Treatment during ramp time

SO I am sure it's just me, but I get really confused when people post that you get no or almost no treatment if you use the ramp feature on CPAP machines.
I have no idea why that would be considered accurate.

I have read the manuals and the machines all respond to an event during the ramp time by increasing pressure, just like at any other time.
My prescription calls for use of the ramp, so I am at prescription pressure during the ramp.

Are the posters suggesting that I go against my Doctors advice?
Are the posters suggesting that the manufacturers are incorrect about how the machine behaves during ramp?
I thought we were supposed to avoid giving medical advice and it sure sounds like telling someone to not do something the Doctor told them to do is giving medical advice.

Please be nice and explain to me what I am missing.

On your machine if you are using auto ramp and if you fall asleep and the machine correctly identifies that you are asleep...then it will increase the pressure because you are asleep...and you can't get obstructive airway collapses unless you are asleep.
It will respond at that time but that's because it has already kicked out of ramp.

ResMed machines have never stopped ramp to deal with an airway collapse and then go back to ramp.

If you find something in your manual that isn't talking about auto ramp...ie..plain ramp..that says otherwise please point me to it as I have read that damn manual a dozen times and I can't find where it says it will suspend ramp to deal with an airway collapse.
I found where it talks about auto ramp...and it will suspend ramp IF it thinks you are asleep and then it could deal with airway collapses but it is suspending ramp because it thinks you are asleep and not because of airway flow reduction. The dealing with any events is secondary byproduct because you are asleep and it suspend ramp to go to full pressure algorithm and there it can work its magic.

I have been all over the ResMed website...and you are going to have to trust me because ResMed has redone their whole website but with all the past models...they plainly said that the algorithm doesn't kick in until ramp time is over. ResMed has moved all the past model documentation so I can't give you a link but this has been discussed hundreds of time in the past on this forum.

The facts, during ramp your XPAP, is not allowed to go to pressures that aren't set by the RAMP, so if you need treatment pressure before RAMP is over, you don't get the pressure you need.

RAMP is a cheat, allowing you to bypass real XPAP treatment pressure, in hopes you will be able to man up, later and get on with treatment.

How much faster could you have learned to ride a 2 wheeler bike, if your daddy hadn't put on the training wheels, in my case it was 1 medium sized tree, and no I didn't hurt the tree much.

I didn't need knee pads or a helmet either, back in those days we grew up fast. Jim

PoolQ wrote:SO I am sure it's just me, but I get really confused when people post that you get no or almost no treatment if you use the ramp feature on CPAP machines.
I have no idea why that would be considered accurate.

I have read the manuals and the machines all respond to an event during the ramp time by increasing pressure, just like at any other time.
My prescription calls for use of the ramp, so I am at prescription pressure during the ramp.

Are the posters suggesting that I go against my Doctors advice?
Are the posters suggesting that the manufacturers are incorrect about how the machine behaves during ramp?
I thought we were supposed to avoid giving medical advice and it sure sounds like telling someone to not do something the Doctor told them to do is giving medical advice.

Please be nice and explain to me what I am missing.

I don't know about the rest of the discussion, but "Ramp" is a COMFORT thing.......just like humidity levels.
You can turn it off or on or change the settings.
Most Ramp settings are user-adjustable without going into the clinical setup.
To suggest that changing it is "against Doctor's orders", is ludicrous.
From what I've read, the vast majority of users don't even use Ramp, or turned it off shortly after trying it.


Den

.

Here is what Respironics says they do with ramp when an apnea event of some sort happens.
Please read carefully what it says about midway to the end.



And here is what ResMed says about the AirSense ramp. Even the picture shows a continuous upward climb.
Please...show me where it says it will suspend ramp if an apnea event of some sort is detected.
I will gladly change what I state if someone will just show it to me ...I can't find it anywhere. Hell, I hope I am wrong but until I see documentation to the contrary...Resmed machines don't suspend ramp to only deal with any apnea events.

Goofproof wrote:The facts, during ramp your XPAP, is not allowed to go to pressures that aren't set by the RAMP, so if you need treatment pressure before RAMP is over, you don't get the pressure you need.

RAMP is a cheat, allowing you to bypass real XPAP treatment pressure, in hopes you will be able to man up, later and get on with treatment.

How much faster could you have learned to ride a 2 wheeler bike, if your daddy hadn't put on the training wheels, in my case it was 1 medium sized tree, and no I didn't hurt the tree much.

I didn't need knee pads or a helmet either, back in those days we grew up fast. Jim

You know Goofproof, I thought of many things to say in response to your posting, but I decided that you are not worth it. You are the second person to be added to my foe list just because I don't want to spend anytime reading anything you have to say. I may miss out an some thing valuable you say, but I just don't care. Life is too short, go bang you head into a tree again.

Spoke too soon I now have three foe tags, the third is for a total lack of logic

PoolQ wrote:

Goofproof wrote:The facts, during ramp your XPAP, is not allowed to go to pressures that aren't set by the RAMP, so if you need treatment pressure before RAMP is over, you don't get the pressure you need.

RAMP is a cheat, allowing you to bypass real XPAP treatment pressure, in hopes you will be able to man up, later and get on with treatment.

How much faster could you have learned to ride a 2 wheeler bike, if your daddy hadn't put on the training wheels, in my case it was 1 medium sized tree, and no I didn't hurt the tree much.

I didn't need knee pads or a helmet either, back in those days we grew up fast. Jim

You know Goofproof, I thought of many things to say in response to your posting, but I decided that you are not worth it. You are the second person to be added to my foe list just because I don't want to spend anytime reading anything you have to say. I may miss out an some thing valuable you say, but I just don't care. Life is too short, go bang you head into a tree again.

Spoke too soon I now have three foe tags, the third is for a total lack of logic

Thank You, Thank You Very Much. Be sure before you go to sleep, put on those Knee Pads, and That Coconut Hat, some headboards are hard. Jim

Pugsy,

It seems we are getting into what is technically going on verses what they publish in consumer level documents.

also I did not say that it suspends ramp, I said "respond to an event during the ramp time by increasing pressure" and according to the Resmed patent on their ramp feature the machine will detect events during ramp and respond by increasing the slope of the ramp to get you up to min pressure faster, because now it can tell that you are asleep and the ramp is no longer useful. They don't however just step the pressure up all at once because that might wake you up.

So it seems to come down to the research says that the vast majority of patients on CPAP fall asleep in 20-25 minutes and IF during that time you have an event the Resmed machine will respond by increasing the rate of increase in pressure and the Respironics will "treat" the event and just keep ramping at the same rate.

There "could" be a time period after either machine detects an event and before it has reached min pressure that you could have an apneic event that would not have happened at full min pressure if you use ramp. It is true that this is a risk and if using ramp gets someone to use the machine or even adapt to the machine faster, then perhaps it is worth the risk of even 5 apneic events before min pressure. In an 8 hour sleep period and a full 45 minute ramp you are exposing yourself to an increased risk of 1 to maybe 5 apneic events for 9% of your sleep, personally I get 40-60 centrals in that timeframe, 1-5 more would mean nothing to me. In fact even if you were not getting any events and this caused 5 events your AHI would be 0.6, still pretty dang good in my book. YMMV

I just can't see telling someone on their first post to turn ramp off because they are not getting treated without knowing a lot more information about how they are adapting to treatment and if they actually are getting apneic events in the first 20-25 minutes of CPAP use a night.

It seems like my doctor and others Doctor's along with Respironics and Resmed seem to think the risk is worth the use of the feature.

Respect to you Pugsy and thank you for an intelligent conversation.

PS. for some strange reason I think that my Doctor put the use of the ramp feature on my prescription for a reason and YES I think not doing something that my Doctor has prescribed is going against his advice. I also think that without knowing much about another member and going only on what I have experienced, that suggesting someone not follow their Doctors advice is indeed giving medical advice (none of this is directed at you Pugsy in ANY way)

PoolQ wrote:Pugsy,

It seems we are getting into what is technically going on verses what they publish in consumer level documents.

also I did not say that it suspends ramp, I said "respond to an event during the ramp time by increasing pressure" and according to the Resmed patent on their ramp feature the machine will detect events during ramp and respond by increasing the slop of the ramp to get you up to min pressure faster, because now it can tell that you are asleep and the ramp is no longer useful. They don't however just step the pressure up all at once because that might wake you up.

It sounds like this is something new in the Airsense 10. For most of us with older machines, we do not have this feature. If I set my S9 autoset to a ramp of 45 minutes, it will use all 45 minutes to slowly get to my pressure regardless of how many times i snore quit breathing. It just isn't programmed to do respond until the ramp time is done.

I do not use ramp, so this is not a problem for me. I didn't like the ramp feature and quit using it after 2 days. Probably a good thing since I fall asleep in about 10 minutes anyway.

PoolQ wrote:

You know Goofproof, I thought of many things to say in response to your posting, but I decided that you are not worth it. You are the second person to be added to my foe list just because I don't want to spend anytime reading anything you have to say. I may miss out an some thing valuable you say, but I just don't care. Life is too short, go bang you head into a tree again.

Spoke too soon I now have three foe tags, the third is for a total lack of logic

WOW...Jim...I'll bet you will loose sleep over this.

I hate bringing up old polls, but, it may be appropriate here... PoolQ won't see this cuz I'm on his "foe list" too.

viewtopic.php?f=1&t=54482&st=0&sk=t&sd= ... =ramp+poll

Egos are rampant here... what a waste of time!

You are assuming all ramp is like the auto ramp on your new machine...the AirSense 10 Autoset...and it's not the case...and you are assuming everyone uses the auto ramp selection who have your model machine ....they might not...they might use regular ramp. Remember there is a choice between Auto Ramp and regular ramp.
The rest of the cpap/apap machines in use don't have Auto Ramp at all...so it's not even a choice.
Not everyone is using your machine brand and model.
And remember...Auto ramp ends when it thinks you are asleep or after a certain amount of time. If it is treating apnea event precursors with more pressure it is because they have gone to sleep because we don't have apnea event precursors without sleep first. While we can easily fool the machine about centrals by holding our breath, we can't make our own airway collapse while awake.

For any machine to respond in ramp to apnea event precursors it has to suspend/temporarily end/halt the normal slow progression of the pressure upwards and go to treatment pressure. There is no other way.
I don't know how the F & P or Devilbiss machines work their ramp. I haven't looked at those manuals in depth. Really haven't needed to. The bulk of machines out there are going to be ResMed or Respironics as they are the 2 main players.

PoolQ wrote: I did not say that it suspends ramp, I said "respond to an event during the ramp time by increasing pressure"

nit picking on wording and I use the word "suspend" because that is what has to happen.

Where in the patent did you find anything to the contrary to what it says in the manuals?

PoolQ wrote:I just can't see telling someone on their first post to turn ramp off because they are not getting treated without knowing a lot more information about how they are adapting to treatment and if they actually are getting apneic events in the first 20-25 minutes of CPAP use a night.

FWIW I tend to agree with you here about telling someone they aren't getting adequate therapy without knowing more particulars....but in general the information is not totally incorrect. It all depends on the machine used..the mode it is used it..the model of machine and even how long the ramp it and how long does it take them to go to sleep. The bulk of the machines out in use...they can't respond during ramp.
Even the Respironics machines have to be in auto cpap mode for it to suspend ramp to treat. If someone has the Pro model...it will be cpap only mode and no auto cpap.

Ramp has always been a feature to help with the adjustment phase and it's especially useful for people who end up needing pressures in the teens. It is a comfort feature and yes..there has always been a trade off or compromise in terms of maybe allowing a few apnea events slip past the defenses because first of all a person has to get to sleep and if the pressures are preventing sleep...let's see what would I rather have...no sleep and thus no apnea events or maybe a handful of apnea events while going to sleep but then I sleep. I need sleep first.

What you and your doctor choose to do is entirely between the two of you. 99.9% of the doctors out there don't have a clue about ramp or how it works and for sure don't know about the new ResMed feature called Auto ramp and how it works and they leave all that up to the DME and the patient. To ramp or not has always been a personal choice. Next time you see your doctor simply ask him why he included it in the RX. You might be surprised at his answer.

Ramp and exhale relief have always historically been considered patient comfort features to help them adjust to this therapy and with the exception of a few power control freaks (DMEs or docs) has always been left up to the patient to choose to use or not use and at whatever setting they feel works best for them.
The primary goal...get to sleep because we have to get to sleep before we can treat anything.

As it stands right now..based on the manual that is given out...Only in auto ramp on the ResMed machines with this feature is it possible for the machine to respond to apnea event precursors because we assume a person is already asleep before those precursors can happen and we assume that in Auto Ramp mode that the machine has already decided that a person is asleep and thus gone to the "let's treat algorithm" and is no longer technically in ramp anyway.

Respironics machines will respond during ramp but only in auto cpap mode from what I understand from the manual.

I have to go by the manuals until I see other documentation.

Pugsy I don't disagree with anything you have said, thank you for taking the time. I better understand both the machines and the users.
With the "suspend" I was reading it as suspend the ramping function and go directly to min pressure and I think you were meaning it to include suspend the ramp, perform treatment and then resume the ramp. nit picking perhaps, but I ended up reading it differently than you meant and that caused my problem.

Thanks again for taking the time to increase my knowledge and understanding.

LSAT wrote:I hate bringing up old polls, but, it may be appropriate here... PoolQ won't see this cuz I'm on his "foe list" too.

viewtopic.php?f=1&t=54482&st=0&sk=t&sd= ... =ramp+poll

WOW! I'm impressed, I wasn't aware I was in such good company. BTW, I slept the same, I don't let people that can't handle the facts bother me much. His post was addressed to RAMP, not AUTO RAMP. Since he failed to send me a machine just like his,all I have to go by is the majority of machines out there in the real world.

He also fail to take into consideration, waking up and hitting the ramp button, starts the process over again.

I started with a CPAP, ramp off, CFLEX 3, PRESSURE 15CM, still healing from a quad bypass, less than two months old, with O2. Yes, as with most people I had shoulder chest tightness from the CPAP pressure strain, by that time I had long stopped pain meds.

At least PoolQ, slept well, ok as well as you can sleeping with knee pads and a coconut hat on. Tighten the hat down and you don't even need a chin strap. Jim