Ramp is a crutch or needed toprevent escaping air ?

luckylinda · Post by **luckylinda** » Wed Apr 04, 2007 3:56 pm

I saw the DME earlier this week to get an auto with c-flex for a two week trial as sleep test results were mixed.

He told me that using the ramp feature was critically important because our lungs are not ready for the sudden pressure and that not using the ramp causes eventual loss of air through the mouth.

I told him that the other RTs I had seen never told me that, nor in all the reading I had done had that statement ever been made. I also told him that I never used the ramp because I was comfortable at my prescribed pressure. He said that I was not getting the best treatment by doing that.

So, any educated answers for me?

Thanks,

Linda

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, DME, Ramp, auto

rested gal · Post by **rested gal** » Wed Apr 04, 2007 4:06 pm

LOL!!!!

I can't say that mine's an educated answer, if you mean in the sense of being from a health care professional...which I'm not.

But here's my honest opinion: the DME that told you that stuff is full of....ummm, "hot air."

sinkem · Post by **sinkem** » Wed Apr 04, 2007 4:08 pm

It is a crutch, I no longer need to use the ramp.

Wulfman · Post by **Wulfman** » Wed Apr 04, 2007 4:09 pm

rested gal wrote:LOL!!!!

I can't say that mine's an educated answer, if you mean in the sense of being from a health care professional...which I'm not.

But here's my honest opinion: the DME that told you that stuff is full of....ummm, "hot air."

Or male bovine excrement. (BS)

Den

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 4:39 pm

It's a crutch, Not to say, that it can't be useful to someone that don't have the ability to control their own thinking (Minds). ( I'm sure I haven't expressed this in the best way)

I'm a believer that if something needs to be done, you grab the harness and do it. Wishing you didn't have to do it won't get it done. You might as well apply yourself to the task, the sooner you get the work done the faster you can enjoy the rewards.

I had pretty well totaled this body, from many different directions. It came down to change or stop the problems or die. Apnea was just one more nail in a rotting coffin, but it was a nail I could do something about. Why use the ramp, and not get treatment until it goes off, when you can get treatment for the whole night. It just made sense to use the treatment, and I started at 14 cm, and just before had my chest opened up. It did cause a minute of panic when the machine spun up, and you wondered if everything was going to open up, but in a few hours you woke up thinking the machine had quit. Amazing what you can get used to. Jim

luckylinda · Post by **luckylinda** » Wed Apr 04, 2007 4:49 pm

Yeah, I agree with all of you. His insistence that not using the ramp resulted in less than optimal treatment blew me away.

It was something I had never heard before, and I hope to hear from others regarding their opinions or experience with this.

Thanks, all

Linda

babydoss · Post by **babydoss** » Wed Apr 04, 2007 5:01 pm

My hubby has been on a Bipap S/T for about 2 weeks now. He started out using the ramp for about 4 days. After that he said he didn't need it. He preferred to just go "full force".

Calling the ramp feature a "crutch" seems a little negative to me. Hey, whatever it takes. I think that it is a valuable tool to help newbies get used to the fact that hurricane force winds are blowing down your throat, especially if you are prescribed a higher pressure.

If people feel the need to use it or not, it's fine. But, in my opinion, I don't see how it could negatively impact the POSITIVE aspects of the therapy.

No one should feel shame whatsoever if they feel the need to use the ramp.

Best wishes,
Mrs. Lee Doss

Goofproof · Post by **Goofproof** » Wed Apr 04, 2007 5:09 pm

babydoss wrote:My hubby has been on a Bipap S/T for about 2 weeks now. He started out using the ramp for about 4 days. After that he said he didn't need it. He preferred to just go "full force".

Calling the ramp feature a "crutch" seems a little negative to me. Hey, whatever it takes. I think that it is a valuable tool to help newbies get used to the fact that hurricane force winds are blowing down your throat, especially if you are prescribed a higher pressure.

If people feel the need to use it or not, it's fine. But, in my opinion, I don't see how it could negatively impact the POSITIVE aspects of the therapy.

No one should feel shame whatsoever if they feel the need to use the ramp.

Best wishes,
Mrs. Lee Doss

If you use the ramp, and have a apnea event, you are not at your treatment pressure, and can be basically untreated.

If the ramp is set at too low a pressure you can starve your air intake needs.

If your ramp is set to last longer than it takes you to go to sleep, you risk apnea events going untreated. Jim

oldgearhead · Post by **oldgearhead** » Wed Apr 04, 2007 5:34 pm

I think the "ramp" feature adds little to those who use "auto" machines.
With the minimum pressure set a little below your titrated (lab or home
with the data), the pressure will probably not rise until the time is right.

A couple of additions to the reasons already stated for not using a "ramp" are:

1) The older Remstar Auto's ramp will not even work as expected
when the ramp feature in enabled. That puts in in "split night" mode.

2) Mask leaks should be dealt with before you doze off. The closer your
starting pressure is to your "sleeping pressure", the better.

Snoredog · Post by **Snoredog** » Wed Apr 04, 2007 5:41 pm

[quote="oldgearhead"]I think the "ramp" feature adds little to those who use "auto" machines.
With the minimum pressure set a little below your titrated (lab or home
with the data), the pressure will probably not rise until the time is right.

A couple of additions to the reasons already stated for not using a "ramp" are:

1) The older Remstar Auto's ramp will not even work as expected
when the ramp feature in enabled. That puts in in "split night" mode.

2) Mask leaks should be dealt with before you doze off. The closer your
starting pressure is to your "sleeping pressure", the better.

Nitro Dan · Post by **Nitro Dan** » Wed Apr 04, 2007 5:49 pm

In my 20+ years of treatment, I have tried ramp only once. I just didn't see the need for it...

stages3n4 · Post by **stages3n4** » Wed Apr 04, 2007 6:32 pm

Only been at this for less than a week. While I think I could do without the ramp, I use it. I set for only 15 minutes, so I'm up to full blast in no time.

BrianRT · Post by **BrianRT** » Wed Apr 04, 2007 6:59 pm

The ramp feature is basically to help improve compliance. I tell my patients it's a comfort feature to ease into it. It would stand to reason that the manuf. felt it could be of some benefit since they went through the trouble to make the extra button and tweak the computer to deliver it.

Think of it as a swimming pool where the temp is a little chilly. Some people ease into it, feet first, then up to your knees, etc. Some people take a flying leap into it to feel the rush. It's a personal preference.

As far as not getting the full treatment from NOT using it (as the DME originally said), that's the first I've heard of it. I can understand the theory, flawed as it is. Airloss from the mouth.....ummm...they're probably thinking that you don't give your mouth a chance to seal up and acclimate to the increased need to stay shut. This is (if I'm right, and it's the only half-plausible thing I can think of) absolutely nothing to worry about. And keeping your lungs protected from the sudden pressure increase is a non-issue too. First off, the lungs are very capable of handling it, trust me. Most intubated/ventilated patients I've seen have airway pressures (expressed Paw) in the 20's, and this is a normal value. Keep in mind that this is straight to the carina via an endotracheal tube, encountering NO naso/oropharyngeal airway resistance, which you do with a non-invasive application like CPAP. We really don't start to get worried until 40+ cmH20 anyway. That's when things like a pneumothorax (popping a lung/collapsed lung) start to be an issue. If anything, the sudden pressure rush (from the CPAP) would help to open some unused alveoli, and that's a good thing.

I agree with babydoss regarding calling ramp a crutch being negative (see my post in the other 'ramp' thread). For some people, it's the ONLY thing keeping them from chucking it in the closet (esp. those at 16+ cmH20). Coming here, to a forum that people frequent for advice and encouragement, and finding out they are perhaps weak or inadequte for needing to use it can foster a "darned if you do/don't" mindset.

I'm not singling anyone out on this, seriously. With average complaince of users at only 40%, staying positive is paramount. I guess I'm just used to being a cheerleader

WearyOne · Post by **WearyOne** » Wed Apr 04, 2007 7:34 pm

I never heard or read anywhere that NOT using ramp was less than optimal treatment!

C-Flex, EPR(?) and ramp are very helpful additions to xPAP machines to help people become adjusted to it, and sometimes stay compliant.

I was only at 9 when I started five weeks ago (8 to 8.5 now) and used the ramp for a couple of weeks. I had the DME set the beginning pressure at 5, because I knew default of 4 was too low. Got home and found that was also too low, so I moved it up to 6. Too low a starting pressure is no problem to fix. You can either have the DME or physician do it, or do it yourself.

I never went to sleep before the ramp got to full pressure, but it still helped. And in the beginning, 9 on CPAP compared to no CPAP was a lot of air to me.

Not being at full treatment pressure for 5, 10, 15 minutes because you go to sleep before the machine hits full treatment and might have an event? Not such a big deal if the alternative means the machine sits unused because the patient can't tolerate starting out at full pressure.

I don't use it now, but it sure was helpful when I did. As others have said, it can help some people get used to it and/or stay compliant, It's a helpful tool, not a crutch.

Pam

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, CPAP, DME, Ramp

tomjax · Post by **tomjax** » Wed Apr 04, 2007 7:36 pm

I think the ramp is more a marketing feature than a practical utility.

If a person starts using one and feels better, then by all means, continue it.

I fail to see any benefit at all in my case and only used it a couple of times,

But then, I tend to read long after I put my mask on and watch tv and do all those things some say are a no-no.
I even unplug my smartcard and read the paper in the mornings with my pap on.
tomjax