Understanding The Absence Of Rem Sleep: Causes And Solutions

Sleep is a complex and mysterious process that is essential for our health and well-being. While we sleep, our body cycles through different stages, including rapid-eye movement (REM) sleep, which is when most of our dreaming occurs. A good night's sleep for an adult is around seven to nine hours, with REM sleep making up about 20% to 25% of that time.

If you're not getting enough REM sleep, it can have negative consequences for your health and quality of life. So, why might someone not be getting enough REM sleep? There are several potential reasons, including lifestyle factors, underlying health conditions, and the use of certain medications.

Lifestyle factors that can impact REM sleep include consuming caffeine, nicotine, or alcohol, especially close to bedtime. Not getting enough exercise or natural sunlight during the day can also disrupt sleep patterns. Additionally, spending too much time in front of screens, especially before bed, can interfere with sleep due to the bright lights and blue light emissions.

Certain medications, such as antidepressants, antipsychotics, opioid pain medications, benzodiazepines, and even some over-the-counter sleep aids, can also reduce or suppress REM sleep.

Underlying health conditions can also be a factor. Mood disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD) have been linked to disturbances in REM sleep. Sleep disorders like insomnia, sleep apnea, and narcolepsy can also impact the amount and quality of REM sleep.

If you suspect any of these factors may be affecting your REM sleep, it is important to consult a healthcare professional or sleep expert for advice and guidance. They can help you identify any issues and develop a treatment plan to improve your sleep quality and overall health.

Alcohol, caffeine, and tobacco

Alcohol

Alcohol negatively affects sleep quality. While it may help people fall asleep faster, it leads to more disrupted sleep in the second half of the night. Alcohol reduces overall sleep time and increases next-day fatigue and sleepiness. It also delays the first REM sleep episode and reduces its total amount.

Alcohol increases the likelihood of snoring and sleep apnea, a disorder that causes pauses in breathing during sleep. It also affects people with central sleep apnea, interfering with the brain's ability to receive chemical messages involved in breathing.

Heavy alcohol use can lead to insomnia, and people with insomnia are more likely to develop alcohol use disorder.

Experts recommend avoiding alcohol at least three hours before bed.

Caffeine

Caffeine can significantly disrupt sleep, even when consumed up to six hours before bedtime. It reduces total sleep time and increases the number of awakenings during the night. It also prolongs the time it takes to fall asleep.

Tobacco

Nicotine, found in tobacco products, is a stimulant that can negatively affect sleep, even with occasional use. It can make it harder to fall asleep, increase nighttime awakenings, and reduce overall sleep time. Tobacco users tend to spend longer in the lighter stages of sleep and less time in the deep, restorative stage.

Quitting tobacco can also disrupt sleep in the short term, and about half of former smokers experience sleep troubles while trying to quit.

Sleep disorders

• Central disorders of hypersomnolence (e.g. narcolepsy)
• Circadian rhythm sleep-wake disorders (e.g. jet lag, shift work sleep disorder)
• Sleep-disordered breathing (e.g. sleep apnea)
• Sleep-related movement disorders (e.g. restless leg syndrome)
• Parasomnias (e.g. sleep myoclonus, exploding head syndrome, bruxism, etc.)
• REM sleep behaviour disorder

Central Disorders of Hypersomnolence

Narcolepsy is a central disorder of hypersomnolence. People with narcolepsy can experience episodes of cataplexy, which involves a sudden loss of muscle tone. Other symptoms include excessive daytime sleepiness, disrupted REM sleep, and hypnagogia (dream-like hallucinations that occur when falling asleep). Narcolepsy is caused by a loss of orexin neurons in the hypothalamus.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders include jet lag and shift work sleep disorder. These disorders are characterised by a misalignment between the body's internal clock and the external environment, resulting in difficulty falling asleep or staying awake at the desired times.

Sleep-Disordered Breathing

Sleep-disordered breathing, such as sleep apnea, is characterised by pauses in breathing during sleep. Obstructive sleep apnea occurs when the airway becomes blocked during sleep, while central sleep apnea is caused by the brain failing to signal the muscles to breathe. People with sleep apnea may experience lapses in breathing, move to lighter sleep cycles, and feel excessively sleepy during the day.

Sleep-Related Movement Disorders

Sleep-related movement disorders, such as restless leg syndrome, involve abnormal movements during sleep. These disorders can fragment sleep and reduce sleep quality, leading to daytime sleepiness and cognitive impairment.

Parasomnias

Parasomnias are a category of sleep disorders that involve abnormal behaviours, movements, emotions, perceptions, or dreams during sleep. Parasomnias can occur during NREM or REM sleep and include sleep myoclonus, exploding head syndrome, bruxism, night terrors, sleepwalking, confusional arousals, and nightmares, among others.

REM Sleep Behaviour Disorder

REM sleep behaviour disorder (RBD) is characterised by a breakdown in the brainstem region responsible for regulating REM sleep. People with RBD may act out their dreams, shouting, punching, kicking, or jerking in their sleep. This can lead to injuries to themselves or their sleep partner. RBD often precedes the development of neurodegenerative diseases.

Medication

People who take certain antidepressants can develop REM sleep behaviour disorder (RBD), a condition in which they physically and/or vocally act out their dreams while in the REM stage of sleep. This can cause injury to the sleeper or their bed partner. Up to 6% of people who take antidepressants have drug-induced RBD.

Other medications that can cause insomnia include those that affect neurotransmitters such as norepinephrine, serotonin, acetylcholine, or dopamine. Less commonly, antibiotics, antihypertensives, oral contraceptives, and thyroid replacements can induce insomnia in susceptible individuals.

If you are struggling with REM sleep disruption, it is important to consult a healthcare professional. They can help determine if your medication is affecting your sleep patterns and guide you on the best options forward.

If your REM sleep disruption is caused by RBD, your healthcare provider may prescribe medication to manage your symptoms. While there are no U.S. Food and Drug Administration (FDA)-approved medications specifically for RBD, studies have shown that melatonin, clonazepam, and pramipexole can reduce symptoms in some cases.

Melatonin is considered the first-line medication for treating RBD as it rarely causes side effects. It is also a safer option for elderly individuals, individuals with dementia, fall risk, or those with sleep apnea.

Clonazepam is a sedative that has proven effective in reducing symptoms for 50-80% of individuals with RBD. However, it can cause side effects such as sleepiness, forgetfulness, and impaired balance in the morning. It can also contribute to or worsen sleep apnea.

Pramipexole is a dopamine agonist primarily prescribed to treat Parkinson's disease and restless leg syndrome. Recent research shows that it can also help treat the symptoms of RBD. Researchers believe this medication works because RBD may be a dopaminergic deficiency disorder.

Mental health

Sleep is essential for our mental health and well-being. When we are asleep, our brain "powers down" and most body systems, including our brain, become less active. This allows our body to conserve energy and heal injuries, and gives our brain time to reorganise and catalogue memories and learned information.

The rapid eye movement (REM) stage of sleep is important for brain health and function. During REM sleep, our brain is highly active, and our brain waves become more variable. Our heart rate, blood pressure, and breathing increase, and our eyes move rapidly behind closed eyelids. Our muscles are temporarily unable to move, which prevents us from acting out our dreams.

REM sleep plays a role in memory consolidation, emotional processing, brain development, and dreaming. It helps our brain process emotional memories, including those associated with fear, and is thought to aid in the development of the central nervous system.

A lack of REM sleep can lead to physical and mental health issues. Physically, it can affect cardiovascular health and increase the risk of type 2 diabetes, cancer, stroke, and neurodegenerative diseases. Mentally, it can cause fatigue, irritability, changes in mood, and issues with cognition and problem-solving. It may also contribute to mental health disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD).

If you are experiencing issues with your sleep, it is important to seek help from a healthcare professional. They can help identify any underlying causes and provide guidance on improving your sleep quality.

Sleep deprivation

The effects of sleep deprivation can be far-reaching and impact various aspects of an individual's life. Here are some of the consequences of sleep deprivation:

• Central nervous system: Sleep deprivation can disrupt the central nervous system, impairing the body's ability to send and process information effectively. It may lead to difficulties with concentration, learning, coordination, and increased risk of accidents.
• Mental and emotional health: Sleep deprivation can negatively affect mental abilities and emotional well-being. Individuals may experience increased impatience, mood swings, compromised decision-making, and creativity. Prolonged sleep deprivation can lead to hallucinations and trigger mania in people with bipolar disorder.
• Immune system: Sleep is crucial for the immune system to produce protective substances like antibodies and cytokines, which help fight off infections. Sleep deprivation weakens the immune system, making individuals more susceptible to illnesses and prolonging recovery.
• Chronic health conditions: Long-term sleep deprivation increases the risk of developing various chronic health issues, including diabetes, heart disease, kidney disease, high blood pressure, obesity, and depression.
• Weight gain and obesity: Sleep deprivation can disrupt the body's hormone balance, leading to increased appetite and weight gain. It can also contribute to reduced physical activity, further impacting weight management.
• Cardiovascular system: Sleep deprivation can negatively affect cardiovascular health, increasing the risk of cardiovascular disease, heart attack, and stroke.
• Hormone production: Adequate sleep is essential for optimal hormone production. Interrupted sleep can impact the production of testosterone and growth hormones, which are crucial for various bodily functions.
• Productivity and social functioning: Sleep deficiency can interfere with work, school, driving, and social interactions. It can lead to difficulties with learning, focusing, reacting, and understanding social cues.
• Safety: Sleep deprivation increases the risk of accidents, especially when operating heavy machinery or driving. It has been linked to human errors in tragic accidents, such as plane crashes and nuclear reactor meltdowns.

To address sleep deprivation, it is essential to identify and treat any underlying causes, such as sleep disorders or medical conditions. Maintaining a consistent sleep schedule, improving sleep hygiene, and seeking professional help when needed are crucial steps toward improving sleep quality and duration.

Frequently asked questions