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Titrating RERAs
#11
RE: Titrating RERAs
What I had you do last night was to take a basic test and you passed. As SR pointed out you had virtually no events of any kind and the ever so important FlowLimit chart.

While the VAuto is without question the more capable machine I'll suggest making the Autoset your daily machine if you have it, because it will flag RERA events, and keep the VAuto as your backup. Believe me, we will have no problems going to the VAuto.

The settings would be Pressure 7 - 16 (what high you use really doesn't matter) and EPR of 3. The EPRof 3 coupled with the min pressure of 7 are the settings that are obviously treating you extremely well. As SR said I see no indication of RERA here.

BUT, one day does not make a trend, let's run for a week and then revisit.

Fred
Fred Bonjour - 1 Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

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#12
RE: Titrating RERAs
The definition of a RERA on CPAP is an increasing respiratory effort (restriction or flow limit) followed by an increase respiratory rate or volume indicating arousal. Your charts make very very clear that in the November 14 chart, that is exactly what is happening over and over again. It looks, and probably was disruptive to sleep, and the auto-pressure repeatedly went to higher pressure to try to resolve the flow limitation resulting in a 95% pressure of 11.74. By comparison January 31 looks tranquil, with nearly constant respiratory rate and tidal volume, that despite the much lower 95% pressure of 7.24/4.34, resulted in much higher tidal volume of 540 vs 480 mL and lower respiration rate of 13.2 vs 19.2 BPM. The difference is not in your head, this is a transformative development that is the direct result of EPR or pressure support. It may take some time for you to catch up on sleep, but it will certainly happen with these very positive results.
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#13
RE: Titrating RERAs
Awesome, thank you SleepRider and Bonjour! I will report back after using these settings for a couple weeks.
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#14
RE: Titrating RERAs
thanks that was helpful
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#15
RE: Titrating RERAs
It's been about 3 weeks since I adjusted my settings. The first two weeks I was traveling and I took my autoset, using settings EPAP 7, EPR 3 Full time. About half the nights were great, the other half had a lot of flow limitations / increased respiratory effort:


Great night:
   

Flow limitations:
   

When I got home I switched to my VAuto and bumped up pressure support to 4. The flow limitations pretty much went away completely, and things went reasonably well until last night. When I woke up this morning I felt horrible, almost like I hadn't slept at all despite having 8.5 straight hours of sleep.

Most nights this week, pretty good results:
   

Last night, felt horrible this morning:
   


I had 13 central apneas last night, which was quite a bit more than normal for me. I went back and counted my central apneas on the different machines:

Central Apnea counts:
autoset(EPAP 7, EPR 3): 1, 0, 3, 7 2, 4,1, 6, 2, 0, 1, 3, 3
vauto(EPAP 4, PS 4): 3, 3, 7, 8, 4, 4, 4, 13

It seems like I'm having slightly more central apneas with a PS 4 and occasionally a lot more. I can really feel 13 and this feels much worse than not using any form of pap therapy.
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#16
RE: Titrating RERAs
I would just back off of the pressure support a bit. You can choose something like 3.6 cm and probably cut out the CA.
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