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Sleep Apnea only during REM sleep? (11 Year Old Son)

This area is for the discussion of Pediatric Sleep Apnea.

Sleep Apnea only during REM sleep? (11 Year Old Son)

Postby Peggy2 » Tue May 06, 2008 12:02 pm

I have sleep apnea myself and have a cpap machine. My poor 11 year old son has been suffering silently for quite some time -- we recently discovered that he too has sleep apnea (it runs heavily in my family and my hubby's). My son had a sleep study and it was determined that his sleep apnea only occurs during REM phase sleep. As a result, his brain is trying to avoid REM sleep. Average people get approximately 25% of sleep being REM, my son is at 6% and thus has little restorative sleep. He is anxious at bed time and hard to wake in the morning.

The doctor mentioned concerns with the cpap machine due to DS's facial bones not yet being fully formed. Also, DS has no issues with tonsils or adnoids -- he does have an elongated soft palate. What is strange is that his obstructive sleep apnea only kicks in during REM sleep. Has anyone else had similar issues? I am not familiar with pediatric sleep apnea and am not 100% confident that the sleep specialist sees enough of this ("Wow, I've never seen anything like this before."). DS has had nose bleeds and allergies. He also has suffered acid reflux.

DS goes for the next sleep study in 3 weeks. He is exhausted right now (and grumpy -- no, I don't blame him).

Does anyone out there have advice for me? I'd love to walk in with better questions on our next visit tot he doctor. I'm worried sick about my son and his lack of sleep. Any advice is more than welcome!

Thank you in advance!!
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Postby tatamom » Tue May 06, 2008 10:33 pm

My DD has OSA. I just looked at her latest report and it shows more apneas during REM sleep, and hypopneas during the NREM sleep as well as apneas. Interesting. I don't know what to say about not getting very much REM sleep or why he would only have apnea during REM sleep.

I would want more information from the doctor and to see the report myself. Sometimes there is information that they "forget" to tell you. Where was his sleep study done? Do they test a lot of children? It does make a difference if they are experienced with children. Who read the study? Was it read by someone qualified to read a childs study, they are more complicated than adult ones. Is your son's doctor a pedi-sleep doc or an adult one? Kids are not just small adults and their apnea requires special care. (We fired 2 pedi-pulmo's before finding one qualified to treat DD). Is your son's reflux being treated? Reflux can play a role in sleep apnea.

As the parent of a child on cpap, I am less worried about the growth of her facial bones than I am in her continuing to breath. I have not been able to find any dentist or orthodontist who has treated a child on cpap. I have been told that bone growth problems are very rare with kids on cpap and usually occur in kids already at risk for these problems. My DD wears a full face mask, so the pressure is over a larger area than just a nose mask. I would prefer the nose only mask, but she will breath through her lips if I put it on her. My greatest concern about cpap is if she should happen to become sick while sleeping........aspiration would be bad, so I listen over a baby monitor so I can tell if she is in trouble. (The upside of listening to her is that I can tell if she is coughing so I can treat her asthma before it becomes a major issue).

I wish I had more answers for you, but apnea in children is hard to understand.

Susanne and her mini-hosehead Chris
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Postby Peggy2 » Mon May 12, 2008 11:17 pm

My son had the 2nd sleep study with the cpap on Saturday and the doctor reviewed it and wrote the prescription today. Tonight the respiratory therapist arrived with my son's machine. Say a prayer for him! I'm hoping his brain will allow more REM sleep once he makes it through a night with no breathing interruptions... Thanks for reassuring me Susanne -- it is good to hear from others in this boat.
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Night 1

Postby Peggy2 » Wed May 14, 2008 12:01 am

He slept with his mask the whole night and didn't wake! AMAZING! =D> Unlike me, one night didn't make him feel better :cry: but, hopefully as he sleeps through the night he will start to get more restorative sleep (more REM). Considering that the REM stage was the only stage he has apnea, it is understandable that his brain adjusted to minimize this stage (hence the exhaustion despite adequate hours of sleep).

May night #2 be a success as well!

I'm more reassured on kids with cpap -- the respiratory therapist told me it is more common than most realize. I'm still open for advice if anyone has anything to offer... pediatric sleep apnea is something that I never thought existed until I suddenly realized my son was living with it!
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Postby embryopathy » Fri May 16, 2008 6:42 pm

I'm curious how much of your son's sleep was in stage 3&4? (These are the stages that I understand to actually be the deep stages of sleep----the most restorative. REM is actually a light sleep, when dreaming occurs). btw, My son also had only 5% REM sleep during his study, and his apnea also only occurred during REM.

I'm especially interested in your statement that his brain adjusted to inimize this stage due to the apnea.....that is exactly what I have been wondering in re: to my son. His sleep study also indicated no stage 3 & 4 and no central apnea. HOwever, I am certain I witness central apnea episodes---just not every night---and he seems to be in a deep sleep when he has them because the apnea does not wake him. So my personal thoughts (not talked to dr. yet) are that he only has central apnea when he manages to get into stage 3 & 4 sleep, but this doesn't happen often because his brain somehow adjusts to maintain breathing.

Did your dr. tell you about the brain adjuststing the sleep stages to avoid apnea, or is that your own thought (like me)????

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Postby Peggy2 » Sat May 24, 2008 11:34 pm

embryopathy -- I wish I could answer you. My son does not spend much time in stage 3 or 4.... most is two. His cycle was over 2.5 hours vs. the normal 90 minutes. The respiratory therapist and doctor BOTH hypothesized about the brain minimizing the REM stage due to the REM only apnea. There is no central apnea (thank goodness). I wonder if you could have home sleep studies for the sporadic issues you are seeing with your son? I admit, I know little on central apnea.

My son is not adjusting well to his mask AT ALL. Any tips? Air leaks are an issue, but then tightening is too -- he is miserable and hates the machine. I feel horrible since my cpap machine has worked wonders for me.... Best of luck -- sorry I'm late checking back embryopathy!!
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