CPAPtalk.com

So what do you think? https://www.cpap.com/cpap-machine/respi ... +Auto+CPAP

What about RERAs? Here they must be talking about RERAs which are below apnea/hypopnea level. It says they are now included in the data but there is no indication the machine changes pressure to deal with them.

I hope there are some early adopters who will post in this thread.

How does the machine possible recognize the arousal part of an RERA (Respiratory Event Related Arousal)? It can surely detect events that are below the level of a hypopnea, but that alone does not make the event an RERA.

I would like to know also. It does say:

RERAs differ from a Hypopnea event in that a RERA shows increasing respiratory effort with each breath, culminating in a shift in brain wave activity and not necessarily a result of obstruction. Periodic breathing conditions such as Cheyne-Stokes respiration and central apneas are distinguishable from obstructed apnea or snoring events.

rooster wrote:So what do you think? https://www.cpap.com/cpap-machine/respi ... +Auto+CPAP

What about RERAs? Here they must be talking about RERAs which are below apnea/hypopnea level. It says they are now included in the data but there is no indication the machine changes pressure to deal with them.

I hope there are some early adopters who will post in this thread.

Per the user manual:

RERA is defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apnea or hypopnea. Snoring, though usually associated with this condition need not be present. The Rera algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the even does not meet conditions for an apnea or hypopnea, a RERA is indicated.

******

Does not specify whether or not it will change pressure to correct them.

Thanks Cubbie.

Seeing RERAs in the data could be useful. I would turn the pressure up a notch or two and see if they go away.

That may be what I did without the RERA data. I was getting AHI< 0 with 8.5 cm pressure but I still did not feel well and had some problems sleeping. After a long time of this, I turned the pressure up to 10 cm. Now I sleep and feel better. It could be I had RERAs (which the M series does not include in the data) at 8.5 and they went away at 10 cm.

If this machine also had the F&P Sleep Series feature to drop the pressure when it detects uneven breathing, I would buy one right away.

Sure would be nice to pick and choose machine features across manufacturers!

Regards,

CpapRRT wrote:

rooster wrote:So what do you think? https://www.cpap.com/cpap-machine/respi ... +Auto+CPAP

What about RERAs? Here they must be talking about RERAs which are below apnea/hypopnea level. It says they are now included in the data but there is no indication the machine changes pressure to deal with them.

I hope there are some early adopters who will post in this thread.

Per the user manual:

RERA is defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apnea or hypopnea. Snoring, though usually associated with this condition need not be present. The Rera algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the even does not meet conditions for an apnea or hypopnea, a RERA is indicated.

******

Does not specify whether or not it will change pressure to correct them.

Thanks for posting that. That's interesting... The assumption by the algorithm probably goes something like this: "Since that was such an obvious quick, sharp spike in respiratory effort, it very likely disturbed sleep."

Wonder what the RERA event-detection sensitivity and specificity happens to be for a non-EEG RERA-detection method like that. Certainly not as accurate as detecting RERAs via PSG's combined flow and EEG channels I would think.

I also wonder how all those 420e users who have to turn off IFL1 (the "heavy" scorers) will fare with this machine's RERA scoring.


-------------------------------------------------------------------------

Also, Respironics now actively differentiates central apneas, for the first time, using launched pressure pulse waves. That method, sometimes referred to as Forced Oscillation Technique (FOT) expects return or bounced wave reflection if the apnea is obstructive. If the airway is open (central apnea) the the pulse wave is only negligibly reflected back to the sensor.

-SWS wrote:
........Wonder what the RERA event-detection sensitivity and specificity happens to be for a non-EEG assumption like that. Certainly not as accurate as detecting RERAs via PSG's flow and EEG channels I would think.

.......

If you think outside the box, you realize it is more accurate. The sophisticated in-lab equipment is measuring a patient in the strange sleep lab environment where he is not sleeping like he normally does. It's a one night measurement costing, what, $1700 - 2899?

The PR System is measuring the patient in his own home in his own bed under conditions identical to what he normally will sleep under. The PR System can do many nights of measurement for under $700.

Get those finally tuned results from the sleep lab and without your own monitoring tools at home, you have no idea whether the lab results apply to the at-home setting and often they don't.

rooster wrote:

-SWS wrote:
........Wonder what the RERA event-detection sensitivity and specificity happens to be for a non-EEG assumption like that. Certainly not as accurate as detecting RERAs via PSG's flow and EEG channels I would think.

.......

If you think outside the box, you realize it is more accurate. The sophisticated in-lab equipment is measuring a patient in the strange sleep lab environment where he is not sleeping like he normally does. It's a one night measurement costing, what, $1700 - 2899?

The PR System is measuring the patient in his own home in his own bed under conditions identical to what he normally will sleep under. The PR System can do many nights of measurement for under $700.

Get those finally tuned results from the sleep lab and without your own monitoring tools at home, you have no idea whether the lab results apply to the at-home setting and often they don't.

That's a very good general argument for any patient having trouble sleeping in the PSG IMHO. In some cases the PSG environment literally alters the very sleep that it proposes to study or measure. I'm one of those patients who sleeps poorly in the lab. Regardless, the technicians managed to nail my 10cm at the titration, despite my repeated wakefulness.

What the techs probably couldn't nail because of my lab-induced wakefulness: my sleep architecture.

What the PSG techs can probably nail MUCH better than this APAP method IMHO: a RERA problem.

I say that because a RERA problem is based in: 1) high resistance that will manifest in any sleep stage unlike many apneas, and 2) heightened susceptibility to arousability itself. Not all high-resistance breathers suffer RERA problems during their sleep. So just how do you accurately distinguish those two patient types with nothing but a single APAP flow-data channel?

-SWS wrote:

rooster wrote:

-SWS wrote:
........Wonder what the RERA event-detection sensitivity and specificity happens to be for a non-EEG assumption like that. Certainly not as accurate as detecting RERAs via PSG's flow and EEG channels I would think.

.......

If you think outside the box, you realize it is more accurate. The sophisticated in-lab equipment is measuring a patient in the strange sleep lab environment where he is not sleeping like he normally does. It's a one night measurement costing, what, $1700 - 2899?

The PR System is measuring the patient in his own home in his own bed under conditions identical to what he normally will sleep under. The PR System can do many nights of measurement for under $700.

Get those finally tuned results from the sleep lab and without your own monitoring tools at home, you have no idea whether the lab results apply to the at-home setting and often they don't.

That's a very good general argument for any patient having trouble sleeping in the PSG IMHO. I'm one of those patients. Regardless, the technicians nailed my 10cm at the titration, despite my wakefulness.

What they probably couldn't nail because of my lab-induced wakefulness: my sleep architecture.

What the PSG can probably nail MUCH better than this APAP IMHO: a RERA problem.

I say that because a RERA problem is based in: 1) high resistance that will manifest in any sleep stage unlike many apneas, and 2) heightened susceptibility to arousability itself. Not all high-resistance breathers suffer RERA problems during their sleep. So just how do you accurately distinguish those two patient types with nothing but a single APAP flow-data channel?

Put them on a good CPAP with software and let them optimize their AHI. Run for six weeks and if they still don't feel good send them home with one of those in-home PSG machines.

10 cm for you after a bad night in the lab? I bet 10 is what they prescribe everyone who has a bad night. I would.

-SWS wrote:What the techs probably couldn't nail because of my lab-induced wakefulness: my sleep architecture.

What the PSG techs can probably nail MUCH better than this APAP method IMHO: a RERA problem.

I say that because a RERA problem is based in: 1) high resistance that will manifest in any sleep stage unlike many apneas, and 2) heightened susceptibility to arousability itself. Not all high-resistance breathers suffer RERA problems during their sleep. So just how do you accurately distinguish those two patient types with nothing but a single APAP flow-data channel?

Most people fit neatly under the bell curve of standard CPAP. For them, this machine will serve all their needs quite brilliantly. As Rooster suggests, a sleep lab can only be so useful with one night's data, and (as you suggest) they can often only make a rough stab at sleep architecture. Machines that can further diagnose potential sleep architecture problems helps cover the rest of us who are outliers on the bell curve. Maybe it's meant to be used as more of an inexpensive indicator for more tests for those outliers. I'm sure the insurance companies are all for that. If a sleep doc has data proving further PSG's or other tests are necessary, insurance can't complain.

Wow, it sounds more like CYA than it does consideration for the cpap user's health...

DreamDiver wrote: ...... Maybe it's meant to be used as more of an inexpensive indicator for more tests for those outliers. I'm sure the insurance companies are all for that. ...

If we had a process that could cheaply and easily screen, diagnose and treat the 95% simple OSA cases and do intensive, repetitive in-lab studies for the other 5%, the total cost would be reduced greatly. Insurance costs would also go down and we could afford the extra work on the 5%.

Forget the conspiracies and work on the basic economics. Gotta keep the 95% from spending two very expensive nights in sleep labs. Save the sleep lab effort for the other 5%.

rooster wrote: Put them on a good CPAP with software and let them optimize their AHI. Run for six weeks ...

Best to screen out all those patients with VCRs that persistently flash 12:00.

rooster wrote: Run for six weeks and if they still don't feel good send them home with one of those in-home PSG machines.

Hmmm.. Perhaps our sentiments about a two-pass approach are not so dissimilar:

Smoking Monkey wrote: Or might it make queuing-theory sense to offload just as many easy-to-diagnose apnea candidates as possible into yet other diagnostic pipe lines---allowing for a PSG "second pass" when/if unresolved symptoms appear after initial treatment?

viewtopic/t44463/viewtopic.php?f=1&t=34 ... 0&#p306250

rooster wrote:10 cm for you after a bad night in the lab? I bet 10 is what they prescribe everyone who has a bad night. I would.

As it turns out, they were gracious enough to stay until mid-morning when I finally managed to hit a REM cycle.

DreamDiver wrote:Maybe it's meant to be used as more of an inexpensive indicator for more tests for those outliers.

I suspect a flow-only method of detecting RERA(rousals) might serve that purpose quite well, DD. Perhaps a similar situation as the 420e detecting central apneas with only a 62% sensitivity rating. Not highly accurate, but an extremely useful indicator.