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I have not noticed any real difference in well being between nights with 0.2 RERA and 3.0 RERA, but I would say there is likely a limit to how high it can get before waking episodes are detrimental to the sleep experience.

Certainly, I would think it would be disruptive at the 10.0 and above level.

I am not sure there is a medical consequence of RERA being very high, unless it is stress induced Insulin Resistance leading to Diabetic conditions. Of course, there are significant impacts to excessive daytime sleepiness. While not medical, comatose driving leading up to an accident is obviously the most morbid circumstance.

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(04-21-2015, 03:51 PM)eviltim Wrote: Do note that the machine is not 100% accurate at classifying apneas and can assign normal obstructive apneas as central events and so on.

I find this very interesting. It also has not been my understanding, so maybe I need to know more.

Here is what actually is my understanding, which certainly may be flawed;

An xPAP can tell the difference between a CA and a OA by using a FOT pulse which lets it know if the airway is open. Open = CA, closed = OA. A hypop is also pretty easy to identify, and it does this by comparing the respiration cycle from each breath to the two breaths before and the two breaths after; if the breath in question meets a requirement of being shallow to a particular degree, in comparison to those four breaths, it flags that as a hypop.

The xPAP has a very solid and accurate continuous feedback loop that by measuring back pressure over time can graph exactly what your respiratory cycle looks like, and whether there are anomalies there. All three event types summarized in AHI are very different from each other, so I would find it surprising to say the least that it could somehow mix them up.

So maybe you could explain that for us. Maybe I am missing something here.

False positives, yes, especially while awake, and especially CAs while changing sleeping positions, etc. Those are very common.

But I am skeptical that the xPAP algorithm would have any difficulty at all distinguishing these types of very different events apart from each other.
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(04-21-2015, 12:23 PM)Terry Wrote: The biggest thing I noticed is that your machine is set for an upper limit of 10cm, and it seems to spend a lot of time there, and is unable to fix all your hypopneas. These will make you feel like crap.

You might want to see about raising your upper limit a couple of CM and see if that makes you feel better. If it does, you could also bump up the lower limit a little so the pressure doesn't spend all night flying up and down, which can also disturb your sleep.

I agree. And I consider this good advice.

But no APAP can "fix hypopneas"; hypops are, once again, flagged by comparison to surrounding breaths, meaning that by the time the determination is made that a shallow breath qualifies as shallow enough to be flagged a hypop, that event happened two or three breaths ago. Without a time machine, nothing can go back and "fix" that hypopnea, or any other successive hypopnea. The APAP will not even recognize a hypop until after it has passed. All it can do is report that it happened; reporting that it happened does not imply that the APAP could do anything about it or "fix" it.

An APAP can raise pressure in the face of OA or FL or snores, and this can help prevent successive OA events, but a hypop typically happens with an open airway, and is completely dependent on how deep your respiration is, and is not dependent on how "open" the airway is. A hypop is a different sort of problem; the APAP is a specific tool designed only to keep the airway open and therefore is not really effective against hypops. It can not force a breath on you.

Pressure increases do not effectively stimulate respiration response, so an APAP can't prevent successive hypops either, although higher pressure may have a minor secondary positive effect on 02 desat. But generally speaking, the only thing that an APAP can do is splint the airway open to prevent a greater percentage of OA events, and then raise pressure to prevent successive OA events once a predictive event occurs.

One would probably need a different type of machine such as a ventilator if their AHI makeup had a lot of (actual and not false positive) CAs and/or hypops. APAP is just not that effective on much other than OA events, although keeping the airway splinted open (which is all an APAP does) may have a secondary positive effect of minimizing other types of events simply by lowering the occurrence of OA events.

Furthermore, whether your APAP prevents or even fixes events has no direct correlation to how you feel, because you can have severe apnea for decades and feel just fine, and then get 100%-effective xPAP treatment and not feel any "finer". "These will make you feel like crap" is an over-generalized assumption that may or may not be accurate, depending.

There is indeed a direct correlation between a lower AHI and how healthy your sleep is, which is the exact point of xPAP therapy in the first place. But this may or may not have anything at all to do with how you feel. This is why SA is such a sinister malady; you may, again, for decades, have no symptoms or clues that tell you that you have it, until you start digging and see a doctor who will also start digging. Unfortunately, no one starts digging until they have a reason to, which may be too late, and is why 11 million SA sufferers in the US alone don't seek treatment.
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