APAP/CPAP setting to minimize RERA and Hypopnea events.

Hi All,

I have a Resmed Air10 APAP and am still struggling to get the pressure settings right. I hope I can get some help here. I have given up on my Sleep Specialist. I don't think she knows about UARS and her technicians seem rather clueless about anything except the basic pressure settings of the device. (This is the second sleep center, first one was even worse.)

Its currently set at a Fixed Pressure of 10. I download the data from the card everyday and view the data using SleepyHead software (https://sleepyhead.jedimark.net). And have notice the following 3 patterns in my sleep.

1. On most days I feel terribly sleepy and on reviewing the previous nights data I see that I've had lot of RERA events (~15) and also some Hypopneas (~5). I will fall asleep if I drive or try to work in front of a computer.

2. On some days I feel sleepy but not that bad. And the data indicates I had only 1-2 RERA events but lot of Hypopneas (~15).

3. Finally on some days I feel great and data indicates I had only 2-3 Hypopneas and 0-1 RERA events.

I believe I have UARS and not OSA as my sleep studies initially indicated no apnea and in the last study indicated I had very low apnea. My events per hour rarely goes above 1. On some nights I sleep very well but terribly on most nights and the events per hour will not have varied much (0.4 - 0.5)

Given this scenario I'm trying to figure out the right mode (CPAP/APAP) and pressure settings to minimize RERA/Hypoapneas.

I also had some questions if anybody knows the answers.

Minimizing RERA/Hypopnea:

Does APAP correctly adjust pressure if it detects RERA? My device documentation says it corrects both OSA & CSA. It says it "reports" RERA. So i'm not sure it corrects it.

If APAP doesn't correct/compensate for RERA can it be fixed by increasing the pressure in CPAP mode.

Similar question about Hypopnea.

EPR Setting:

I see an EPR option on the device that the documentation supposedly says increases comfort and yet it is set to off. Does anyone know / have experience with this setting?

Hello, @purush. The MyApnea.Org Forum cannot provide official medical advice, but I can share some information that may be helpful for you to know. As a technologist, I have seen both CPAP and APAP work effectively to treat residual upper airway resistance. Sometimes, it cannot be completely eliminated. RERA stands for Respiratory Effort-Related Arousal. Since arousals occur in the brain and are identified by looking at brainwave activity via an EEG recording, a CPAP/APAP machine cannot actually identify a true RERA because it cannot identify arousals. However, the machines do detect decreased airflow. If you are on CPAP machine at a fixed pressure, the machine is not going to do anything when it detects decreased airflow. However, APAP can adjust based on how a patient breathes and will usually respond to decreases in airflow, snoring, and other events. The pressure settings dictate the range within which the machine can adjust to your breathing. For patients on APAP who do not have the correct settings, it is possible that breathing issues do not completely resolve. EPR stands for Expiratory Pressure Relief. It detects breathing and briefly reduces the amount of positive pressure when a patient is about to exhale and quickly returns to a therapeutic pressure to keep the airway open and prevent obstruction. This is designed for patient comfort and ease of exhalation (less pressure when you breathe out). The settings simply determine how much relief is provided. I hope this information is helpful, and best wishes for better sleep!

resmed air 10 has 3 levels of EPR it has to be turned on it does help with hi pressure settings