Sleep Fundamentals || R is for RERAs, or Respiratory Effort Related Arousals

If you don’t have sleep apnea following a sleep study, you might still have problems with upper airway resistance, as shown by your RERA count.

What are respiratory effort related arousals (RERAs)?

In relations to sleep breathing disorders (SDBs), apneas are the prime target for identifying and diagnosing sleep apnea. However, apneas aren’t the only measure of upper airway resistance.

Another event known as a RERA shows significant impact on breathing as you sleep. RERAs are primarily determined by identifying a different measure from the usual apneas and hypopneas.

RERAs are disruptions in breathing that can cause arousals from deeper stages of sleep or which can reduce one’s level of blood oxygen which do not otherwise qualify as apneas or hypopneas.

Why to RERAs matter in sleep studies and sleep disorder diagnoses?

Many people will have overnight sleep tests which find they don’t have sleep apnea, but they might still encounter upper airway resistance due to a large number of RERAs.

A great example is those who snore but do not have sleep apnea. They may believe they are perfectly fine, but high numbers of RERAs on their tests (by looking at the RDI, or respiratory disturbance index, which combines apnea and hypopnea scores with RERAs) may reveal that they are still being awakened frequently at night (or aroused from deeper stages of sleep) due to these breathing disruptions.

People who have narrow airways, allergies, or other cranial features that lead to crowded space in the passages of the throat, nose and sinuses often experience many RERAs without actually qualifying for a sleep apnea diagnosis.

This is important to understand because it can be difficult to get treatment for problems with upper airway resistance without a sleep apnea diagnosis.

Some insurance payers will not reimburse for therapies to treat UARS (upper airway resistance syndrome) and some doctors will simply ignore a UARS diagnosis because treatments can be limited and expensive.

However, people with UARS who feel that the resulting daytime fatigue they experience is being neglected by their sleep physician may find some help through a visit with a sleep-medicine dentist or ear, nose and throat specialist (ENT) who has additional training in sleep medicine.

Often, solutions include positional therapy, oral devices to help open the airway, or outpatient procedures to reduce resistance.

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