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SleepuHead RERA Stats question
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Snowbird47 Offline

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Post: #1
SleepuHead RERA Stats question
I am relatively new here, but an avid follower of the board - most valuable info I can find anywhere.
I have been monitoring my Sleepyhead data, concentrating on AHI data, which has mostly been coming down. Last night I had an AHI of around 1 (yay!), but did not sleep too great. When I checked my RERAs, I noticed i had 55, mostly coming in two separate hour-or-so blocks in the night.
Upon close examination of the events, I became confused about how the machine (or SleepyHead, I don't know which) decides what is an RERA. I have annotated the screenshot below to show my question - why isn't the circled area a RERA?

[attachment=1778]

I looked at a number of event times, not just this one, and there were a number of other examples.

As well as the above question, should i be concerned about the increase in RERAs. Is this a meaningful number? Even though this was just a one time thing. I will of course monitor as time goes on.
10-12-2015 09:25 AM
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PaytonA Offline
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Post: #2
RE: SleepuHead RERA Stats question
It is my understanding that the PAP machine looks for a particular flow pattern that is typical of RERAs. At least that is what was reported when I asked the question,"How does the machine score a RERA?".

In answer to your question of why one pattern was scored and a similar pattern was not, I am somewhat clueless. I have looked at your traces and nothing I see makes sense to me yet.

Best Regards,

PaytonA
10-12-2015 10:22 AM
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justMongo Offline

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Post: #3
RE: SleepuHead RERA Stats question
The FL graph shows flow limitation; FL is also evident in the "flat top" of the air flow graph.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-12-2015 10:38 AM
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Snowbird47 Offline

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Post: #4
RE: SleepuHead RERA Stats question
(10-12-2015 10:38 AM)justMongo Wrote:  The FL graph shows flow limitation; FL is also evident in the "flat top" of the air flow graph.

I agree, JustMongo, but the FL graph for the program's RERA events is much the same as for the place I circled which was not an "event". this makes me distrust the accuracy of the machine in determining RERAs. I can recognize a OA when I see one, and the machine is good at marking those AFAIK.
10-12-2015 01:56 PM
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justMongo Offline

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Post: #5
RE: SleepuHead RERA Stats question
(10-12-2015 01:56 PM)Snowbird47 Wrote:  I agree, JustMongo, but the FL graph for the program's RERA events is much the same as for the place I circled which was not an "event". this makes me distrust the accuracy of the machine in determining RERAs. I can recognize a OA when I see one, and the machine is good at marking those AFAIK.

I am inclined to agree with, "this makes me distrust the accuracy of the machine in determining RERAs."

The definition of RERA is Respiratory Effort Respiratory Arousal. Neither Effort nor arousal can be directly measured by the machine. In a sleep lab environment a band around the chest measures effort; and an EEG measure sleep stages and arousal.

The scoring of RERA is, as far as I know, new to the 10 series machines. It likley needs refinement.

Although arousal implies a disturbance to sleep quality, if the scoring is inaccurate, then little weight should be given to it.

The fact that your flow waveform is flat-topping; and it appears to be when at max pressure is suggestive that a slight increase in max pressure might be of value. Your call on that one.

Kindest Regards,

Mongo

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 10-12-2015 02:09 PM by justMongo.)
10-12-2015 02:08 PM
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PaytonA Offline
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Post: #6
RE: SleepuHead RERA Stats question
It may be a little too early to be distrustful of the machine's scoring of RERAs. We do not have a clue what the actual criteria are for the machine to score them. I am personally somewhat suspicious of this scoring since the machine can not sense breathing effort or arousal (especially since arousal may be no more than preventing the subject from progressing from one sleep stage to the next). Like central apnea detection, the machine can not directly sense the features that comprise definition of the event but maybe the approximation is good. Without knowing more about how the machine scores RERAs, I do not think that we have a very good basis for making a firm decision.

Just my feelings.

Best Regards,

PaytonA
10-12-2015 07:02 PM
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justMongo Offline

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Post: #7
RE: SleepuHead RERA Stats question
Actually there is solid science behind the differentiation between an obstructive and a clear airway apnea.
The 4 Hz wave created by the FOT detection algorithm reflects back with high amplitude when the airway is obstructed.
In a clear airway, the 4 Hz pressure wave is dampened by the aveoli in the lungs.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-12-2015 10:01 PM
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PaytonA Offline
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Post: #8
RE: SleepuHead RERA Stats question
(10-12-2015 10:01 PM)justMongo Wrote:  Actually there is solid science behind the differentiation between an obstructive and a clear airway apnea.
The 4 Hz wave created by the FOT detection algorithm reflects back with high amplitude when the airway is obstructed.
In a clear airway, the 4 Hz pressure wave is dampened by the aveoli in the lungs.

Actually is it detection of reflected waves or is it determining if the flow changes to mirror the pressure waves or not that is the telltale.

But the machine does not measure respiratory effort therefore my point is that it does not quite fit the definition but I find it hard to believe that there are very many occasions where there is no breathing and the airway is open where there might be some respiratory effort. Does not sound plausible to me.

We know all of this good stuff about airway patency detection so we have some basis for our degree of trust in the results. When it comes to RERA detection, as far as I know, we are pretty much in the dark, so I think it may be premature to make any decisions on how meaningful the results are.

Berst Regards,

PaytonA
10-12-2015 10:42 PM
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Mosquitobait Offline

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Post: #9
RE: SleepuHead RERA Stats question
FWIW, I bumped my bottom pressure up a bit and now I never have more than one or two RERAS every few days. They never show in the AHI calculation. I think .6 did it. RERAs were my main problem.
(This post was last modified: 10-13-2015 01:25 AM by Mosquitobait.)
10-13-2015 01:24 AM
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