RERAs and Sleep Quality

[holden4th]

While my treatment has been going well I still feel as if it could be better. Now that I have my new Remstar PRS160 I get to see more data than my S9 loaner could give me.

Sleepyhead results show that RERAs are the biggest events of my nights sleep. Last night I had 23 of them, mostly in the first three hours of sleep. I didn't feel that good this morning and am wondering if these are indeed true arousals and how they are affecting my sleep.

One suggestion is that I slightly raise my minimum pressure level.

[Sleeprider]

Just a quick correction. You are using a PRS1 Remstar Auto model 560, not 160. You are doing very good on the therapy, with nearly no leaks and very few indicators of obstruction like flow limitation or snores. You seem to have the pressures dialed in and get good stable therapy without a lot of pressure fluctuation. Hypopnea seems to be the dominant event, but RERA can be very tiring.

RERA can be a symptom of upper airway resistance, and bilevel is generally easier to work with to deal with it. That was t he reason I got a bilevel originally, even though most don't consider this a therapy problem. With the auto cpap, you can try small pressure increases and see if it improves the volume reductions of hypopnea and reduces RERA. Trying increases in minimum pressure of 0.5 cm at a time and observing the results is really the best approach, and leaves you the option to return to current prescription if it becomes uncomfortable. You have not crossed the pressure thershold to where you're seeing CA, so this option is pretty open to you and is the only tool I see you have readily availalble.

[holden4th]

Just a quick correction. You are using a PRS1 Remstar Auto model 560, not 160. You are doing very good on the therapy, with nearly no leaks and very few indicators of obstruction like flow limitation or snores. You seem to have the pressures dialed in and get good stable therapy without a lot of pressure fluctuation. Hypopnea seems to be the dominant event, but RERA can be very tiring.

RERA can be a symptom of upper airway resistance, and bilevel is generally easier to work with to deal with it. That was t he reason I got a bilevel originally, even though most don't consider this a therapy problem. With the auto cpap, you can try small pressure increases and see if it improves the volume reductions of hypopnea and reduces RERA. Trying increases in minimum pressure of 0.5 cm at a time and observing the results is really the best approach, and leaves you the option to return to current prescription if it becomes uncomfortable. You have not crossed the pressure thershold to where you're seeing CA, so this option is pretty open to you and is the only tool I see you have readily availalble.

Thank you for your reply Sleeprider. I increased the min pressure to 11.5 last night and it resulted in lower RERAs but still too high for my liking.

I did some research today and Flow Limitation came up when I typed in RERA. I've looked at the graphs where the RERAs occur but can't see the typical 'seat' signature of flow limitation where I have RERAs. However, the wave form doesn't look that normal either.

Another suggestion that came up in my research was to lower the EPR (Aflex). It's currently set to 2 and maybe I'll try at at 1. I'll leave the min pressure at 11.5 for a few days to see what sort of pattern develops.

If I do have UARS, how do I determine that?

[MitchS]

I ended up turning Flex off and raising my pressure (fixed) to get rid of my RERAs. They only appear in sleep/wake junk now.

[Sleeprider]

When I had PRS1 Auto CPAP, I also changed Aflex to 1 and it did help. Keep in mind Flex is different from EPR and is flow based. People with good tidal volumes and normal exhalation flow will probably find lower flex numbers to be comfortable, while those with low volume or flow during exhale may never even see the full pressure reduction of a higher flex setting. Sounds weird, but true, and contrast that to the bilevel implementation of EPR in Resmed which always drops EPAP pressure regardless of respiratory effort, and does not recover IPAP pressure until spontaneous inhalation is initiated.

Anyway, take the changes slowly or you risk over-shooting the mark. It may take 3-days or more for a setting to settle in.

[OpalRose]

The approach I took to lower RERAs and Flow Limitations was to raise pressure slowly and set AFlex to 1. It didn't take much of an increase in pressure to accomplish this. Raised it .5cm until those events were pretty much gone.
Overall, I ended up with 1cm higher in miimum pressure.

[holden4th]

Thanks folks, I'll implement that tonight.