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Sleep Disorders

Improving Stage 3, Stage 4 and REM Sleep

09/25/2008

Question:

My recent test results showed 83% stage 2, 2.2% stages 3 and 4 and 6.7% REM. I was told stage 3, stage 4 and REM should each be about 20%. Is there any way to improve these?

Answer:

There is limited information on the ideal sleep stage distribution over a night's sleep, though we have an understanding of what are considered normal ranges for sleep stages across the night. The amount of slow wave sleep (stages 3 and 4, also called deep sleep or SWS) and REM sleep (dream sleep) reported on your study would be considered low, but not unusual for a night in the sleep laboratory.

The distribution of sleep stages varies depending on a multitude of factors that include the presence of sleep disorders such as sleep apnea, insomnia, or periodic limb movement of sleep. The sleep stage distribution also varies in the absence of sleep disorders depending on your age, prior sleep deprivation, time allowed for sleep, caffeine, alcohol, medications, and environmental factors. It is very common, even in normal individuals who have no sleep disorders, to have a disrupted night sleep when they present to the sleep lab. This is related to the new and strange sleep environment, and is similar to spending the night in a different place than what one is used to.

It is somewhat ironic that sleep in the sleep lab is often not typical compared to sleep at home, so why do we do sleep studies? Laboratory sleep studies are generally done to evaluate for or rule out sleep disorders such as sleep apnea. The disruption in sleep stage distribution during a sleep study thus may be a measure of the severity of the underlying sleep disorder. However, if a patient had no significant sleep disorder, but has disrupted sleep architecture during their sleep study, this could be merely due to the new environment. It could also be due to disorders not diagnosed on the sleep study such as chronic pain, heart burn, depression, and anxiety disorders. The consumption of alcohol or caffeine, along with the effect of certain medications, such as antidepressants, can result in the pattern you described.

Without knowing your clinical history and the details of your sleep study, the cause of your reduced SWS and REM sleep cannot be determined. And since the way to improve the percentage of SWS and REM sleep will depend on the specific cause, its hard to say how can improve it. Assuming you have none of these disorders and you adhere to good sleep hygiene, the abnormality of sleep stage distribution on your sleep study may well be due to the new sleep environment.

I recommend you discuss your sleep study results with your Sleep Medicine Physician. After reviewing your sleep study, they should be able to provide with you a more specific answer to your question.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University