Did your sleep dr include RERA's in AHI & RDI ?

[angela6]

I had both a polysonogram and a titration done. In both cases the sleep doctor included RERA's to come up with the AHI and the RDI.

I had another sleep doctor tell me that the current thinking is not to include RERA's in the calculations.

Does anyone have any imput on this?

[harry33]

as an older CPAP user Ive never had the slightest interest in data but have managed OK

I wonder if the trend to examine all data daily via computer programs might become an unhealthy obsession

[twasbrillig]

I think they should include RERAs! They cause arousals, which contribute to your daytime sleepiness, even if there is not oxygen de-saturation.

The real concern is whether the technicians work with RERAS (flow limitations) in the titration study. If you have a lot of flow limitation, and they don't titrate for it, you will probably end up with a prescribed pressure that doesn't make your feel better.

BTW, doctors seem very varied in their knowledge of sleep medicine. (I am on my 4th) Some of them seem to be completely unaware, others not terribly curious. I don't think there is much consensus, frankly. It scares me a little, because I thought doctors had to do regular professional learning - conferences, courses, etc - but I am beginning to doubt that happens with sleep doctors. So some of them are not very knowledgeable. The problem is, everyone thinks they know about "apnea." What they don't know could fill a book.

[Whoa!]

Would somebody mind explaining what flow limitations are. I have seen them on my data report but don't know what it means.

Thanks

[ozij]

as an older CPAP user Ive never had the slightest interest in data but have managed OK

I wonder if the trend to examine all data daily via computer programs might become an unhealthy obsession

I'm a younger (I guess) cpap user, and would not have managed to tolerate my therapy had it not been for the availability of data.

I wonder if the trend to ignore data and information available on modern machines might become unhealthy denial.

O.

[twasbrillig]

Flow limitations are events that are identified by the scoring technician who is looking at the data from your study, according to rules from some Academy or sleep group. (Sorry, I forget who). The polysomnographic tech (the one who sets you up and monitors you) should also be looking out for flow limitations. In one lab I was in, they were only scored in the final report by the scoring technician. In the other lab, the poly. tech actually noted them in the log she kept during my study.

The idea is that you haven't stopped being able to breathe (apnea) nor had a reduction in airflow that causes de-oxygenation (hypopnea) but you have had a respiratory event that is responsible for some disturbance in your sleep. Most of the researchers agree that these arousals, which are demonstrated in the EEG, are responsible for the daytime sleepiness and fatigue as much as the oxygen issues.

As a UARS patient (1 OSA, 1 CA, 3 H and 148 RERAs in my diagnostic study) I KNOW the flow limitation is a huge factor in daytime sleepiness. I didn't have any oxygen desaturation, but boy! do I have fatigue, mental fog and irritability.

[twasbrillig]

As to the other topic, data. There are ways to err in both directions. It's possible to get caught up in the minutiae. Like so many kinds of data, it appears it's best to look for patterns. We are all looking for cause-and-effect relationships, so we can address our problems more effectively. At least, that's what I want to do.

I WISH I had data. I went to see my doc 2 weeks ago, and mentioned data capability. He doesn't believe in it. ( However, he doesn't believe in BiPAP either, or in air coming through your tear ducts - just not the kind of doc who says he learns as much from his patients as they learn from him ) I am not sure what it will take to get a prescription for a data capable machine.

Those of us who have had miserable titration studies know that one night is like a snapshot. It's just not enough to go on with something as complex as breathing. And I don't think the docs feel my pain. They act quite sympathetic, but I have been counseled to suck it up and continue my therapy despite a lack of demonstrable improvement. I want evidence! And I would hate to settle for "ok" if that meant I was missing out on something better. So, IMHO, even though the machines have only rudimentary data, it's still has the potential to be better than guesswork.

[jdm2857]

Sounds like you need a new doc. (I do believe in data. I do believe in data. I do believe in data....)

I had to contact several practices before I found one that would consider prescribing APAP without a titration.

And, BTW does anyone know what RERA stands for?

[Pugsy]

does anyone know what RERA stands for?

Respiratory Event Related Arousals

[jdm2857]

Aha! It's not just a flow limitation.

Arousal is a required element.

[cpapquuen]

According to the new Medicare guidelines, RERA's are not included when calculationg RDI's. By doing so, an AHI now equals an RDI. This is why some docs have changed the way they score. This new method has kept numerous people from getting pap devices.