CPAP Ramp Pressure start

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 5:03 am

So I set it for 6 with 20 minute ramp which essentially equals zero since my pressures begin at 6, I noticed nothing at all. My numbers still are terrible, so I see no impact at all.

Julie · Post by **Julie** » Tue Jul 24, 2018 5:20 am

Do you understand that for 20 mins you've lessened your therapy (of a whole 6 cm of pressure) by that time? Six is so low that even with no ramp time at all you're still getting relatively little therapy, let alone having curtailed what you might get by 20 mins. Why are you so afraid to abandon the ramp altogether (or at least shorten the time greatly) and/or raise your min. pressure by at least 1-2 cms?

zoocrewphoto · Post by **zoocrewphoto** » Tue Jul 24, 2018 5:31 am

SirGaspAlot wrote: ↑
Tue Jul 24, 2018 5:03 am
So I set it for 6 with 20 minute ramp which essentially equals zero since my pressures begin at 6, I noticed nothing at all. My numbers still are terrible, so I see no impact at all.

When you set it for ramp starting at 6 with a minimum therapy pressure of 6, you are telling the machine NOT to do anything more than 6 for that time period. So, it can't go up if it sees a reason to. Ramp is for comfort. It limits your therapy until it ends. It isn't going to do anything to help your therapy. I can't remember which problems you are having, but if you are trying to reduce obstructive apneas and hypopneas, you most likely need a higher minimum. Restricting it to 6 for 20 minutes won't hurt much, but it won't help either.

My pressure is set for 11-15, no ramp. I put my mask on, turn on the machine, let it get to 11 (maybe 10 seconds), make some faces to make sure my mask is fitting well, and I am usually out within 10-15 minutes. I think my machine was set with ramp for 30 minutes (not sure what it started at). I didn't like it, so I reduced it the 3rd day, and turned it off the day after that.

I use a full face mask. I tried a hybrid mask for a couple weeks. I couldn't stand the the pillows touching my nose. I have tried inhaling through my nose twice, and I hated it. I am also capable of using a mouth only mask with my nose completely uncovered and no air escaping that way. My nose pretty much shuts off. So, I don't know what nasal mask users feel when they start out with higher pressure.

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 6:20 am

Julie wrote: ↑
Tue Jul 24, 2018 5:20 am
Do you understand that for 20 mins you've lessened your therapy (of a whole 6 cm of pressure) by that time? Six is so low that even with no ramp time at all you're still getting relatively little therapy, let alone having curtailed what you might get by 20 mins. Why are you so afraid to abandon the ramp altogether (or at least shorten the time greatly) and/or raise your min. pressure by at least 1-2 cms?

Because theres no setting for that on dreamstation patient settings. There is no option to turn it off altogether. The choices are 2/4/5/6. I begin at 6. Same as starting at my beginning pressure anyway. Not sure where you were going with that.

I'm sure if I desired to go any further, Id end up with another 3 hours sitting in a car on 2.5 hours sleep to another face to face consult with my Doctor to do something which could/should have been done over the phone. I'm in the midst of a Doctor change, until then, I'm not going to do anything overboard with it outside of advisement.

Pugsy · Post by **Pugsy** » Tue Jul 24, 2018 6:26 am

SirGaspAlot wrote: ↑
Tue Jul 24, 2018 6:20 am
Because theres no setting for that on dreamstation patient settings. The choices are 2/4/5/6. I begin at 6. Same as starting at my beginning pressure anyway. Not sure where you were going with that.

She wasn't going anywhere and failed to understand that you are now using bilevel and you did increase the ramp from 4 to 6 which happens to be your EPAP pressure setting anyway.
What she said might have been useful for someone on cpap and not bipap and starting ramp at 4 and if the cpap setting it went to was say maybe 10...what she said might have been more applicable.

Pugsy · Post by **Pugsy** » Tue Jul 24, 2018 6:30 am

I know you had a crap load of CAs/centrals last night..
How many OAs and hyponeas and FLs and snores did you have?
If giving me total numbers...give me total hours of use also..
or give me hourly averages and was there in dense clustering of OAs and hyponeas?

zoocrewphoto · Post by **zoocrewphoto** » Tue Jul 24, 2018 6:42 am

Pugsy wrote: ↑
Tue Jul 24, 2018 6:26 am

SirGaspAlot wrote: ↑
Tue Jul 24, 2018 6:20 am
Because theres no setting for that on dreamstation patient settings. The choices are 2/4/5/6. I begin at 6. Same as starting at my beginning pressure anyway. Not sure where you were going with that.
She wasn't going anywhere and failed to understand that you are now using bilevel and you did increase the ramp from 4 to 6 which happens to be your EPAP pressure setting anyway.
What she said might have been useful for someone on cpap and not bipap and starting ramp at 4 and if the cpap setting it went to was say maybe 10...what she said might have been more applicable.

Well, I am really confused. I thought he was talking about the starting pressure, and i am guessing that is what Julie thought too. But he is saying the options are 2/4/5/6. That can't be starting pressure.

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 6:44 am

I apologize, I thought she knew. I'm very sorry.

I can only post my totals from Dreamapper. My Centrals are getting worse definitely.

Pugsy · Post by **Pugsy** » Tue Jul 24, 2018 6:49 am

Post your DreamMapper totals...it's enough to give me a decent enough idea what happened as long as it includes hours of use.
also tell me approx how many wake ups you might have had last night.

I have one idea to maybe consider trying...it's a long shot for sure...very long shot but hey...it's not like what you are doing is working now anyway. It all depends on how much obstructive stuff you are having.

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 6:56 am

I am on a Govt computer at work, so theres understandable restrictions on what can be loaded, but Dreamapper is web based, so that's ok. Ill load a Sleepyhead later. But the trend seems to be every single night up for no reason at 11:30 pm with a full blast of pressure and mask leaking all over the place. If I call the doctor, I get "Well, youre going to have to go see the Doctor for a consultation..."

I already have a new Dr. in mind, and have the referrals, but now comes the problem of transferring everything over. I don't know what kind of problem that presents, But I'm fairly certain I'm on the wrong machine as everyone has said.

Julie · Post by **Julie** » Tue Jul 24, 2018 7:32 am

Sorry, didn't realize it was bipap.

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 7:39 am

Oh, its ok, I didn't realize the ramp numbers were any different, which is why I reacted as I did. My apologies.

Gator5000e · Post by **Gator5000e** » Tue Jul 24, 2018 7:45 am

palerider wrote: ↑
Mon Jul 23, 2018 8:05 pm

Gator5000e wrote: ↑
Mon Jul 23, 2018 3:45 pm
Ok. I do have a feature in the clinical settings called SmartRamp on my biPAP Pro machine I just got. Is it something different?
Ok, according to the manual, Respironics "SmartRamp" is:

Respironics wrote: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 H 2 O 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.
Vs Resmed, (which doesn't call their feature "smart ramp"... they call it "auto".)

Resmed wrote:Ramp Time can be set to Off, 5 to 45 minutes or Auto. When Ramp Time is set to Auto, the device will detect sleep onset and then gradually increase from the start pressure to the minimum treatment pressure at a rate of 1 cm H 2 O per minute. However, if sleep onset is not detected, the device will reach the target pressure within 30 minutes.
So, back to my initial... "That's not a Respironics feature, the article is wrong.

Thanks for clarifying that. I will turn it off on my machine.

SirGaspAlot · Post by **SirGaspAlot** » Tue Jul 24, 2018 8:32 am

Pugsy wrote: ↑
Tue Jul 24, 2018 6:49 am
Post your DreamMapper totals...it's enough to give me a decent enough idea what happened as long as it includes hours of use.
also tell me approx how many wake ups you might have had last night.

I have one idea to maybe consider trying...it's a long shot for sure...very long shot but hey...it's not like what you are doing is working now anyway. It all depends on how much obstructive stuff you are having.

I had 3 wakeups, one at the usual 11:30 pm with leaks and no explanation. Another two for restroom trip.

Pugsy · Post by **Pugsy** » Tue Jul 24, 2018 8:49 am

So what were the event category totals and the number of hours used?

The bathroom breaks...probably related to the ANP stress hormone and if/when the apnea events get reduced and thus reducing the stress hormone in your blood stream then if the sleep apnea events are the lone cause of the nocturia...it should go away.

There's a very small chance that if the OAs and hyponeas along with any snores, FLs or RERAs (the obstructive stuff) is better prevented that the number of centrals will also reduce.
Fix or try to fix a known problem (in this case the obstructive stuff) with the machine you have and cross your fingers that you get lucky and the central stuff that this machine can't fix will reduce in number.
It's a big maybe...but hey, at this point you don't really have anything to lose.
Tackle a known problem that is fixable with your machine and see what problems are left over that we can't fix with this machine. I have seen this idea work..not often but I have seen it work so it's not totally impossible.

CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Re: CPAP Ramp Pressure start

Mask	Humidifier

Additional Comments: Started June 19, 2018.

Mask	Humidifier

Additional Comments: Started June 19, 2018.

Mask	Humidifier

Additional Comments: Started June 19, 2018.

Mask	Humidifier

Additional Comments: Started June 19, 2018.