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Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
#1
Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Hello all - I was using a Resmed S9 for my first 2 years plus. Did not know about Sleepyhead then and didn't need to as all was grand - slept well and felt good after several weeks of usage (After Sleepyhead I found that I had about 400 days of usage with AHI 0.23). Then one night I woke up to a storm blowing in my head. My S9 wa set min pressure 4 / max pressure 16. I found my mouth open and dry. So I started taping. I was starting to feel sleepy in the day so I my friend loaned me his back up Respironics System 1 RemStar Pro because I was thinking the S9 had malfunctioned. 

I stated to get back into a rhythm and was no longer mouth breathing. But I wasn't feeling the same results as I did with the S9. Good but not great.

Then I discovered Sleepyhead and found out that with the Respironics System 1, AHI's averaged 0.9 at 8.5 95% pressure - but what I also found was that I had an RERA index of 3.5 with the System 1 set at min 4 / max 16. I was averaging around 24 RERA events a night and waking often.  I have not been able to find the S9 RERA index from 2015 in Sleepyhead).


Now I am using a Resmed  Airsense 10 set at 6 min / max 16. Have had it about a week. My RERA index is 0.8 but my 95% pressure is 15.58. I find it uncomfortable.

The Respironics System 1 machine kept me at a comfortable 8.5 95% pressure - but with RERA index of 3.5 (20-28 events a night). AHI 0.73.

The Resmed Airsense 10 machine kept me a 15.58 95% pressure with much lower ERA index  of 0.8 (5 events a night). AHI 1.4.

I have not had the Airsense very long but I think I am waking less. I do know that the pressure has woken me up. And my mouth was a bit dry. So maybe mouth breathing as a result of the pressure??? It feels as if I am going to have the same experience I had with the S9 (high pressure resulting in mouth breathing - which made me think the S9 was malfunctioning - but after my new experience with the Airsense 10 maybe the S9 was not malfunctioning at all.


The Respironics System 1 machine wakes me from a much higher amount of RERA events.

I am feeling the the Airsense 10 wakes me from much higher pressure - but it seems as if less often.

(Note - Last night I lowered the max pressure to 11.4 and raised min pressure to 6 - and the AHI went up from 0.73 to 1.54 - The RERA index went up from 0.8 to 1.14 ).

I found that as a compromise.

I guess the question is if it's better to be woken by too much pressure which from past experience will lead to mouth breathing, or being woken by hi RERA events? At this moment I'm thinking the compromise Max pressure setting of 11.4 may be best.

Any insight or suggestions are appreciated.

Thanks!

Phil
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#2
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
I would look at your Flow Limitation. Resmed's will increase pressure if it detects flow limitations. My S9 will always go to .2 cm below the maximum set pressure if I don't use the EPR feature. . . But that's just me.
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#3
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
It would be really helpful if you posted a SleepyHead daily detail screen shot. The link in my signature will help you optimize it so you get the most important detail on the screen before you do the F12 screen capture. 

About the only comment I could make with the detail you gave is that if you think the maximum pressure is what is waking you up, and you are using EPR you could set the EPR to act only during the ramp period. It should lower your maximum mask pressures. But, it will make it a bit harder to exhale. Trying it is about the only way to see if it helps or not.
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#4
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Thank you Crimson and thank you Ron.

I am not using the ramp feature.

My EPR is set to 2. I'll disable it.

yesterdayI forgot to put the card back in the machine so I will post tonight's (Wednesday) results in the morning (Thursday).
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#5
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Just a note. Turning off the EPR on the AirSense doesn't reduce the Maximum pressure if flow limitations are driving the pressure up. Capping the maximum pressure is the only way to reduce it as Crimson Nape pointed out.
[url=https://To download ----> CLICK HERE ./]Download SleepyHead[/url]
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Beginner's Guide to SleepyHead
Mask Primer
5
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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: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Phil, as Ron said, posting some #Sleephead results would be a great help. Meanwhile, if you find the pressure at 16 disruptive, the reduce the maximum pressure to a tolerable level like 12.0. It's possible that the machine is increasing pressure due to flow limitations that could be meaningless for apena events. It is programmed to do that and some people just need to restrict the maximum pressure, and can do so with no significant increase in events. I have even coached some users to lower pressures and they achieved better results. Give it a try. Comfort is one of the main objectives of the therapy.
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#7
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Thank you Sleeprider- tonight I am going to adjust the max to 12 and the min to 8 and the EPR to 1. And use that for a couple of nights and go from there. Sounds good?
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#8
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
(04-25-2018, 04:07 PM)Walla Walla Wrote: Just a note. Turning off the EPR on the AirSense doesn't reduce the Maximum pressure if flow limitations are driving the pressure up. Capping the maximum pressure is the only way to reduce it as Crimson Nape pointed out.

Sorry, but I can't agree. It is the EPAP pressure that addresses obstructive apnea and flow limitations. Turning off EPR reduces IPAP, not EPAP. The pressures are going up because the EPAP is not high enough.
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#9
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
Ron, You said maximum pressure not IPAP. They're two different things.

Also we don't know what's driving the pressure up without the charts to look at. It could be apneas. It also could be flow limitations or Snoring.
[url=https://To download ----> CLICK HERE ./]Download SleepyHead[/url]
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
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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#10
RE: Lower 95% pressure higher RERA index. Higher pressure lower RERA index.
(04-25-2018, 08:47 PM)Walla Walla Wrote: Ron, You said maximum pressure not IPAP. They're two different things.

Also we don't know what's driving the pressure up without the charts to look at. It could be apneas. It also could be flow limitations or Snoring.

I was talking about maximum mask pressure. That is an actual maximum pressure, not a maximum pressure limit you put in the machine. I was also referring to actual maximum IPAP pressure. A pressure limit is just that a limit. You may or may not be at the limit. I think that is a point that some people are confused by. They think when they set a maximum pressure limit they are setting a pressure. They are not. The machine responds to events and measurements and sets the pressure. The machine may or may not ever be limited by the limit pressure.
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