Question about RAMP on Respironics BiPAP M Series

[drdigital1]

I just switched to Bipap (Respironics BiPAP Auto M Series) from a CPAP.
Because my IPAP pressure setting is relatively high (14) the ramp feature is VERY useful when I go to sleep. The ramp start pressure was set at 4 on the CPAP and it is set at 4 also on the BiPAP. It worked PERFECTLY on CPAP but it does not perform as expected on the BiPAP. The reason is that during the ramp up, the IPAP pressure is too high (10) and is noisy. The IPAP pressure at ramp cannot be manually set. According to the provider manual (see Figure 1-4), if I understand correctly, the difference between the ramp IPAP and EPAP pressures is delta where “delta is defined as the lesser of 2 cm H2O and the difference between IPAP and EPAP pressure settings”. I would then expect the IPAP pressure at ramp to be 6 (delta=2); instead, it is 10 (as if delta= the difference between IPAP and EPAP pressure settings).
My question to the forum experts: is the machine defective or is it the manual? If the machine is fine, is there any way to reduce the IPAP pressure at ramp to just 2 above the EPAP pressure?

Many thanks,

[GumbyCT]

I am not following your explanation at all. Try to find out what your current settings are and post them here.
IPAP
EPAP
Ramp Press
Ramp time

[drdigital1]

You are right; I should have indicated my settings:
IPAP: 14
EPAP: 8
Ramp start: 4
Note: the Ramp start setting of 4 refers to EPAP. As I mentioned, the IPAP at ramp is shown on the display as 10 but this does not seem to be a value that can be set by user or provider.

I'd like to know if there is a way to reduce the IPAP at ramp to 6.

Thanks (and sorry for being confusing),

[GumbyCT]

If your ramp is set to 4 then it would go to 6/4cm when you press the Ramp button. So you must have another setting.

[drdigital1]

Indeed, according to the provider manual, for my settings of IPAP (14), EPAP (8) and RAMP START (4) the ramp should be 4/6, exactly as GumbyCT indicates. Instead it is 4/10. Is there anything I can do?

[GumbyCT]

Indeed, according to the provider manual, for my settings of IPAP (14), EPAP (8) and RAMP START (4) the ramp should be 4/6, exactly as GumbyCT indicates. Instead it is 4/10. Is there anything I can do?

Have you double checked to make sure it is not at 6/4? Make sure the Ramp is being pressed. Have someone else look at the LCD with you.

[drdigital1]

One more atempt to get an answer:
According to the provider manual, for my settings of IPAP (14), EPAP (8) and RAMP START (4) the ramp should be 4/6, exactly as GumbyCT indicates. Instead, (GumbyCT, I HAVE RE-CONFIRMED!) it is 4/10. Does anybody know of a way to reduce the IPAP at ramp from 10 to 6?

Best regards,

[rested gal]

Is your BiPAP Auto's operating mode set for just bilevel?

Or is it set for auto bilevel?

When you say your IPAP setting is 14 and the EPAP setting is 8 .... if the machine is set for auto bilevel mode those pressure settings should actually say "Max IPAP 14" and "Min EPAP 8".

The words max and min appear in front of the words "IPAP" and "EPAP" if the machine is set for auto bilevel mode.

But "max" and "min" don't appear alongside IPAP and EPAP if the machine is set for plain bilevel mode.

[drdigital1]

Thanks for looking into the issue - the machine is set for BILEVEL (not AUTO BILEVEL).

[rested gal]

Thanks for looking into the issue - the machine is set for BILEVEL (not AUTO BILEVEL).

Ahhhh. Ok. I thought that might be the case.

Auto bilevel is the mode that will cause IPAP to start out only 2 cm's above EPAP.

[drdigital1]

Thanks, rested gal. What you describe is EXACTLY what the note below Figure 1-4 in the Provider Manual says i.e., “when the device is in Auto Bi-level or Auto Bi-level with Bi-Flex mode, pressing the Ramp button provides pressure relief by lowering the device output pressures to the EPAP = Ramp Start pressure setting and IPAP = Ramp Start pressure setting + 2 cm H2O”.

The text right under Figure 1-4 though refers to “the lesser of 2 cm H2O and the difference between IPAP and EPAP pressure settings”. I was hoping that this comment refers to the Bi-level mode.

My provider is contacting the manufacturer for clarification – will let you know what they say.

The good news is that the 2nd night with the new BiPAP machine was MUCH better and the uncomfortable ramp didn’t matter at all.

[rested gal]

The text right under Figure 1-4 though refers to “the lesser of 2 cm H2O and the difference between IPAP and EPAP pressure settings”. I was hoping that this comment refers to the Bi-level mode.

I think the key is the text note just below what you quoted under Figure 1-4. The text note starts out by saying:

NOTE: When the device is in Auto Bi-level or Auto Bi-level with Bi-Flex mode, (bold red emphasis mine.)

I think it's safe to say the entire note itself is talking about being in Auto Bi-level mode or Auto Bi-level with Bi-Flex mode.

Near the end of the note, when it mentions "Bi-level mode" that's referring to the first part of the night if a "Split Night" time has been set. That setting (Split Night) appears in the menu only if the machine has been set for Auto Bi-level or Auto Bi-level with Bi-Flex. By the way, Split Night should always be set to "off."

Screenshot of the note in the Provider Manual:

The good news is that the 2nd night with the new BiPAP machine was MUCH better and the uncomfortable ramp didn’t matter at all.

Excellent! Hope everything continues to get better and better for you, drdigital!