RERA Problem

[SideSleeper]

I've always had fairly high RERAs in the year I've been on PAP. Every once in awhile then get below ten, but I think, if averaged, they would be about 25 to 30/night, and higher spikes. After a 30 day average of AHI 0.7 or 0.8 they were running max 15 to 20, then the other night all hell broke loose and I had a 3.68 AHI--very high for me--2 nights ago. CSRs and CAs are not unusual but have been low. On that night CSRs were 8 (not too worried--no flat lining in the waveform and no apneas recorded there--this is common), 3 CA, 17 hypopneas (high for me) 6 OA (usually zero or 1) and an incredible 110 RERAs! I had turned off my exhale support (A Flex)--had been running on 1--to see if it would lower RERAs which had been creeping up this week. That didn't work! Turned it back on last night to 1 and had a 2.31 AHI--8 CSR, 0 CA, 16 Hypop, 0 CA and a mind-popping record 124 RERAs. I did notice on SH statistics I had set flex on C-Flex, not A-Flex where it as always been. I am running APAP to be able to read the flow rate in SH, but it is set at 11/11. In previous trials I found no better success on a variable setting. I did change masks a few days ago--back to Dreamwaer from Wisp--because the Wisp mask went over a bunch of spots I just had burned off my face and nose by the dermatologist. First two nights were great--below AHI 1. Leaks are nearly non-existent--haven't had a major leak for some time and I've never had a Large Leak recorded. What do I do now?

[sonicboom]

Try setting a range between 9 and 13. I decreased RERAs to 0 by raising minimum pressure to bring flow limitations down as close to 0 as possible.

[Mosquitobait]

I primarily have RERAs and also find that raising the lower of the range higher eliminates RERAs. It doesn't take much - go up one setting (.2?) and try that for 3-4 nights and then go up again another setting. You make a lot of changes over just a couple of nights - your body will never settle down that way. Small changes and one change at a time is the best way to go.

[SideSleeper]

Thank you. I had been considering switching over to variable APAP settings. My sleep doc did set it at 10/14 three months after I started using the machine. I left it alone for awhile, then made very small changes occasionally. He, and my DME, warned me not to go any higher because of the centrals. I didn't notice much of a change in anything and early this year went back to the fixed 11 pressure--the same as used for my titration and the setting used when I first got the CPAP.

Since I'm on fixed pressure now (11) that is both my high and low number. I think I'll try the 9/12 change for a week and see what happens. I'm going to leave the EPR on 1. What is the difference in A-Flex and C-Flex on a PR machine?

[sonicboom]

Since I have no familiarity with PR machines I'll leave the Flex question to a more knowledgeable member.

[holden4th]

I am also struggling with RERAs so this is a very interesting thread for me.

With a new machine I've gone back to my basic settings of AFlex 2, 10-16 pressure range. I'm getting good AHI numbers but have not felt as good as I did earlier in the year with similar numbers. I was using an S9 at that stage but the deterioration happened while I was still on it.

My RERA was 1.7 and someone else said that they slept well when this dropped below one so this is my goal. I've had a decrease in RERAs since going back to my original APAP pressures.

I'd also be interested to see a SH graph of a couple of your nights.

As has been mentioned above, I am going to take this slowly and will up my minimum pressure by .2 tomorrow night. I do have fatigue during the day but it's nowhere as bad as it would be if I didn't use the APAP machine.

[OpalRose]

Thank you. I had been considering switching over to variable APAP settings. My sleep doc did set it at 10/14 three months after I started using the machine. I left it alone for awhile, then made very small changes occasionally. He, and my DME, warned me not to go any higher because of the centrals. I didn't notice much of a change in anything and early this year went back to the fixed 11 pressure--the same as used for my titration and the setting used when I first got the CPAP.

Since I'm on fixed pressure now (11) that is both my high and low number. I think I'll try the 9/12 change for a week and see what happens. I'm going to leave the EPR on 1. What is the difference in A-Flex and C-Flex on a PR machine?

Hi SideSleeper,
The Flex system is a little complicated, but here is an explanation:

Flex settings 1, 2, and 3. for PR machines
You can receive up to 2cm pressure relief, but is flow based.
• C-Flex – Provides pressure relief upon exhalation.
• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

I stared out using an a flex setting of 3. Now I find that a setting of 2 or 1 works best for me.

With flex settings, there is a slightly different feel. With a setting of 3, I felt like the machine was cutting short my inhalation. On 2 or 1, it feels natural.

Just a suggestion....switch to Apap mode, with a narrow range of 10 to 13, and try Flex set at 2 or 1. This should help with the Reras.

And give it a few days....I find that when I make a change, it takes a few days to settle in.

I wouldn't use ramp unless you really feel it is needed.

[Perchas]

Hi SideSleeper,
The Flex system is a little complicated, but here is an explanation:

Flex settings 1, 2, and 3. for PR machines
You can receive up to 2cm pressure relief, but is flow based.
• C-Flex – Provides pressure relief upon exhalation.
• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

I stared out using an a flex setting of 3. Now I find that a setting of 2 or 1 works best for me.

With flex settings, there is a slightly different feel. With a setting of 3, I felt like the machine was cutting short my inhalation. On 2 or 1, it feels natural.

Just a suggestion....switch to Apap mode, with a narrow range of 10 to 13, and try Flex set at 2 or 1. This should help with the Reras.

And give it a few days....I find that when I make a change, it takes a few days to settle in.

I wouldn't use ramp unless you really feel it is needed.

Thanks for the clarification, has now been easier to understand the function A-Flex and C-Flex.

[holden4th]

Thank you. I had been considering switching over to variable APAP settings. My sleep doc did set it at 10/14 three months after I started using the machine. I left it alone for awhile, then made very small changes occasionally. He, and my DME, warned me not to go any higher because of the centrals. I didn't notice much of a change in anything and early this year went back to the fixed 11 pressure--the same as used for my titration and the setting used when I first got the CPAP.

Since I'm on fixed pressure now (11) that is both my high and low number. I think I'll try the 9/12 change for a week and see what happens. I'm going to leave the EPR on 1. What is the difference in A-Flex and C-Flex on a PR machine?

Hi SideSleeper,
The Flex system is a little complicated, but here is an explanation:

Flex settings 1, 2, and 3. for PR machines
You can receive up to 2cm pressure relief, but is flow based.
• C-Flex – Provides pressure relief upon exhalation.
• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

I stared out using an a flex setting of 3. Now I find that a setting of 2 or 1 works best for me.

With flex settings, there is a slightly different feel. With a setting of 3, I felt like the machine was cutting short my inhalation. On 2 or 1, it feels natural.

Just a suggestion....switch to Apap mode, with a narrow range of 10 to 13, and try Flex set at 2 or 1. This should help with the Reras.

And give it a few days....I find that when I make a change, it takes a few days to settle in.

I wouldn't use ramp unless you really feel it is needed.

So is CFlex the same or similar to the EPR system you'll find on resmed machines.

Could AFlex cause RERAs that could be avoided by CFLEX. Considering that I have spent the majority of my therapy using Resmed EPR this is a point worth considering.

[OpalRose]

holden4th,
Ive read that CFlex is similar to ResMeds EPR in that it provides relief when exhaling, but ResMed gives a full 3cm pressure drop if set at 3, whereas CFlex can only give up to 2cm drop in pressure regardless if set at 1,2 or 3. The drop is based on flow, or how forceful a person exhales.

As far as any of the pressure relief features letting Apnea events through, it may be possible.

A higher pressure relief drop has been known to cause more clear airway events, but not for everyone.

All you can do is try the different settings, and compare results with SH graphs.

What's most important to me is comfort. Sometimes it's a trade off between comfort or having a little higher AHI reading.