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95% Rate Has Risen Significantly
#1
Concerned about RERAs I have lifted my minimum pressure by .5 to 11.5 and lowered my Aflex from 2 to 1. The last three nights has seen a big increase in my 95% pressure rating with last night peaking at 16.5. Previously I've hovered around the 11 to 13 mark.

On these nights my RERAs have come in two main clusters which are in the first hour of therapy which is the biggest and the last part of the night in which I've been semi awake. The rest of the night only sees a few RERAs.

I don't feel quite as good in the morning. AHIs have been under 5 but up in the twos and threes compared to much lower.

The temptation is to dial back my minimum pressure and raise the Aflex one notch.

Here is last night. You can see where I woke up. I didn't get much sleep after that.

[Image: 6knA1O.png]
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#2
You really should use the Imgur site to host images. This is far too small to read. https://sleep.tnet.com/reference/tips/imgur
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#3
holden,

As Sleeprider points out, your image is too small to be useful. Can you repost it?

(10-20-2016, 04:57 AM)holden4th Wrote: Concerned about RERAs I have lifted my minimum pressure by .5 to 11.5 and lowered my Aflex from 2 to 1. The last three nights has seen a big increase in my 95% pressure rating with last night peaking at 16.5. Previously I've hovered around the 11 to 13 mark.
Increasing the min pressure often will increase the 95% pressure, particularly if you spend most of the night hovering near the min pressure.

But it sounds like you may have had a larger than expected jump in the 95% pressure level.

Quote:On these nights my RERAs have come in two main clusters which are in the first hour of therapy which is the biggest and the last part of the night in which I've been semi awake. The rest of the night only sees a few RERAs.
Ignore the part of the night when you were semi awake. That's likely sleep-wake-junk (SWJ) breathing: In other words, there can be a lot of normal variation in the breathing when you are semi-awake that the machine mis-scores as sleep apnea related "events". And the machine can and will respond to all that SWJ with pressure increases. The more SWJ "events" there are in a night, the higher the 95% pressure level is likely to be.

Quote:I don't feel quite as good in the morning. AHIs have been under 5 but up in the twos and threes compared to much lower.
I know what you mean here. I've been fighting this a lot myself this fall. Sometimes there's an explanation. Sometimes there's not much of an explanation beyond bad sleep. What I mean by that is all kind of things can temporarily increase the severity of our OSA, but as those things resolve, our treated AHI tends to go back down to where it usually is.

For me, stress is a biggy: When I'm under a lot of stress, I don't sleep well in the first place, as in I have much more trouble getting to sleep and staying asleep. And when I have this kind of trouble, my AHI tends to go up, sometimes drastically, because a lot of my events are sleep transitional. And there's not much I can do about it except to work on the stress that leads to the insomnia.

Other potential causes of a temporary increase in the AHI include nasal allergy season. Head colds and other upper respiratory illnesses can also lead to increased AHIs that resolve over time.

Quote:The temptation is to dial back my minimum pressure and raise the Aflex one notch.
I'd encourage you to go back to your previous settings if your overall sleep felt even slightly better or at least no worse with them.

Quote:Here is last night. You can see where I woke up. I didn't get much sleep after that.
Nope. Can't see a thing. So we can't tell when you woke up. And that means we can't accurately assess the events.


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#4
Imgur was good until they went commercial and I have had troiuble trying to post images with them since.

Is this image better?

[Image: 6knA1O.png]

Based on Robysue's comments I might dial the minimum back down.

Last night was back to normal. I would be interested to see what you make of the RERA clusters.
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#5
The image is a bit better, but still blurry. Try another site like photobucket.

I agree with robysue, ignore the sleep/wake junk toward the morning hours. You may have rolled on to your back at that time. and your pressure didn't jump up until the morning hours.

Don't forget that the 95% pressure doesn't mean you were at that pressure for the whole night. It means you were at and "below" that pressure for 95% of the time.

Dial back your settings to where they were prior, and then make only one change at a time. If you want to adjust the Flex, then make that change and watch for a week. If all goes well, and you feel better, then raise your minimum pressure by .5 until you see a drop in RERAs.


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#6
Your 95% pressure got set during all that SWJ in the morning after 4:00. Most of the night, your pressure is very constant. Since much of that morning session is not real, your actual AHI appears to be very low. If this pattern is typical, I would actually limit max pressure to 14. It's not doing you any good at 17 when it is responding to SWJ events anyway, and it might even be a source of disruption.

Did I mention it? Nice graphs! Works a lot better and is big enough to read.
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#7
[Image: DXIlWD.png]

This was last night. My minimum setting of 11.5 basically flatlined. Do I need to drop it down? Will that reduce the RERAs? Still looking for that sweet spot but feel that I might be getting closer.
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#8
I was never able to address RERA with CPAP, and quickly migrated to an auto bipap which resolved it. Your OA is essentially zero if we discount the crap just before you end in the morning, same with hypopnea. You have room to allow lower pressure, and really anything over 14.0 is not doing much good. If you want to get after the RERA, you will have to zoom in on the wave form and see if there are any consistent patterns when that occurs, but with a CPAP, I don't know what you can really do about it, since it is pressure support that we usually use to deal with it.

I used to feel a RERA over 1.0 and suspect you're feeling the effects of it being over 2. Whatever you decide to do in adjustments, you should take it slowly as RERA is kind of transient and can take a few days to respond to any change.
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#9
After responding here, I noticed Robysue had posted in another thread about pressure support on a Respironics BiPAP. http://www.apneaboard.com/forums/Thread-...t-function It is as good a discussion that relates to your RERA as I can think of. My original bilevel machine was a PRS1 60 series auto bipap, and the variable PS was very helpful. With the Resmed Aircurve, I get fixed PS and have to limit it to 3 to avoid getting CA; also I have lost the ability to have RERA data even reported. I'm pretty sure it's under control because I feel fine, but I do miss this aspect of the Philips machine.
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#10
I understood quite a lot of what Robysue wrote but not all of it. As it applies to BiPAP machines it won't work for me anyway but gives an interesting insight into what might be happening.

I am wondering what might be triggering RERAs and whether with APAP I can still deal with it or do I need to take that big expensive step up to BiPAP. The thing that concerns me is that I have had some great nights sleep with my APAP but not recently. I also notice that I have periodic breathing at times and wonder what causes this to happen.

I'm also hoping that Robysue reads this post and can add to what you've already posted. I appreciate your feedback feedback and how it's adding to my understanding of my condition.
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