Does the Vauto display RERA?

[SevereApnea]

Quick question, as per title.

I have been going through a number of threads of folk with UARS and RERA switching to the Vauto.

so far I haven't seen any Vauto Charts displaying RERA.

I am still bothered with FL and RERA and wondered if I lose the ability to track RERA with the Vauto?

Thanks!

[Sleeprider]

RERA flagging is very unreliable and generally under-counted. There are other ways of identifying it without an event flag by watching the flow limitation and any spikes in the respiration rate. The Vauto actually will reduce flow limitation to an extent that RERA becomes much less likely, and optimization should be the goal, rather than seeing event flags ticked off.

[happydreams]

My experience with the VAuto is that I have 0 RERA flagged events, but not zero RERA's.  The VAuto seems to score them differently than a Respironics machine.  It's obvious, if you inspect your data there are still some RERA's, whether flagged or not.  I look at the RERA flag as merely a convenience flag, but not essential.  

That being said, the therapy I have received from the VAuto is superior.  Fewer disruptions to my sleep.  And that's what one wants.

[SevereApnea]

@ Sleeprider:

Agreed, 

I am the stage of seeking comfort and good sleep, which is great.

However, it does help to see what is going on, and what flags might be an indication of what is happening underneath the bonnet (hood in the USA I think) so to speak, while we are sleeping.

On my Airsense 10 when I get RERAs they are related to one of two things: either maxxing out near top of pressure, or sudden increase in FL followed by a recorded RERA which is likely an arousal following that.

Notably, in other post you mentioned that the For Her setting does not treat FL above 12 cm H20 so that is important to know.

For the last 3 nights I have used the Soft Mode, and so far, no RERAs flagged.

Also, just out of interest, I found this document, Resmed Product Therapies from Resmed which would indicate the Vauto models and higher do not flag RERAs. Wonder why that would be...

@ happydreams

I notice from your "looking for some help" thread that you have some UFs (user defined flags) set up. How do you know how/what to set up, based on what you are looking for?

[OpalRose]

@ Sleeprider:

Notably, in other post you mentioned that the For Her setting does not treat FL above 12 cm H20 so that is important to know.

Hi SevereApnea,

This small excerpt from the Clinicians Manual suggests that the "For Her" mode responds to Flow Limitations up to
20 cm.

AutoSet for Her mode is based on key aspects of ResMed’s AutoSet algorithm and delivers therapeutic responses tailored to the characteristics of female OSA patients.
The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:
 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O.

[SevereApnea]

Thanks OpalRose

I stand corrected. I must still not be understanding well, and perhaps misquoted Sleeprider from post #7 in this thread:
Road to Success...

Re-reading his comment:

"Another problem is that with the For-Her mode, your machine is not responding appropriately to the obstruction when pressure is at 12 or higher. I recommend you move to Autoset Standard, and increase max pressure to 15."

You mentioned the following: 

 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O


Does this mean that if we have an Apnea starting at > 12 cm H20 the For Her mode will ignore this and not increase the pressure?

Hopefully it will detect FLs above 12 cm H20 and still respond to that.

I need to think about this some more to try and understand this better. There seems to be a difference to how the AutoSet For Her responds to OSA vs FLs and at what pressure levels.

[Crimson Nape]

No, it means that 12 cm and above does not use the "For Her" softness ramp. If everything that you are experiencing is at 12 cm or higher, then the For Her setting is not being used, thus useless.

[Sleeprider]

The wiki on CPAP algorithms describes the function of the For Her, and Rose is correct. What the FH does is to initially respond a bit faster to flow limitation but as flow limited breathing continues the standard mode ends up with more pressure increase through 3-4 flow limited breaths. For Her responds to apnea up to 12, the responds to flow limitation up to 20 cm, so it is still not ideal where apnea occurs above 12-cm. http://www.apneaboard.com/wiki/index.php...Algorithms I'm guilty of misquoting my own wiki article, but in the end, I have observed the For Her works best for those users that have relatively low pressure requirements, and once we see them move above 12 the algorithm leaves behind more events.

[OpalRose]

SevereApnea,
Wasn't meant as a correction to anyone.  I've had a hard time understanding the "for her" mode myself, as I've been helping my daughter with this machine, and the "for her" mode doesn't seem to be her best option.

[SevereApnea]

Hello again All:

Thanks for the responses and more detailed explanations here.

I am kind of off my own topic here, but here goes anyway...

I have looked at this again and understand what Resmed are trying to do.
For me it does not work as expected.

Reading the article here by McArdle (referenced in the excellent Wiki) I simply make note of the following:

1. Some authors were Resmed sponsored and shareholders.
2. n = 20 with only 2 nights per patient, unlike users in this forum who self titrate continuously (at least those of us with OCD).
3. I don't believe they used EPR or bilevel settings (see first exclusion criterion). If they did there is no mention of that and that would confound the interpretation of the 12 cm H20 cut off point: IPAP or EPAP equivalents.
4. Average pressures were less than 12 anyway.

I have a number of my own charts which show response to OSA with pressure increase to above 12 cm H20 Max Pressure: from the above explanations we can take it that this response was with the Standard and not the AfH algorithm.

It would be nice if FLs were reduced with the AfH algorithm: my own data from the last week using Soft Mode show my FLs were lower with the Soft Mode than with the AfH algorithm.

I conclude, that for the moment at least: 
1. I understand what they are trying to do and there may be some validity in that sector of the population (male of female) with low pressure requirements and tendency to FL rather than outright apneas.
2. This is a propriety algorithm, that is not fully disclosed (commercial reasons, perhaps?)
3. That for me this is not optimal. Using the Soft Mode I am not topping out at near my Max Pressure setting yet, hence minimal RERA. All other things being equal my pressures and FL are lower in Autoset Soft Mode than with For Her.
4. Perhaps the more "muted" response to FLs allows the flow limitations to climb a bit higher than with the Standard Autoset Mode.
5. I did see less pressure fluctuations which was part of their reason for introducing this mode.
6. This is a comfort setting which will work for some, up to a point, at which the AfH algorithm bails out then defaults to a more aggressive therapy mode.
7. I would have more control with the settings available in Vauto, which kind of brings me back On Topic.

(An interesting aside is under the Heading Data Analyses where they describe some of the factors Resmed use to calculate Flow Limitations.)

Thanks for the illuminating replies and pointers.

It was certainly worth trying, but it is time for me to move on from this.

PS @ OpalRose: No offence intended or taken: corrections are good if they lead to understanding. It's the only way I learn.

Chris