UARS: What are your ODI 4 % numbers with good/bad bi-level therapy?

[THEVGE]

In my search of good UARS therapy using bi-level I am currently focusing on ODI (Oxygen Desaturation Index) 4 % using a pulse oximeter (re-branded Contec 50 series). I do see a reduction at higher pressure, but wonder how far I have to go and what your typical ODI numbers are in relation to how well you feel. Getting 0 AHI and 0 leak is easy for me (typical UARS), getting good sleep is not, hence this new KPI I am chasing.

Example for me (I see this correlation for multiple pressures):

P 7,6/PS 5,0 (IPAP 12,6) = 18,5 ODI 4 % events/hr + risk of desaturation < 88 %.
P 10/PS 5,0 (IPAP 15,0) = 4,4 ODI 4 % events/hr + no risk of desaturation < 88 %.

It seems that I can still have limited desaturations < 88 % at IPAP ~ 14 or below. So it makes sense for me to stay > 14. It is too early to state if my subjective sleep quality has increased, but I am positive although CA's (TESCA) started to emerge at these pressures. I decided to stick to P 10/PS 5 (IPAP 15) for a while and see if the CA's reduce, if my ODI 4 % remains stable and if my sleep improves before changing a setting.

Any numbers out there for people with good and bad UARS therapy using bi-level?

[Jay51]

Great job figuring this out.  You have one tool at your disposal with the VAuto that can help prevent CA's.  It is the trigger setting.  Moving up to high (and better yet, very high) has shown to decrease CA's in many charts that I have personally seen here at ApneaBoard.

[THEVGE]

Thanks Jay51, I am aware of the trigger settings. I used "very high" to get no CA's but often felt like driven over by an Abrams tank.......not good. I am now on "high" and although I have ~ AHI 5 in CA's I feel better than with AHI 0. I hope that my body is able to recover the coming days, if not, I will try trigger "very high" again.

[THEVGE]

After some training I got used again to "trigger very high" and as a result I am "CA-free" at high pressures again, yay!

I have achieved 1,0 ODI 4 % (2,1 ODI 3 %) event/hour using P 11 PS 5 with a basal SpO2 slightly above 95 (during sleep my highest SpO2 was 96,6 with P 9 PS 5,8). I also notice at higher EPAP/IPAP my SpO2 baseline is more stable.

So I still feel as if I am going the right direction, but I am shocked I am already at IPAP 16 and my sleep is still pretty bad. I actually think my PS should still go up a bit, still having the feeling like having flow limited breathing (currently the cold season started so I actually have additional flow limitation in my nose). A Breath Right nasal strip does not solve that as the block is on the inside. I will keep testing for a while, and just for testing purposes I have arranged an ASV to see what that can do for me. I more and more get the feeling bi-level pressure levels are getting to high to deal with for me, although every time I surprise myself what "training" can do. There was a time where P 7 on CPAP felt like impossible to do ;-) .

I have not seen many people on this forum with such high pressures. Additional note: soon I have an intake with ENT and we will discuss DISE (without bi-level).