Help, panic with full face mask during ramp phase

[IDRIck]

I've been on a CPAP for 6 nights and have excellent results for 4 nights (AHI < 4) and not so good for 2 nights (AHI 7 and 13). The CPAP pressure starts at 6 cm and ramps up to 15 cm over 45 minutes. The first ramp up generally works just fine, it is the later ones that give me pause... You know, a quick trip to the restroom and back to bed. When I restart the CPAP, the 6 cm seems inadequate and "I think" I am short of air although if I just relax, I can readily go to sleep and not experience any health problems... At the same time thought, the psychological panic is disconcerting, what can I do? Should I increase the original pressure and/or decrease the ramp up time? I'm planning on visiting with my DME provider and DR tomorrow.

[trish6hundred]

Hi IDRIck,
I have read on the forum that some people have trouble with the ramp feature and turn it off. You could decrrease the time maybe from 45 minutes to 30 minutes.
When I can get someone to help me make some changes to my machine, I am thinking about turning my ramp off completely but everyone is different, what works for me might not work for you. That's one of those trial-&-error things.
Hang in there for more responses to your post, best of luck with this.

[jgjones1972]

The ramp controls should be right out on the main menu. Have you considered using the ramp when you first go to sleep, then if you have to go away and come back, just shut the ramp off when you start the machine again?

I stopped using the ramp after the first night because of that feeling of suffocation. I think the ramp is just a comfort feature for those who don't feel comfortable with the sudden onset of pressure - so if it's not making you MORE comfortable, there shouldn't be any problem with shutting off or switching back and forth (off - on) at your discretion. I could be wrong here so I hope someone corrects me if there is some theraputic benefit to the ramp.

[PaulaO2]

Just say no to The Ramp.

Kidding.

45 minutes is a long time. First, try decreasing that time. What happens is the pressure starts at 6 and, 45minutes later, it is finally up to 15. Which is fine when you first go to bed. But later, like you said, you get up, turn it off, do your business, and turn it back on. But at that point, you and your body are "used" to the 15 and you feel smothered. You're getting more than enough air to breathe but it doesn't feel like it.

Cutting the time down will not change that beginning pressure but it will rise to 15 faster and you may feel like you are getting enough air. If cutting the time down doesn't work, change the starting pressure. I would guess that 10 would feel better. You'll need to get into the clinician settings to do that, I think.

The longer you use CPAP, the more you get used to the treatment pressure. I used to use the ramp feature but just could not breathe, even when first going to bed. The first few nights, I had ear issues but they cleared up once everything settled. I recently started using an autoPAP and have the minimum setting for 10 so that's what it starts at. I had problems going to sleep with that for several nights!

[zonk]

Should I increase the original pressure and/or decrease the ramp up time?

don,t mess with set pressure but definitely decrease ramp time and increase ramp pressure from 6
if were me would turn ramp off ... use the machine in auto something like 10-15. might don,t need 15 all night long but will check the data and see how thing work out
the machine reports AHI, 95% percentile pressure/leak and ResScan would shows what pressure/leak was doing during the night breath by breath
ramp, EPR and humidity are comfort features ... everyone is different
just like mask choices ... only you can find out what works best for you

[IDRIck]

Awesome, thanks for the replies everyone! I'll start by lowering the ramp up time to 30 minutes and I will try it without the ramp (after the initial ramp up to go to sleep). Very interesting observations by Paula, I seem to be following a similar pattern of getting used to the target pressure. It is a huge blessing to have people to talk to about these issues!

All the best,

Rick

[TheWerkz]

IDRIck,

I have the same machine and mask combination and I know exactly what you're saying!

As someone that suffered from panic attacks for 10 years before finally getting them under control for the last 10 years, I had not even come close to having an actual attack until I started using CPAP 4 1/2 years ago, although, then I had a ResMed S8 AutoSet II with the same Mirage Quattro mask.

What I ultimately figured-out was that for me it was both the start pressure and the ramp (called Settling on the S8) was causing it, I came to that conclusion one night after I had removed the mask but left the machine running, I went to the bathroom and when I returned the pressure was all the way up to 20 cm since it was just running without being attached to my face, but, after I put it back on the pressure would slowly start dropping but I never felt panicky when the pressure was running at a higher level than my ramp and/or starting pressure which was at 4 cm & 6 cm.

First I turned the Ramp (Settling) off and then turned-up the minimum starting pressure from 6 cm to 8 cm and I've never felt panicky since, when my poor old S8 AutoSet II bit the dust 7 weeks ago, I bought the S9 AutoSet and immediately turned the Ramp off and set the starting pressure at 8 cm and left the max set at 20 cm in auto mode and my AHI has been even better with the S9, I went from an average AHI of 4.5 on the S8 to and incredible average AHI of 1.40 for the last 30 days, and that number is actually skewed too high since the majority of the AI's occurred from huge mask leaks (I just bought a new cushion) and I have had days of AHI 0.0, 0.4, 0.5 etc.

The Ramp feature is purely for comfort and its only real benefit is compliance, since most new users need to gradually ease-into using CPAP as opposed to all-at-once full pressure in your face.

I think the reason CPAP never bothered me at a higher starting pressure was because of 8+ years of SCUBA diving, I was already used to sucking air through a hose (regulator actually) but I do vividly remember ripping my mask off during the first few weeks when I thought I was suffocating (I wasn't of course) but after my light-bulb moment I've at least found the solution that works for me, I hope it might help you too.

[IDRIck]

Quick report back, last night I reduced the ramp time from 45 to 30 minutes and increased the start pressure from 6 cm to 8 cm. Slept well with these settings but was still a bit uncomfortable (slight sense of not enough air) when restarting after a bathroom call. I'll try again this evening. BTW, the AHI was excellent at 0.7 with 8.25 hrs of operation!

Oh, I didn't shut off the ramp for the later starts because I couldn't figure out how to do it... Can some one give me directions? I know how to adjust the ramp time and how to get into the clinician settings to adjust start pressure but could not find anything that suggested turning ramp on and off. Thanks!

[PaulaO2]

Do not make too many changes at once. By changing both the time and the pressure, you don't know which one made it better.

As for how to turn it off, not sure. I don't think it is easy.

[PaulaO2]

Yes, you can only turn it on and off inside the secondary (clinician) menu. It is where you changed the start time and pressure. Basically, you'd enter into that, turn off the ramp, exit out, and then turn the machine on. Then reverse the process when you go to bed the next time.