Ramp time? Why do YOU use it? And how much ramp time?

My experience is the same as most of you - I don't use the ramp. When ramping is on, my machine starts my out at such a low pressure that I am gasping for breath. My pressure is set at 9, so starting at that point is no big deal. In the end, it's a mater of personal preference.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Ramp

Hi dllfo,
I think you misunderstand the ramp feature. If it's set to a pressure of 4, all it's going to do is take the pressure down to 4 for thirty minutes whenever you hit the ramp button. It's just a brief, temporary measure to lower the pressure to allow you to fall sleep, if you have trouble - it doesn't do anything else.

Changing the ramp pressure setting but not actually using the ramp feature (which you weren't, since you weren't using the button) won't have any effect at all.

Setting the ramp for a *higher* pressure than the lowest pressure of your auto's range (5-13, I think you said?) makes no sense at all.

Hope this helps clarify things.

[quote="CollegeGirl"]Hi dllfo,
I think you misunderstand the ramp feature. If it's set to a pressure of 4, all it's going to do is take the pressure down to 4 for thirty minutes whenever you hit the ramp button. It's just a brief, temporary measure to lower the pressure to allow you to fall sleep, if you have trouble - it doesn't do anything else.

Changing the ramp pressure setting but not actually using the ramp feature (which you weren't, since you weren't using the button) won't have any effect at all.

Setting the ramp for a *higher* pressure than the lowest pressure of your auto's range (5-13, I think you said?) makes no sense at all.

Hope this helps clarify things.

Forgot to add -

I don't use the ramp, either. I definitely can't breathe at a pressure of only 4.

I use the ramp with my Auto BiPAP. My basic settings are 13 exhale minimum/21 inhale maximum. I CAN start right off at 13, but I prefer to start at 9.5. However, I have the ramp set for only 5 minutes, because that is about how long it takes me to fall asleep, at least on a good night. (On a bad night, I can always hit the ramp button again, if I want to.) Originally I had a longer ramp period, but my data from EncorePro and MyEncore showed apneas during the period just after I fell asleep, when I was UNDER my lowest regular pressure.

dlfo, you mention that your bipap is set to "full auto" and it sounds like you mean "Auto BIPAP" rather than "Auto BiFlex." Is that correct? If you set the unit for auto bipap, it gives you a "rise time". If you set it for auto biflex, it gives you a "pressure support" setting instead.

Since your wife is having pain from breathing with the bipap, I would definitely try it with the biflex feature on. It really smooths out the transition between pressures. AND I would set the pressure support for the maximum, 8 cm. That will allow the unit to have between 2cm (the minimum) and 8 cm difference between the inhale and exhale pressure. My GUESS is that this will make more difference for your wife than just lowering the overall pressure.

In answer to your question about whether the auto feature overrides the ramp. In my own experience, I don't think so. When I have fallen asleep before the ramp is over, the software shows I have experienced apneas at the lower (ramp) pressures. I THINK, but I am not sure, that the ramp overrides the auto rather than the other way around. Thus I would recommend a ramp that is NO LONGER than the usual time it takes you to fall asleep.

As always, my own personal, non-medical opinion, take it or leave it,
Moogy

I'm a little unclear, and maybe it's the difference between Respironic and Resmed reporting. It was my understanding that when the ramp is in force, data is not collected (or at least not calculated in the night's stats) nor events responded to. From what I'm reading, I'm wrong about the data collection part. Can someone please clarify for me?
Kathy

Hi dllfo! I agree with Moogy that your wife (and you) might like using the BiPAP Auto with Bi-flex enabled, and with Bi-Flex set for "3". The operating mode needs to be set for ABFLE. I've tried it both ways -- using it in BiPAP Auto mode with a Rise time setting, or using it in BiPAP Auto Bi-flex with Bi-flex set at 3.

Like Moogy, the reason I prefer using Bi-flex is for that bit of extra pressure reduction it gives at the very end of the inhale and very beginning of the exhale. Bi-Flex made the transitions seem much smoother to me than setting a Rise time did. Rise time governs how quickly the machine will switch from exhale to inhale when you start to breathe in. You can't use both at the same time. It's either/or... you can use Bi-flex (when operating in a "FLE" mode) or you can set a Rise time (when not operating in a "FLE" mode)...or not use either at all by setting them for 0.

The Rise time setting screen will not show up if you set the operating mode for AbFLE (auto bipap with bi-flex.)

The Bi-Flex setting screen will not show up unless you've set an operating mode that includes the letters "FLE" at the end.

Simplest way to do an entire setup, or to just look at the settings, will be through the therapy setup menu on the machine itself, rather than via "Create Prescription" in the software.

I'm not a doctor, nor anything in the health care field. But if I were your wife and had been prescribed a pressure of "6" from a sleep study, here are the settings I'd want to try with my BiPAP Auto:

AbFLE setup (operating mode)

5.0 Min EPAP (exhalation pressure)

10.0 Max IPAP (inhalation pressure)

5.0 PS (Pressure Support)
Note: I'd always set the PS as high as it will go (8 is as high as it can go.) The PS can't be set higher than the difference between IPAP and EPAP, so in this case "5" will be as high as the PS can be set.

3 Flex (Bi-Flex)

0:00 Ramp (amount of time for the ramp to work)

0:00 Start (Split Night mode)
Note: If you see the word "Start" on the LCD, be sure you have that timer set for 0:00. Do not set "Start" for 2:00, 3:00, or 4:00. Keep it at 0:00. The "Start" screen will show up only if you have the machine set for AbFLE (auto bipap with bi-flex.)

0 or 1 Patient (Patient "disconnect" alarm)
Note: If you want the disconnection alarm to beep, as when there is a large continuous leak (as when the mask comes off) set "Patient" for 1 (On). I have mine set for 0 (Off) but if keeping a mask on or having large leaks is a problem, you might want it On.

0 or 1 Light
Note: 1 keeps the LED backlight on to illuminate the buttons while the machine is being operating...airflow going. Regardless of whether you set the "Light" On or Off, the lights will always be on when you are not using the machine but have it plugged into electricity. I keep mine set for 1 (On) but it really doesn't matter.

The last number you'll see in the setup menu says "Nights". The hours of use.

dllfo, one more thought...

Where I wrote:

0:00 Ramp (amount of time for the ramp to work)

That zero setting turns Ramp off. I have never used Ramp, and I don't think your wife would need it if she uses AbFLE mode with IPAP 10 - EPAP 6, and Bi-Flex at "3".

But, you never know. What seems like an easy pressure to one could feel like "a lot" to another.

If she tries the settings I suggested and decides she'd rather have RAMP turned on, then when you get to that setting, I'd do it this way:

0:15 Ramp (amount of time for the ramp to work -- can be set for as long as 45 minutes.)

5.0 Ramp Start
(or 4.0 or 6.0 -- whatever feels comfortable to her)

0:00 Start
Note: Be careful not to confuse "Ramp Start" with the single word "Start". To repeat, because it is soooo important... any time you see only the word "Start" in the menu, be sure that is set for 0:00 so the machine will not accidentally be put into "split night" mode.

Used the ramp feature for about 4 nights when I first started - now I hit the full throttle button and suck in that 17cm pressure from the first breath into the mask. I quickly figured out that by the time my machine hits my "full on" pressure (after 45 min) - that I'm asleep and any leaks I have will then wake me up to readjust - so no thanks to the ramp - it does help you adjust to the mask the first few nights on CPAP but at some point you have to ride the bull the minute the gate opens...

We are on Auto BiPAP, I forgot it has Auto BiFlex. And the rise is "3".

I will reset the machines for BiFlex, see how she likes it. I have felt the surge a few times, but with everything wrong with me, I tried to ignore it.

We are looking into a way for me to use oxygen with the Swift, but titrated at 2Lm is too high for the Swift...may have to try a FF mask. I also have to be able to get the heliox in when I have an attack, so breathing is getting more complicated......I used to say it could always be worse, but I thought I had better find a better expression.

Thanks for the advice, I love the way you lay it out, perfect for me.

As I vaguely recall, it seems the Auto BiPAP can be a BiPAP, BiFlex, CPAP and something else. I love these machines. Life is a lot better with them.

I used RG's numbers and I slept great. Well, my IPAP setting was 22.0 for safety, but with the wife, I used your exact numbers.

She said she still felt like it was "blowing her up" - - did not seem to notice the difference between BiPAP and BiFlex. She slept about 6 hours.
Avg 90% IPAP 8.5
Avg 90% EPEP 5.0

No NR Apnea/Hypop.

Avg Obstructive Apnea Index 1.0

Avg Hypopnea index 4.0

Avg Flow Limitation 1.0
Avg VSI was really high at 4.0

Total AHI 4.4, which is high. She is 2.7 or so most of the time.

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Auto Bi-Level Stats
Max Titrated IPAP 10.0
Avg IPAP 90% 8.5
Max Titrated EPAP 6.5
Avg Device EPAP 90% 5.0
Avg time in Apnea per day 24 sec
Avg time in Large Leak 40 min

I am not sure which data you and Moogy use when you "work" your numbers,
but I am open for suggestions. Her compliance on this machine, which replaced another Auto BiPAP is 100%. MUCH better than pre-XPAP days.

Avg max leak 129.0
Avg 90% leak 71.0
Avg Leak 59.0
Avg Large leak 40 minutes