[Equipment] EPR, Min and ramp on Resmed10

[mcman56]

I'm trying to make sense of a change so please correct what I'm not understanding.

EPR is the reduction in pressure during exhale, it is Min Inhale pressure - EPR Value = Exhale pressure?

If I have min set to 7, EPR at 2 and ramp begins at 5, when the machine starts, is the exhale pressure 5 (7-2) or 3 (5-3)?

If I change EPR from 1 to 2 and with ramp starting at 6 is 6 (7-1) or 5 (6-1).

Does it follow that EPR to 2 and ramp at 5.4 is 5 (7-2) or 3.4 (5.4-2)

I guess the question is if the Min pressure used to calculate the exhale pressure is calculated from the ramp setting during ramp and min setting during non ramp.

If it always uses the set min pressure couldn't the exhale pressure during ramp be higher than the inhale.  Lets say min at 7, EPR at 1 and ramp at 4,  (6 > 4)

Thanks

[SarcasticDave94]

When you set the pressure on this PAP, it is equal to IPAP. When you introduce EPR, you have effectively added in EPAP. Take your left panel setting info of 7-11, this is an IPAP range. Add in EPR 2, now you have EPAP 5-9, IPAP 7-11 and EPR has become identical to PS/pressure support of 2 from the BPAP.

No matter the setting, your PAP will not go below 4. It is not possible no matter the setting. Except when the PAP has been turned off.

Combining Ramp and EPR, I am not so sure. I had used an AutoSet one night of torture and I never use Ramp, so I'm not at all certain of the combo. Ramp typically has no pressure range that I am aware of.

[staceyburke]

I don’t use ramp and most people here do not. Why?  Because if, for example, you have ramp set for 30 minutes and get out of bed 2 times to use the Restroom you would be on the ramp for an hour and a half. You are not getting therapy during ramp. 

As far as the EPR - I believe it can be set for “full time” which I think would include ramp.  As Dave said all pap machines can go no lower than 4. So min 5 and EPR 3 would make exhale 4 not 2.

[Neelix]

You can see the effect of this in Oscar's Pressure graphs. The IPAP rises up from 4cmH2O and once it reaches 4 + EPR the EPAP pressure starts to follow it.
If you zoom in on the beginning of the Mask Pressure graph you can actually see how the pressure difference between the inhale and exhale increases during ramp. (if you have ramp enabled)

-Neelix

[mcman56]

I don’t use ramp and most people here do not. Why?  Because if, for example, you have ramp set for 30 minutes and get out of bed 2 times to use the Restroom you would be on the ramp for an hour and a half. You are not getting therapy during ramp. 

As far as the EPR - I believe it can be set for “full time” which I think would include ramp.  As Dave said all pap machines can go no lower than 4. So min 5 and EPR 3 would make exhale 4 not 2.

This is a very interesting comment.  I get zero events during ramp which I find rather strange.  Could the machine not register events during ramp?  It ramps for 20 minutes so maybe it takes time for me to get into deep sleep and have issues.  Or, does this suggest I'm going about this all wrong?

[staceyburke]

While on ramp it does not show events because it can not treat them at the lower pressers.  They only use ramp for people who are not use to pap therapy and is turned off by most of us within a short time after beginning using cpap.  It really is not terrible to use one time as you get to sleep (if it is short in duration) but the problem is when someone stops the therapy 3 or in some cases we see up to 5 times in one night - each 30 to 45 minute long, anywhere from 2 to 4 hours or half the time the person is on the machine.

With EPR most people find it very easy to not use ramp at all.

[Crimson Nape]

I haven't used the ramp feature since my early days using an S9. I found that the S9 wouldn't report any events during this time period, so I used this feature to allow me to drift off to sleep before it really starting counting. The ramp pressure was set to match the minimum therapy pressure, so I was always within treatment parameters. Now, I'm doing good to hit the pillow before going to sleep.

[SarcasticDave94]

I find ramp disruptive and that it does delay therapy for the duration ramp is on. My needs are a bit different than most being very high CA based, but still ramp seems to complicate therapy IMO.

[Dog Slobber]

The advice you've been given regarding ramp is correct, if you are on timed ramp. Your device will not be monitoring, flagging events and adjusting pressure, should you need it.

However, it is not [necessarily] correct with an AirSense 10/11 in AutoRamp mode. In AutoRamp mode, the AirSense will monitor your breathing and then switch from ramp mode to therapy mode, should it detect sleep onset, or events sufficient to start therapy.

Specifically, AutoRamp will switch to therapy mode under the following conditions:

• 30 breaths of stable breathing (sleep onset)
  
• 30 Minutes since starting machine
  
• 5 consecutive snore breaths
  
• 3 obstructive apneas or hypopneas within 2 minutes