My Periodic Soapbox Speech About Ramp

[Goofproof]

I too never used the ramp, I learned to ride a bike without training wheels. One bike I had had them but we took them off after the first hour, it took the fun out of it, the whole point is to learn balance, you can't do that with outriggers.

With XPAP, the point of using it is to stop the airway from closing up, without the needed pressure, it can't work. I want my treatment to work, so I use it in a mode that allows it to work. Jim

[msla]

Maybe some people would be better treated by a veterinarian,
who must deduct symptoms without language to confuse them.

Thumbs up!

[Matt00926]

Ramp is helpful if you carefully set the minimum parameters so that even at the beginning you are still being adequately ventilated.

When IPAP is below 10 I feel like I am not getting enough air, so I set the machine to have a minimum pressure support of 10 so that the IPAP begins at 14 (max IPAP for me is 20; EPAP at 4 since I need a high PS for hypoventilation). The difference between 14 and 20 is not that much in the short-term, but it does wonders in increasing my chances of falling asleep.

YMMV

[hegel]

When I took my new machine into Kaiser, Nurse Ratchett took it and set a 30 minute ramp. It had been set at 8 with no ramp. I did not want any changes. She insisted, however, that the Aflex would respond with increased pressure if I fell asleep in five minutes, as often happens, and I needed increased pressure. this thread suggests otherwise. So if I fall asleep in five minutes and suddenly need a pressure of 10, when the ramp is 5, will that pressure of 10 occur to respond to my event? Or am I stuck at the slow ramp up to 8, my starting pressure--which I was completely fine with!!!

[Wulfman...]

When I took my new machine into Kaiser, Nurse Ratchett took it and set a 30 minute ramp. It had been set at 8 with no ramp. I did not want any changes. She insisted, however, that the Aflex would respond with increased pressure if I fell asleep in five minutes, as often happens, and I needed increased pressure. this thread suggests otherwise. So if I fall asleep in five minutes and suddenly need a pressure of 10, when the ramp is 5, will that pressure of 10 occur to respond to my event? Or am I stuck at the slow ramp up to 8, my starting pressure--which I was completely fine with!!!

Soooooo........change your settings to what works best for you and provides you with optimal therapy.

A-Flex is exhale relief and has nothing to do with increasing pressure. If she told you that, she's an idiot to begin with.

But, be sure to monitor your therapy with software.


Den

.

[MarylandCPAPer]

The way the A10 machine tries to determine that you've fallen asleep has to be based on analyzing the shape of the flow rate curve: Sleep breathing is much more regular and somewhat shallower than wake breathing. My guess is that as soon as the flow rate is sufficiently regular and there's a measurable decrease in how deep the inhalations are, the machine concludes that you are asleep and bumps the pressure up. It would be really useful to see some data posted by someone who is using an A10 with an Auto Ramp to see just what that machine does.

I have an A10 For Her. I used the feature (for one night only and NEVER again). We had a recent discussion about this here. The way it is SUPPOSED to work, per the manual, is to increase to the specified minimum pressure when a person falls asleep or 30 minutes later, whichever occurs first.

When I used it, I don't think the ramp ever stopped running, as I never went to sleep with the A10 the first night until I turned off RAMP entirely after several hours. I was used to a PR System One Autoset with no ramp but the DME insisted on setting the ramp setting when I got a new machine (the A10).

It sometimes has taken me hours to get to sleep with the CPAP on and I could never get to sleep at the ramp pressure or even the minimum pressure in my APAP range (10-20). Maybe some people fall asleep quickly and would find the ramp set to AUTO useful on the A10, but it was very annoying to me. The next day, someone told me where to find the clinician's manual and I checked it to find out what my settings meant. That was when I found out that ramp on the A10 set to auto was not my friend, especially if I went for hours without falling asleep.

[hegel]

oops, sorry, I'm weak on terminology...my nurse/tech also initiated a-flex, which seems fine. What I'm trying to ask is, if you have an event in the first minutes of sleep and your machine is in ramp mode, will it respond with increased pressure to address that event--I mean one of any number of possible apnea events, if my terminology is right here--or does the machine have to finish its ramp up cycle first?

Of course, once my machine hits it's established bottom pressure of 8, it will respond as needed.

[Wulfman...]

oops, sorry, I'm weak on terminology...my nurse/tech also initiated a-flex, which seems fine. What I'm trying to ask is, if you have an event in the first minutes of sleep and your machine is in ramp mode, will it respond with increased pressure to address that event--I mean one of any number of possible apnea events, if my terminology is right here--or does the machine have to finish its ramp up cycle first?

Of course, once my machine hits it's established bottom pressure of 8, it will respond as needed.

With the newer machines, I'm not sure.
I was always under the impression that it would not auto-adjust pressures until after the Ramp time was completed.

It would be apparent if you're using software to see what's happening. Mostly, an APAP in a range of pressures will respond to Snores and Flow Limitations.......and not Apneas directly or in progress.


Den

.

[Pugsy]

What I'm trying to ask is, if you have an event in the first minutes of sleep and your machine is in ramp mode, will it respond with increased pressure to address that event--I mean one of any number of possible apnea events, if my terminology is right here--or does the machine have to finish its ramp up cycle first?

According to the provider manual for the PR System One machines...it will treat whatever it thinks needs treating and then return to normal ramping. I don't remember what it did with the M series or older.
I also don't remember how ResMed might cover this issue but for some reason I want to think it doesn't do anything but don't hold me to that right now. I have been under the weather and my memory isn't quite as sharp as I would like.

But the PR S1 machines...they will treat events during ramp.

[hegel]

Thanks Pugsy! So I owe an apology to my Kaiser nurse/technician. She did say that my machine would treat apneas during the ramp period. My new machine just keeps looking better and better!

[MarylandCPAPer]

When I took my new machine into Kaiser, Nurse Ratchett took it and set a 30 minute ramp. It had been set at 8 with no ramp. I did not want any changes. She insisted, however, that the Aflex would respond with increased pressure if I fell asleep in five minutes, as often happens, and I needed increased pressure. this thread suggests otherwise. So if I fall asleep in five minutes and suddenly need a pressure of 10, when the ramp is 5, will that pressure of 10 occur to respond to my event? Or am I stuck at the slow ramp up to 8, my starting pressure--which I was completely fine with!!!

Soooooo........change your settings to what works best for you and provides you with optimal therapy.

A-Flex is exhale relief and has nothing to do with increasing pressure. If she told you that, she's an idiot to begin with.

But, be sure to monitor your therapy with software.


Den

.

Re apologizing to the tech, that's up to you. Without software and data that shows you had an event during ramp and the pressure went up, we don't know how the PR S1 worked. Also, it sounds like Nurse Ratchett gave you bad information about how A-flex works. It is a shame people who probably have never used a CPAP machine are the supposed experts on what they do.

[Krelvin]

Without software and data that shows you had an event during ramp and the pressure went up, we don't know how the PR S1 worked.

?? It is in the manual. Actually, some people actually read the documentation to find out what the machine does and don't assume that it does what they are told by a stranger that you may see once or twice.

I record my sessions with the DME to know exactly what they said so there is no misunderstanding than assuming that what I thought they said. Peoples recollection of what the session was like easily assume the wrong things because they are given terminology and phrasing they are unfamiliar with and unable to ask the questions necessary to clarify due to time constraints and inability to think of the good questions during such a short time span.

It is a shame people who probably have never used a CPAP machine are the supposed experts on what they do.

I agree, some people shouldn't make statements on a forum without doing some research themselves before hand as well.

[MarylandCPAPer]

Without software and data that shows you had an event during ramp and the pressure went up, we don't know how the PR S1 worked.

?? It is in the manual. Actually, some people actually read the documentation to find out what the machine does and don't assume that it does what they are told by a stranger that you may see once or twice.

There have been a number of occasions om which people here other than myself have reported that CPAP machines, masks, etc. have been different than the way the manual specified they were supposed to be, so i consider online manuals as guidelines of how the machine was intended to work when the manual was written but may be different in actual experience.

[palerider]

It is a shame people who probably have never used a CPAP machine are the supposed experts on what they do.

I agree, some people shouldn't make statements on a forum without doing some research themselves before hand as well.

she does that a lot. yap first, fact check never.

[MarylandCPAPer]

It is a shame people who probably have never used a CPAP machine are the supposed experts on what they do.

I agree, some people shouldn't make statements on a forum without doing some research themselves before hand as well.

she does that a lot. yap first, fact check never.

Not true. I read manuals and do research.Actual reported experiences (mostly by others) sometimes differ from the manuals. This is particularly true on the machine and mask I am using. I trust people's actual experiences more than manuals that may or may not be up-to-date.