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+--- Thread: Appreciate help adjusting settings (UARS) (/Thread-Appreciate-help-adjusting-settings-UARS)
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-05-2019
(09-05-2019, 04:33 PM)cmcphee Wrote: @slowriter thanks for the links - to confirm, did your machine pick up zero RERAs as well? I'm seeing zero RERAs ever over the past few weeks - which is inconsistent with my sleep study.
Yes, and same here.
RE: Appreciate help adjusting settings (UARS) - Melman - 09-05-2019
(09-05-2019, 04:13 PM)cmcphee Wrote: Thanks, @melman. I'm not seeing an option to add RERAs. Uploaded a screenshot of the dropdown - is there a setting I'm missing maybe? Appreciate your help!
I believe it needs to be turned on there for two reasons. 1) I've seen similar instruction from those who are considered the forum gurus. 2) If I change the RE tab from green to red RERAs disappear from my daily charts.
I know some early S10 autosets did not upport RERA. Perhaps that's why you don't see an RE button.
RE: Appreciate help adjusting settings (UARS) - sheepless - 09-05-2019
someone with more knowledge can tell you how RERA is identified. my subjective impression is that they aren't very reliable. I don't think my asv flags them but with apap I saw tons of flow limitations in my flow rate, some to many of which I suspect caused arousals, but only a few flags. I think it's more useful to scroll through the flow rate to find them ourselves. in any event (!), you may not see the row for it in the event flag box until your machine actually flags one. if I remember correctly, the for her model came out after my 2016 model autoset which does flag rera.
RE: Appreciate help adjusting settings (UARS) - cmcphee - 09-05-2019
@melman - I checked my AirView reports from my doc, and on Aug 26 (before I had an SD card) the charts shows 0.1 for RERA. This is still really low given my sleep study results (attached a snippet bc the image is too big to upload). I checked the corresponding night in Oscar and there are no RERAs reported in the summary metrics (graphs don't show up bc of lack of SD card). Given that I've already turned on RERAs in the preferences and they aren't showing up in the drop down list at the bottom of the graphs - is there possibly a bug? Or is there a chance that what the PAT at home sleep study showed as RDIs, AirSense is showing as centrals? Feeling confused and not sure what to do next
RE: Appreciate help adjusting settings (UARS) - Gideon - 09-05-2019
OK, here we go.
ResMed looks for a series of Flow Limits (reduced flow or lower height on Flow Rate chart) and I'm not sure how much reduction, of several minutes (2-3) followed by Arousal to classify as RERA. The trouble with this algorithm is that it assumes that what immediately precedes this is normal breathing. I have seen cases where nearly the entire night was flow limited and ResMed caught very few of the actual RERAs. This is more the exception than the rule.
Your data:
First, your NUMBERS are excellent. Not even going to try to change them.
You said
I am experiencing fragmented sleep (1-4 conscious arousals a night) Not really concerned You are doing the right things here. You can try turning your Ramp off to get to your therapy pressure sooner.
constantly waking up feeling exhausted, with clouded thinking, a headache (dull pain/pressure in forehead and behind eyes). A number of causes, but NOT your Apnea, that is well treated.
I get really tired by early afternoon but am unable to nap. I have been on disability from work because of the exhaustion and brain fog. Again this is NOT your Apnea.
I’d appreciate any ideas you have for how to adjust my therapy to reduce arousals and improve how I feel when I wake up, as I need to return to work ASAP. That is what we are working on.
Sep 2 has some "tells" in the Flow Limit chart. Can you give me some 5 minute views around the Flow Limit Spikes near, 1:05, 4:10, 5:10. No guarantees but that spike has indicated the timing of a RERA in other users. This is NOT a good indicator of RERAs, it just says look here. You have spikes on other night's but they are not as prominent.
Read this WIKI to help you spot RERAs and Flow Limitations. http://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#RERA
This is step 1 of solving the mystery.
Look at the bottom of the charts, there is an indicator that expands on the right and left of the bottom of the charts, look there and make sure everything is showing green.
Your 9/3 3:31 OA event looks like you stirred (irregular breathing) then held your breath as you shifted positions, by itself nothing, if there are many of these it is some form of a Sleep hygiene issue.
Your 9/3 3:47 CA event looks like just that, a CA event and you don't have enough of them to worry about.
Your 9/3 2:07 UF1 events are brief interruptions but the detail is too coarse to evaluate Flow Limitations.
Your 9/3 2:32 event looks normal non-restricted breathing followed by what looks like flow limitation but was your effort in turning off your machine or it auto-offed after you removed your mask. Nothing showing here.
Your 9/4 3:29 event is the same as the above one Normal breathing some movement and the machine is turned off.
Post the Advanced graphs as well
Event Flags, Flow Limit, Minute Vent, Tidal Volume, Insp Time and Exp Time. Some zoomed views of what looks like problematic areas as well.
Sorry, nothing yet
RE: Appreciate help adjusting settings (UARS) - Sleeprider - 09-05-2019
We have dealt with UARS recommending EPR and pressure support in bilevel to overcome this problem. Our wiki on UARS and using bileve is very important. But a recent thread reminded us to look at oxygen saturation as a priority. It is very inexpensive to use a recording oximeter to monitor oxygen saturation, which can be dangerously low, even with good AHI. http://www.apneaboard.com/forums/Thread-Therapy-Questions-EPR-CA-Low-O2
Please look at your results with CPAP and if you have not had oxygen monitored, please consider getting a $100 recording oximeter from Supplier #19. We can coach you to optiimize AHI to the extent possible with your current machine, but we don't want to overlook the critical matter of ensuring your oxygen saturation is acceptable or at least safe.
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-06-2019
@sleeprider - was there something in particular that caused you to raise the O2 issue with the OP?
RE: Appreciate help adjusting settings (UARS) - Gideon - 09-06-2019
Very significant desats with CPAP in latest sleep study to the point where the lab put her on Oxygen and validated oxygen levels with CPAP.
Both SR and I missed the previous separate (now combined) thread where desat concerns were voiced
RE: Appreciate help adjusting settings (UARS) - slowriter - 09-06-2019
Oh wow; that indeed explains it!
RE: Appreciate help adjusting settings (UARS) - cmcphee - 09-06-2019
Thank you a ton for all the detailed responses and thoughts.
@bonjour, I've read the links and uploaded the additional graphs provided. I'm out of document space, so I created a shared Google Drive here with the files you requested: https://drive.google.com/open?id=1OyZzYs67ahtqqFotnCopr3RfgrVkjTPi
I've included:
- Charts labeled with '5MIN Sept 2' are zoomed in on the times you requested on Sept 2
- Charts labeled with 'Full Sleep - Date - Advanced' have the advanced graph information requested for Sept 2-5
- Chart labeled 'Full sleep Sept 5' with standard and advanced charts from last night, as well as 'Wakeup' charts with details on the 3 arousals - lmk if you want the advanced charts for these too?
- Full sleep study (take home only) with oximetry
Please let me know if you have any file access issues. This evening I'm going to do a full review for RERAs and will post what I find.
@sleeprider, I have a Mac that I can't partition. Any alternative oximeters you recommend? I will order whatever you recommend today.
Thanks again, everyone.