Meaning of RERA

[Rip and Rosie]

Been using Sleepyhead for a month and am puzzled by RERA.
I have looked up the definition, but don't really understand how serious (or not) this actually is.

[Sleepster]

Respiratory effort related arousal means you're waking yourself up to start breathing again. I don't think CPAP machines are very good at detecting this, since they can't tell if you're awake or asleep. You really need a sleep study to determine if it's happening.

If you're concerned about it you need to speak with your doctor. You could get an oximeter and monitor your blood oxygen level, since low oxygen is what triggers arousals.

[Sleeprider]

RERA tend to be treated better by pressure support form a BiPAP than from a CPAP or Auto CPAP. In conventional CPAP titration, the first level to be controlled is obstructive apnea, followed by hypopnea, and eventually RERA. Bilevel therapy provides different inhalation and exhalation pressures, and is more effective in overcoming certain forms of upper respiratory resistance. CPAP may work with higher pressures, so give it a try, but the next step may be bilevel or something like the Resmed Airsense 10 with exhale pressure relief (EPR)

[Rip and Rosie]

thanks

[Hmm888]

Sorry to bump this topic. I understand the CPAP may not detect RERAs correctly; however, my machine showed a RERA of 2.2. I don't know if this is considered acceptable or not?

Additionally, I looked at my old PSG, I did not see any column for RERAs which makes me wonder if this is something fairly new that they started testing for?

[vsheline]

thanks

Sorry to bump this topic. I understand the CPAP may not detect RERAs correctly; however, my machine showed a RERA of 2.2. I don't know if this is considered acceptable or not?

Additionally, I looked at my old PSG, I did not see any column for RERAs which makes me wonder if this is something fairly new that they started testing for?

Hi Rip and Rosie -- If your Pro has C-Flex Plus and you set it to 1, I think it may help reduce RERA a little. Of greater help would likely be raising the pressure somewhat.

Hi Hmm888 -- 2.2 seems perhaps a little high. If your Dreamstation has A-Flex or C-Flex Plus, I suggest trying a setting of 1 to see if it helps any, and, after that, raising the pressure a little, too.

I don't know but I would guess scoring RERA would likely take more time when reviewing the sleep data than if not scoring RERAs, and perhaps some sleep labs or doctors simply don't take the time to do it?

From PRS1 Auto manual
Event definitions: RERA (Respiratory effort-related arousal) is defined as an arousal from sleep that follows a 10 second or longer sequence of breaths that are characterized by increasing respiratory effort, but which does not meet criteria for an apnea or hypopnea. Snoring, though usually associated with this condition need not be present. The RERA algorithm monitors for a sequence of breaths that exhibit both a subtle reduction in airflow and progressive flow limitation. If this breath sequence is terminated by a sudden increase in airflow along with the absence of flow limitation, and the event does not meet the conditions for an apnea or hypopnea, a RERA is indicated.

Take care,
--- Vaughn

[Hmm888]

Thanks vsheline, I will try changing the setting to 1 on my machine to see if that makes any difference.

What, if any are treatments available with RERA? I wonder if PTSD plays any role?

[green wings]

Hi, Hmm888. You can do a web search for "UARS" and find a fair bit of information about it. I especially like the articles at Dr. Steven Parks' website. They are thorough and easy to understand. There is one called "Taking the Mystery out of UARS" that I'd recommend.

I had 20+ RERAs/hour scored in my sleep study in addition to the 30+ obstructive events/hour, so I have been interested in trying to get rid of these.

My original treatment pressure was not high enough, and I typically saw an average of 2-3 RERAs/hour in a night's SleepyHead data. It's down to 2 or 3 events during the whole night most of the time now.

As far as treatment for UARS, one of them is xPAP treatment. Another can be surgery if you have something like a deviated septum.

As far as PTSD playing a part, Dr. Google says that it can. I can't explain how, because I don't understand it. It seems to be something along the lines of autonomic nervous system dysfunction causing impaired tone of the tissues of the airway during sleep - basically they are getting way more relaxed and floppy than they are supposed to.

My understanding is that xPAP treatment is the most effective tool for treating UARS as well as obstructive sleep apnea. If you stick with your xPAP treatment and watch your SleepyHead data, you can make sure you are breathing well while asleep and not having arousals (at least not ones due to events that your xPAP machine detects.)

What, if any are treatments available with RERA? I wonder if PTSD plays any role?