Sleep Disorders: Insights on NREM and REM Sleep Issues

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Hello, doctor.
Here's the situation: If I'm not mistaken, a lack of slow-wave sleep combined with vivid dreaming, where REM sleep occurs within a few minutes and has a higher proportion, could indicate depression.
However, after undergoing five sleep studies, my sleep efficiency, sleep onset latency, REM onset time, and percentage are all completely normal; it's just that the expected N3 and N4 stages are filled with N1 and N2.
I also had a sleep study done the night before (which, aside from the absence of N3 and N4 and some obstructive sleep apnea, was normal), and the following day I underwent a Multiple Sleep Latency Test, where I fell asleep five times during the day, but the doctor concluded it was not narcolepsy because my REM did not appear immediately.
The psychologist I consulted, who specializes in sleep disorders and is also a renowned child psychotherapist, continues to see me.
Initially, I experienced anxiety and insomnia due to complications from OSA surgery, and the psychiatric medication prescribed did help me through that period, but I soon stopped taking any medication.
However, now, aside from the extreme sleepiness and fatigue caused by insufficient sleep, leading to very low activity levels, I don't see any other issues.
My sleep onset and wake times are normal, and others in similar situations say I seem fine; I have no difficulties interacting with others.
Only I know the constant struggle of feeling tired and wanting to sleep (my appearance also reflects a very fatigued and lethargic demeanor).
When it comes to anxiety, tension, or overthinking, I don't feel any of that either.
I'm unsure what aspect of psychological therapy should be addressed.

nobody, 40~49 year old female. Ask Date: 2017/01/13

Dr. Zhong Mingxun reply Psychiatry

My response is more focused on general common possibilities.
If you have already sought medical attention, I recommend discussing it thoroughly with your psychiatrist.

Reply Date: 2017/01/13

More Info

Understanding sleep disorders, particularly the dynamics of NREM (Non-Rapid Eye Movement) and REM (Rapid Eye Movement) sleep, is crucial for addressing various sleep-related issues. Your situation presents a complex interplay between sleep architecture, psychological factors, and overall well-being.

Sleep Architecture and Its Importance
Sleep is divided into several stages, primarily categorized into NREM and REM sleep. NREM sleep is further divided into three stages: N1 (light sleep), N2 (moderate sleep), and N3 (deep sleep). REM sleep is characterized by rapid eye movements, increased brain activity, and vivid dreaming. Each stage plays a vital role in physical and mental health.

1. NREM Sleep: This stage is essential for physical restoration, immune function, and energy conservation. N3, also known as slow-wave sleep, is particularly important for memory consolidation and growth hormone release. A deficiency in N3 can lead to feelings of fatigue and decreased cognitive function.

2. REM Sleep: This stage is crucial for emotional regulation, memory processing, and creativity. It typically occurs about 90 minutes after falling asleep and recurs several times throughout the night. A lack of REM sleep can lead to mood disturbances and cognitive impairments.

Your Sleep Issues
From your description, it appears you are experiencing a predominance of lighter sleep stages (N1 and N2) at the expense of deeper sleep stages (N3 and N4). This imbalance can lead to feelings of fatigue and low energy, as you have noted. The fact that you are experiencing extreme tiredness despite having normal sleep onset and wake times suggests that the quality of your sleep is compromised.

Psychological Factors
You mentioned a history of anxiety and the impact of previous surgeries on your mental state. Anxiety can significantly affect sleep quality, often leading to increased awakenings and a reduction in deep sleep stages. Even if you do not currently feel anxious, underlying psychological factors could still be influencing your sleep architecture.

Recommendations
1. Cognitive Behavioral Therapy for Insomnia (CBT-I): This is a structured program that helps address the thoughts and behaviors that contribute to sleep difficulties. It can be particularly effective in treating insomnia and improving sleep quality.

2. Sleep Hygiene Practices: Establishing a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants (like caffeine) close to bedtime can enhance sleep quality.

3. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or yoga can help reduce anxiety and promote relaxation, potentially improving your sleep quality.

4. Consultation with a Sleep Specialist: Since you have already undergone multiple sleep studies, it might be beneficial to consult with a sleep specialist who can interpret your results in the context of your overall health and psychological state. They may recommend further evaluations or treatments tailored to your specific needs.

5. Regular Physical Activity: Engaging in regular exercise can improve sleep quality and reduce feelings of fatigue. However, it’s best to avoid vigorous exercise close to bedtime.

6. Nutritional Considerations: A balanced diet can also play a role in sleep quality. Foods rich in magnesium, tryptophan, and omega-3 fatty acids may promote better sleep.

Conclusion
Your experience of fatigue and low energy, despite normal sleep patterns, highlights the importance of addressing both sleep quality and psychological factors. By implementing strategies to improve sleep hygiene, considering psychological interventions, and consulting with specialists, you can work towards enhancing your overall sleep quality and well-being. Remember, sleep is a critical component of health, and addressing these issues can lead to significant improvements in your quality of life.

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