Airsense 10 Upgrade for Detecting RERAs

[schmatt]

I am currently using a Resmed Airsense 10 Autoset. It was originally purchased about two years ago, although I only started using it 6 weeks ago. My understanding is that this model didn't start flagging RERAs until sometime last year. I am dealing with a possible UARS issue and would really like to be able to see this type of data. I'm seeing a bunch of "arousals" based on erratic breathing patterns. It would be nice to see if these events would be flagged as RERAs, because almost all show no flagging at all. All of my CAs and most of the OAs come after this erratic pattern, which suggest they are not real.

Is there a way to upgrade the firmware to add this capability? I tried calling Resmed, but they only tell you to contact your DME.

[ChicagoGranny]

Is there a way to upgrade the firmware to add this capability?

Which version of the software do you currently have?

Select the “Settings” menu when in clinical mode. Or, view the software versions on the device by selecting “My Options.” “Essentials” must be set to “Plus.” The software versions are listed under the “About” option.

If you have been using the Modem (Not configured to be in Airplane mode.) and you are in a service area, the latest software may have already been downloaded.

[ChicagoGranny]

It would be nice to see if these events would be flagged as RERAs

BTW, do you understand the machine is not capable of definitively recognizing RERAs? Thoracoabdominal belts or esophageal manometry are required for definitive measurements.

[klv329]

I have seen over-the-air humidifier and modem software updates noted in other threads for the Airsense10/Aircurve10 lines, but so far nobody has noted an over-the-air device software update.

I suspect it is the device software update the might have such an improvement as you describe, but I don't really know.

If a DME can provide a device software update to a machine, well, that would be good to know.

[schmatt]

I do understand that a true RERA requires an EEG to determine whether an arousal actually occurred. But currently, I'm barely seeing any hypopneas. I would think that the algorithm for determining RERA's might detect more of my breathing disruptions. I've attached a typical night and a close up to give you an idea of what I'm trying to get a better look at automatically. I hope they show up.

I have the following software versions on my machine. I've always turned my machine off during the day. Is this a problem for potential updates? Should I be leaving it on all day?

Software: SX567-0302
Humidifer: SX556-0204
Modem: SX558-0312

From what I've found online, the Autoset for Her had the RERA detection built in. The Autoset didn't include this until around June of 2015, which was after mine was acquired. I wasn't sure if this was a simple software update, or if it was from additional hardware.

[schmatt]

Sorry, but the images didn't show up. These should work.

[ChicagoGranny]

I am dealing with a possible UARS issue

What makes you think this?

I'm seeing a bunch of "arousals" based on erratic breathing patterns.

Can you point one or two out on the charts you posted?

Forget the data for a moment, what is your subjective judgment of how well you sleep? Do you remember arousals? How many per night? Do you fall back to sleep quickly?

How do you feel the next day? Energetic? Any excess sleepiness?

Your pressure requirements vary widely during the night. For the periods when the pressure is in the lowest of the range, do you think you were asleep or awake? What position(s) do you sleep in?

[klv329]

Looks like you have received the humidifier and modem over-the-air updates, although not very many people responded to that thread inquiry. You could try leaving powered up, I suppose.

Not sure about the RERAs, as CG asks, how do you feel with this therapy? Any daytime tiredness?

[schmatt]

My symptoms are excessive daytime sleepiness, unrefreshing sleep and easily fatigued. I had a sleep study performed. My AHI was 4.7, but I had an arousal index of 22.2, of which only 1.0 was due to respiratory events. My sleep doc mentioned possible UARS since the AHI was so low, but I still had the symptoms of poor sleep. I don't remember waking for almost all of them. Most of the time, I might only remember waking once or twice. I had a CPAP titration done and the arousal index was 19.9 for that with only 0.3 due to respiratory events.

I've been on CPAP for the last 6 weeks and have seen a mild improvement in symptoms, but still not great. I was titrated at 7cm, which I had fixed for this entire time. Last night, I decided to switch it to APAP to see if a higher pressure would help. The flow graph looks pretty ratty, with very little events. The CAs are all after some sort of odd breathing, which means it is a false positive. This is pretty typical of most of my nights. I'm assuming that these disruptions in a normal breathing pattern are probably some sort of arousal.

I'm really just trying to figure out whether this really is my problem. I really don't know what else it could be. I just have a pretty high spontaneous arousal rate. Given that I've seen some improvement on CPAP, it does suggest a breathing issue, but I'm not entirely sure about that.

[ChicagoGranny]

I'm really just trying to figure out whether this really is my problem.

Here is a basic checklist from another thread. It's a good idea to run through it to see if you spot any problem areas; with our lifestyles these days, most people do see some areas for significant improvement.

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

[schmatt]

In general, I'm a pretty healthy person. I get regular checkups with my doctor. I have good sleep hygeine. The bed is only for sleeping and sex. No TV or even books in bed. No naps, except when I randomly fall asleep watching TV from sheer exhaustion, which is one of my symptoms. I only drink one cup of coffee a day first thing in the morning. This is how I realized I had a problem. I used to drink 3-4 throughout the morning, which was masking my symptoms. I don't eat much chocolate. I have no issues falling asleep. In fact my sleep onset latency was only 2.8 minutes. And that felt quite a bit longer than it takes me to fall asleep at home.

Really, the flow rate of the CPAP tells most of the story. I think this points to something causing significant disruption with my sleep. I'm just trying to figure out that root cause. I'm positive it is something beyond just normal sleep hygeine/stress issues. When I have significant stress, it manifests as some level of insomnia, which I'm not really having much if any.

[ChicagoGranny]

the flow rate of the CPAP tells most of the story.

Are you talking about the flow rate changes at approximately 00:5:25 and 00:26:20? If so, I interpret these differently from your interpretation. In both cases, for a person sleeping, you are breathing normally right up to the point the flow changes. You did not have the arousal because the flow changed. It's the other way around. The flow changed because you had an arousal.

There are other members who have more experience than me interpreting flow charts. I would like for one of them to offer an additional opinion.

[schmatt]

I guess this is kind of a chicken or egg type of deal. Basically, I guess I'm saying the same thing you are. The flow rate changes denote an arousal. Whether this is due to an airway issue or the flow rate change is due to an arousal of some other cause, I think the fact that the flow rate changes so dramatically says I'm having an arousal. The fact that I've had some improvement of symptoms on CPAP suggests that it is at least partly due to an airway issue. But whether it is totally from an airway issue or not is the real question. I do see my sleep doc for a follow up tomorrow, so hopefully I can get more information. I just wanted to get as much background as possible leading up to this to help me better discuss the issue with him.

[OkyDoky]

We all have some irregular breathing at times. maybe due to dreams, leaking masks, etc, What I see on your graphs is your machine increasing pressure and some leaks, that may be enough to disturb your sleep. You may be someone who is sensitive to the pressure increases. You may need a minimum pressure of 9 or 10. If you make changes monitor and see how high the Maximum is going. A narrow range may be better for you. Monitor how you sleep also not just the data.

[klv329]

Well, with a 7cm at the sleep study, maybe tighten up the range to 7-10 or 8-11 and see if the CAs go away.

I think the goal with apap is to find a tight range (or even a fixed pressure) that elimitates OAs and doesn't go so high that it creates CAs.

I see you appear to have CAs and OAs in odd places, so someone else might offer some help.

After experimentation with the apap, it may be that you will still have problems and your physician should always be involved to help find a solution (maybe even a different machine) that works and to help discover what the problem might be.