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Lot of RERA; waking during night
#1
Lot of RERA; waking during night
I often have one or more clusters of RERAs and I wake up during the night. Are there settings I should change?  I am using a cervical collar and a nasal mask with mouth taping (better AHI and comfort than full face mask).

(1) Sept 1
   
(2) Sept 5
   
(3) Sept 5 normal part
   
(4) Sept 5 RERA part
   
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#2
RE: Lot of RERA; waking during night
obviously your ahi is great. that doesn't include rera however. this may be one of those it depends on how you feel situations. your remaining problem appears to be upper airway resistance (uars) seen in near constant flow limitations and the rera. I've yet to figure out how to deal with this other than wearing the c-collar and higher min pressure. your machine is also bumping up against your current max chasing after those rera. it's possible the pressure is producing the rera or the pressure is too low to resolve them. you could open up the top end (max pressure) to see where it wants to go.
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#3
RE: Lot of RERA; waking during night
I didn't realise that Resmed series 10 machines recorded RERAs. I've got the Aircurve VAuto and haven't seen it. Do I have to enable it in Sleepyhead?

EDIT: It appears in the Events section of SH in preferences but not in the Events flags graph. Do I have to add it and if so how do I do it.
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#4
RE: Lot of RERA; waking during night
(09-07-2018, 04:36 AM)holden4th Wrote: I didn't realise that Resmed series 10 machines recorded RERAs. I've got the Aircurve VAuto and haven't seen it. Do I have to enable it in Sleepyhead?

EDIT: It appears in the Events section of SH in preferences but not in the Events flags graph. Do I have to add it and if so how do I do it.

The VAUTO doesn't have RERA events. Only the later Air Sense 10's have it and all for her models have it.
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#5
RE: Lot of RERA; waking during night
(09-06-2018, 09:52 AM)Linnea Wrote: I often have one or more clusters of RERAs and I wake up during the night. Are there settings I should change?  I am using a cervical collar and a nasal mask with mouth taping (better AHI and comfort than full face mask).

(1) Sept 1

(2) Sept 5

(3) Sept 5 normal part

(4) Sept 5 RERA part

The flow limitations are triggering the RERA's. Increasing the minimum pressure is about the only way to try and reduce them on the Air Sense 10. If you had a VAUTO than you could increase the pressure support which usually is the better option.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#6
RE: Lot of RERA; waking during night
I agree with Wala. You are already using EPR at 3 which helps with the flow limitations, but as you can see, there are times when flow limits kick in and raise the pressure on your machine. I'm actually not sure the increased pressure helps at all. The RERA are actually recovery breathing and likely arousal from the flow limitations. The flow limitations do not seem to go away with higher pressure and it might be just as good to limit the maximum pressure to around 13. You seem to do well at 12/9 cm most of the night, but when the flow limits kick in the pressure rises and you are arousing anyway. My best guess is the cervical collar is slipping.
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#7
RE: Lot of RERA; waking during night
I have no help from MDs or DMEs and have depended totally on this board for help. THANK YOU. Here is a quick summary of my results:

The suggestions I received and followed were:

  1. Wear a cervical collar to take care of the clusters of apneas
  2. Change from DreamStation to ResMed Autosense 10
  3. Narrow the pressure range from where it was set at 5-20 to 10-13
Here are the results:
  • Home study AHI 45
  • Received Dreamstation = AHI ranged from about 8-17. Felt euphoric - not sleepy.
  • Cervical collar - AHI went down to 4-5. Felt even better.
  • Changed to Resmed and narrowed range - AHI usually under 1  (narrowed range very slowly to avoid chipmunk cheeks)
Here are the SleepyHead charts:

First few nights with DreamStation:
   

After cervical collar:
   

After ResMed AirSense and narrowing range:
   

One question: Here is a closeup of a good sleep area. Is this normal breathing? It isn't the nice round graph in your illustrations.
   

I encourage all of you to contribute to this board. It has been invaluable to me and many others.
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#8
RE: Lot of RERA; waking during night
It doesn't get much better than that. Congrats on the excellent results, and sticking with it to solve the problems. You don't need to match the examples of flow rates we post, this is well within what we look for in all aspects...rate, volume, ratio, shape etc.
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#9
RE: Lot of RERA; waking during night
Thank you so much for all your help. This has been a life-changing process.
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#10
RE: Lot of RERA; waking during night
In my personal battle with RERA, reducing EPR from 3 to 2 helped. Bumping up pressure a little bit at a time is what eliminated them. So, I would bump up .2 and leave it there for 4 days. Then bump up another .2.
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