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RERAs - first time poster
#1
Hello. New to forum but have read up a little. I am a military pilot and was diagnosed with sleep apnea about a year ago. In summary, I am a male, late 30s, 180 lbs, 6'0" tall, otherwise generally good health. I was having a period of rough sleep and tiredness and once I mentioned snoring, my flight doc referred me out for a sleep study. I knew the potential of the negative implications this may have on my civilian FAA medical clearance and career flying. After discussing with my wife I came to the conclusion that if sleep apnea really was the issue, it would be better to know. With that said, I was diagnosed with "Mild to Moderate Obstructive Sleep Apnea" There were actually no apneas but they recorded 202 "RERAs" during 369 minutes of sleep. After that I was given a Resmed S9 machine (later I would learn I was given a "brick" and not the one that would do the most good), instructions for use and little more.

I have been using the CPAP machine now but only about 50% of the time. I am still having adjustment issues and looking to try out some different style masks/ nasal pillows and machines. I am currently using a nasal mask but looking at the Philips Respironics Dreamwear and a Resmed Airsense 10 autoset and possibly the Airsense 10 autoset for her (for the RERA algorithm). If I switch to the Airsense 10 it will have to be out of my own pocket sense insurance paid for the 1st machine.

Although I do not mind continuing to experiment and trying to adjust to sleeping with the CPAP if really needed, I still have some cynicism about the initial diagnosis. My profile is not that of a typical person with sleep apnea and no actual "Apnea and Hypopnea Arousals" were recorded, just 202 RERAs. Are RERAs just snores? If so, is it actually worth wearing a mask to resolve (health wise, not spouse wise : )) It sometimes seams that the whole system is somewhat of a monetary racket and many people/business have a huge financial incentive on diagnosing people with sleep apnea.

My questions to you folks who are more experienced with this topic than I are four fold:

1. How common / abnormal are 202 RERAs in a sleep session?

2. Are RERAs more than mere snores?

3. After looking at my sleep study reports (see my personal webpage listed in my profile) would you agree with the initial assessment of sleep apnea?

4. Any advice in general?

I tried to attach the studies and link them directly but the forum would not let me due to attachment size and the fact that I have not posted previously. Thank you for your time and advice in advance.

-JJ

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#2
RERA can be helped with common CPAP, but it would be better if you had a machine that actually recorded them, so you could fine-tune. RERA (respiratory event related arousals) are generally obstructive events that do not progress to full apnea, but do reduce your intake of oxygen. Since they disturb your sleep, even though you may not be aware, they are important to control for daytime alertness.

If you have the resources to buy a new or used machine, there are several that actually collect data and report your RERA:
Philips Respironics 60 Series Auto
Philips Respironics Dreamstation Auto
Philips Respironics BiPAP Auto
Resmed Airsense 10 Autoset

Try to get one of these machines. The Resmed and PR BiPAP have more inhale/exhale pressure differential (pressure support) which is more effective in treating RERA. Chances are your RERA is much improved with your S9 brick, but given your occupation, you should have feedback that lets you be in control.
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#3
Your sleep study said 30+ RERAs per hour. That is a lot. It could be either that you have UARS or it's a start to the process which may lead to a diagnosis of OSAHS later.

This is what our body does: once you have stopped getting in enough air due to airway closing (completely or partially), the body can
EITHER cause a RERA to knock you out of a deeper sleep stage to a shallower one.
OR let your oxygen saturation go down and then do a partial wake up to restart breathing. This is typically reported as a Apnea event.

Currently, your body is in good shape so the body can trigger RERAs and get by. Over time, it may delay that effort and will start showing as AHI.

And in any case RERAs mess up your sleep architecture and it has effects on things like memory, executive function and other cognitive abilities. It will be good to start tracking the RERA number and fixing them.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#4
Hi JJ7801,
WELCOME! to the forum.!
Hang in there for more responses to your post.
Good luck to you on your CPAP journey.
trish6hundred
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#5
Hi JJ and welcome to the Apnea Board!

That is a LOT of RERAs. I would be a wreck the next day. You are not getting deep, restorative sleep like that. As others have indicated, these are are a real problem in terms of preventing restful sleep and are likely a precursor to hypopneas and then apneas later in your life. I was diagnosed with hypopneas and chose to mostly ignore it. What? Me have a real problem? Six years later it had progressed to full blown obstructive apnea. Trust me, you do not want that.

So, yes, I would agree that you have a medical problem that justifies treatment. And I will also agree that many of the companies supplying the CPAP machine seem more interested in profits than patients. That does not mean your problem is not real.

As for advice, use this forum to learn as much as you can and find a way to get used to CPAP. We are here to support and help you. You need to use it all the time for it to be fully effective. If you can learn to be a military pilot, you can do this easily.
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#6
Thanks all for your responses and PMs. I am currently in the mode of continued research and visiting a new sleep doc (moved to new town) and will update all with any new info I find out.

-JJ
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#7
my recommendation is to see a sleep doc and get them to prescribe a bilevel. it is more effective for your condition and you are currently failing to get adequate therapy due to inability to adjust. Then make sure you get an auto bilevel. voila - better therapy, + data! Would possibly require a new sleep study to titrate for bilevel and confirm a greater efficacy - but more and more not so much as the sleep study cost more than just giving you a bilevel. YMMV.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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