UPDATE: Trouble with RERAs vs. centrals

[Sireneh]

Update July 5, 2011:

I'm not sure what's happening lately, but I've hit a sweet spot and am waking up feeling ready to GET up, and I'm not sleepy during the day until late afternoon. I have my pressures at 9.0 - 11.0 with a-flex 2.

The one thing possibly worth noting is that I just finished a series of 6 acupuncture treatments. One of the points was targeting sleep (at the outside of my wrists.) The other two areas were to treat digestion and depression. I'm also using some herbal tea formula that he's come up with for me that I take at night and he says it can help with sleep also.

Below is a record of my nightly RDIs since May 30th. I really wanted my RDI below 5 because my biggest problem was RERAs so my AHI would always look great, but once my RERAs were accounted for my number would be unacceptable. You can see I was not always very patient. Recently I've started to note how I feel. I note how I feel BEFORE I see the data so I know I'm being honest.

Oh, interesting to note my highest RDI was on June 18 when I took melatonin. Not significant data, mind you, but interesting. Anyone else noticed different results when using melatonin?


Pressure: 9.0 C-flex
May 30: 6.26

Pressure: 10.0 C-flex
June 2: 6.63
June 3: 8.11
June 4: 6.95
June 5: 8.45

Pressure: 9.5 C-flex +
June 6: 6.31
June 7: 3.83
June 8: 4.36
June 9: 5.24
June 10: 5.8
June 11: 9.7
June 12: 8.6

Auto: 8.0-9.0 A-Flex 3
June 14: 7.1
June 15: 5.8

Pressure: 8.0 C-Flex+
June 16: 7.34

Auto 8.0-9.0 A-Flex 3
June 17: 7.5

Pressure: 9.0 C-flex+
June 18: 11.1 (melatonin)
June 19: 5.17
June 20:
June 21: 6.2

Pressure: 9.0 C-Flex
June 22: 10.4
June 23:

Pressure: 9.0 no flex setting
June 24: 6.22

Auto 9.0-9.5 no flex
June 25: 9.3
June 26: 9.5

Auto 9.0-11.0 A-flex 2
June 27: 8.85
June 28: 4.75 (feel great)
June 29: 5.87 (slept a long time, not feeling as great today)
June 30: N/A
July 1: N/A
July 2: 4.27 (feel great)
July 3: 3.54 (tired)
July 4: 3.62 (feel great)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I have been fiddling with my pressures for a few weeks now, staying in the range of 8-10, sometimes on auto, sometimes on CPAP, using various exhale settings. What I've been finding is that at a pressure of 9 my centrals are at a minimum (say 3-6 per night) but my RERAs jump way up. At a pressure higher than 9 my RERAs drop and my centrals become the problem. I fear I may have invested in the wrong machine and should be using a BiPAP.

Before I start thinking seriously about that, is there anything else you may be able to suggest? I have not yet tried turning off the flex setting and just using a straight CPAP at 9 and see if I can do that comfortably. I may just try that tonight.

If you are knowledgeable about UARS and/or bi-PAP machines, any input you may offer would be greatly appreciated!

[Sireneh]

Anyone?

I have been using no flex setting for the past three nights, which is working fine but I don't know if it makes any difference as far as results go.

[M.D.Hosehead]

I think the term RERA on PRS1 is misleading.

In a sleep lab, they score RERA if there is respiratory effort on the chest band + an an arousal to a lighter stage of sleep on EEG. An xpap doesn't have either of those; when the PRS 1 detects a sudden increase in the rate and/or amplitude of breathing they call it RERA, but it's obviously not the same thing. The reason for considering RERA's at all is that they may be responsible for poor quality sleep

So IMO, if the AHI is low and if there is no desaturation, and if you don't feel sleep deprived, the "RERA's" can be disregarded. If, OTOH, you feel sleep-deprived, the "RERA's" might be involved.

Another point to consider: several of us here have concluded that some of the centrals scored by PRS1 can be spurious. You can look at the waveform on Okor, SleepyHead or EncorePro to see whether the centrals are really there.

If you have or can borrow an oximeter, that might be helpful. If the CA's are not accompanied by desaturation, they may be spurious or unimportant.

Considering all the above, you may decide a bipap is unnecessary.

[Sireneh]

Thanks, Hosehead. So... the data may be useless, then?

[cowlypso]

Not useless, just in need of careful interpretation.

For the centrals... Look at the waveform data. If you're breathing nice even breaths and then see the wave suddenly stop, usually followed by some deeper breaths when you start breathing again, that's a true central apnea. If you're breathing nice even breaths and then see one or more deep breaths, followed by a brief stop in breathing, then resuming normal breathing without deep breaths, that's not a central apnea. That's likely a sigh or an arousal.

For the RERAs, sometimes I look at the wave data and see absolutely nothing weird at all about it. I'm guessing that the machine detected a flow limitation, but my breathing never changed. I ignore those. Now, if I see something funky in the waveform, like slowed breathing followed by some deep breaths, then it looks more convincing to me.

Of course, the most important question is: how do you feel? Do you feel good? Do you notice a difference in how you feel depending on your pressure? Yes, the data is helpful, but it really all comes down to feeling better.

[Sireneh]

Hmm... looks like I have to post to bump the thread.