We relate sleep to relaxation, late Sunday mornings and unexpected holidays that call for cozying about in the bed for longer than usual. It is one of the most favorite hobbies of most adults, who rarely get time away from work and other life duties. Remember the time when our parents struggled to get us into bed for afternoon naps when we were children? Only now we realized how we wasted the sweet privilege of going to sleep in the middle of the day.
Today, adults crave the opportunity to grab some much-deserved rest during the day and night, before it’s time to start the rat race once again. Sleep has become a precious commodity that pharmaceuticals sell in expensive bottles.
According to a study, over 70% of the US adults do not get enough sleep. Some of them wake up repeatedly due to recurring nightmares, breathing difficulties, leg cramps, and associated problems. Most of the rest deprived souls believe that they will be able to catch up on sleep “the next weekend.” Adults, teenagers, and young kids are victims of deliberate sleep deprivation.
It starts out as something innocent and manageable, but with constant abuse of resting schedules, it takes only a couple of months to become a sleeping disorder.
What Should You Know about REM Stages of Sleep?
Proper rest is significant for every mammal with a brain structure similar to their human friends. In fact, the structure of sleep is conserved among higher mammals. According to human sleep studies, regular rest consists of several stages. It is not as simple as falling asleep and dreaming about Zac Efron until you wake up.
Even a child’s rest has multiple complicated steps. However, the distribution of the stages varies as a child grows up into an adult. Infants and toddlers experience about 80% of their sleep time in the REM stage. Adults only spend about 20% to 25% in REM (Random Eye Movement) sleep.
As you drift off to sleep each night, your brain enters the NREM (non-REM) sleep stages first. After four such NREM stages, the mind enters the REM stage. Some people even begin dreaming almost immediately after falling asleep. However, dreams during the REM stage are unique.
These dreams are more vivid than others, and rapid intermittent eye movements accompany these images. Research shows that these linear movements of our eyes may have something to do with the vivid images that our brain conjures. Studies also link these image formations with memory construction. Without enough REM sleep, it would be impossible for anyone to remember and recollect details correctly.
Interestingly, the REM stages increase in duration as we reach waking time. Each successive phase is longer than the previous one. Scientists have studied the intensity and extent of each period through electrooculography (EOG). This process measures the rate and scope of the movements of the eyes.
Observation of several REM sleep study subjects shows us that the action is intermittent and not constant. The eye movement during the REM stages has a direct relationship with dreams and memories. However, their exact function is still a mystery to modern sleep study experts. REM also show a significant correlation with spikes in the brain wave activity, and they have direct links with the stimulation of the visual cortexes of the brain.
Why do Experts call REM “Paradoxical Sleep”?
The brain wave during REM is typically slow. It is a part of the slow wave activity that characterizes restorative sleep. They consist of low-amplitude, mixed-frequency brain waves. Experts often refer to this stage of sleep as paradoxical since its brainwave activity is very similar to the waking stage of a human being.
Sawtooth waves comprise the wave activity of REM sleep.
Beta waves, alpha waves and theta waves make up the total wave composition that reflects a high level of energy consumption and oxygen take-up. As a result, the rate of respiration during this stage increases and almost reaches that of wakefulness. The core temperature reaches ambient temperature, and blood pressure tends to increase as well.
These factors can help explain why people face difficulty in entering REM with sleep apnea and associated sleep disorders. The increasing rates of oxygen consumption lead to rapid breathing. People suffering from sleep apnea, without CPAP assistance ( Continuous Positive Airway Pressure ), risk breathing difficulties when they enter paradoxical sleep. Our muscles tend to relax when we are asleep, but during REM, we lose complete control over our muscles.
Neurologists and sleep experts often compare this to paralysis and atonia. The part of the brain that sends impulses to the muscular neurons experiences complete suppression. Only those that control ocular movement, breathing, circulation and diaphragm rhythms remain active. The beginning of this suppression mechanism occurs at the pons via the release of norepinephrine.
At a neurological level, REM sleep begins with the secretion of acetylcholine. The levels of this neurotransmitter remain high during wakefulness and REM sleep. It makes neurologists believe that acetylcholine is imperative for memory formation. An acute deficiency of acetylcholine points towards difficulties in memory formation and information retention.
Serotonin or the happy hormone in our brains have the power to inhibit proper restorative sleep. People with serotonin-dependent depressive disorders often experience severe challenges in meeting their daily REM requisition. In fact, surgical elimination of serotonin production sites can eliminate REM sleep. It shows that acetylcholine activation and norepinephrine secretion are not enough to begin the REM stage. Complete deactivation of “wakefulness” is mandatory for REM.
How is REM sleep a contradiction of its own?
Learning the mechanisms of REM sleep is not the confusing part. Finding out what the lack of it does to people is. Numerous studies show that the lack of it has a handful of effects on complex human behavior. People, who do not get enough restorative sleep for days on end show impaired learning, compromised memory and the ability to complete complex tasks. Such profound effects may be characteristic of chronic sleep apnea, but for most parts of the population, these effects are much less intense. Our brains have an exceptional rebound mechanism that can make up for the lost REM activity. When you do not experience enough REM sleep during successive nights of rest, your brain enters a state of rebound REM.
The original duration of a REM stage is between 90 minutes and 120 minutes. During rebound REM, the period can increase by about 20%. A rebound state may be as long as 24 minutes or more. You could think of this as an adaptive mechanism that makes up for the loss of restorative sleep. That is what forms the fundamental principle of all kinds of polyphasic sleep patterns. When the polyphasic sleepers deprive themselves of enough REM night after night from forceful awakenings, their brains delve into a rebound mechanism immediately after they go for a short nap in the next three or four days.
Can REM Rebound Hurt Your Health?
It is very common in patients undergoing CPAP titration. Untreated sleep apnea results in acute sleep deprivation. When people experience CPAP titration for the first time, they tend to enter a stage of a long REM rebound. Restorative sleep leads to heavy breathing and fast respiration rates. Therefore, people with severe obstructive sleep apnea (OSA) face a more significant threat from REM rebound than the general sleep-deprived populace. They are likely to enter deeper stages of restorative sleep, especially during the later portions of the titration. The type of architecture of restorative REM during the later phases of CPAP titration makes it more challenging for the OSA patients.
People do not wake up after each REM stage. However, cats and dogs do. In fact, almost all mammals, who live in the wild experience intermittent stages of wakefulness after each REM phase. These are the periods of “micro-awakenings” that intersperse sound sleep for most feline, canine and ungulate species. Research into their sleep behavior shows that it might be an adaptive mechanism that ensures the safety of their cohort while the other members sleep.
The windows of micro awakening help them survey their surroundings and weigh the threats from their predators before they nod off again. Depending on the extent of sleep animals require, an individual member can wake up from 6 to 8 times during their slumber.
Why do Some People Experience Disturbances during REM Sleep?
There are only a handful few in the world, who do not remember their dreams at all. Most of us remember them vividly and often recount the curious ones to our friends. Unless you cannot remember your dreams at all, you can be sure that you are getting REM sleep.
Nonetheless, there are a few unlucky ones, for whom rest is not just a cerebral experience. It is also a physical experience since they have to act it out during sleep. It is more common among children than it is among adults. Children often talk, move and walk in their sleep. Enacting dreams is not as odd for children as it is for the grownups. In a majority of the cases, these children grow out of this habit by the time they enter their teens or early twenties.
The problem of enacting dreams becomes dangerous when adults “pick it up” in their late teens or early twenties. Sometimes, people in their late 40s and mid-50s begin to move around, speak and walk in their sleep suddenly. These are telltale signs of REM-related sleeping disorders. Psychiatrists, psychologists, and sleep behaviorists refer to this as REM sleep-related behavior disorder (RBD).
The issues take a more severe turn when the RBD sufferers engage in physical harm, attacks or sexual acts in their sleep. Unattended cases of RBD have shown instances of adults unlocking their doors in the middle of the night or driving to a 24-hour store and wandering aimlessly on the streets. It is possible since these people do not undergo atonia and they can control limb movements during the REM stages.
When children go through night terrors, adults often try to calm them down by talking to them or shaking them awake. When adults experience such instances, it is more difficult to overpower them physically. Studies show that jostling sleepwalkers and RBD sufferers from deep sleep can harm them physically and mentally. Apart from removing sharp items, locking the windows securely, keeping the keys away and contacting a sleep expert, there is nothing much a concerned family member or friend can do.
Sleeping on the same bed with someone suffering from RBD is challenging and risky. The co-sleeper can experience physical injuries due to unpredictable movements. However, if you have a family member, who suffers from chronic RBD, you need to put your annoyance on the back seat and speak with a sleep expert for their proper treatment.
The cause of any REM behavior disorder can be complicated. Several interlaced factors can contribute to RBD, and those include genetic predisposition as well. Other factors include stress from daily routines, recent trauma, brain surgeries, brain tumors, depressive disorders, other psychosocial disorders and neurodegenerative disorders. Some medications like serotonin-modulating antidepressants, new opioid, and drug withdrawal therapy can induce RBD.
How do Experts Diagnose RBD in Individuals?
Studying REM is now simple with EOG and determining the presence of RBD in an individual is now equally quick with additional tests. The aim of most of these diagnostic tests is to study the physiological responses and signals of REM. Here are a few ways experts will determine if you or your loved one has RBD –
They will speak to you. There is no better way to find out if a person moves in their sleep than to ask their partner. If you move around, it is bound to wake your co-sleeper at one point or another. Once you and your partner can attest to the fact, experts can push further and recommend the diagnostics necessary for the process.
Thorough physical and neurological tests. A complete neurological test and physical exam will reveal if you have a predisposition towards RBD. It can also state if you have any other sleeping disorder that is masking itself in the form of RBD. In several cases, narcolepsy and sleep apnea show symptoms identical to RBD in adults.
Polysomnogram. Apart from electrooculography, doctors perform a polysomnogram on their patients to see how they sleep through the night. During polysomnograms, doctors may ask you to sleep over at a sleep clinic or lab. They will hook you up to monitors via sensors on your head, arm, legs, and chest. These leads will help them monitor your brain activity, limb movements, vocalizations, heart activity, and breathing.
Usually, multiple studies are necessary, since sleeping in a sterile environment like a sleeping lab is different from sleeping in a bedroom. If you have chronic breathing difficulties and REM awakenings in your bed, you might be suffering from severe allergic reactions unknowingly.
It is possible that you will sleep much better in a sterile environment than you would in your bed. Contrary to this, people have also reported feeling uncomfortable and sleep-deprived in clinics. Doctors sometimes make an exception and agree to set up monitors at home for critical cases.
What the Present Medical Treatments for REM Sleep-related Behavior Disorder?
Apart from physical safeguards, there are other pharmacological indications of RBD. Thankfully, the advancement of medicine has enabled people to experience a better quality of sleep irrespective of their REM challenges.
Melatonin: Melatonin is the human sleep neurohormone. Although human brains should produce this molecule naturally, not every person has enough supply of it. Therefore, doctors prescribe melatonin as a supplement. In several states, melatonin is an over the counter (OTC) product. You should be able to find OTC form of this naturally occurring hormone at any pharmacy. However, you should always consult an expert before beginning the dosage.
Clonazepam: Clonazepam has been one of the longest standing arch enemies of RBD. In fact, clonazepam and its other forms can combat any REM disorders in adults. It is not a medication for children. It is helpful for treating anxiety and chronic fatigue syndrome. However, it is not free from unpleasant side effects like worsening sleep apnea, decreased balance and coordination and daytime sleepiness.
While doctors keep investigating the other possible causes and treatments of REM sleep-related disorders, you should talk to your sleep specialist regularly. That will ensure that you are receiving the latest treatment and medication with the best possible benefits.
Before heading to a sleep clinic and spending a fortune on these fancy tests, you may want to consider the possibility of a false alarm. To rule out the possibility of a false positive, you can opt for smartphone applications, smart wearable technology, and headbands that can record your sleep duration, quality, and movements.
Millions of people around the world use these devices with sleep applications including white-noise generators and melatonin monitors to regain control over their sleep schedule. Always remember, these methods do not replace professional guidance and care. These are additional procedures that can give you the peace of mind before you step into a clinic worried about finding no treasure at the end of the hunt.
A Layman’s Take on REM and non-REM Sleep
You must have heard how your father could sleep through a blizzard and how your mother would wake up at the noise of leaves falling on the roof each night. While we were children, it was strange for us to believe that people could wake up to the sound of footsteps or falling leaves. For a few lucky ones, it is still unbelievable. However, most adults have faced the brunt of light sleep by now. It is a rough transition that finally lets us know that we have entered the adult stage of our lives.
Most babies and children sleep like a log. They can sleep through home reconstructions and the sound of jackhammers outside their window. Their blissful sleep is deep, and they spend most of their times dreaming. The incredible power of the child’s brain syncs the surrounding noise within the dream and allows them to stay relaxed even when there is possibly a parade outside.
It usually happens during the deep sleep or slow-wave sleep stages. It consists of the N3 and part of the N4 stages of non-REM sleep. It shows a lack of eye movement and the presence of muscle tone. It is an intrinsic part of memory formation in all ages.
These are the basic categorizations of deep sleep and light sleep most people experience. Light sleep is a form of non-REM sleep that makes up for 80% of an adult’s resting time. For children, REM sleep or deep sleep is much longer. Infants can sleep for about 16-hours per night, and they will be in the REM state for about 12 hours per day. Unless you baby has colic or some other physiological discomfort, he or she should sleep for 14 to 16 hours.
REM sleep is vital for their rapid growth, the formation of the cognitive and logical part of their brain, and proper rest. If you see your newborn waking up every 20 minutes to an hour, you must consult your pediatrician immediately. The same is valid for adults. Those, who do not experience enough delta sleep and REM sleep, experience impaired judgment, compromised cognitive abilities, and enhanced fatigue.
These are common effects of sleep apnea, sleep deprivation and shift-changing work that directly affect the sleep quality of individuals. The recurrence of REM and delta-sleep scarcity increases the chances of developing different types of cancer, Alzheimer’s, diabetes, heart problems and breathing problems.
Several studies have shown a direct link between the accumulations of beta-amyloid protein complexes (plaques) on the brain. These destroy the neuronal network and cause the deterioration of memory in adults. If a person’s genetics predisposes him to neurodegenerative diseases, the lack of enough deep restorative sleep can increase his chances of developing the disease in the future.
How to Gain Control over your REM Duration and Quality?
Unless you have been living under a rock for all these years, you must already know that the architecture of sleep is not as flat and dull as we surmise it to be. There are two primary stages – REM and NREM. These have sub-structures that include N1, N2, N3, and N4.
While N3 is a part of the deep sleep stage that involves delta wave activity or slow waves, N4 is the REM stage that helps with memory reconstruction. Rapid eye movement or REM sleep has a restorative function for the body and the brain. Therefore, it is only natural that people want to gain better control of the onset of it and its quality.
It is no secret that the lifestyle we lead reflects directly on our sleep quality. The amount we work out each day and the kind of circuits we perform affects our sleep. Working out for about 20 to 40 minutes per day can help regulate your melatonin levels well, reduce the tendency to binge on sugary food and improve your body’s core temperature that can aid REM actively.
2. Regulating environmental temperature
While we are in the REM state, our core temperature falls significantly. We are unable to control it. It is easier to understand the sudden drop from the perspective of coldblooded creatures, which need an external source of energy to remain warm during the colder months.
Many RBD patients invest in smart sensors that determine the body temperature and adjust the temperature of the air conditioner to prevent rude awakenings. You can also time your AC to switch off at a particular time before it freezes your toes off. The reverse is advisable for people living in warmer climates.
3. Avoid certain food items
We all know about the eponymous enemies of sleep including sugary food and caffeine. The latest research shows that fatty food can take a toll on how you nap and rest throughout the night. Eating a bulk of deep fried and saucy food can keep you up for long, or it can force you to wake up repeatedly due to upheavals of your metabolism.
Caffeine stimulates wakefulness and Voltaire is known to have had 50-odd cups per day. Unless you are aiming at breaking his alleged record, you need to stay away from it post-evening. One or two cups of coffee are typical for the adults of the 21st century, but always have the last cup by 6 pm. Caffeine has a long half-life, and espresso at 8 pm can keep you up until 1 am.
4. Alcohol is not sleeping medication
There is no greater enemy of proper rest than alcohol. Thanks to Hollywood blockbusters and the glitz lifestyle, many US adults have the habit of going for a nightcap before they hit the hay. Our parents, grandparents and even their parents may have believed in the efficiency of a highball to knock us out like light, but they did not consider the after-effects of the delicious poison.
Apart from waking up to pee in the middle of a freezing night, the alcohol in the body can prevent your mind from entering REM altogether. Alcohol suppresses the release of the sleep hormones necessary for sound restorative sleep. You might find it easier to fall asleep initially after consuming enough liquor, but your chances of waking up after a couple of hours increase drastically.
5. Regulate your sleeping habit
What do you need more than diet and coffee every day? You need to regularize your resting schedule. Begin by going to sleep about 30 minutes earlier than usual. That will give you enough time to mull over the day’s happenings and recount the next day’s tasks.
Always let the thoughts flow freely before you float into a deep sleep. Having enough time to indulge in deliberate thoughts, imaginations and predictions will help you relax your mind. You will always know that you have time in hand for completing your rest and waking up on time for office. Unless you accommodate an extra half-an-hour into your sleeping routine, you will never learn the pleasures of true relaxation post-sleep.
6. Check your mattress
It might sound too trivial, but the quality of your mattress determines how well you rest each night. The number of allergens in your bedding, the hardness or softness of it and its age dictate the level of restoration. Mattresses tend to lose their support over the years. Some of them require replacement after 6 to 8 years.
Check the manufacturing date of yours to find out if it is still usable. Children grow up faster, and they need sound sleep. Therefore, their mattresses require regular cleanup, maintenance, and replacement. Super hard or excessively soft bedding can hinder REM by causing sharp pains and discomfort. If that is the case with you, you should try memory foam or orthopedic mattresses to assist better sleep.
No matter how acute your problem is and how efficient you are in self-diagnosis, it is never advisable to try OTC treatments for sleep apnea or RBD. All forms of sleep deprivation require medical attention. Chamomile tea, jasmine infusions, aromatherapy and relaxing spas can help you find some relief from the stress and fatigue building up over the days.
In most cases, these methods of ineffective in inducing or improving REM sleep in patients. In short, there is no cheaper or easier replacement for expert diagnostics and care for REM sleep disorders. If you think you might have one, you can begin by installing sleep monitor applications or buying pocket-friendly wearable technology. However, always know that sleep experts and medical experts should oversee the final treatment.
Co-founder of Counting Sheep and Sleepaholic