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Reras and Dreamstation v Airsense10
#1
Hi guys

A question for everyone which I'm struggling with. My sleep study showed an AHI of 9.5 with frequent RERAs for an RDI of 21. I currently use the Airsense 10 which does not track RERAs (not my model anyway).

My AHI with the Resmed varies around 1 to 1.5.

I have read that the DS tracks RERAs and also responds to RERAs. Given my overall RDI of 21 and that from what I hear a RERA is an actual awakening, would the Dreamstation be a better bet for treatment of RERAs specifically. Apnoeas and hypopnoeas are well under control with a low AHI but I have read that the PR algorithm in the DS is programmed to respond well to RERAs. In any event, at least with the tracking in the DS, I can at least get some indication in Sleepyhead about how well the RERAs and hence overall RDI is being treated.

Any thoughts would be welcome.
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#2
The AirSense for Her is also programmed to detect and manage RERAs.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#3
(12-10-2016, 04:46 AM)marcus10 Wrote: Hi guys

A question for everyone which I'm struggling with. My sleep study showed an AHI of 9.5 with frequent RERAs for an RDI of 21. I currently use the Airsense 10 which does not track RERAs (not my model anyway).

My AHI with the Resmed varies around 1 to 1.5.

I have read that the DS tracks RERAs and also responds to RERAs. Given my overall RDI of 21 and that from what I hear a RERA is an actual awakening, would the Dreamstation be a better bet for treatment of RERAs specifically. Apnoeas and hypopnoeas are well under control with a low AHI but I have read that the PR algorithm in the DS is programmed to respond well to RERAs. In any event, at least with the tracking in the DS, I can at least get some indication in Sleepyhead about how well the RERAs and hence overall RDI is being treated.

Any thoughts would be welcome.

I am new to CPAP so can't advise on which machine would be better. But my DreamStaton is working well to reduce my RERAs. I started flagging 50% flow reduction events lasting less than 8 seconds and worked to reduce those. Then I started seeing great results with both my AHI and RERA index. That might be a backwards way to go at it, but it's working!
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#4
Later models of the Airsense 10 Autoset are capable of detecting RERA. My Aircurve 10 Vauto also does NOT detect or report these. The accuracy of reporting RERA is not well documented, and even with PSG, the detection of RERA involves a somewhat invasive sensor to detect esophageal pressures, so I think many professionals would question whether the reported RERA from a CPAP machine is valid, and neither Resmed nor Respironics is documenting their technique. Anyway, I found the RERA reporting useful on both my PRS1 60 series auto and the PRS1 BiPAP auto. I found that bilevel therapy resulted in lower RERA than the auto. This makes me think that the EPR on newer Airsense 10 autoset machines might be better than the A-Flex of a Respironics. There is no way to confirm that unless someone has used the two side by side for the purpose of reducing RERA.Dont-know
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#5
Both Dreamstation and Airsense treat and report RERAs. If RERA reporting is not showing up, then you need to look at your settings within Sleephead. The majority of my RERAs were treated by simply having the lowest setting on 8. I can often go a week without seeing a RERA on the report.
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#6
May just be a difference in the parameters used for scoring RERAs.
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#7
(12-10-2016, 01:06 PM)Mosquitobait Wrote: Both Dreamstation and Airsense treat and report RERAs. If RERA reporting is not showing up, then you need to look at your settings within Sleephead. The majority of my RERAs were treated by simply having the lowest setting on 8. I can often go a week without seeing a RERA on the report.

When the Resmed Airsense was first released, it did not have RERA detection. Machines produced in the first 6-9 months do not have that capability. The For Her model was the first to have RERA detection, it was later brought to the regular Autoset. Respironics had the detection since the PRS1 60 series across the CPAP and BiPAP lines. Resmed still has not put the capability in to Aircurve.
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#8
(12-10-2016, 04:46 AM)marcus10 Wrote: Hi guys

A question for everyone which I'm struggling with. My sleep study showed an AHI of 9.5 with frequent RERAs for an RDI of 21. I currently use the Airsense 10 which does not track RERAs (not my model anyway).

Hi marcus10,

RERA is an arousal caused by partial restriction of the airway, making it hard to inhale without excessive effort. Disturbs sleep and can lead to fatigue and excessive daytime sleepiness. RERAs are usually treated by increasing the pressure, in particular the pressure during inhalation.

Although not reporting or specifically reacting to RERA events, the ResMed algorithm aggressively responds to subtle signs of partial airway restriction during inhalation ("Flow Limitation") and thereby helps to avoid RERAs. So it is not at all like your apneas and hypopneas are being prevented but your RERAs would still be occurring as frequently as during your diagnostic study.

If you are still feeling fatigued and excessively sleepy, increasing the Min Pressure likely will help. Also, keeping the EPR on its max setting definitely makes it easier to breathe in, as long as the Max Pressure setting is not so low that it is preventing the pressure from going high enough much of the time.

For a minority of users, increasing the EPR (or A-Flex or C-Flex+) setting increases the number of Clear Airway Apnea events, as might also result from increasing the Max Pressure setting.
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
(12-10-2016, 01:06 PM)Mosquitobait Wrote: Both Dreamstation and Airsense treat and report RERAs. If RERA reporting is not showing up, then you need to look at your settings within Sleephead. The majority of my RERAs were treated by simply having the lowest setting on 8. I can often go a week without seeing a RERA on the report.

Is it correct that the Airsense 10 Autoset reports RERAs? I could only find reference to the For Her machine doing this or rental Airsenses of both types. The standard Airsense doesn't do this as far as I'm aware? In addition, I can only find two places where there is a box to tick against RERAs in SH and they are both ticked - however, no RERA reporting.
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#10
(12-10-2016, 04:34 PM)vsheline Wrote:
(12-10-2016, 04:46 AM)marcus10 Wrote: Hi guys

A question for everyone which I'm struggling with. My sleep study showed an AHI of 9.5 with frequent RERAs for an RDI of 21. I currently use the Airsense 10 which does not track RERAs (not my model anyway).

Hi marcus10,

RERA is an arousal caused by partial restriction of the airway, making it hard to inhale without excessive effort. Disturbs sleep and can lead to fatigue and excessive daytime sleepiness. RERAs are usually treated by increasing the pressure, in particular the pressure during inhalation.

Although not reporting or specifically reacting to RERA events, the ResMed algorithm aggressively responds to subtle signs of partial airway restriction during inhalation ("Flow Limitation") and thereby helps to avoid RERAs. So it is not at all like your apneas and hypopneas are being prevented but your RERAs would still be occurring as frequently as during your diagnostic study.

If you are still feeling fatigued and excessively sleepy, increasing the Min Pressure likely will help. Also, keeping the EPR on its max setting definitely makes it easier to breathe in, as long as the Max Pressure setting is not so low that it is preventing the pressure from going high enough much of the time.

For a minority of users, increasing the EPR (or A-Flex or C-Flex+) setting increases the number of Clear Airway Apnea events, as might also result from increasing the Max Pressure setting.

That explanation makes a great deal of sense. If a RERA is a flow limitation, then both machines would be treating it. It's pretty clear in SH correlating the machine's response to the flow limitation occurring. The Resmed does this (and fairly quickly) but the PR site states that they do this specifically in relation to RERAs. As RERAs are just flow limitations from this perspective, perhaps PR's stating they respond to RERAs is just marketing since both machines do.

Seems the difference is you actually get postive feedback on RERAs with PR. If your apnoeas and hypopnoeas are under control then I think you're probably right that the RERAs and hence overall RDI are too - although it would be nice to get positive confirmation of that through SH.
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