Respiratory Event Related Arousals (RERA)

[enriquezx5]

All,

Looking for guidance on RERA's as it seems based on what I have been able to find, mine are high. In an attempt to define "normal" I found most say 8-10 event per hour is normal.

After looking at my data in SleepyHead, I am well above that on a typical night. For example, last Friday I had 37 events during 8:12 of sleep. 9 in the 11:00 hour, 13 in the 12:00 hour, etc.

I've pointed this out to my sleep Dr. on a couple of occasions and he dismisses it as my overall AHI is low to him. I have moderate apena with a AHI of 10 on my back and 7 on my side. "Normal" treated AHI is under 2.

Recently this has creeped up to the point where it is almost to the untreated level, 6.46 being the high last Friday night. I have also been losing weight and am currently down 17 pounds. I undertook the weight loss effort to try and improve my apnea not make it worse.

At this point, I am changing my pressure almost nightly trying to find something that works.

[Krelvin]

At this point, I am changing my pressure almost nightly trying to find something that works.

Make a change, use it for 3-4 days. One day is not a good sample. Also make small changes when you do.

[Sleeprider]

I find RERA events are very disruptive to sleep. I really don't have a good strategy for reducing them other than to optimize therapy for AHI, but I average just over 1.5 per hour, and if it goes over 3/hour I don't feel rested.

I have been working over the last 30 days to fine-tune my settings, and started using a BiPAP last week. Results are getting better with the BiPAP. Once you find something that seems to be working, try to resist the temptation to change settings. You need a week to really get a meaningful average of how the settings are working. Make small changes, one thing at a time, and keep them until you're sure where you need to go with the next change.

What machine are you using? What settings? How long have you been on XPAP?

[enriquezx5]

Sleeprider,

I have been using my CPAP for a little over a year now. Compliance has not been an issue for me as I am rarely unable to wear. I have however, not seen a marked improvement in my sleep as noted above. That is really the main reason, I chose to lose weight. I don't consider myself to overweight...5' 11" and 200 lbs. I'm now down to 185.

My machine is a REMstar Auto C-Flex.
http://i1381.photobucket.com/albums/ah2 ... 7d00c2.jpg

Thank you for the response.

[Krelvin]

Old version of SleepyHead.

[Sleeprider]

Enrique, you can download the latest version of Sleepyhead from the link in my signature. It make it easier to take screenshots because you just use the F12 key and the screenshot is saved to My Documents/Sleepyhead/Screenshots.

Your apnea events are primarily hypopnea and clear airway events with minimal OA. What strikes me is the really large periodic breathing we're seeing here. This is NOT a diagnosis, but it's with discussing with your doctor.

Your pressure is set at 6.0 constant, and if that periodic breathing and CA mean anything, you might be on the wrong machine. Anyway, I suspect it's been a while since you tried alternative pressures. It would be interesting to see the response at 7.0 or 8.0 pressure. Are you game to give something else a try, or have you already done this?

[enriquezx5]

Sleeprider,

I have tried different pressures but so far, the results are similar. I will download the new version of SleepyHead and upload additional data tonight. I appreciate the guidance as I'm really new to trying to interpret the data.

I think the most discouraging thing with my current Dr. is that he doesn't want to look at the data. For example on my last visit I printed out several nights data and wanted to discuss the RERA and what, if anything it was doing to me. He really didn't want to look at only wanted to look at my monthly average AHI. He's a young guy and has an impressive resume but has been tough to engage. I had to fight for several months to even get a machine that would show AHI.

Thanks,

Enriquezx5

[Sleeprider]

Last night I had a first ever 0.00 RERA with a low 0.80 AHI. In other words one of the best nights ever for me. I'm using an auto BiPAP that I recently acquired and it seems to be working well.

With the limited data you posted, I thought a little more pressure support might be helpful. Have you considered trying a higher pressure? If the doctor won't take an interest, it's kind of up to you to take the lead. That's a pretty common story, and I have not had a doctor's involvement in my therapy for years.

[Jay Aitchsee]

I think the most discouraging thing with my current Dr. is that he doesn't want to look at the data

It's possible he doesn't want to look at because he's not familiar with it. I think many doctors might dismiss SleepyHead as not "official" and are more comfortable with ResScan or, in your case, Encore. That said, it has been my experience, that few doctors, DME's, or others look at anything more than summary AHI and compliance no matter what software is used to present it.
Your solution might be to keep looking until you find a Dr. that will "engage" and work with you.

[Krelvin]

My PCP was interested in how much data and detail I had at my fingertips. May not understand it all, but she was genuinely interested. Asked if I would bring in a current report my next appointment.

Sleep Dr on the otherhand: meh.. don't need that much detail. "Your overall numbers look good"

No more visits for the sleep Dr.

Guess who bills more...

[palerider]

He really didn't want to look at only wanted to look at my monthly average AHI.

that's gross incompetence/ignorance.

and far too typical.

[enriquezx5]

All,

Finally got the new software loaded and have captured my last three nights. My RERAs are high and my AHI up.

Please let me know what you think.

Enriquezx5
http://s1381.photobucket.com/user/chris ... 6170341683

[Sleeprider]

So far, this is going pretty good, and well done to post the graphics.

Your increase of pressure from 6.0 to 7.0 has resulted in a significant decrease of RERA and AHI based on a limited trial. You may want to continue to monitor this new pressure. I would move the pressure to 8.0 with C-Flex at 2 -3 and evaluate results again. You appear to have Ramp on. I would set it to a minimum of 6 and 5 minutes, or turn it off. You are not quite there yet, but getting closer.

[enriquezx5]

Last night wasn't much better at 8.

Thoughts?
http://s1381.photobucket.com/user/chris ... 8593535264

[Sleeprider]

Not much change at all. You're still showing a lot of hypopnea and a bit of obstructive apnea. If it was my results, I'd increase pressure because that is all indicative of obstructive events. Let's see if anyone else has a thought. I'd hold at 8.0 or go to 9 if you're not experiencing discomfort. It might help to know where you have Cflex set (0-3).

Your data show that your tidal volumes are slightly higher at the higher pressure, so it seems CPAP at higher pressures is not suppressing ventilation and you may tolerate a higher pressure.