Correlation between REM sleep and AHI

Reviewing a recent sleep study I noticed that a disproportionately high number of AHI events occurred during REM sleep. At the same time the study showed my proportion of REM sleep was much lower than it should be. If somehow I was able to improve my amount of REM sleep I would be raising my nightly AHI. How should I view this?

Experiencing more apneas during REM sleep is common amongst Apnea sufferers. During REM we lose a lot of muscle tone and that can contribute to greater collapse of the airway.

Having our sleep disrupted during REM will result in less REM as a percentage. Now that you are managing your Apnea, you may no longer be disrupting your REM and it might be proportionately higher.

My own OSA is about 5 times worse in REM than non REM. It's very common and you may or may not need more pressure to deal with those REM apnea events. 53 per hour in REM vs 12 per hour in non REM documented during an in lab sleep study with desats to 73%.

We need all the sleep cycles in the normal amounts and normal progression for the restorative powers of sleep to work their magic.
Without cpap we have a bunch apnea events during REM and it wakes us up so we don't get the amount of REM we need.

So we need REM and we really can't or wouldn't want to reduce REM so what we do is use the cpap machine and prevent the airway collapses in the first place and it doesn't matter how many we "might" have had in REM just as long as they don't happen now.
When cpap therapy is optimized it doesn't matter how bad the OSA might have been in the past...we just don't want it happening now and that's why prevention of the airway collapse is the key to optimizing therapy. Not fixing a problem after the fact.
So we think PREVENTING those REM apnea events from ever materializing and go on about our sleep. It doesn't matter how many were prevented...we just want them to not happen in the first place.

When I see my reports now...rarely any events in what would likely be REM sleep....but I do see the pressures go up most likely trying to prevent those REM related collapses. The machine just does its job of preventing a bad thing from happening in the first place.

You want REM...you need REM and all the other sleep stages. Just trust your machine to prevent the collapses that would be happening if you weren't using the machine and don't worry about it.

BTW this REM pressure needs stuff is a good argument for auto adjusting pressure mode. I might need 6 to 8 cm more pressure during REM only. It's much more comfortable to use lower for 80% of the night and use 6 to 8 cm more for the 20% we are normally in REM than to use the much higher pressure all night long as a fixed pressure just to cover REM pressure needs.

Also all the same can be said of supine sleeping worse OSA....I always say sleep in whatever position a person sleeps best in and use the machine in a mode that can auto adjust and let the machine sort it out.

As long as we are preventing something...it doesn't matter how many we prevented. We only care about the ones we aren't able to prevent from happening.

Thank you Pugsy for your very comprehensive explanation. Would it be reasonable to infer from my OSCAR report periods with the highest CPAP pressure as periods of REM sleep .... I had been wondering how I could monitor my amount of REM without investing in an Oura Ring?

A reasonable assumption yes that when you see the pressures increase especially if in a cycle looking thing that it's probably REM related.
If you google "sleep stages" and look at normal hypnograms you can get a reasonable idea when REM is going to happen in terms of the sleep cycles. Bear in mind if you get up to pee during the night then the cycles sort of get out of whack and have to reset a bit.
In general the first REM will happen around 90 minutes after sleep onset and is relatively brief in duration but as the night goes on the REM stage will come on more frequently and last a little longer each time with the greatest amount of REM happening in those wee hours of the morning. I would almost always see a marked increase in pressure about 90 minutes into the night and in the wee hours of the morning it will stay higher a lot more.

As for buying the OURA ring thing....assuming it is reasonable accurate (which I personally take what they say with a grain of salt)....it's really pricey and let me ask you a question. Assuming it was 100% spot on accurate....what would you change or could you change based on its results that would really matter?

These companies are making fortunes on stuff like this but if you sit back and really ask yourself the question...what could I or would I change based on the results this gadget offers that would really impact anything except my wallet????
I did the FitBit Charge thing that supposedly did sleep stages and heart rate and all that myself. $150 but nothing it told me....even if it was 100% correct which it wasn't....offered me anything to do to improve my sleep.
It once told me I was in REM sleep when I was awake and letting the dogs go pee...none of them are 100% accurate.
It told me I did 7700 steps when I was on the riding lawn mower and mowing the pasture. I got a nice little badge for all my "walking" and the only walking I did was up to the barn to get on the mower.

Now if you like gadgets like this and you don't mind the cost and want to play around with things like this....it's your money to burn on whatever you want to burn it on. Not my place to tell you what to spend your money on but the most I would consider paying for a gadget like the OURA ring is around $50 and I would have to think about it first. Been there and done that with the FitBit (which died 6 months after I got it) and it wasn't worth replacing IMHO.

Ask yourself....what would knowing for sure something or other it reports cause me to change anything...if I could even change anything...and assuming it was 100% correct (which none of them are). I don't need a gadget to tell me if I slept poorly or not...my body itself does a good job telling me that fact.

For *some* people, myself included, REM shows up on my OSCAR reports in my Respiration Rate. I've hi-lighted in yellow.

For me, it shows up as higher and more volatile breathing. It typically lasts about half an hour with about 90 minutes in between. With the increased respiration rate, I often get more activity in my Flow Limitations and a machine pressure response. Before I increased my minimum pressure, it was during these period that most of my apneas occurred.

Below are two graphs from my AirSense and AirCurve demonstrating my REM sleep.

I rarely see other graphs posted here that demonstrate REM sleep as apparent as mine. But the graph presentation doesn't encourage posting the breathing volume oriented graphs.

Thanks Pugsy and DS for two very helpful replies to my inquiry about identifying REM sleep. I'll admit I haven't looked into remedies for deficient REM sleep but I intend to look into what Dave Asprey has to say on the subject, he claims some remarkable accomplishments in fine tunings sleep stages.

I'm similar to Pugsy where my events are about 5 times worse during rem sleep. Like DS my rem sleep is pretty apparent when I study my flow rate chart. Rem stage seems to happen about every hour to 90 minutes after sleep onset and last around 30-45 minutes. Of course those times vary somewhat. For me rem stage breathing is quite a bit more erratic, events go up considerably and I trash around in bed. I wake up during most rem stages so that means nearly every night I wake up every 1-1.5 hours. Pretty annoying.

Looking at my Oscar chart you can see the periods of erratic breathing and the bump in pressure during those times. I also have Oscar set to report events that are between 8-10 seconds(UF1 & UF2). I get quite a few of those flags during rem stage. Not every night is this consistent but it shows the rem stages pretty well.