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Hypopneas, centrals, obstructive apneas, and rera's
#1
Hi,

I just have a few question about different types of SBD.


Can someone please explain to me the difference between all of these? Also, are having residual rera's during cpap treatment bad? Reason I'm asking is because I was looking over my study's and noticed an increase in rera's during the titration study from the original one.

One other thing I noticed was a lot of hypopnea's as opposed to actual obstructive apneas. To me it looked like I had 1 or 2 obstructive apneas, 1 central, and about 50 hypopneas. How were they able to determine an AHI of 10.5 based on that?

Does CPAP treat hypopneas and RERA'S? Why would I still have residual RERA's? Does that mean the pressure needs to be adjusted?

I'm just trying to get an understanding as to what all of this means. I am unable to track my therapy data because my machine is very limited and only provides leak rate, mask seal, and AHI.

Thanks
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#2
AI = (# of obstructive apneas + # of central apneas)/sleep time in hours
AHI = (# of apneas + # of hypopneas)/sleep time in hours
RDI = (# of apneas + # of hypopneas + # of RERAs)/sleep time in hours

AHI is the average number of apneas and hypopneas per hour.

The Wiki (linked at the top of the page) has a lot of good info.
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#3
I'm still a newbie myself, but they don't always titrate to the point of complete elimination of events. Very often, these extra events disappear over time due to therapy improving your situation.

My RDI had been 36 (lots of RERAs) and using a machine, I have not had more than 6 RERAs in any night using either straight or auto pressure. Many nights, fewer than 6 and none at all. So yes, the machine does handle them. My hypopneas go the same way - way down, but not completely eliminated. All of my events are much shorter on auto pressure than they were on straight pressure as well.

I've had my replacement Airsense for Her for a week and it is set at 8-12 and it is no longer topping out at 12, so I think things are doing better. 80% of the night, my pressure is below 9, which is great! I'm still trying masks. Last night was the Sleepweaver Elan and that seemed to go very well except that I stupidly forgot to put my SD card in, so I doubt the flow chart info is there. Oh well.
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#4
(07-30-2015, 05:15 AM)mzdawn74 Wrote: Does CPAP treat hypopneas and RERA'S? Why would I still have residual RERA's? Does that mean the pressure needs to be adjusted?

Yes. It usually it means your pressure is a little low.

I get these when my allergies are in bloom, because it's harder to get air through my nose.

Terry

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#5
The forum Wiki includes definitions of these acronyms and some explanations that might be useful. http://www.apneaboard.com/wiki/index.php..._%28SAI%29

The Resmed machines have not scored RERA events, except the Autoset For Her model. Recently all Autoset models measure RERA.

Quote:There may be respiratory events during sleep that generate "spontaneous" arousals. like snores or flow limitations. Indeed, the whole Upper Airway Resistance Syndrome is based on the presence of a large number of spontaneous arousals without the presence of scorable respiratory events such as hypopneas or apneas. These are RERAs (Respiratory Effort-Related Arousals). If you take this number, RERA, and add it to the AHI, you have the Respiratory Disturbance Index (RDI). There are numerous factors that could create a scenario for the appearance of a large number of truly spontaneous arousals, such as medications that deter sleep (pseudoephedrine, caffeine, some antidepressants, too much thyroid medication, etc.), depression and narcolepsy.

You can certainly find more information on RERA and UARS, by searching the subject online. These issues might be important to you as you seem to have very low apnea incidence, but relatively high Hypopnea and, based on your most recent study, RERA and possibly UARS have to be suspected. Here is an excerpt from one online resource. It might sound familiar:

Quote:Unlike sleep apnea where you have obstruction, apnea, then arousal, UARS patients typically have mostly obstructions and then arousals. As mentioned previously, all UARS patients have some form of fatigue, almost all state that they are “light sleepers,” and almost invariably, they don’t like to sleep on their backs. In some cases, they actually can’t. Some people attribute their poor quality sleep to insomnia, stress or working too much. Due to repetitive arousals at night, especially during the deeper levels of sleep, one is unable to get the required deep, restorative sleep that one needs to feel refreshed in the morning. In most cases, the anatomic reason for this collapse is the tongue. There are many reasons for the tongue to cause obstruction including being too large or being overweight. But once it occurs, the only thing you can do is to wake up.
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#6
(07-30-2015, 05:48 AM)iSnore Wrote: AI = (# of obstructive apneas + # of central apneas)/sleep time in hours
AHI = (# of apneas + # of hypopneas)/sleep time in hours
RDI = (# of apneas + # of hypopneas + # of RERAs)/sleep time in hours

AHI is the average number of apneas and hypopneas per hour.

The Wiki (linked at the top of the page) has a lot of good info.

Thanks for the info.
(07-30-2015, 08:45 AM)Mosquitobait Wrote: I'm still a newbie myself, but they don't always titrate to the point of complete elimination of events. Very often, these extra events disappear over time due to therapy improving your situation.

My RDI had been 36 (lots of RERAs) and using a machine, I have not had more than 6 RERAs in any night using either straight or auto pressure. Many nights, fewer than 6 and none at all. So yes, the machine does handle them. My hypopneas go the same way - way down, but not completely eliminated. All of my events are much shorter on auto pressure than they were on straight pressure as well.

I've had my replacement Airsense for Her for a week and it is set at 8-12 and it is no longer topping out at 12, so I think things are doing better. 80% of the night, my pressure is below 9, which is great! I'm still trying masks. Last night was the Sleepweaver Elan and that seemed to go very well except that I stupidly forgot to put my SD card in, so I doubt the flow chart info is there. Oh well.

Thanks and good luck with your treatment!
(07-30-2015, 09:30 AM)Terry Wrote:
(07-30-2015, 05:15 AM)mzdawn74 Wrote: Does CPAP treat hypopneas and RERA'S? Why would I still have residual RERA's? Does that mean the pressure needs to be adjusted?

Yes. It usually it means your pressure is a little low.

I get these when my allergies are in bloom, because it's harder to get air through my nose.

Terry

Thanks.
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#7
(07-30-2015, 09:45 AM)Sleeprider Wrote: The forum Wiki includes definitions of these acronyms and some explanations that might be useful. http://www.apneaboard.com/wiki/index.php..._%28SAI%29

The Resmed machines have not scored RERA events, except the Autoset For Her model. Recently all Autoset models measure RERA.

Quote:There may be respiratory events during sleep that generate "spontaneous" arousals. like snores or flow limitations. Indeed, the whole Upper Airway Resistance Syndrome is based on the presence of a large number of spontaneous arousals without the presence of scorable respiratory events such as hypopneas or apneas. These are RERAs (Respiratory Effort-Related Arousals). If you take this number, RERA, and add it to the AHI, you have the Respiratory Disturbance Index (RDI). There are numerous factors that could create a scenario for the appearance of a large number of truly spontaneous arousals, such as medications that deter sleep (pseudoephedrine, caffeine, some antidepressants, too much thyroid medication, etc.), depression and narcolepsy.

You can certainly find more information on RERA and UARS, by searching the subject online. These issues might be important to you as you seem to have very low apnea incidence, but relatively high Hypopnea and, based on your most recent study, RERA and possibly UARS have to be suspected. Here is an excerpt from one online resource. It might sound familiar:

Quote:Unlike sleep apnea where you have obstruction, apnea, then arousal, UARS patients typically have mostly obstructions and then arousals. As mentioned previously, all UARS patients have some form of fatigue, almost all state that they are “light sleepers,” and almost invariably, they don’t like to sleep on their backs. In some cases, they actually can’t. Some people attribute their poor quality sleep to insomnia, stress or working too much. Due to repetitive arousals at night, especially during the deeper levels of sleep, one is unable to get the required deep, restorative sleep that one needs to feel refreshed in the morning. In most cases, the anatomic reason for this collapse is the tongue. There are many reasons for the tongue to cause obstruction including being too large or being overweight. But once it occurs, the only thing you can do is to wake up.

Does CPAP treat UARS? Or is there another treatment method?
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#8
PAP therapy seems to work pretty good for most on RERA. Most titration studies attempt to first control OA, then H then RERA. It's part of most titration protocols, and can be addressed with CPAP or bilevel machines.
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