Dreamstation "SmartRamp" Feature

[palerider]

I've just had my machine upgraded to a DreamStation.
I'm trying to make sense of what SmartRamp does.
I wondered if any of the contributors to this thread have anything new to say on this subject.
I'd very much appreciate a simple summary of how it works on a DreamStation Auto CPAP machine.

There's been no mention above of what the Clinicians Guide says:

When SmartRamp mode is enabled, the therapy device’s ramp function utilizes an Auto titrating algorithm during the ramp period.
It allows patients the ability to stay at lower pressures during the ramp period, to improve their acclimation to therapy.
SmartRamp mode functions differently, depending on the therapy mode that the device is using.

*In CPAP or CPAP-Check mode, the SmartRamp applies the Auto-CPAP algorithm during the ramp period.
The Ramp Start pressure becomes the Auto Minimum pressure during the ramp period.
The Auto Maximum pressure during ramp is the CPAP or CPAP-Check pressure.

*In Auto mode, the SmartRamp applies the Auto-CPAP algorithm during the ramp period.
The Ramp Start pressure becomes the Auto Minimum pressure during the ramp period.
The Auto Maximum pressure during ramp is the Auto Minimum under normal Auto mode.

*In BiPAP or Auto-BiPAP mode, the SmartRamp applies the a modified version of the Auto-BiPAP algorithm during the ramp period.
The Ramp Start pressure becomes the EPAP Minimum pressure, and the Pressure Support Minimum pressured is applied.
The IPAP Maximum pressure during ramp is the EPAP or EPAP Minimum under normal BiPAP or Auto-BiPAP mode.

The SmartRamp period will terminate in either of two ways:

1) If SmartRamp pressure reaches the minimum pressure of the therapy mode selected, then SmartRamp ends, and the device continues to deliver therapy under the selected therapy mode, or:

2) If SmartRamp pressure does not reach the minimum pressure of the therapy mode selected by the end of the Ramp Time, then pressure is increased at a rate of approximately 1 cm H2O per minute. Once the pressure reaches the minimum pressure of the therapy mode selected, then the device will continue to deliver therapy for that mode.

If SmartRamp mode is not enabled, then the standard, linear pressure ramp mode is active.

(Which I don't understand! )

you quoted the whole manual section, then said "which I don't understand".... which *PART* don't you understand?

[foo]

I know this is a little old but I was looking for this exact information.

In the following video at 9:20 you get a good explanation of what the smart ramp feature does.

https://www.youtube.com/watch?v=0BhrJPDq_5s

[gwatuk]

Thanks for that foo.

I think the key thing there is that it's usually used with fixed pressure CPAP.
(I'm a bit puzzled as to why someone would want to use a Dreamstation in this way.)

I have my minimum pressure set to 9cm of H2O which I'm comfortable with, and have the ramp start pressure at 5.
I have smart ramp off and ramp time set to 20 minutes.
I don't have any problem with the ramp working in the usual way (not smart) - I usually fall asleep before it reaches 9.
And this setup works well if I wake up during the night and the machine has raised its pressure to a suitable therapeutic pressure (usually about 12) - I can hit the ramp button and fall asleep again at a lower pressure.

I had an interesting experience with the company who provide my equipment and monitor its performance (not my consultant).
They were insistent that I should use the settings that the box had when supplied (minimum pressure 4, ramp start 4) which if you think about it means the ramp never works!
But after I explained the logic behind my preferred settings to my consultant they allowed me to continue with them.
The logic is that the machine reaches a pressure (9) which is fairly close my usual therapeutic setting (about 12) so it needs fewer events to nudge it up to the therapeutic range, thus starts treatment sooner.

[foo]

Well, it seems like it's actually a pretty cool feature. Especially with a Fixed PAP machine.
Like in my case, I'm now using a nasal mask instead of the full face mask I started with.
I am still getting used to it.
The pressure does bother me and I find relief in the ramp feature.
I don't always fall asleep at the same times. Sometimes I fall asleep after 30 minutes, sometimes I fall asleep right away. I've used 45 minute ramp times as well...

So, what I think is possibly helpful with this autoramp feature is that;
lets say that you fell asleep within 7 minutes. At minute 15, you have an event because the ramp is below your pressure level setting prescription. You may have multiple events during the ramp session.
With the autoramp feature, it remains at a low pressure and it's sensing when you're asleep. Let's say 15 minutes into your 45 minute interval setting. It then automatically goes up to your prescribed pressure level. I don't know how quickly.
Thus I would think this feature is pretty beneficial in you staying comfortable as long as possible at lower pressure until you are asleep. While still providing treatment in a consistent manner.

I just discovered this today and am going to try this myself.

If someone has more information or experience with this, please add on/correct.

[gwatuk]

Hi foo, you said:
"With the autoramp feature, it remains at a low pressure and it's sensing when you're asleep."
I'm not sure that's the case.
If you look back through this thread I think the general opinion is that the ResMed machines sense when you fall asleep, but the Dreamstation only starts to increase the pressure (during the Smart ramp) when an apnea event occurs.
(I might be wrong - this is quite along thread!)
If this is the case and you set the ramp start pressure at a low value but your normal therapeutic range is quite high, then it will take quite a while to reach that therapeutic pressure (I think).
Do you use any software to look at the details of what's happening (e.g. Sleepyhead)?
That's probably the only way of establishing exactly how it works.

[Pugsy]

If you look back through this thread I think the general opinion is that the ResMed machines sense when you fall asleep, but the Dreamstation only starts to increase the pressure (during the Smart ramp) when an apnea event occurs.
(I might be wrong - this is quite along thread!)

My understanding of the Smart Ramp with the DreamStation in fixed pressure mode....is it will act like normal ramp until it maybe senses some sort of apnea event happening prior to the end of the ramp time...and then it will suspend the ramp and increase the pressure to the fixed pressure setting it was on its way to before it sensed the event.
We assume that the person is asleep because we don't normally have the airway close up while awake.
So ramp either ends when a person has an apnea event or warning sign....or the time limit for ramp is used up.

Respironics machines have done this in the auto adjusting mode for years...so that's nothing new. It was available on my first apap the M Series 9 plus years ago. They always suspended the ramp if it sensed some sort of warning sign for impending airway collapse.
What's new is that they renamed it and added it to fixed pressure mode.
Big whoopie....they should have done that years ago...they had the technology.

Now ResMed...they never did that with any models or modes of operation until the new AirSense/AirCurve machines and even now only when the AutoRamp feature is selected for use and they say it's tied to if the machine senses that you are asleep....not so much for the apnea event itself.

As to how accurate these machines are in actually figuring out if we are asleep or not....whole other discussion.

Ramp has its place when people need it...we have to be able to fall sleep in the first place..
Keep it as short of duration as possible though even when using one of the "smart" ramps....because we don't know just how accurate they are in figuring out sleep for one thing.
And if we do fall asleep before the end of the ramp and an apnea event happens...probably not the end of the world but we want to limit those events as much as possible.

[foo]

@gwatuk;

Ya, it's new to me. Been trying to decipher it from the limited info I can find. The video seemed to suggest what little I have read.

Welp, I'll give it a go and see what the results are. Only way to be sure if it's a good thing or not.

@Pugsy;

I was writing at the same time. Thanks for the added info. It seems that it may be beneficial. I'll give it a go and be mindful to still try to shorten the ramp time when it's of benefit.

[TropicalDiver]

I briefly used a Dreamstation between a S9 VPAP Auto and an Aircurve 10. Smart ramp was set to on and the machine was in auto (min 10, max of 20).

SmartRamp was awful for me -- it felt like it was actually fighting my normal breathing pattern. It felt like the pressure sometimes/often dropped before I was finished with an inhalation. Turning off the ramp was a huge improvement for me. YMMV.

[gwatuk]

If you look back through this thread I think the general opinion is that the ResMed machines sense when you fall asleep, but the Dreamstation only starts to increase the pressure (during the Smart ramp) when an apnea event occurs.
(I might be wrong - this is quite along thread!)

My understanding of the Smart Ramp with the DreamStation in fixed pressure mode....is it will act like normal ramp until it maybe senses some sort of apnea event happening prior to the end of the ramp time...and then it will suspend the ramp and increase the pressure to the fixed pressure setting it was on its way to before it sensed the event.

I don't think that's how it works.
The point about Smart ramp is that it does not act like the normal ramp. It stays at a low pressure until an apnea event occurs.
(But I have no idea what happens when the ramp time ends if there has been no events.)

[Pugsy]

I don't think that's how it works.
The point about Smart ramp is that it does not act like the normal ramp. It stays at a low pressure until an apnea event occurs.
(But I have no idea what happens when the ramp time ends if there has been no events.)

I assume you have seen this? Look carefully again at what it says about when Smart Ramp ends.
I don't think you are understanding it correctly. It doesn't stay in ramp forever if no events happen. It will end at the end of the time limit that has been set for ramp to end if no events happen and it works its way up to whatever the pressure settings are.

[palerider]

I don't think that's how it works.
The point about Smart ramp is that it does not act like the normal ramp. It stays at a low pressure until an apnea event occurs.
(But I have no idea what happens when the ramp time ends if there has been no events.)

I assume you have seen this? Look carefully again at what it says about when Smart Ramp ends.
I don't think you are understanding it correctly. It doesn't stay in ramp forever if no events happen. It will end at the end of the time limit that has been set for ramp to end if no events happen and it works its way up to whatever the pressure settings are.

Yeah, gwatuk posted the whole thing upthread, said "I don't understand" I asked "what part don't you understand" and got crickets for a response.

[Pugsy]

Yeah, gwatuk posted the whole thing upthread, said "I don't understand" I asked "what part don't you understand" and got crickets for a response.

I didn't even look up thread.

I guess he reads it one way and I read it another. I don't know how to make it any clearer but he's thoughts aren't correct.
Having used a Respironics machine for years....I kinda know what I am talking about but he doesn't seem to understand that all the Smart Ramp in fixed mode is the auto adjusting algorithm briefly doing what it has always done in ramp in auto mode.
If set for 10 minutes...Ramp ends...no matter if it is Smart Ramp or not or whether events happen or not. A person will be up at their set pressures at the end of whatever time period has been set...even if they don't have a single event all night long. Ramp (all the ramp modes) goes bye bye at the end of the ramp time period.
Maybe his EPAP is 4...and that would explain why it appears that ramp stays on all the time.

Shrugs and moves on.

[gwatuk]

First of all palerider my apologies for not replying to you way back in 2107.
The answer to your question "which *PART* don't you understand" was (at the time) "all of it".
And I was just looking for a simple summary.
But I should have replied - sorry!

Pugsy we seem to be misunderstanding each other.
You seem to have got the impression that I thought the machine would stay in ramp forever if no events happen. What I said was that I didn't know what happens when the ramp time ends if there have been no events.

The thing I was picking up on from your post was your statement that Smart Ramp "...will act like normal ramp until it maybe senses some sort of apnea event..."
Which I think isn't correct, but maybe I misunderstood what you were saying.

[Pugsy]

The thing I was picking up on from your post was your statement that Smart Ramp "...will act like normal ramp until it maybe senses some sort of apnea event..."
Which I think isn't correct, but maybe I misunderstood what you were saying.

You don't understand what I was saying....read the manual...it is explained there and you also need to understand what the "normal" ramp in auto mode does to understand what Smart Mode does.

Smart Ramp does act like any ramp ....until/unless it senses and apnea event.
If no apnea event is sensed...then any ramp simply ends once the time limit for using ramp has ended. Once you work up to the pressure setting...ramp ceases to function.
If it senses an event...then it does what the auto algorithm would do... increase the pressure up to the pressure setting your machine is set at.

So the time limit for ramp is a factor and whatever your fixed pressure settings might be is also a factor.

Ramp ends...no matter what...once the time limit for ramp is used up. Events or not....it ends because you should be but to the settings for pressure by the end of ramp.

You are using the Bilevel Pro...so what are your EPAP and IPAP settings?

[gwatuk]

Pugsy, what you said was:
"My understanding of the Smart Ramp with the DreamStation in fixed pressure mode....is it will act like normal ramp until it maybe senses some sort of apnea event happening prior to the end of the ramp time..."
Normal ramp starts gradually increasing in pressure as soon as it starts.
When Smart ramp starts it stays at the same pressure until an apnea event occurs.

https://www.youtube.com/watch?v=Lvcnx6-0GhA
5 minutes or the full half hour?