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Titrating RERAs
#1
Titrating RERAs
On my last cpap titration, there was a 17 minute period of time where I had 5 RERAs at 10cm H20 constant pressure. My doctor prescribed me a bilevel machine at 10-14 but I've been sleeping worse on the higher pressures. Is it possible that the RERAs I experienced at 10cm could be titrated out at a lower total pressure on a bilevel machine with pressure support, i.e. 5-9? Or would pressure, even on a bilevel need to be higher than 10?
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#2
RE: Titrating RERAs
This post is so incomplete, I don't know where to start. What mode is in use and what is the pressure support. Want to try a chart? RERA is almost alway related to a lack of pressure support in CPAP. Now that you're using an Aircurve 10 Vauto that does not even record RERA, how are you tracking RERA?
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#3
RE: Titrating RERAs
Thanks for the reply Sleeprider, sorry I'm lacking some information. The numbers I quoted are from my sleep titration study so I don't have a chart. I know that the 5 reras occurred at 10cm with no pressure support. In theory my machine is supposed to capture RERAs, but I don't actually think it does it that well(you technically need an EEG anyway right?)

What other information can I provide? Maybe a better way to ask the question would be: if apneas stop at a low pressure, say 5cm, and I show RERAs with a pressure of 10cm with zero pressure support, is it possible that my RERAs might go away on settings below 10epap with pressure support (5-8). Does that make sense?
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#4
RE: Titrating RERAs
I don't think I was explicit enough but I was trying to say those numbers were from an in person overnight sleep lab titration study
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#5
RE: Titrating RERAs
We probably had a miscommunication. I see you have an Aircurve 10 Vauto in your profile. If you want to know how to set it up based on your CPAP titration, then my recommnedation is EPAP min 9.0, PS 4.0 and IPAP max 18.0. If you try that and post a chart, we can go from there.
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#6
RE: Titrating RERAs
Thanks Sleeprider, I really appreciate you taking the time to help me. I have been on 10-14 for a bit and have generally been feeling worse. Here's a chart from Monday where I had 20 central events. I know this number is within the normal threshold but this is a lot for me, I usually only have a couple a night. I have definitely been having more central events on the 10-14 setting, although it's always within a normal range. It has been hard for me to optimize on the charts because my apneas / hypopneas have generally been very low on both CPAP and Bilevel. The machine doesn't record RERAs so I can't really look at the charts and make intelligent adjustments. I just know CPAP didn't make me feel better, and I feel worse at 10-14 with bilevel.

I'm wondering if it's possible I could get away with lower pressures, somewhere in the 5-7 EPAP and PS 3-4 range. I don't have many apneas / hypopneas at those pressures(I learned this from my time on CPAP). Could RERAs that occurred at 10cm H20 on CPAP be titrated out with pressure support when IPAP is at or below 10 cm? Or is that just not how it works and I should try to keep IPAP above 10cm H20? Is there anything to be said for just sucking it up and hoping it gets better over time?


   
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#7
RE: Titrating RERAs
OK, let's do a 1 night test to see what pressures do for you.


Mode = VAUTO
EPAP min  4, 
PS 3
IPAP max 14

and Please make sure that you are in Auto  mode not "S" mode that you are currently in.

This could really open up what we can use to help you out.  Whether this works or not is valuable info.  This is basicly a titration as you had in your sleep study.

I'm sure SleepRider would go along with this.
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#8
RE: Titrating RERAs
Here is last nights chart with the settings bonjour recommended (EPAP min 4, Max IPAP 16 PS 3 VAUTO). I slept a little better but do not feel 100%. From what I've read it can take several weeks to get back to normal on proper therapy. This is a pretty typical chart for me from when I used CPAP. How do I know if these settings are treating the RERAs properly? 

   
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#9
RE: Titrating RERAs
Fred has you going the right direction here, but I'd like to see the monthly calendar disappear, and include the flow limitation chart. Speaking of flow limits, they are completely absent! The maximum was 0.17 and you have 0.0 in the median and 95% stats. That almost certainly precludes RERA. Way to go Bonjour.
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#10
RE: Titrating RERAs
Attached two charts, 1 is from last night w/out calendar and with flow limit, one is from November on similar settings with APAP(no pressure support). How do you interpret the difference in the flow limit graphs? Are RERAs likely in APAP chart and not the BiLevel?

BiLevel 4-16 PS 3
   

APAP 4-20 No PS
   
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