Please explain RERAs

[Mr Snuffy]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

[palerider]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

that's really not enough to worry about.

a rera (and the machine is making a guess) is a disturbance in your breathing flow that can't be attributed to anything else, apnea, hypopnea, snore, flow limitation...

[WindCpap]

RERAs (Resperatory Effort Related Arousals) happen because your airway is obstructive but not enough to cause a true apnea or a hypopnea, and the extra effort causes you to arouse from your current stage of sleep. Without an EEG, they are virtually impossible to properly detect. I am actually not sure how the machine flags these since, in a lab, they would read as hypopneas on the flow graph that don't have a large oxygen drop, but with an associated arrousal on EEG. If you are getting only 3-5 reported from your machine, they can be ignored.

Edit: Just looked this up in the clinical manual. It is not well described, but I think the machine flags all hyopopneas from a flow point of view as hypopneas, and RERAs are flagged when a series of flow limitations leads to what the machine interprets as an arousal. Again, without an EEG, this is really not something that can be realistically flagged. I imagine that sometimes these would be falsely flagged if you had a flow limitation before changing sleep phases, or if you had a flow limitation followed by an exciting point in a dream.

[WindCpap]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

that's really not enough to worry about.

a rera (and the machine is making a guess) is a disturbance in your breathing flow that can't be attributed to anything else, apnea, hypopnea, snore, flow limitation...

Now who's making shit up?

[Wulfman...]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

I recently posted this link.

http://www.sleepdynamictherapy.com/inde ... imitation/

A quote from the link:

A reminder that for all practical purposes, the following three terms are interchangeable:

· UARS (upper airway resistance)
· Flow limitation
· RERAs (respiratory effort-related arousals)


Den

.

[palerider]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

that's really not enough to worry about.

a rera (and the machine is making a guess) is a disturbance in your breathing flow that can't be attributed to anything else, apnea, hypopnea, snore, flow limitation...

Now who's making shit up?

I'd say you are, based on your previous post, so what did I say that is wrong? there's no EEG connections, there's on chest band connections to a home machine, so it's making a guess. yes?

if it was another identifiable event, then it would be flagged, yes?

some of what you say is sound, but you seem to have no idea when you go off the rails. how long have you been at this, again? you're just another newbie that thinks they know everything. *sigh*

[palerider]

I recently posted this link.

http://www.sleepdynamictherapy.com/inde ... imitation/

A quote from the link:

A reminder that for all practical purposes, the following three terms are interchangeable:

· UARS (upper airway resistance)
· Flow limitation
· RERAs (respiratory effort-related arousals)

I think one could reasonably class that as "gross oversimplification". have a bit of science: http://www.journalsleep.org/Articles/230605.pdf

[robysue]

RERAs (Resperatory Effort Related Arousals) happen because your airway is obstructive but not enough to cause a true apnea or a hypopnea, and the extra effort causes you to arouse from your current stage of sleep. Without an EEG, they are virtually impossible to properly detect.

Yep. This much is accurate.

I am actually not sure how the machine flags these since, in a lab, they would read as hypopneas on the flow graph that don't have a large oxygen drop, but with an associated arrousal on EEG.

I don't think this is accurate.

There are two definitions of hypopnea that can be used to score events according to the American Association of Sleep Medicine. According to this clarification of the scoring standards the AASM recommended scoring criteria for a hypopnea is:

Recommended
1A. Score a respiratory event as a hypopnea if ALL of the following criteria are met:

a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative hypopnea sensor (diagnostic study).

b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.

c. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal.

Note that Part C of this definition is worded in such a way that a 3% drop in oxygen desaturation is NOT required to score a hypopnea if there is an EEG arousal. In other words, if the flow rate drops by 30% or more for at least 10 seconds and there is an EEG arousal, a hypopnea is supposed to be scored regardless of whether there is an oxygen desat.

There is also an older Acceptable criteria for scoring hypopneas that requires a 4% drop in oxygen desaturation. This standard is still around because Medicare and some other insurance companies are unwilling to adopt the newer recommended standard that the AASM believes should be used to score hypopneas.

A real RERA on in-lab sleep test is a string of breaths with characteristics that indicate increasing respiratory effort (distress) that end with an EEG arousal. In a RERA, the increasing respiratory effort does not meet the 30% reduction in air flow that is required for a hypopnea. Basically in the lab, a RERA is a flow limitation that ends with an EEG arousal.

As far CPAP-detected RERAs are concerned: PR obviously has designed an algorithm that looks for inhalations in the wave flow data that have many of the characteristics of the wave flow of in-lab scored RERAs. In the PR algorithm, a machine-flagged RERA should end with one or more "recovery breaths"---one or more inhalations that are much larger than expected followed by a more normal looking, regular sleep breathing pattern. The idea is that the recovery breaths indicate there's a high probability that there was a real arousal that would have been detected by an EEG if it were available.

In other words one important difference between a PR APAP scored RERA and a PR APAP scored FL is whether the machine thinks it sees evidence of an arousal in the form of "recovery breaths".

[Wulfman...]

I recently posted this link.

http://www.sleepdynamictherapy.com/inde ... imitation/

A quote from the link:

A reminder that for all practical purposes, the following three terms are interchangeable:

· UARS (upper airway resistance)
· Flow limitation
· RERAs (respiratory effort-related arousals)

I think one could reasonably class that as "gross oversimplification".

Take it up with "Dr. Krakpot".

Now I'm disappointed........I was beginning to think you had put me on your "Foe List".


Den

.

[Wulfman...]

have a bit of science: http://www.journalsleep.org/Articles/230605.pdf

Already have that one in my archives.


Den

.

[palerider]

Take it up with "Dr. Krakpot".

Now I'm disappointed........I was beginning to think you had put me on your "Foe List".

I have no need.. others have explained it better, and as RobySue said, so well: "Basically in the lab, a RERA is a flow limitation that ends with an EEG arousal." ergo, they *aren't* the same.

also, I'd never put you on the foe list, for one thing, you provide a lot of good advice to people...

for another, someone has to be around to refute your attempts to project your perceived problems with Auto machines onto everyone else.

[WindCpap]

Can someone explain RERA events, how they affect sleep apnea (if they do), and how do they affect your sleep?

I have read the definition and looked online, but need it explained in more detail to what causes it or how to prevent them. I have between 3 and 5 a night.

that's really not enough to worry about.

a rera (and the machine is making a guess) is a disturbance in your breathing flow that can't be attributed to anything else, apnea, hypopnea, snore, flow limitation...

Now who's making shit up?

I'd say you are, based on your previous post, so what did I say that is wrong? there's no EEG connections, there's on chest band connections to a home machine, so it's making a guess. yes?

if it was another identifiable event, then it would be flagged, yes?

some of what you say is sound, but you seem to have no idea when you go off the rails. how long have you been at this, again? you're just another newbie that thinks they know everything. *sigh*

The whole part beyond (and the machine is making a guess) is bullshit. You pulled it out of your ass. At some point in time, you took it upon yourself to troll all of my posts, and I thought maybe I should start trolling some of yours. If it wasn't for your previous behaviour, I would have ignored this error since knowing what RERA flags mean is irrelevant to anything. There are times when I post on personal experience, and instead of asking for explanation, you shoot down the post. I would really like for you to stop trying to be the police of this forum, and instead, ask some intelligent questions when you aren't sure about what somebody is saying.

Case in point would be my post on nasal rinsing. My personal experience has shown that if I do nasal rinses, the CPAP will give me a power sniffle (no better way to describe it) when i put it on. It clears my nasal passages. This is fact because I experience it every time as long as any congestion is fluid enough. You jumped all over this post instead of asking questions.

[palerider]

Take it up with "Dr. Krakpot".

I do find it amusing that you reference the writings of someone to support your claims, then refer to them as "Krakpot".

[palerider]

The whole part beyond (and the machine is making a guess) is bullshit.

and yet, you apparently can't point to a single thing that's in error.

I would have ignored this error since knowing what RERA flags mean is irrelevant to anything.

if you actually paid attention to things, instead of just running around looking for where you could "contribute", you'd know that Mr Snuffy just got himself a new Resmed Airsense 10 autoset, which has RERA flags, and .... gee, that was what he was asking about.

I would really like for you to stop trying to be the police of this forum,

and I'd like it if you'd just go away... but, we can't always get what we want, now can we?

I'm glad it was RobySue that pointed out the errors in your previous statement, she did it much better than I could have.

are you going to start stalking her now?

[WindCpap]

"is a disturbance in your breathing flow that can't be attributed to anything else, apnea, hypopnea, snore, flow limitation..." is bullshit. It is not even close to an explanation.

You will note how RobySue politely correct what were fairly minor inaccuracies in my interpretation.

I am not sure why I thought explaining how you could better respond to posts would get anything but the response I got. I guess once an asshole, always an asshole.