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Great AHI....for somewone else
#1
Had a repironics machine returned to our loan closet, so read out the data on sleepyhead, before deleting data.  I wish I had those AHI numbers, with few exceptions AHI were less than 1.0 and exceptions touched near 2.  Here was a typical

   

Ironically, user said this was no help and felt worst than before.  So Unless I misinterpret/mis-understand this data I think she had good numbers.
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#2
I think the high RERA may be causing her to fail to achieve stage 3/4 and/or Rem sleep. OR she could have something totally unrelated going on.
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#3
In my view, and perhaps others, the 10 second cutoff to make something an apnea is a bit arbitrary. Why not 11 seconds? Why not 9? So, something that is a sleep arousal that doesn't last at least 10 seconds could be considered a RERA. She had lots and lots of those. I suspect that failure to get the RERAs under control (which by definition are arousals from sleep) likely compromised her therapy.

J Bras Pneumol. 2010 Jun;36 Suppl 2:19-22.
[Diagnostic criteria and treatment for sleep-disordered breathing: RERA].
[Article in Portuguese]
Palombini Lde O1.
Author information
Abstract
In polysomnography, RERA is defined as a respiratory parameter that indicates an arousal associated with a respiratory event and an increase in respiratory effort. Initially, RERA was described by means of esophageal manometry for the evaluation of respiratory effort. This greater respiratory effort occurs as a response to an increase in upper airway resistance, which is a factor present in the pathophysiology of sleep-disordered breathing, such as obstructive sleep apnea syndrome and upper airway resistance syndrome. Later, the use of a nasal pressure cannula was reported to be a reliable means of identifying airflow limitation and one that is more sensitive than is a thermistor. In addition, the nasal pressure cannula method has been used as a surrogate for esophageal manometry in the identification of periods in which upper airway resistance increases. Consequently, the American Academy of Sleep Medicine recommend the use of either method for the identification of RERA, which is defined by the flattening of the inspiratory curve, characteristic of airflow limitation. Although RERA has been identified and evaluated in current medical practice, it has yet to be standardized. Therefore, it is recommended that polysomnographic reports indicate which abnormal respiratory events were taken into consideration in the evaluation of the severity of sleep-disordered breathing.

https://www.ncbi.nlm.nih.gov/pubmed/20944976
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. 
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#4
So proves AHI ain't all its cracked up to be.  That is, you can have great numbers but still fall down elsewhere.
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#5
(05-28-2017, 02:38 PM)CPAPreturnee Wrote: So proves AHI ain't all its cracked up to be.  That is, you can have great numbers but still fall down elsewhere.


Exactly!  That's why we advise not to chase AHI numbers.  You have to look at all the events.  
You may have a low AHI, but feel exhausted the next day.

Rera's aren't added to the AHI, but they are arousals, and disrupt your sleep.  (I like to call them baby apneas). You may not remember the sleep disruption,  but it happens.  

If you add the (rera's) to her AHI, that would be her real number to watch, the RDI. You can track RDI in SleepyHead instead of AHI.
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#6
This is very educational! Thank you for this thread.
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#7
(05-28-2017, 03:40 PM)OpalRose Wrote:
(05-28-2017, 02:38 PM)CPAPreturnee Wrote: So proves AHI ain't all its cracked up to be.  That is, you can have great numbers but still fall down elsewhere.


Exactly!  That's why we advise not to chase AHI numbers.  You have to look at all the events.  
You may have a low AHI, but feel exhausted the next day.

Rera's aren't added to the AHI, but they are arousals, and disrupt your sleep.  (I like to call them baby apneas). You may not remember the sleep disruption,  but it happens.  

If you add the (rera's) to her AHI, that would be her real number to watch, the RDI. You can track
RDI in SleepyHead instead of AHI.

Thanks like
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#8
...and I thought my RERAs were bad. Actually, since moving to BiPAP, they have come down though I do have the odd night where they go back up. I feel much more rested and any fatigue I attribute to a hard term in front of the chalk face - only three weeks to go until the school holidays.
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#9
(05-28-2017, 02:30 PM)sonicboom Wrote: In my view, and perhaps others, the 10 second cutoff to make something an apnea is a bit arbitrary.  Why not 11 seconds?  Why not 9?  So, something that is a sleep arousal that doesn't last at least 10 seconds could be considered a RERA.

Many many RERAs that my machine scores are not even close to a halt in breathing, and they occur on my chart where "flattening of inspiration curve" is present (example below). An average night, I have several RERAs and they span multiple breaths, generally 25 to 55 seconds long.

This example catches a RERA event right after a hypopnea.  In this case, the RERA can be thought of as a slowly progressing hypopnea, so slow that it does not meet the criteria set for detection of a hypopnea.  If you see enough of the charts, you can home in on how disruptive the events are based on how much recovery breathing occurs.  In this example you see I have more and deeper recovery breaths after the RERA than after the H.

example:

[Image: qwgZfvY.png]



If you want to, you can use a User Defined flag and set any parameter.  That would allow you to count separately those halts in breathing for any amount of time, say 4 seconds.  And the software will faithfully count all those up, and display them.  If you do, you are likely to get multiple counts for the same prolonged sleep transition or disturbance, such as in the chart below.  I have set a user flag F08 for 65% flow reduction for over 8 seconds, I got 4 hits in the same transition, probably shifting my position upon arousal from REM and then going back to sleep.

[Image: A4caD1c.png]



Best regards,

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#10
One more, to show RERA is something that does affect some people:

(YELLOW in the top RDI panel)

[Image: GAfGXKp.png]

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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