RERA Issue

I have been using cpap since 2004 diagnosed UARS. In Oct 2018 new sleep study diagnosed OSA. AHI 15 RDI 50.8, explains the exhaustion. All drs have commented on narrow airway.

My APAP was set 4-20, AHI 2.8, felt better but not great. Changed the setting 9-16. Since then my 90% pressure went up from 9.0 to 10.5, My sleepiness is not bad most days, AHI 0-1.

Days like today are the problem. AHI 0.43, totally unproductive, tired all day. This happens on the RERA days. The last few hours of sleep I remembered being awake, RERA was 6 events over 2 hours plus 2 hypopneas. I'm frustrated that the apap isn't reacting to the RERAs.

I changed pressure to 10-16, with a 6-10 ramp. I had insomnia every single night at that pressure and couldn't tell if it helped. On SleepyHead it says I have no pressure relief. What is that and would turning that on help with the higher pressures?

Is there a way to get the machine to react faster to events? Both hypopneas the pressure was hanging at 9 and went up after the fact. I've contemplated setting a long ramp 7-14 over 5 hours.

Thanks a lot!

I don't know anything Hannah14 but others do.

What CPAP machine do you have. Phillips Respironics are known to react slower than ResMed.

In either case speed of reaction can be improved by narrowing the range sol that less increase is needed to resolve events. With a fixed Pressure you need to raise the pressure to prevent the events.

It would be really helpful to know what manufacturer and model of a machine you have. To my knowledge PAP machines may report RERA events, but they do not respond to them with increased pressure. And of course when you increase minimum pressure you are taking manual action which in turn should prevent RERA events from happening. That said I do see RERA flags in my SleepyHead graphs and I am now using a fixed pressure. They can still happen with higher pressures. If you have a DreamStation I believe there may be an option in it to change the sensitivity.

You may be interested in a ResMed article on their For Her algorithm specially developed for what they believe are the different needs of a woman compared to a man. The differences between the For Her algorithm and the standard version are highlighted in the table at the bottom of page 5. Both versions report RERA, but the For Her version is more sensitive to upper airway resistance and flow limitation. It uses single breath data to initiate a change while the standard version uses a 3 breath average and will be slower to react. The For Her version ratchets up pressure in response to apnea in close succession and holds it to a minim for the sleep session. It is more responsive to flow limitation and snoring, and less to apnea. Apnea alone will not increase pressure beyond 12 cm. It raises and lowers pressure at a slower rate. This feature may in fact be an option in the standard machine too, as there is a Response setting which can be set to Soft or Standard. The idea is to prevent arousals. As I understand it the difference between a flow limitation and a RERA is that an arousal is associated with the flow limitation.

The For Her algorithm is included as an option in the specific For Her AirSense 10 AutoSet machine. They sell at the same price, and they can be changed with the Mode setting to the standard algorithm. They can of course be used by men too, if the nature of the apnea they have is more of upper airway resistance and less of the obstructive apnea. The good part is that you can simply try it, and if it works it works. If not you go back to the standard algorithm.

Hope that helps some. Post back with your specific machine and I may be able to add a bit more...

Thanks for your responses! My machine is an older Dream Station. I'm pretty sure it is used, they have removed all data relating to cumulative hours.

Last night 14 FL, 6 RERA, 3 hypopneas, VS2 25 - it is the same thing the not responding correctly. I started snoring as the pressure has increased.

Sierra thank you for the paper. I will read it in depth. My dr spent about 5 min looking at my data and said I was cured and gave me prescriptions to sleep and stimulant to stay awake. I have not taken either. Since my first study, I was diagnosed with hypothyroidism and have a foot injury that prevents me from activity, menopause - gained 12 lbs but much more is body fat.

It sounds from the article that progesterone can help also.

Do I need to see a different type of dr? My current sleep dr is a neurologist. Figure 1 resembles my sleep. Flow rate is very inconsistant with mini apneas all over.

I'm lost on how to attach the file.

Not working, will have to try after work.

SH data is saved as .png, this website won't let me save it here.

I ran as cpap at 90% pressure of 12. Feel a lot more rested. No FL or CA and reduced RERA.

I work 2nd shift and sleep is 2 -10:30. When I awaken I always hear noise in our household. Is it possible it is the noise and not actual RERA awakening me?

Trying again.

Perhaps it is taking a while. I got a success image message and could it see it in preview.

Thanks so much Sierra. I have 4 roommates who don't have stuff in the morning and the walls are thin. I found today one took off for a month and the other 2 are just not home. They socialize and the house is full of people in the morning. It gives me a chance to see what my sleep is doing without the noise.

I've looked all over the RERA data and see nothing happening. Regarding VS2 I didn't have any until it got cold and I started putting the hose under the covers.

I haven't seen much mention of these in the forum.

CPAP Hose Insulater

Does anyone use them and do they work?

All room mates are gone. I took a 2 hour nap yesterday, usually AHI =0 but I had 3 OSA and felt rested. I think the apnea was from sleeping more deeply. Today no one waking me up also more OSA, had no memories of awakening. 3 OSA.

BugUglyGremlin, I made my own hose cover with tube socks, I cut a hole in the toe and taped them since I don't sew, it works great. I also used AU hose, it is great and lasted over 10 years.

Last night I used APAP with min pressure 12 and max 17. It was the same as the other apap nights but again more OSA and I woke up before the alarm and not sloggy headed.

It would now be better to not scrunch down the Flow Rate as much. It is OK if AHI slips off the bottom I have not found the AHI graph to be really useful. Also not so much zoom in on that RERA event. It is hard to see the shape of the inhale and exhale flow. If you zoom out and put the RERA event off to the right it should be easier to see if there is any flattening, and if there are any other events leading up to it. Something more like this:

I am 80 and I have been on CPAP for about two years. My AHI's went dramatically down around a median value of 0.50/night. Lately I feel. however kind of sluggish and sleepy until early afternoon, even though I sleep about 8 hours . Looking at my Oscar reports, I noticed RERA episodes, every other day, at around a median value of 0.15. I hardly if ever had RERA episodes in the past. My doctor says not to worry about it. I wonder if it has something to do with the fact that I repeatedly adjusted the min/max pressure settings. They were originally set by my doctor at min 10/max 15. and, looking at the history, there have never been RERA's with those settings. Since last year, I adjusted them to 13-16, 13-17 and lately to 13-18.. The RERA's seem to have increased with the upward adjustments. of the min and max mask pressure values. To day I have adjusted them again to what they were originally ( 10-15). I'll keep an eye on them. May be this was the problem. I wonder if you have any comments.

Thanks

Franco

Thanks Sierra

1. Where do I see the RERA events on the Oscar graphic? The summary shows one ( 0.37) but I cannot see it on the graph.
2. Mine is a ResmedAirSense10 Autoset. Now that come to think, why adjusting the pressure settings if if there is an Autoset feature?
3. I forgot how to post the daily screenshot. Can you tell me, please?

Thanks

Franco

Thanks Here is the screenshot . I cannot see any RERA on the event flag graph, only H and OA events. Ref. the min/max pressure settings, I now understand . The AUTOSET feature will work only within these manually set limits.