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What Are Respiratory Effort Related Arousals (RERA)?

Posted On February 12, 2014
February 12, 2014

You finally admitted it. Yes, you snore, but not all of the time. On occasion, you wake up from sound sleep and realize it is increasingly difficult to catch your breath. This problem has been a concern and so you made an appointment with your physician who believes that you actually might suffer from respiratory effort related arousals (RERA) but you need more tests to confirm.

Sound familiar? Often times it is hard to differentiate between RERA and obstructive sleep apnea (OSA). For people with OSA, breathing stops on a number of occasions during the course of an hour due to a partial or complete obstruction of the sufferer’s airway. People with RERA labor to breathe due to resistance and hence this disease is also known as upper airway resistance syndrome (UARS). Chest muscles and the diaphragm labor to assist the sufferer to breathe properly. As a person with RERA progresses into deeper and deeper stages of sleep, his or her airway becomes more restricted. When trying to inhale becomes too difficult, the individual with RERA wakes up and hence arousal occurs.

Unfortunately, many folks with RERA are misdiagnosed and suspected of having a variety of other problems besides OSA such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia and temporomandibular joint (TMJ) syndrome.

Nevertheless, both OSA and RERA produce similar symptoms such as disrupted sleep, fatigue and daytime sleepiness. But with RERA, the airway is not obstructed and thus during a sleep study, the individual will not demonstrate low oxygen blood saturation levels. Instead with an invasive special type of study known as a pneumotachograph that analyzes air flow, resistance in the upper airway is discovered.

How RERA or UARS Differs from OSA

Although symptoms can be similar between RERA and OSA, there are quite a number of differences. With RERA, these events are usually one to three breaths in length and can last 10 seconds or longer. In OSA, stoppage of breathing can occur anywhere from 5 times to over 30 an hour and can last as long as a minute.

For the most part, people with RERA are young, not obese and female. The reverse is true for OSA with older, middle-aged men on the heavier end of the weight scale predominately plagued with this condition. In addition, RERA sufferers are more likely to also have chronic insomnia.

In a study published in CHEST, researchers discovered that subjects with UARS had an increase in airway resistance due to reduction in the circumference of the pharynx when asleep. Other groups have found an anatomical connection for instance, a deviated septum and UARS.

Unfortunately, treatment options do not always work in that symptoms are not always relieved and the individual does not have a normal follow-up airway resistance study. Nevertheless options do range from conservative and non-invasive (nasal continuous positive airway pressure, oral appliances and weight loss) to invasive surgery.

If you believe that you might be experiencing RERAs or suspect sleep apnea and would like to discover your best treatment option, please contact one of our medical concierges today at  or schedule a free consultation.

About Phoebe Ochman

Phoebe Ochman, Director of Communications for Sleep Apnea Treatment Centers of America, manages all content and communications for the company.
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