Am I done tinkering?

[zonk]

All good stuff, but it does not appear that my ResMed APAP is capable of flagging RERA events;

"AirSense 10 AutoSet for Her" is the only ResMed machine report RERAs
Phillips Respironcis System One Auto and Pro also report RERAs and periodic breathing

I'm not sure what sort of adjustment can be made in response to such events and how to tell whether they're for real

[quiescence at last]

and I totally got the reference to death relayed by "AHI of zero" for those apnea sufferers that do not get diagnosed. It is probably more accurately 1/(indefinitely long period before the next breath), but that still approaches zero.

[Sleeprider]

Original test at AHI = 55.7

next 50 days at AHI = 8.9
next 60 days at AHI = 2.8
last 30 days at AHI = 1.8

There were 3 or 4 adjustments to APAP pressure along the way, a mask change, etc.; all indexes are consistently down (no one index has stayed level or increased).

So my inclination here is to stop tinkering and just let things be; stay at the same pressure, etc.

Or is there something I should be considering as a potential improvement?

May I just reply to the original question?

Hahahahahahah! No way!

I started this journey in 2008, and I'm a newbie. Yes I pretty much did like you, and then got complacent. I rode the APAP wave for 7 years with the same machine, logging almost 20,000 hours on a M-Series Auto. Along the way, I occasionally checked the charts and made minor tweaks. There is always room for improvement.

Finally in December, I was shamed into upgrading my old P.O.S. and got a 60 series Auto. I was able to cut my AHI in half with that, but I'm still dragging a bit, and now that I can see them, i've got a bunch of CAs to deal with.

So today I got a PR S1 Auto BiPAP Series 60. Very cool machine, and I'm going to learn to use it tonight.

Just saying, the journey may pause, and that's good. Things need to settle, but stay engaged and look for improvements. It was just "this close" to passing me up. This journey is one we are obliged to continue for the rest of our lives. Things change and we need to adapt and learn new tricks.

By helping others, you will advance your own knowledge and progress. You've already well along that path from what I've seen.

[vsheline]

All good stuff, but it does not appear that my ResMed APAP is capable of flagging RERA events; I have it all turned on in SH, but it does not appear. If I change it to RDI, the number is the same as AHI, so I don't think it is counting them.

Right. I think ResMed messed up by not adding RERA detection to all or most of its S9 and A10 devices.

Regarding ResMed CPAP machines for home use, I think only the AirSense 10 AutoSet For Her model reports RERA events. It does this in all three of its therapy modes (fixed pressure CPAP mode, standard AutoSet mode, and the new gentler AutoSet For Her mode). I think none of the other AirSense 10 or AirCurve 10 models and none of the S9 models report RERA events.

I think all or most of the fully data-capable Philips Respironics System One devices do report RERA events.

The PRS1 RERA detection algorithm monitors for a 10 second or longer sequence of breaths that exhibit both a subtle reduction in airflow and progressive Flow Limitation. If this breath sequence appears to be terminated by an arousal (as evidenced by a sudden increase in airflow along with the absence of Flow Limitation) and if the event does not met the conditions for an apnea or hypopnea, then a RERA is indicated.

[Sleeprider]

Excellent point. I've noticed that when RERA is high it can impact me almost as much as an elevated AHI. The new PRS1 reports these, and I was never even aware of them until I upgraded.

[TyroneShoes]

Possibly ResMed considers them therapeutically insignificant.

But it makes me wonder; what would "partially arouse" someone from sleep other than a OA, CA, or H (or the wife getting up to pee or the dog barking) that could be a medically-significant sleep disturbance?

[vsheline]

it makes me wonder; what would "partially arouse" someone from sleep other than a OA, CA, or H ... that could be a medically-significant sleep disturbance?

Flow Limitation caused by partial obstruction of the airway.

Although RERA events might not create significant O2 desaturations or might not reduce the Tidal Volume by at least 50% (and therefore not meet the definition of an hypopnea), the arousals will fragment sleep and can lead to fatigue and excessive daytime sleepiness.

[PaytonA]

Original test at AHI = 55.7

next 50 days at AHI = 8.9
next 60 days at AHI = 2.8
last 30 days at AHI = 1.8

There were 3 or 4 adjustments to APAP pressure along the way, a mask change, etc.; all indexes are consistently down (no one index has stayed level or increased).

So my inclination here is to stop tinkering and just let things be; stay at the same pressure, etc.

Or is there something I should be considering as a potential improvement?

TyroneShoes,

I think you are done tinkering unless your handle is Retired_Guy. He gets restless after a while with no tinkering and feels that he must change something. Must be an ex-engineer. If it ain't broke, break it and then you will have something that you can fix.

Best Regards,

PaytonA

[quiescence at last]

I resemble that remark. So it is probably time to interject a question - in the interest of more tinkering, is anyone thinking they will invest in EmotivTM Insight coming out this spring? I am seriously considering it. I think I can scrape enough together soz I don't have to justify it (as a medical device) with Mrs. QAL. It sure would be fun to do some backyard [back bedroom] research with EEG to correlate with all the wonderful data grabbed and displayed by the sleepyhead.

[TyroneShoes]

TyroneShoes,

I think you are done tinkering unless your handle is Retired_Guy. He gets restless after a while with no tinkering and feels that he must change something. Must be an ex-engineer. If it ain't broke, break it and then you will have something that you can fix.

Well, at least one of us is (but I'm not ex for a few years); and you are probably right, RG, who we all love desperately, sort of fits the suspect description. Part of being good at being an Engineer is knowing what NOT to try (hence, this thread), and I give RG the benefit of the doubt, because he seems too smart not to have learned that.

@ Sleeprider, your advice is great, and I am taking it under advisement. I do not expect to just brush off my hands and claim "well, that's over". I'll be checking daily looking for chinks in the armor. My thought there is that things change, and I do not trust 2014-vintage APAP technology to be smart enough to always catch everything and adjust; the ability to change parameters is there for a reason; by design.

But I am at a point where watchful waiting is the order of the day, and tinkering is on hiatus unless something pops up.

Your story piques my curiosity, tho. Should I assume that the algorithm in your older xPAP did not have the sophistication to catch certain events?

In August of 2019, assuming things don't change a lot between now and then, the 5-year (insurance) clock will have run out on my Autoset, and I expect whatever they have by then to be an improvement.