Do you REALLY know your settings?

kteague · Post by **kteague** » Tue Dec 19, 2006 7:48 am

Just looked at settings on old machine - ARRGH! This morning I pulled my prior machine, ResMed S7 Lightweight, out of the closet to try to answer a question about changing the pressure, and thought it was a good time to see if it was the same as my ResMed Auto Spirit. I had changed to an autopap with data capabilities when my insurance was ending and it was apparent I was going to need followup. Back then I didn't know how to change the settings, so since I switched machines, I never played around much with this one. Knowing what I know now I could just scream! Here I had been telling the DME and sleep doc how I felt like I was suffocating and kept snatching the mask off in a panic. Their answer was that they could try a pressure increase and see if it helped. Since I didn't want to play guessing games with no insurance and more doctor's visits, I just got an auto machine I could monitor.

Now I look back and find my ramp was set to 4 for 30 minutes! No wonder I couldn't keep the mask on for more than a few minutes after falling asleep! (On my new machine I upped the ramp pressure to 6 and reduced time to 5 minutes.) So before, since every time I snatched the mask off, I pushed the button to stop the air, then every time I restarted it, the ramp began again. I was basically trying to breathe all nite at a pressure of 4. No wonder I kept getting worse and worse! Unbelievable! I came to this site after giving up on cpap therapy. Had I not come here, I would have never known to change the ramp on my auto (or that I could even get one). But I never looked back till now, and now I am furious. Although it did turn out I needed a higher pressure, this ramp issue was the main cause for my initial "failure to thrive" on cpap therapy. During that time my cognitive and functional abilities deteriorated to the point of causing me to give up my career. My blood pressure soared, I developed diabetes, and have an enlarged heart. Can I say once again how angry I am?!

Hopefully if anyone else has similar issues and reads this, they will benefit from my experience. That thought is all that takes the edge off of my anger - at least it wouldn't all be for naught. Guess this forum is the closest thing to standing on a soapbox at the town square. I'll step down now.

Kathy

Goofproof · Post by **Goofproof** » Tue Dec 19, 2006 9:14 am

I firmly believe in No-Ramp, the quicker you adapt to this new way of sleeping, the faster you can see success. It's quite a rush to be blasted by 15 cm, but in a minute it's normal. However APAP is easyer on you, I just had to jump mine to start at 11 instead of 10, 10 felt too low. Jim

tomjax · Post by **tomjax** » Tue Dec 19, 2006 9:15 am

Yours is a powerful testimony on how much harm or lack of benefit can come from ignorance, that is not knowing about our condition or equipment.
It is conversly a powerful treatise on the benefits of knowledge and how and why we should be in control of our health.

It is a shame that there are so many out there relying on the expertise of their docs and DMEs. Some are very ignorant themselves and some rely on them!!

We must continue to try to reach those who should get in control and stop relying on those wh cannot or will not.

SelfSeeker · Post by **SelfSeeker** » Tue Dec 19, 2006 9:19 am

Kathy,

Vent away, you have every right to do so.

Hopefully your experience will help someone else.

I wonder how many people have their ramp set to low causing problems like yours or not sealing their interface well enough because there is not enough pressure to do so.

When I got my Comfort Curve (CC) interface, I read in the papers that came with it, that the CC need a minimum pressure of 6 for the carbon dioxide to wash out.

I posted a topic about people knowing the minimum pressure for their mask. I am sure many people do not know what the minimum pressure is for their mask.

Whenever a newbie comes on to chat and say they feeling like they are sufforcating, I ask them what the minimum pressure of their mask is.

OwlCreekObserver · Post by **OwlCreekObserver** » Tue Dec 19, 2006 9:29 am

Goofproof wrote:I firmly believe in No-Ramp, the quicker you adapt to this new way of sleeping, the faster you can see success.

Yep, I tried very hard to adjust to the ramp that the sleep doc recommended, but since I learned from this group how to disable it, I've been ramp-free. I much prefer to adjust the mask at full pressure right away instead of waking up 20-30 minutes later to do it. Then of course there's that smothering sensation....

OCO

kteague · Post by **kteague** » Tue Dec 19, 2006 11:07 am

Thanks all. You know, at this point I'm not so sold on the value of the ramp outweighing its potential detriment. But of course it's like so many other things in life - not a safety hazard when used as intended. So I can't say I think they should be done away because of some misuse. I'm guessing many truly benefit from that option used correctly. But the longer I'm on this journey, the more I feel like there should be a "movement" to educate potential users.

About the minimum mask pressure to maintain seal, I was trying to see if there was a compiled source on here but couldn't find one. (I did find a chart with vent/flow rates at different pressures.) If there is a source for the minimums, could someone please direct me to it? My back-up-in-case-of-no-other-choice mask did not include paperwork when I confiscated it from the closet of a nonusing friend. Surely others have obtained masks similarly.

Thanks.

Kathy

Mile High Sleeper · Post by **Mile High Sleeper** » Tue Dec 19, 2006 12:46 pm

Kathy,

I'm with you on that soapbox, been there, done that about harm incurred by lack of patient education; and believe that many on this forum are equally concerned about the lack of information and misinformation disseminated by some respiratory therapists in large national DMEs (or small ones) who don't know or don't convey much information about CPAP therapy. Many doctors need to provide more patient information, if it's not being provided by the RT. What concerns me are the patients who may be harmed by lack of information, leading to health deterioration and abandonment of CPAP therapy, as your posting indicates.

That's why I wrote the articles in the light bulb/our collective wisdom section and my blog, http://smart-sleep-apnea.blogspot.com . I encourage giving those links (or printouts) to DMEs and doctors and sleep labs and friends and acquaintences. If you are so inclined, send a complaint to JCAHO, speak at an AWAKE meeting (as a participant or presenter), write an article, do what you can to build awareness of effective CPAP treatment. Write more articles for Our Collective Wisdom. Add your ideas on how this information can be shared! Turn that anger into zeal! Help others!

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

Guest · Post by **Guest** » Tue Dec 19, 2006 2:59 pm

I'm a big fan of single-pressure, no ramp, straight CPAP.

Put on mask. Hit power button. Spend the 60 seconds it takes to adjust to the pressure checking for leaks in various head/pillow positions. A minute later, not only are you accustomed to the pressure, but you're also pretty sure the mask will be leak-free all night... something you easily can't do up front with an APAP machine.

I never saw any reason for the ramp, and I've never used it on my machine, not even once.... nor will I ever.

By the way, if you suffered major harm (new diseases and disorders, etc.) as a result of the ineptitude of the doctor or the DME people, you may want to speak to an attorney. Just a thought.

shippy · Post by **shippy** » Tue Dec 19, 2006 10:12 pm

Interesting ! I too decided about five nights ago as an experiment to try it without the ramp feature and like the others who have commented i get hit with a blast of 16cm. I right away fix the leaks and after a minute or so every thing is stabilized and i can go to sleep. I am new at this (18 nights)and certainly not an expert but my machine has c-flex and if i understand correctly the machine is supposed to sense my breathing and allow me to exhale freely, seems like it doesn't take long for the machine to allow me to breathe correctly even when starting without the ramp.

OwlCreekObserver · Post by **OwlCreekObserver** » Wed Dec 20, 2006 5:20 am

shippy wrote:Interesting ! I too decided about five nights ago as an experiment to try it without the ramp feature and like the others who have commented i get hit with a blast of 16cm. I right away fix the leaks and after a minute or so every thing is stabilized and i can go to sleep. I am new at this (18 nights)and certainly not an expert but my machine has c-flex and if i understand correctly the machine is supposed to sense my breathing and allow me to exhale freely, seems like it doesn't take long for the machine to allow me to breathe correctly even when starting without the ramp.

That's right. The ramp feature and C-flex are two different things. Ramping up is supposed to allow you to become accustomed to the pressure gradually as you fall asleep. I found it more of a distraction than anything else because I'd just as soon face the pressure right away and fix whatever needs fixing -- probably saying something about my personality.

C-flex, on the other hand, is just designed to help you exhale against the pressure. It's working whether you're ramping up or not. I've always used the C-flex feature and I think it would probably be more uncomfortable to exhale against a steady pressure -- 11 cm, in my case -- without that feature.

OCO

kteague · Post by **kteague** » Wed Dec 20, 2006 6:49 am

In my original post I referred to the ramp on my ResMed Auto Spirit. The feature that starts off at a lower pressure for a period of time is actually called "settling" on my apap. Didn't want someone new to be looking for a term in their menu that isn't there. (Thanks Chuck)
Kathy

stoverquill · Post by **stoverquill** » Wed Dec 20, 2006 9:41 am

This is all very interesting. I, too, have been waking up soon after going to sleep and never realized that it might be the ramp feature. I think I'll turn my off tonight and see.
Thanks!

svh · Post by **svh** » Wed Dec 20, 2006 10:03 am

Count me in as another no-ramp user. My machine came with the ramp feature enabled, and I played with it the first night, but quickly decided it was more trouble than it was worth, and have never used it since. I do have cflex set at 2, but as others have said, that's a completely different thing. I just have the initial burst of air, and am used to it in no time. Absolutely worth trying, for everyone, as far as I'm concerned!

Snoredog · Post by **Snoredog** » Wed Dec 20, 2006 3:00 pm

Your S7 lightweight should program the exact same as the Spirit, think I sent you the Clinical manual, should be able to apply the 95% pressure found from the Spirit to the S7.

I would setup a Ramp from say 6cm -95% pressure with a 30-minute timer and use the S7 as a backup machine.

Offerocker · Post by **Offerocker** » Wed Dec 20, 2006 4:51 pm

I stopped using the ramp feature when I still had the old "Pro" cpap w/cflex. (watched the DME RT program it, so knew how to get at the features).
I now have an Auto with c-flex, range set 7-13, usually spent at 11.
With an Auto, I don't feel the need to ramp - I want my air NOW! .
...also helps keep the mask fitting properly, as mentioned earlier.

Do you REALLY know your settings?

Do you REALLY know your settings?

pressure

Guide to minimum pressures?

information campaign

Ramping

Re: Ramping

Point of clarification