RERA

I am trying to understand my stats on Sleepyhead. I want to know if there is any way to find out if I tossing and turning or if I am having leg "jerking." I can't get comfortable with my mask (Amara View Full Face Mask) and I constantly am fighting the mask or tossing and turning trying to get comfortable and there are oftentimes I feel my legs or arms doing that horrible jerking that I am sure a lot of people here understand. I do NOT feel rested after a night's sleep. I feel groggy and foggy-headed even though my stats have a very low AHI and a 100% mask fit.

Is it RERA data that I need to look at? That sounded logical to me after looking at the glossary of terms:

RERA: Respiratory Event Related Arousal... a sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but which does not meet criteria for an apnea or hypopnea.”

RERA Detection in the Respironics System One data..Respiratory effort-related arousal..defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apenea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.

Is this "tossing and turning?" Is there some other data I need to look at?

Y'all are so wonderful here--I thank you in advance for you help! NOTE: I am seeing my DME provider tomorrow for a consultation on achieving a better fit or getting a different mask.

Tossing and turning doesn't necessarily mean RERA or even show up on any of the graphs as some sort of event.

We can toss and turn for any number of reasons besides a reduction in air flow.

What?? No magic wand? I hate reality!

No magic wand and no crystal ball either.

I wish it were that easy but as good as the machines might be there's just some questions it can't give us nice clear cut, black and white, answers to. No matter how much we wish it were true.

True RERA flagged events are related to respiration patterns and there's simply no way to know for sure unless someone gets really good at analyzing the breath by breath flow rate and that takes a lot of work and experience and even then there are a ton of "maybes".

If someone says they have a large number of RERAs and they slept soundly (or thought they did) then we think that it's very possible that the changes might be "real" but if someone tells me that they have a lot of RERAs and they fought with the mask all night...it's very possible that the irregular breathing that might get flagged as RERA was just awake/semi awake fighting with the mask stuff.

Remember these machines only measure breathing and air flow. They don't measure tossing or turning or if someone is asleep or not.

I have had nights where I know I slept horribly. Lots of wake ups and tossing and turning and not one RERA flag.
I have also had those same horrible tossing and turning nights and a few RERAs.
Knowing my own history the tossing and turning nights are unrelated to cpap or mask issues. I have other issues going on that mess with my sleep that the best cpap therapy in the world can't fix.

Usually when we see a lot of RERAs and they are "real" as in related to breathing issues there are also other indicators of sub optimal therapy....like FLs or hyponeas or even OAs. So the RERAs alone don't often mean much but instead it's when they get added to the big picture that they become more important.

If someone is having known sleeping issues where they know there are a lot of wake ups from whatever then we have to sort of take these outlier events with a grain of salt when they are the only thing really showing up.
You already know you are having mask comfort/fit issues. You will need to address those issues first before trying to look too far under the microscope for explanations for any outlier issues. Known awake/semi awake time really puts a shadow over any of the data we see because the machine just reports what it senses...and not necessarily why it happened.

I once helped a guy whose AHI was horrible, horrible...like in the mid 20s and mixed with all sorts of indicators of sub optimal therapy but they weren't showing up like we would expect to see them. We would have periods of nothing much going on and then periods where all hell would break loose. Come to find out he was experiencing some significant insomnia issues and spending hours awake with the mask and machine on. Did some work on the insomnia and also made a point to not spend so long with mask and machine on and low and behold the AHI dropped to a nice 1 to 2 range. Never changed anything in terms of pressure.
The times on the graphs where not much happened he was actually asleep but those times were greatly overshadowed by the awake times. His therapy was working...his sleep quality was crap but once he addressed those issues things cleaned up nicely.
This is why one of the first questions I ask someone who has an ugly report is "did you spend much time awake/semi awake with mask and machine on". We can't trust the data if there are lots of known wake ups or time spent awake with mask and machine on.