Sierra

You can get an idea of how serious they are by zooming in on them and comparing the minute to minute air flow rate to OA, CA, and H events. I have very few RE events flagged but I found this one. It seems to me when looking at the air flow disruption it is quite minor compared to an OA or CA event. Each flagged OA and CA event is a minimum of 10 seconds with no air flow. From what I see of RERA events, they are more of a small flow reduction, not a total interruption of flow.

I was thinking more that you may be able to go back to look at those nights when you had RERA events flagged and see what may be different about your settings that makes them show up on the event bar.

Another thought would be that OSCAR may have had a brain fart and needs a jump start. You could try turning off the flag switch for RERA events (RE) to red and then shutting OSCAR down, starting it back up again, and then try again to switch it to green (on).... The Bill Gates Microsoft standard solution!

I looked back at some of your older screen shots and I can see the RERA flags on them... See this thread: https://myapnea.org/forum/flow-limit-and-ahi-s/1#comment-62193

Seems strange, but I recall the RERA event flags can be hard to see as they are a light yellow. Another way to look at them may be to click on the Events tab beside the details tab and below the date. This should list the type of events and if you click on they it should list each event and the times.

About the only way to see what a pressure change will do is to try it...

I suspect you may have the flags for RERA events turned off. Left click on the box under the Flow Limit. title at the bottom of the screen, that says CSR. It should display what flags are turned on (green) or turned off (red). Click on the switch to turn the "RE" event flags on. It looks like the first event that started to raise pressure was a hypopnea event. But then the pressure stayed up. Perhaps RERA events were keeping the pressure up. If your minimum pressure was set higher, that initial hypopnea even may have been avoided. It also looks like you are having significant flow limitations. That also may be driving the pressure up.

1. The top bar on the Daily screen shows the events. The RERA ones should be represented as a yellow one. That will let you determine at what time and pressure the event happened.
2. The AutoSet feature adjusts the pressure within limits that you or the sleep tech sets. The max pressure setting is to limit how high the machine will increase pressure. The minimum pressure limits how low it can go. Generally it is best to get the pressure up quickly and not let it go too low during the night.
3. Display the Daily screen full screen, and press the F12 key. It will be saved in a location which will display briefly in the bottom right corner of the screen. Use File Explorer to find this file. Left click on it and drag it into a message here. It is best to start a new full width window for the post by using the orange Write a Reply button.

I very seldom suffer from RERA events. My thoughts are that RERA events occur when the pressure setting is too low, not too high. When the minimum pressure is set low these RERA events can occur before the pressure increases automatically enough to stop them. It would be worthwhile to take note when they occur and what the pressure is at when they happen. With the maximum pressure reduced to 15 cm you also will want to watch how much of the night you are at this maximum pressure and what events are occurring when the pressure is at max. If you post a daily screenshot I can comment on what I see.

Sometimes you can get away with a lower pressure when it is fixed instead of in Auto. I think you would be better to leave it in Auto for a while to collect some more data before trying to go back to a fixed pressure. From what I can see you had the EPR in Ramp Only mode for your previous report, and now it is full time. In some people having the ramp on full time can increase the frequency of apnea events, and force the pressure to go higher. Because the pressure is reduced on exhale you can be getting an apnea event on exhale. Unless you are having a high frequency of hypopnea events I would switch your EPR back to Ramp Only to see if that reduces the pressure needed. I also see that your ramp time is set at 5 minutes. You may get better results with the ramp time set to "Auto". And it may also be of benefit to increase both the minimum pressure to 14, and the Ramp Start pressure to 14 cm as well.

That would be my thoughts for now.

Based on this one night you do not seem to be hitting the max of 18 cm, so that max setting should be fine in AutoSet mode. Minimum pressure could be increased to 14 or 15. There is a rule of thumb that says if you want to go from auto mode to fixed CPAP mode the initial pressure setting should be the 95% pressure. So for you, based on one night that would suggest 15.8 cm. However, you may want to collect more data in Auto before you make that switch. Moving the start ramp up to 13 is good. If you move your minimum up I would also move the Ramp Start up too if you find it comfortable. I don't believe you can set the ramp start higher than the minimum though. But that said, I have not tried it. In any case it is not a good idea as you don't want the pressure to drop at the end of the ramp.

The idea of moving the ramp start pressure up is to prevent apnea events during the ramp period. The idea of moving the minimum pressure up is to prevent apnea events when the auto function ramps it down during the night. It also avoids the initial events needed to ramp up the pressure early in the night.

I see there are some CA or central events. It is hard to read the graphs accurately, but this may be due to the higher pressures. Once you get more data in Auto one possible advantage of switching to fixed CPAP mode is that it can limit the maximum pressure and possibly avoid some of the CA events.

I hope that helps some. l suggest you post more daily reports as you gain experience with the AutoSet mode. There is nothing totally consistent about CPAP treatment. It can be very misleading to make setting changes based on one night only. It is better to get a few and average them.

The AutoSet mode is useful in determining how much pressure is necessary to control the obstructive apnea. The fixed pressure of 13 cm looks like it may be a little too low. Later when you know how much pressure you need, there can be advantages in using the fixed pressure CPAP mode. That is what I do. If you can post a daily screen when it was in AutoSet I may be able to suggest how much pressure is needed, especially if the maximum pressure was set higher than 13 cm.

You can tell when the Ramp is in Auto mode as the pressure will be flat until it ramps up when you go to sleep. With your issue of waking up gasping when you go to sleep there should be an advantage to having the pressure higher during ramp. The chart you posted looks like the ramp is starting very low at 4 cm pressure. That can be uncomfortable, and has limited impact on controlling apnea while you are going to sleep. If you look at the chart I posted you can see the flat pressure of 9 cm until it ramps up slightly to 11 cm. You may want to expand out that portion of your sleep to look at the flow in more detail to see if there are apnea events occurring during the ramp. They won't be flagged, but they may be there.