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+--- Thread: RERA help for new OSCAR user (/Thread-RERA-help-for-new-OSCAR-user)
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RERA help for new OSCAR user - sleepylibrarian - 12-31-2024
I've been using a CPAP since August of 2023, but just downloaded OSCAR yesterday. My usual equipment (ResMed AirSense 11) has been sent for warranty repair, so I'm using a loaner (ResMed AirSense 10 Autoset). I saw that it included a SD card and had been meaning to try out OSCAR so gave it a go.
I'm noticing I have a lot of RERA events - between 5-20 per night since I started using the machine on December 11th. I'm wondering if this is the culprit for my continued daytime fatigue - much improved since starting therapy, but still present. I read some posts on UARS and the post on flow limitation (I'm not able to post links), and thought that maybe increasing EPR to 3 may help. Any insight into reducing RERA (or anything else of note in my charts) would be appreciated!
RE: RERA help for new OSCAR user - Sleeprider - 12-31-2024
Increase your EPR to full-time at setting 3 and sleep with it. That should lower your flow limitations. Post new results tomorrow. You may need bilevel to fully resolve your flow limits which are at a 95% level of 0.55. That's very high, and is the source of your problems. Our wiki on flow limitations explains how this leads to RERA and how we use EPR and pressure support to resolve the problem. https://www.apneaboard.com/wiki/index.php?title=Flow_limitation
RE: RERA help for new OSCAR user - sleepylibrarian - 12-31-2024
Amazing, thank you! I have made that change and will post an update tomorrow.
RE: RERA help for new OSCAR user - Sleeprider - 12-31-2024
Sleepylibrarian, I think it may help to offset the EPR increase by setting you pressures to minimum 7.0 and maximum 10.0. This will result in a range of pressures of 7/4 to 10/7 (inhale/exhale).
RE: RERA help for new OSCAR user - sleepylibrarian - 01-01-2025
(12-31-2024, 11:12 AM)Sleeprider Wrote: Sleepylibrarian, I think it may help to offset the EPR increase by setting you pressures to minimum 7.0 and maximum 10.0. This will result in a range of pressures of 7/4 to 10/7 (inhale/exhale).
Thank you for your insight! I made those two changes and it looks like things have improved quite a bit. Is the 95% flow limitation number indicative of needing BIPAP?
RE: RERA help for new OSCAR user - Sleeprider - 01-01-2025
We generally try to get that 95% flow limit as low as possible, and certainly under 0.10. So increasing EPR alone, seems to have cut it in half, but in my opinion that is not enough. Do you have a sense or feel of having a lot of breathing resistance? How many pillows do you use? Are you aware of chin-tucking as part of your sleep architecture either on your back or side? Positional apnea can be a significant source of airway resistance, so we have a wiki that explains it. You don't actually have a high apnea index, but you seem to be struggling a bit on inspiration. https://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#Positional_Apnea
If you are comfortable at current pressure levels, I encourage you to increase settings to 8-12 range and continue with EPR 3. That may provide some additional stent to the airway.
RE: RERA help for new OSCAR user - sleepylibrarian - 01-02-2025
Increasing the pressure more than halved the 95% flow limit again! Is there any harm in increasing the pressure slightly until I can get the 95% number under 0.01? I don't find the pressure bothers me at all, and I'm not feeling a sense of breathing resistance while awake.
Thank you for the information on positional apnea. I sleep with one pillow on my side. After reading that I realized my issue may be my pronounced receding jaw/chin. I paid attention to my sleeping position last night, and my receding jaw makes it so that I can't tuck my chin without it becoming very uncomfortable, but I'm assuming my particular jaw structure is likely at least contributing to my flow limitations.
Your help is much appreciated! I felt kind of terrible yesterday morning but today is much improved!
RE: RERA help for new OSCAR user - Sleeprider - 01-02-2025
By all means, it seems pressure helps. Let's take the maximum to 14, and minimum at 10. If you are going to use ramp, put it on Auto and use a higher pressure you tolerate. It would be best to just turn off ramp if you can. There are a couple breaks as you started and that may because pressure is too low for you.
RE: RERA help for new OSCAR user - sleepylibrarian - 01-02-2025
I'll give it a go, thanks for the advice!
Ah, I forgot to mention the two sessions at the start of the night - I originally thought I would use my full-face mask as I was somewhat congested, but got annoyed with it 10 minutes in and switched back to the pillows. Second break it me getting up to get heartburn medication
RE: RERA help for new OSCAR user - sleepylibrarian - 01-03-2025
Whelp, seems like upping the pressure has perhaps maxed out the benefit for flow limitation. My husband said I was coughing a lot last night, which makes me think I wasn't tolerating the increased pressure well. I also woke up a couple of times and felt like the increase in pressure was bothering me.
I see I have less leaks, which makes sense as I tightened my mask slightly before going to bed.
I'm going to switch back to auto ramp tonight and pull the pressure back to the previous night's settings since it seems the increase didn't change anything. I've also reached out to a local orthodontist to see if they have any ideas that might help. Any additional suggestions welcome, and thank you so much for all your help!