Spontaneous arousals and PB 420e?

On my original sleep study there were lots of "spontaneous arousals" per hour. During my titration study there were about the same number of them, though my AHI was lower. My sleep study did not include RERAs, so it could be something like that.

I don't have restless leg or periodic limb movements, so that's not what caused them. I hardly snore at all and don't move around much either.

From some things I've read here, I got the impression that the PB 420e might be the best machine for someone with this kind of problem, but I'm not too clear on this. I'd appreciate any explanations of this.

RosemaryB wrote:From some things I've read here, I got the impression that the PB 420e might be the best machine for someone with this kind of problem, but I'm not too clear on this. I'd appreciate any explanations of this.

I don't think any brand or type of cpap machine can take care of "spontaneous arousals", as those kinds of arousals are not associated with respiratory events. Those mean something else is interfering with your sleep even if "cpap" is doing its part of the job fine in taking care of preventing OSA events.

The spontaneous arousals could be from just about anything else. Uncomfortable mattress, neighbor's dog barking or car starting, getting too warm or cold, med side effects, bed partner jostling you, A/C or furnace kicking on noisily, pet moving around on the bed. You get the idea. Could also be from any number of other underlying health problems...episodes of GERD (acid reflux), pain from arthritis, fibromyalgia, and on and on....

it is as RG suggested, that can be caused by almost anything.

Spontaneous arousals are arousals seen on the EEG which screw up your sleep architecture. If these arousals happen during REM, they kick you out of REM back to Stage2 or even back to Wake state. If they happen during Deep sleep, they can kick you out of or prevent you from every reaching those deeper states of sleep. The result of being kicked out of that deeper sleep is you feel tired the next day.

We know that if you have an apnea, you have an associated arousal. This arousal can kick you out of REM or deep sleep back to Stage2 or even a Wake state.

When they apply CPAP pressure they can see that apnea go away, when the associated arousal goes away with it they can correlate those two and say that arousal was related to that apnea event.

When you have the spontaneous arousal, they see it on the EEG and yet they cannot correlate it to an apnea or respiratory event we would classify as OSA (Flow limitation, Hypopnea, Snore, Apnea). Although I've seen some suggestions that they can be associated somewhat with snores.

It is also thought that spontaneous arousals may be associated with chronic muscle-skeletal pains such as from a bad back, or even arthritis. If you feel pains from this during the day you may also feel it during the night during sleep in the form of an arousal. While it is only theory, the theory is those pains may cause an arousal just like the apnea associated one does.

Certain medications are thought to also contribute to those spontaneous arousals. They are called "spontaneous" because the actual cause of them is unknown.

There is no cpap machine I know of that can track them unless it has a built-in EEG.

Thank you RG, and Snoredog! Your answers clarified some things that I was trying to get at.

Snoredog wrote:When they apply CPAP pressure they can see that apnea go away, when the associated arousal goes away with it they can correlate those two and say that arousal was related to that apnea event.

When you have the spontaneous arousal, they see it on the EEG and yet they cannot correlate it to an apnea or respiratory event we would classify as OSA (Flow limitation, Hypopnea, Snore, Apnea). Although I've seen some suggestions that they can be associated somewhat with snores.

That's my concern, in a way. During my sleep studies they did not track RERAs. So, I'm wondering if the "spontaneous arousals" were really arousals due to RERAs. These RERAs might register on Encore Pro or Silverlining as FL's if I'm understanding it right.

Then during the titration, the tech left me at 4 for much of the night and finally bumped it to 5 during the later part of the night (which wasn't all that long). She never tried anything over 5. However, at home, when I set my auto to 5 (bottom pressure) I was still getting too many events (AHI >5). At 7.5 it goes under 5.

But from what both of you have said and my sketchy understanding of it, if the machine is taking care of FL's it would also be taking care of the hypothesized RERAs. If they were the cause of the "spontaneous arousals" (i.e., arousals due to RERAs) then a machine that best takes care of the FLs would also take care of the extra arousals.

Does this seem to make sense?

RosemaryB wrote:Thank you RG, and Snoredog! Your answers clarified some things that I was trying to get at.

Snoredog wrote:When they apply CPAP pressure they can see that apnea go away, when the associated arousal goes away with it they can correlate those two and say that arousal was related to that apnea event.

When you have the spontaneous arousal, they see it on the EEG and yet they cannot correlate it to an apnea or respiratory event we would classify as OSA (Flow limitation, Hypopnea, Snore, Apnea). Although I've seen some suggestions that they can be associated somewhat with snores.

That's my concern, in a way. During my sleep studies they did not track RERAs. So, I'm wondering if the "spontaneous arousals" were really arousals due to RERAs. These RERAs might register on Encore Pro or Silverlining as FL's if I'm understanding it right.

Then during the titration, the tech left me at 4 for much of the night and finally bumped it to 5 during the later part of the night (which wasn't all that long). She never tried anything over 5. However, at home, when I set my auto to 5 (bottom pressure) I was still getting too many events (AHI >5). At 7.5 it goes under 5.

But from what both of you have said and my sketchy understanding of it, if the machine is taking care of FL's it would also be taking care of the hypothesized RERAs. If they were the cause of the "spontaneous arousals" (i.e., arousals due to RERAs) then a machine that best takes care of the FLs would also take care of the extra arousals.

Does this seem to make sense?

No actually it doesn't, RERA's =RESPIRATORY EFFORT RELATED AROUSALS (RERAs).

RERA's are sleep arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.

Meaning RERA's shown on your report are Flow limitations or "respiratory" related events.

I don't think spontaneous arousals are summed up in any index category but their own. They are not included in RDI since that is also Respiratory Disturbance Index, again respiratory.

I couldn't find any RERAs on my report. I'm going to try and post it and see if anyone can find them.

Thanks for the help!