[CPAP] Low AHI, High RERA (Sleep Study) vs CPAP Reports

[Qine]

Hi everyone! I need help in understanding whether I'm actually improving based on CPAP reports versus my initial sleep study. 

I've been on CPAP for 3 weeks now, but based on subjective experience (Epworth sleep scale, energy levels etc), I can't tell if my CPAP is actually helping. 

I've attached both results to this post, but in summary:

Sleep Study
Central Apnoea = 0
Obstructive Apnoea = 0
Mixed Apnoea = 0
Hypopnoea = 2.6 / hour
Apnoea + Hypopnoea (AHI) = 2.6 / hour

RERA = 9.0 / hour
AHI + RERA (RDI) = 11.7 / hour

versus the CPAP report, where I'm actually getting higher than zero Obstructive events (1.44 / hour) and zero RERAs. 

Questions:

1. Based on the reports, is CPAP potentially actually making it worse for me (especially re: obstructive events) ?
   
2. Does my Resmed Airsense Autoset 10 have accurate RERA reporting? If it's close to zero now, any thoughts on why I haven't been subjectively feeling better?  
   

[factor]

Looking at your data.

I would set your
Min pressure to 7. (to use epr minimum is 7)
Max pressure to 14
Turn on epr at 2

Turn off the ramp. If you cant tolerate no ramp.  Turn the pressure on ramp to 6 and time to 15.  Then time to 10 then to 5 then off each time change a week a part.  The goal is no ramp.

Try that for a week and report back.

[quiescence at last]

My understanding was that the AirSense10 Autoset did not record RERAs, but OSCAR still thinks it is something to count.  Check this, and maybe our advisory folks can correct me if that is untrue, but thought in AirSense10 it needed to be the Autoset For Her model to record RERAs.

Your goal is to reduce the RERAs, absolutely. Think about the sleeping positions and the environmental things like temperature swings that could also cause your alertness routinely during sleep.

You may also be able to drill down to breath by breath analysis, like a 10 minute, 15 minute to 30 minute close up, and see a breathing pattern that shifts drastically to pick out the potential RERAs.  This would take a few of us posting some examples of what that RERA would look like.  I'll try to do that later on.

     
highlighted area is period of alertness, higher tidal volume, and sinusoidal breathing.  in general, sleep breathing is 'in-out-pause'. you can see that just before and after.

Stick with it!

QAL

[Sleeprider]

I agree with previous advise to add EPR (I would just go to Full-time at setting 3) and a minimum pressure of 7.0. Your Autoset is capable of providing bilevel pressure in the form of EPR with up to 3-cm of pressure difference between the inhale and exhale pressure. It is pressure support that treats flow limitation by supporting inspiration flow with higher pressure, then reducing pressure during exhale. Flow limitation is the root cause of RERA and hypopnea. Your AHI from the sleep study places you in a mild category of sleep disordered breathing, with nearly all events being hypopnea. The presence of a few obstructive apnea is not an indication that therapy has made your condition worse, in fact your AHI has gone from over 10 to less than 2 per hour with pressure. Keep in mind that a breathing pause of 10 seconds is all it takes for the machine to flag an apnea. Without looking closely at these events, we really don't know much about how they evolved or their duration, however your AHI is considered treated at current levels. Adding EPR will further optimize your therapy and I expect to events drop under 1/hour.

Later editions of the Resmed Autoset machines report RERA the same as early For Her models did. We tend to see RERA under-reported by these machines. Reading the flow rate graph, focusing on periods of increasing flow limitation and locating arousals as indicated by in increased volume or rate of respiration is likely to find more events.

[Supercharged]

Hello,
I’m certain I’m experiencing RERAs, but am not seeing that anywhere on my Oscar report. My AHIs are all under 0.5, mostly 0 but I still feel very tired.  It took quite a bit of work to reduce AHI but now am waking up  4 or more times a night.  Don’t know if I should start a new post or continue on this thread. Please advise.  Thanks…

[quiescence at last]

it would make sense to start your own thread, if you want to share stuff and want some input from members on this forum.  Thanks for just the affirmation that RERAs are a predicament for many.  It is going to be pretty keen when we can reduce and/or eliminate those pesky RERAs.

QAL