms of sleep stage distribution, the patient transitioned through different sleep stages so that NREM stage 1,2,3/4 sleep was ntoed to be 6, 64, 28% and REM sleep accounted for 0%.  WASO was noted to be 2%.  The sleep architecture reveals decreased REM sleep.

Cardiorespiratory events: From the cardiorespiratory standpoint, the awake heart rate was 85-120/minutes.  Asleep heart rate ranged from 70 to 120 beats/min. which is normal for patient's age and medical condition. (medical condition?) There were no ectopic beats noted on one-lead limited EKG and no evidence of tachy or brady arrhythmias noted.

The respiratory rate during awake was noted to be 24/min. with normal respiratory effort.  There were a few episodes of obstructive apnea, hypopnea and one central apnea noted with apnea-hypopnea index (AHI) of < 1/h.  However, the patient demonstrated evidence of snoring and respiratory effort related arousals at 9.7/hour for a total RDI of 10.7/hour, suggestive of an upper airway resistance syndrome.

The oxy-hemoglobin saturation distribution shows that patient spent the sleep time with pulse oximetry (SpO2) ranging between 94-99% showing normal oxygenation.  There was one desaturation down to 88% associated with a central apnea.  The end-tidal CO2 (ETCO2) ranged from 40 to 50 mmHg sleep which is not indicative of alveolar hypoventilation.

Additional parameters: Analysis of EEG arousals noted that there were 15 arousals/hour mostly respiratory effort-related RERA.  The EEG pattern appears normal for the limited channels studied with no spike and wave pattern.  Analysis of EMG of anterior tibialis reveals no significant movements with PLMI of 0/h which is not suggestive of periodic limb movement disorder during sleep.

* OK - I've done some reading, on this board & other sites and I cannot find any information on no REM sleep and that seems like an odd thing...?  The rest of it I expected, I know she has a lot of arousals & I knew she had *some* apnea... I'm confused on the central one, only because of what I've read on this board...

We're not sure what to do.  Her ENT & Neuro. both said (seperately) that they would go ahead with the T&A surgery only because that's what is always done/tried first.  I'm just not sure.  If they (T&A) are both normal size & there is plenty of room, why do the surgery?  We saw the ENT yesterday who said he was going to talk to her Neuro. & get back to me later this week.  (Oh - she also has a depressed nasal bridge but the ENT said it's fine - I've always wondered if that could be what the "obstruction" is, and if so - how do you fix that?)

Any thoughts?  Any info. or links on the no REM sleep?  THANKS!  This board is awesome! :)


_________________
Chera & Cassidy (9-4-02) :)

hi  Chera

Sleep is broken down into 4 stages of nrem sleep

Stage 1 is very light sleep (drifting off)

Stage 2 is an intermediate stage of sleep. Lasts around 20 minutes.You go into a deeper sleep get harder to wake up

Stage 3 is the start of deep sleep lasts about 40 min

Stage 4  is the deepest sleep

then rem
You could also post the results in the sleep studies section of the forums.Heres a link to surgery ,not sure if it covers what your looking for

http://www.apneasupport.org/about32.html

good luck to both you and Cassidy

Hi Chera,

This being a discussion forum, most of us are just ordinary folks trying to learn as well.  
It does seem odd that she was found not to have sleep apnea yet you described the gasping and choking sounds.  

But you saying you searched the internet got me to searching as well.  You're right, searching for stuff on non-REM comes up with little or nothing, mostly nothing.  And boy, reading this stuff, it's clear that REM is as mysterious today as always.  I did learn alot about REM sleep disorder, but that's WITH REM, not without it.  So the search is difficult, as you said.

But I did run across this rather technical article on "Sleep-related Epilepsy" you might want to read:
Click here for link

There's alot of technical talk in there that doesn't apply probably and I got a headache browsing this, BUT, I was intrigued by this statement buried in this report:

Quote:

Frontal lobe epilepsies are a frequent diagnostic dilemma for a number of reasons. The seizures are frequently unwitnessed and semiology is often bizarre. Prominent choking and abnormal motor activity can lead to a misdiagnosis of sleep apnea or other sleep disturbance.

This made me think back on your description of her gasping and choking.

I don't understand much of this article, but it did seem interesting, it's comparing the relationship of sleep disorders, particularly sleep apnea, with epilepsy.  Thanks for bringing this issue to my attention.  Perhaps someone else might have some more understanding of this.    We do have a respiratory therapist here who volunteers and answers a lot of sleep study questions (named Sleepydave), but he hasn't been around lately (bet he's vacationing or working hard).  You might consider sending him a private message (PM) asking him about this, but it may take some time for him to get back to you.  If he can't answer things, he's good at finding information.


Linda

Wow, I thought I was the only one out there with a child having this kind of problem.  A little history on my son who will be 4 in April.  He was born premature at 23 weeks gestation. He is a twin.  He had a grade 2 head bleed at birth and is blind due to retinopathy of prematurity.  He had some bowel resectioning and is only 22 pounds to date.  Since he could crawl at 18 months of age he has been getting up at night and rocking in his bed for hours at a time.  We just had a sleep study done back in January and they said to have his tonsils and adnoids checked and NO REM.  His tonsils are fine according to are ped and we are going to see an ENT in the beginning or March.  Have you had the surgery done on your child?  Is your child underweight?  I heard that the majority of the brain maturity happens during REM.  If you have any information I would love to hear.

Thanks

A desperate mom
Karen

This is an old post, but since it got bumped to the top, and since Karen is having a similiar scenario, here is my 2 cents:

It is important to note that the longest period of REM sleep happens at the end of a person's sleep phase(usually just before we wake up in the morning).  While it is odd that there was NO REM at all, this could partially be partially explained by the relatively short total sleep time.  Kids require much more sleep than adults, and sleep labs usually only run sleep studies that are sufficient in length to reflect a normal ADULT sleep architecture.  A sleep study that was only about 7.5ish hours long doesnt reflect the normal distribution of sleep for a four-year-old, who normally should sleep 10-11 hours per night.  I have co-authored a small abstract on this topic that I conducted using data for another research study I am helping to work on.  Basically, the results are that, in healthy kids, you have to run longer sleep studies to show their normal sleep architecture, and when you run a study that is the length of some adult studies, you will likely not even record the final (& longest) REM period of the night, which will skew the percentages of the rest of the stages as well, and could potentially even skew the respiratory numbers, because apnea events are more likely to happen in REM sleep.