I have the cpap model...not the elite

[vsheline]

Does the APAP treat the RERA's as well as the apnea and hypopneas?

Yes.

By measuring Flow Limitation and by raising the pressure in response to Flow Limitation, RERA tend to be eliminated or reduced.

A bilevel machine can even more optimally treat RERA by having separate settings for IPAP (pressure setting for inhalation) and EPAP (pressure setting for exhalation). Since Flow Limitation only occurs during inhalation it may be only the IPAP pressure which needs to be higher in order to eliminate the Flow Limitation and resulting RERA.

Usually bilevel machines are only prescribed for those who have been diagnosed with UARS (Upper Airway Resistance Syndrome, which is when Flow Limitation is causing an excessive number of RERA, which was not evident in your diagnostic study nor during your titration study but which, nonetheless, may be happening now) and are also commonly prescribed for those who are on high pressure (such as 15 or higher) because many cannot tolerate high pressure unless the pressure during exhalation is significantly lower than the pressure during inhalation, which a bilevel can provide.

[mzdawn74]

One issue that has not been raised is that the AHI is low at least in part because she is not asleep. To get a true picture of the efficacy of the therapy, you first of all need to actually sleep. It would be very helpful to consider what is keeping you from sleep and address those issues.

Dawn - If you are using the machine 4 hrs a night and are asleep during those four hours, the AHI the machine calculates would be considered valid. The reported AHI would not include any RERA events which might have occurred but the AHI reported would be considered a valid AHI calculation for the average number of apneas plus hypopneas occurring while you are asleep.

Only the data recorded during time you are asleep and at full therapy pressure can be validly used in calculating the AHI. The machine does not know whether you are asleep or awake but assumes you are asleep. If you are awake half the time or all the time you are receiving therapy then the AHI calculated by the machine would be half or totally invalid.

The machine does not count the time or the events during the Ramp time (if the Ramp is used) but assumes you we asleep and uses the events (or lack of events) for all other therapy time in calculating the AHI.

I am asleep for at least 90% of the time I wear the machine.

On a separate subject my doctor is out of town until the 27th, so I am stuck with this machine until then.

I tried dealing with the DME, but they said my prescription stated cpap, and that's what they gave me. They referred me back to my doctor.

[mzdawn74]

RERA events are arousals which disturb sleep, but because the reduction in respiration was less than 50% (or because some other requirement for being classified as hypopnea was missing) these will not be counted as hypopneas and therefore will not be counted in the AHI. (By definition, an event cannot be counted both as a RERA and as an hypopnea.)

So, conceivably, a person who has lots of RERA but few apneas and hypopneas may have a great AHI but may be unable to sleep well and may feel always fatigued and mentally foggy, etc.

My RERA from initial study was Total RERA 6, Score 1/ hour. My titration score was Total RERA 12, Score 4.6/ hour. Is this high?

[tedburnsIII]

That is a good question, msdawn. I, like you, await an answer based on medical standards.

My titration chart is below. RERA's seem to be noted separately, then there is an arousal index.

What confuses me is whether the arousal index reflects arousals or RERA's (something 'more' than an arousal, apparently). I'm not yet ready to make the jump based on my own titration study, though I had no RERA's (at higher pressures) but showed an 'Arousal Index'.

'Arousals' of 20-22/hr are considered normal for 50-60 year olds. I have no idea about RERA's, hence the confusion.

RERA's are counted toward RDI, hence the difference between AHI and RDI, the latter of more import. If there's no difference in the study between AHI and RDI, it's probably reasonable to assume there weren't any RERA's. YOUR DIAGNOSTIC study results (NOT depicted below) should show they are different numbers, with total RDI higher than total AHI. The RDI number predominates over AHI in determining severity of disordered breathing/OSA, etc.

[mzdawn74]

That is a good question, msdawn. I, like you, await an answer based on medical standards.

My titration chart is below. RERA's seem to be noted separately, then there is an arousal index.

What confuses me is whether the arousal index reflects arousals or RERA's (something 'more' than an arousal, apparently). I'm not yet ready to make the jump based on my own titration study, though I had no RERA's (at higher pressures) but showed an 'Arousal Index'.

'Arousals' of 20-22/hr are considered normal for 50-60 year olds. I have no idea about RERA's, hence the confusion.

RERA's are counted toward RDI, hence the difference between AHI and RDI, the latter of more import. If there's no difference in the study between AHI and RDI, it's probably reasonable to assume there weren't any RERA's. YOUR DIAGNOSTIC study results (NOT depicted below) should show they are different numbers, with total RDI higher than total AHI. The RDI number is used to determine severity of disordered breathing/OSA, etc.

Confused...I just want to know should I be concerned with RERA's according to my scoring? My RDI during initial study was 11.4. I can't find it on my titration study. All this terminology is hard for me to understand right now. Can someone help me out? Should I be concerned with these numbers?

[tedburnsIII]

mzdawn-

I wouldn't be concerned if your total diagnostic RDI was only 11.4.

And your total diagnostic AHI? What was that again?

I'd be concerned now with getting your CPAP daily AHI <5 or better (which you have proven admirably), and staying on the machine as long as possible (you need to work on that).

[mzdawn74]

I wouldn't be concerned if your total diagnostic RDI was only 11.4.

And your total diagnostic AHI? What was that again?

I'd be more concerned now with getting your CPAP daily AHI <5 or better (which you have proven admirably) , and staying on the machine as long as possible (you need to work on that).

My AHI was 10.5. Yes, I do need to work on staying on the machine. Last night I only got 3 hours on it of my 4 hours of sleep.

[tedburnsIII]

If it were me, I'd forget about RERA's of diagnostic 1/hr. Though your titrated pressure had more RERA, I'd still not be concerned at this juncture, if at all.

Just my advice- put it aside, dear, at least for now. TMI.

I may not be correct about this- vsheline may have commented on it or not- but RERA's generally better treated by increase in pressure? If so, I would say stick with the current pressure of 8cm, which you have not yet adapted to anyway. See how it goes over the next week. It would be nice if you could get a full night's rest or two with CPAP.

[mzdawn74]

If it were me, I'd forget about RERA's of diagnostic 1/hr. Though your titrated pressure had more RERA, I'd still not be concerned at this juncture, if at all.

Just my advice- put it aside, dear, at least for now. TMI.

Thanks Ted. Now to this keeping the mask on issue and improving my sleep time and quality...

Open to all suggestions....

[49er]

Dawn,

As an FYI, the RDI is a calculation of the RERAS and Hypopneas/Apneas that occurred per hour during the hours you were observed sleeping. Since your AHI is 10.5 and your RDI is 11.4, the gap isn't significant as far as I can see.

Now in my case, the RDI was definitely significant as I had an AHI of 5.9 but an RDI of 23 because of the RERAS. By the way, I am not sure how much of a minimum gap there would have be statistically between the AHI and RDI for it be significant. I have seen some links regarding scores that say that the RDI which covers all the sleep breathing events is considered to be the true apnea index and would be treated the same way AHI scores are characterized as far as severity characterization. All I can say is my sleep breathing issues don't feel mild to me.

Anyway, agree with the goal of focusing on getting more sleep on the machine. I forgot, is your problem, falling asleep or staying asleep or both? If you wake up, can you get back to sleep eventually?