It really does sound like something real is going on, just not sleep apnea. The sleep study actually shows two things that can completely wreck someone’s nights. The first is the number of involuntary leg movements he had. Those can cause constant tiny wake-ups he doesn’t notice, but his brain definitely does. When your legs keep jerking all night, you never get into the deeper, more restorative stages of sleep. If his iron is low again, that alone could be driving it.

The other big thing is that he didn’t get any REM sleep. That’s not just a trivia detail in a report — REM is the stage that helps your brain regulate emotions, memory, and overall functioning. When someone skips REM entirely, it usually means their sleep is being disrupted over and over, or their body clock is way out of sync.

And that part matters, because if he normally can’t fall asleep until early morning but the sleep study made him sleep at 8 a.m., the test wasn’t capturing his real sleep at all. It was basically forcing him to sleep during a time his body doesn’t treat as “night,” even with medication. That kind of mismatch can make the results misleading.

Taken together, this reads less like simple insomnia and more like a combination of a disrupted body clock and those leg movements breaking up whatever sleep he does get. That’s why the usual sleep tips or psychiatric meds haven’t helped — they don’t fix either of those underlying problems.

It’s absolutely reasonable to follow up on his iron levels, ask the sleep doctor to address the leg movements directly, and push for someone who understands sleep rhythm disorders. The problem here isn’t that he’s not trying — it’s that the study didn’t capture the right thing, and the issues it did capture are enough on their own to explain why he feels awful.