APAP or CPAP? Very confused

[The Latinist]

Could you please add your equipment to your profile (click the "User Control Panel" link under the search box at top left, select the "Profile" tab, then "Edit equipment" menu on the left. Choose your equipment from the drop-down menus and choose to display your equipment as Text -- not Image)? It will really make it much easier to help you if we know exactly what your equipment is and what its capabilities are.

[Drowsy Dancer]

Again, thank you to all: Unfortunately last night I felt the pressure more (maybe because not as tired the night before) and had to disconnect myself from the machine after 15 minutes.

Are you saying that you stopped using the machine before your ramp was complete? If you did, then you would never have reached your starting pressure.

You can reset the ramp by hitting the button again. I think the ramp resets every single time you hit the button.

[BlackSpinner]

Again, thank you to all: Unfortunately last night I felt the pressure more (maybe because not as tired the night before) and had to disconnect myself from the machine after 15 minutes.

Are you saying that you stopped using the machine before your ramp was complete? If you did, then you would never have reached your starting pressure.

You can reset the ramp by hitting the button again. I think the ramp resets every single time you hit the button.

Unfortunately the ramp starts ridiculously high so that wouldn't help.

[zoocrewphoto]

Again, thank you to all: Unfortunately last night I felt the pressure more (maybe because not as tired the night before) and had to disconnect myself from the machine after 15 minutes.

Are you saying that you stopped using the machine before your ramp was complete? If you did, then you would never have reached your starting pressure.

You can reset the ramp by hitting the button again. I think the ramp resets every single time you hit the button.

Unfortunately the ramp starts ridiculously high so that wouldn't help.

The ramp starts at 8, and her previous machine was getting up to 12 during the night, so 8 shouldn't be that hard for her. She could start the ramp at 6 if she wants, but changing the range of pressures from 12-20 to 10-20 won't change anything if she can't get through the ramp.

[BlackSpinner]

Unfortunately the ramp starts ridiculously high so that wouldn't help.

The ramp starts at 8, and her previous machine was getting up to 12 during the night, so 8 shouldn't be that hard for her. She could start the ramp at 6 if she wants, but changing the range of pressures from 12-20 to 10-20 won't change anything if she can't get through the ramp.

Yes it was getting to 12 but it started at 4. Ramp is not a therapeutic function it is a comfort function to allow one to get comfortable and fall asleep. Once asleep she won't notice the pressure.

[zoocrewphoto]

Unfortunately the ramp starts ridiculously high so that wouldn't help.

The ramp starts at 8, and her previous machine was getting up to 12 during the night, so 8 shouldn't be that hard for her. She could start the ramp at 6 if she wants, but changing the range of pressures from 12-20 to 10-20 won't change anything if she can't get through the ramp.

Yes it was getting to 12 but it started at 4. Ramp is not a therapeutic function it is a comfort function to allow one to get comfortable and fall asleep. Once asleep she won't notice the pressure.

That was what the old escape was doing. The new machine was set for 12-20 with ramp starting at 8 and going for 20 minutes. She turned it off at 15 minutes, so it never made it to 12, even though she has experienced 12 before.

The dme lady was going to ask the doctor if she could change it to 10-20 instead of 12-20. But how will that help if she can't get past the ramp? She either needs the ramp to start a little lower and/or practice during the day to get used to 12. Or maybe there is something else that is causing her to struggle and take it off.

[BlackSpinner]

Unfortunately the ramp starts ridiculously high so that wouldn't help.

The ramp starts at 8, and her previous machine was getting up to 12 during the night, so 8 shouldn't be that hard for her. She could start the ramp at 6 if she wants, but changing the range of pressures from 12-20 to 10-20 won't change anything if she can't get through the ramp.

Yes it was getting to 12 but it started at 4. Ramp is not a therapeutic function it is a comfort function to allow one to get comfortable and fall asleep. Once asleep she won't notice the pressure.

That was what the old escape was doing. The new machine was set for 12-20 with ramp starting at 8 and going for 20 minutes. She turned it off at 15 minutes, so it never made it to 12, even though she has experienced 12 before.

The dme lady was going to ask the doctor if she could change it to 10-20 instead of 12-20. But how will that help if she can't get past the ramp? She either needs the ramp to start a little lower and/or practice during the day to get used to 12. Or maybe there is something else that is causing her to struggle and take it off.

Normally ramp is set starting at 4 You really think a newbie is helped by starting them at 8 ?!? Most people are asleep by the time the ramp get up to 8 -10 -12 after 15 -20 minutes. THERE IS NO THERAPEUTIC VALUE TO RAMP. It is training wheels. If it takes her a month or two of hitting the ramp button at 4 for a while it doesn't matter. The cpap is useless unless she can keep it on - the ramp starting at 4 is to get her used to it - just like training wheels on a bike. It is absolutely counter productive to put some one on a ramp starting at 8, they will give up.

For that matter that 12 reading might be due to leaks - nobody knows, it was just a guess.

[zoocrewphoto]

Normally ramp is set starting at 4 You really think a newbie is helped by starting them at 8 ?!? Most people are asleep by the time the ramp get up to 8 -10 -12 after 15 -20 minutes. THERE IS NO THERAPEUTIC VALUE TO RAMP. It is training wheels. If it takes her a month or two of hitting the ramp button at 4 for a while it doesn't matter. The cpap is useless unless she can keep it on - the ramp starting at 4 is to get her used to it - just like training wheels on a bike. It is absolutely counter productive to put some one on a ramp starting at 8, they will give up.

For that matter that 12 reading might be due to leaks - nobody knows, it was just a guess.

Most people struggle at 4 and thus fail at cpap. They never get past the ramp because they are fighting with the low start pressure. I see no reason at all to ever start somebody at 4. I see no reason for a machine to have the option of 4. Very few people who have actually used a cpap machine like 4 or 5. It is a feature that hurts people and causes them to fail.

There are also people who keep hitting the ramp button, never get real treatment, never feel better, and then blame the cpap for not helping. I'm sorry, but I believe ramp hurts far more people than it helps.

I used ramp of 20 minutes for 2 nights. I changed it to 5 minutes the 3rd night, and turned it off after that. I turn my machine on, and it goes straight to 11 in less than 10 seconds. I realize that some people need some time before they can deal with the normal pressure right off. But most people can adjust to the pressures with some practice. And once they actually use a successful pressure setting, they can start feeling better.

[Luthie2006]

I thank all of you for helping me. I had the machine starting at 4 for 2 weeks, and didn't have a problem with that except I woke up every hour in the middle of sleep and got horrible sleep. The sleep clinician thought that was because it may be set too low and waking me up when it got up to 12 which is showed I needed, actually 14.8 according to the new autopap machine. So she set it at
12 with a ramp at 8. I think what happened the last few nights is that I was still awake (with my training wheels on at ramp speed) and when it started to climb in pressure up to 12 I couldn't handle it.
She seems to think that starting it at 10 with a ramp at 8 for 20 minutes would help me instead of starting it at 12 I am bringing the machine back to her tomorrow morning and picking it up later.
Thank you all for your comments. I am going to bring them to her.

[The Latinist]

The job of the ramp is to get you to sleep. Since you're having problems with starting at 8, I would think that the solution would be decreasing the starting pressure and increasing the ramp time. Maybe a 30 minute ramp starting at 6 and a pressure range of 10-14.

[Luthie2006]

Thank you Latinist. My sleep clinician said that the ramp time maximum is for 20 minutes on the AutoSet Machine. I will bring it in tomorrow and have set my settings to 10-20 and have the ramp set at 8 for 20 minutes and try it again tomorrow night. Who knows? Hopefully it will work. I will get back on Tuesday. Thank you so much for all your help.

[zoocrewphoto]

Thank you Latinist. My sleep clinician said that the ramp time maximum is for 20 minutes on the AutoSet Machine. I will bring it in tomorrow and have set my settings to 10-20 and have the ramp set at 8 for 20 minutes and try it again tomorrow night. Who knows? Hopefully it will work. I will get back on Tuesday. Thank you so much for all your help.

The ramp can go as long as 45 minutes, but be aware. During ramp, the machine can't get up to the pressure needed to help you, so you can still have events during the ramp, and those can be waking you up as well.

[avi123]

If you had added your age I could then comment (participate) in your conversation but you did not! So...........

[The Latinist]

]My sleep clinician said that the ramp time maximum is for 20 minutes on the AutoSet Machine.

I'm not sure I'd be putting my faith in someone who lied to me like that.

The ramp can go as long as 45 minutes, but be aware. During ramp, the machine can't get up to the pressure needed to help you, so you can still have events during the ramp, and those can be waking you up as well.

Of course, if she is unable to keep her mask on, the machine won't do her much good either.

[robysue]

Normally ramp is set starting at 4 You really think a newbie is helped by starting them at 8 ?!? Most people are asleep by the time the ramp get up to 8 -10 -12 after 15 -20 minutes. THERE IS NO THERAPEUTIC VALUE TO RAMP. It is training wheels. If it takes her a month or two of hitting the ramp button at 4 for a while it doesn't matter. The cpap is useless unless she can keep it on - the ramp starting at 4 is to get her used to it - just like training wheels on a bike. It is absolutely counter productive to put some one on a ramp starting at 8, they will give up.

For that matter that 12 reading might be due to leaks - nobody knows, it was just a guess.

Most people struggle at 4 and thus fail at cpap. They never get past the ramp because they are fighting with the low start pressure. I see no reason at all to ever start somebody at 4.

Zoocrewphoto:

YOU are uncomfortable breathing at 4cm. But that does NOT mean EVERYBODY is uncomfortable breathing at 4cm. There are as many people who FAIL at CPAP because they can't get used to the hurricane of pressure that they've been prescribed as there are people who give up because they "can't breathe" because the pressure is too low.

In this case Luthie2006 cannot tolerate 8cm of pressure because it hurts to breathe and the pressure feels TOO much. She has had some nights previously where she DID get through the ramp period when the ramp was set to start at 4cm.

BlackSpinner is right here: Having the ramp start at 8cm is doing NOTHING for Luthie since she can't stand that much pressure (yet) when she's awake. Luthie's ramp SHOULD be set to 4cm so that LUTHIE is more comfortable.

I see no reason for a machine to have the option of 4. Very few people who have actually used a cpap machine like 4 or 5. It is a feature that hurts people and causes them to fail.

If I had to use a PAP that could NOT go below 6cm, I would have failed miserably: When I am at EPAP = 6cm for the whole night, I wake up with basketball-in-stomach type aerophagia. The two weeks I spent at the beginning of my PAPing with an S9 AutoSet in CPAP mode at 9cm with EPR = 3 were two of the most miserable weeks of my entire life due to the severe aerophagia. It was only relieved (a bit) when my PA finally switched me to an auto range of 4-8cm, and it wasn't really resolved until I was switched to my BiPAP Auto with my current pressure range.

Now, I know that I'm NOT a typical PAPer, but I'm not all that atypical either. There are people who don't need more than 4-6 cm of pressure for PAP to be therapeutic and some (probably MANY) of those people who only NEED low pressure settings are probably happier sleeping with their low pressure than they would be at a higher than needed pressure.

There are also people who keep hitting the ramp button, never get real treatment, never feel better, and then blame the cpap for not helping. I'm sorry, but I believe ramp hurts far more people than it helps.

If you can't get to sleep in the first place, the PAP is going to make you feel worse. And that's where Luthie is at: She can't get comfortable enough to get to sleep in the first place because breathing against the hurricane of 10cm of pressure when she is AWAKE is making her deeply uncomfortable and her chest muscles ache from exhaling against the pressure.

For CPAP to do any good at all, you have to be able to fall asleep with the machine on your nose. if you can't get to sleep due to discomfort and you take the mask off so you can get to sleep, that doesn't provide any chance of any benefit. If repeatedly hitting the ramp button eventually allows you to fall asleep, there's a chance you'll eventually sleep long enough with the PAP to benefit.

I used ramp of 20 minutes for 2 nights. I changed it to 5 minutes the 3rd night, and turned it off after that. I turn my machine on, and it goes straight to 11 in less than 10 seconds. I realize that some people need some time before they can deal with the normal pressure right off. But most people can adjust to the pressures with some practice. And once they actually use a successful pressure setting, they can start feeling better.

And what was your latency to sleep at the start? Were you falling asleep comfortably and quickly once you turned the ramp off? If so, that's great and wonderful.

But many newbies (and some not so new users) feel deeply uncomfortable because of exhaling against too MUCH pressure when we're lying in bed awake with our full therapeutic pressure blowing at us. The judicious use of a well adjusted ramp can allow us to get to sleep BEFORE we become too uncomfortable.

The trick, of course, is that the ramp setting needs to be well adjusted. That means: the starting ramp pressure is as high as you are comfortable with (and in Luthie's case that seems to be 4 cm) and the ramp time should be about as long as the person's normal latency to sleep.