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[quote="Country4ever"]Thanks Bookbear.
Question about Ramp......that's just how the pressure starts out low and increases over a set amount of time, so we don't feel so much pressure at the beginning, right? I think its called "settling" on my machine? Why would people not want that? Thanks!

I think its called "settling" on my machine? Why would people not want that? Thanks!

I was using it regularly for the full 45 minutes. I also noticed on my software read outs I never seemed to have any apnea events during the ramping/settling period...zero AHI during ramping. Then someone told me the machine doesn't record events while on ramping so in effect the results were skewed for the first 45 minutes after going to bed and when I got up in the middle of the night. For all I know I might be having lots of events at the lower pressure so I canned it in favor of getting an accurate reading. That's why I don't use it anymore.

Thanks Msheda and Track!

The Vantage has both Settling and Ramp... they are essentially the same function. Ramp is used in straight cpap mode, Settling is used in apap mode.

You are correct in your assumption... it is a comfort feature, helpful at higher pressures to let patients get to sleep before full pressure is applied.

On the Vantage, I believe that apneas and hypopneas are ignored for statistical purposes during Ramp or Settling time, not sure on other machines.

I finally figured out how to access all the stuff. I think I'll start by going from 4 and 8 to 5 and 9. Would that make sense?
Also.....since Big Brother is always watching (meaning the doc will be able to see what I've done)..........what would be the best approach to not ruin our relationship? Do I just say I've talked to alot of people and decided for such and such reasons to go up a little on the pressure and see how that affected by numbers??
Even though I wouldn't tolerate an obnoxious doc who was closed minded, I feel like I don't want to look like I'm ignoring this doc's input. I just don't feel like making an extra appointment with him, before going up.
This doc allowed me to get a machine, without a titration study, and I don't want to lose such a flexible doc. (although maybe because of his flexibity, he won't mind my messing with the settings??). I just don't know what to expect. I won't own the machine until February. If I made him mad, could be force me to give up the machine??
I learned long ago to think for myself and do what I feel is best. And I'm thinking this change is perfectly okay to try. I just don't want to screw myself over with insurance, or have to get another sleep study because I ticked this doc off.

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

Country4ever wrote:I finally figured out how to access all the stuff. I think I'll start by going from 4 and 8 to 5 and 9. Would that make sense?
Also.....since Big Brother is always watching (meaning the doc will be able to see what I've done)..........what would be the best approach to not ruin our relationship? Do I just say I've talked to alot of people and decided for such and such reasons to go up a little on the pressure and see how that affected by numbers??
Even though I wouldn't tolerate an obnoxious doc who was closed minded, I feel like I don't want to look like I'm ignoring this doc's input. I just don't feel like making an extra appointment with him, before going up.
This doc allowed me to get a machine, without a titration study, and I don't want to lose such a flexible doc. (although maybe because of his flexibity, he won't mind my messing with the settings??). I just don't know what to expect. I won't own the machine until February. If I made him mad, could be force me to give up the machine??
I learned long ago to think for myself and do what I feel is best. And I'm thinking this change is perfectly okay to try. I just don't want to screw myself over with insurance, or have to get another sleep study because I ticked this doc off.

I think you're letting your imagination run away with you.
Don't forget.....your doctor works for YOU. You and your insurance are paying HIS fees.
As long as you're compliant and showing decent results, that's all he should care about......and you, too.

Another thing you need to check into (since you mentioned February) is whether your insurance starts a new fiscal year on January 1st. Do you have deductibles? If so, they'll kick in on Jan. 1 and it'll ding you for more money on your PAP machine.....till you meet your deductible.

Quit worrying about what the Doc thinks. It's YOUR therapy.

Den

Thanks Wulfman,
I've been through alot in the past 12 years.......developing fibromyalgia. I've been through tons of docs. Some of them were real jerks and I dropped them......but it does take time to find a new decent one.
I have alot of fears, and this doc was willing to work with me a bit on them, so I don't want to appear non-compliant. I guess I just need to toughen up a bit on being secure in knowing that I do know what I'm doing and having faith in my perception of the situation.
I'm usually not afraid to stand up to people, but I don't want to tick this guy off, so I have to go to another sleep doc who says I need the get tested all over again. That's what I'm more afraid of.
But thanks for the pep talk!

Country4ever wrote:
I was pretty insulted that she was taking the power of my being involved in my treatment away from me. She should have given me credit for having half a brain. Perhaps she just works with mostly people who don't??? I just don't know....but I didn't like it.

Sad as it is, I think this is probably the case. Most people simply accept the authority of anyone in the health care field without question. It is your body, your health and your decision. You are a participant in your own health care.

Country4ever wrote: Like I said earlier, my doc let me have this treatment without another sleep study. He could have gotten real obnoxious about it, but felt, considering my anxiety, that we could monitor things well, just by looking at the data.

P.S. If I ever do get alienated from my sleep doc.....I worry about not being able to get insurance coverage for supplies, etc. What do you think?

I wouldn't worry about alienating your doctor. As long as you are complying with the therapy he shouldn't be upset about how you do it. Most good doctors want to form a partnership with their patients. If he is not a good doctor, don't you want to find one who is?

Susan

One approach you might take with this doc (who does seem to be willing to think outside the box at least a bit -- you were prescribed a machine, a top of the line auto, no less, without a titration) is to come right out and state that you intend to be actively involved in your treatment, that you know and understand that the doc's time is both valuable and in short supply, and that you will heed and follow directions and keep appointments, but that you want to and are capable of monitoring and adjusting your treatment on a day to day basis (here's the kicker!:shock:) just as diabetics are expected to monitor and adjust their treatment on a day to day basis. Polite, reasonable, and firm.

Good luck with your therapy!

Country4ever:

Though some of them hate to admit it, doctors are mere mortals like the rest of us! If you were to go in and say "The folks on CPAPtalk told me to try different pressures" your doc will likely hear you as saying "Those folks with no expensive education and no letters after their name are smarter than you are."

On the other hand, if you go in with a solid rationale: that your 90% pressure is close to your upper limit, and your machine spends a lot of time at the upper limit and that other users suggested that what worked for them was setting both limits up a little so that the machine woujld respond quicker and have a little more pressure available at the upper end as needed. Hopefully that will sound like an involved patient who has done his homework. If you can do it in a tone that indicates a willingness to be educated, a reasonable doctor should be pleased.

Seems to me that if you outline that you're monitoring the data, that you understand the wisdom of taking several days between changes and changing only one thing at a time, you've defined the scientific method pretty clearly, and you'll reassure your doc that you're not some flake who decides that if some is good, more is better.

FWIW---

Bookbear got in while I was still typing. Mine shouldn't be interpreted as a reaction to the previous and certainly not in conflict with it. It's just a matter of timing.

Panhandler wrote: ... On the other hand, if you go in with a solid rationale: that your 90% pressure is close to your upper limit, and your machine spends a lot of time at the upper limit and that other users suggested that what worked for them was setting both limits up a little so that the machine woujld respond quicker and have a little more pressure available at the upper end as needed. Hopefully that will sound like an involved patient who has done his homework. If you can do it in a tone that indicates a willingness to be educated, a reasonable doctor should be pleased. ...

Except I wouldn't say

... that other users suggested that what worked for them was ...

I'd say that it occured to you that setting both limits up a little so that the machine woujld respond quicker and have a little more pressure available at the upper end as needed made sense.

That totally eliminates reference to advice from other patients rather than a sleep "professional" and just makes you look even more involved in your therapy and obviously educating yourself and thinking things thru carefully.

I wouldn't argue with that, Slinky.

Thanks everyone,
You've given me lots of things to think about. I won't have to see him for awhile......so I have lots of time to practice what I'd say. hahaha.....which I will promptly forget to say when I see him!
I think that's a good idea to word things so I don't say something like "lots of people have been saying that......." and just focus on my wanting to let my machine do the most it can for me. Many great points! Thanks so much!

P.S. .....so do you think going from 4 and 8 to 5 and 9 would be okay, or is that too small of a change?

I made all my changes one cm at a time. I think it makes very good sense.