Ramp Confusion
First off, let me just clarify that I DO NOT have a computer to download OSCAR to, so I will try to keep my question in the realm of requesting a general useful explanation.
This may be a stupid question but keep in mind that my brain has been deprived for many, many years and the CPAP recovery process is show in my case.
I find everyone here to be very wise and most importantly, PATIENT, so here goes:
What exactly is the difference in how the APAP ramp works, between (1) timed ramp, (2) auto ramp and (3) no ramp?
My machine is set up for a range of 6-15. I currently have it on auto ramp. It takes me a L-O-N-G time to fall asleep, at least an hour, so the timed ramp, which I assume starts at 6 and gradually ups to - what, 15? - will run for up to 45 minutes. Does that mean that at the end of the ramp, the pressure will be 15? Or, since it's an APAP, it will just rest where it feels I need to be until it senses an apnea event?
Now, with the auto ramp, which is where I have mine, it starts at 6 and at any given time, when I look to see where it's at, it can be at 7.5, 9.2, 13.9, whatever.
If I turn off the ramp completely, does it still start at 6? (Assuming this is a yes, and of course I could just check that myself.) Then what happens? Does it quickly go to 15, or just go to where it senses I need it to be until it senses an apnea event? And, how is this different to the auto ramp?
With all this being said, I think I pretty much understand how the timed ramp works. But I'm not sure I understand the difference between the auto ramp and no ramp. Hopefully my question makes sense. Thanks in advance!
RE: Ramp Confusion
In AutoSet mode, ramp time defines the period during which the pressure gradually increases from a lower more comfortable start pressure (which you probably have set at 4?) to the minimum treatment pressure (which is set at 6) before the auto-adjusting algorithm starts.
Once ramp reaches your minimum set pressure of 6, the auto-adjusting algorithm takes over. The pressure will vary during the night according to what apnea events are detected and can go up to your maximum pressure of 15. This is no longer ramp.
I believe you are confusing ramp (start time) with the minimum pressure set.
With such a low minimum pressure of 6, you probably don’t need to use the ramp feature. Just turn it off.
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 H2O per minute. However, if sleep onset is not detected, the device will reach the target pressure within 30 minutes.
Hope that makes sense. The Clinicians manual explains in more detail. If you don’t already have a Clinicians manual, order it here:
https://www.apneaboard.com/adjust-cpap-p...tup-manual
RE: Ramp Confusion
My machine range is set from 6-12. I've tried the ramp feature in auto mode and in the manual mode. I really didn't notice all that much difference.
It can take me a while to fall to sleep. So, that being the case, I usually leave the ramp mode in auto.
RE: Ramp Confusion
When I first got my machine, it was set to start at a pressure of 4, which I subsequently raised to 5, then 6. Are you saying that even thought my "minimum" pressure is 6, that my "start" pressure may still be 4? When I start it up, it reads 6.
How do I know what my "target pressure" is? Is that the same as the maximum pressure (15)? I thought it would only go up that high if it detected an event?
RE: Ramp Confusion
On my Resmed Airsense 10 Autoset in the Clinicians Settings menu if ramp is set to On then there is a setting for 'start pressure'. Factory default is 4.
This is different then the therapy pressures which are minimum and maximum.
While you are in 'ramp mode' the machine doesn't auto adjust between your therapy minimum and maximum.
RE: Ramp Confusion
The in the clinical menu ramp on a Resmed has a start pressure which can be changed. I cannot tell what yours is set at without looking at a graph. But you can easily check
RE: Ramp Confusion
Thank you! I ordered the manual and will check.
RE: Ramp Confusion
(12-30-2019, 12:07 PM)suzeecat Wrote: When I first got my machine, it was set to start at a pressure of 4, which I subsequently raised to 5, then 6. Are you saying that even thought my "minimum" pressure is 6, that my "start" pressure may still be 4? When I start it up, it reads 6.
Your "start" pressure is what you have set the Ramp to start. You can actually start the Ramp at any number, but in your situation, it doesn't make sense, because your minimum pressure is set at 6. You may very well have Ramp set at 6, I don't know, but if you do, then it won't work the way you want to, because it doesn't have any room to ramp up to anything. Ramp only goes as far as the min set pressure, then the therapy pressure (which is set at 6) starts.
How do I know what my "target pressure" is? Is that the same as the maximum pressure (15)? I thought it would only go up that high if it detected an event?
I'm not sure what you mean by "target pressure". The maximum set is not necessarily a target pressure. Your pressure range is 6 min and 15 max. Since you don't have a computer to download software, it makes it a bit hard to answer where your pressure range should be set. Please order the Clinicians manual and familiarize yourself with your machine. It almost sounds to me like your ramp isn't on at all. Again, I think you are confusing "ramp" with minimum pressure.
Do you have a friend with a computer that you can download software to?
My comments in blue.
RE: Ramp Confusion
There are 3 variables that affect ramp.
1) Ramp time. Ramp time is the length the ramp function will run for. This can be a set time or it can be set to auto. In auto mode the machine determines when it believes you have fallen asleep at which time it ends ramp. I am not sure exactly what auto ramp time uses for a ramp rate (I am guessing it uses 45 mins then ends earlier if it senses you have fallen asleep).
2) Start pressure. This is the pressure that the ramp function starts at.
3) Min pressure. This is the pressure that the ramp function ends at, this is your treatment min pressure.
This ramp function is a comfort setting that is meant to help you fall asleep however it doesn't always do this and I believe it is horribly overused and should primarily only be used for users that require higher minimum pressures (8+) but have trouble falling asleep at those pressures. The reason for this thought is two fold.
a) Many users find it harder to breath at 4 cm of pressure because at that low of a pressure you do not get any advantages of EPR (exhalation pressure relief which reduces pressure during exhale but also will never fall below 4 cm). Pressures greater than 4 cm (for example your minimum pressure of 6) allow for EPR (yours would be 2 cm assuming you have EPR turned on and set at 2 or 3) which many find to be more comfortable, myself included. I actually prefer a minimum pressure of 7 just so that I can always get the full advantage of 3 EPR.
b) During ramp the machine literally ignores any trouble that you have breathing. It ignores apnea events, hypopneas, flow limitation, all of it. It won't flag these events nor will it increase the pressure to try and deal with them. For example lets say you are a user with start pressure set at 4 cm, min pressure 6 cm and shortly after falling asleep you usually start having apnea events that cause the machine to increase pressure to 10 cm before the events subside. If you have ramp set to 30 mins and fall asleep after only 10 minutes then you are going to have 20 minutes of sleep at only 4-6 cm of pressure, a significant number of apnea events during that time and all you are doing is providing yourself with inadequate treatment. If you have the machine set to auto at least there is a chance it might realize you fell asleep at 10 mins and start your treatment earlier.
In your specific example I see no reason to use ramp. Your minimum pressure of 6 cm is easy to breath at and may very well be more comfortable to you due to the EPR comment above.
One more thing to note about ramp is that it goes through the paces every time you turn on the machine. If you are a user that often turns the machine off one or two times a night (bathroom breaks etc) then a long ramp period can eat up a lot of the night so if you are going to use it you need to be sure that it is set up properly for you (which will require checking OSCAR and seeing how you pressure requirements change etc).
RE: Ramp Confusion
(12-30-2019, 12:43 PM)OpalRose Wrote: (12-30-2019, 12:07 PM)suzeecat Wrote: When I first got my machine, it was set to start at a pressure of 4, which I subsequently raised to 5, then 6. Are you saying that even thought my "minimum" pressure is 6, that my "start" pressure may still be 4? When I start it up, it reads 6.
Your "start" pressure is what you have set the Ramp to start. You can actually start the Ramp at any number, but in your situation, it doesn't make sense, because your minimum pressure is set at 6. You may very well have Ramp set at 6, I don't know, but if you do, then it won't work the way you want to, because it doesn't have any room to ramp up to anything. Ramp only goes as far as the min set pressure, then the therapy pressure (which is set at 6) starts.
How do I know what my "target pressure" is? Is that the same as the maximum pressure (15)? I thought it would only go up that high if it detected an event?
I'm not sure what you mean by "target pressure". The maximum set is not necessarily a target pressure. Your pressure range is 6 min and 15 max. Since you don't have a computer to download software, it makes it a bit hard to answer where your pressure range should be set. Please order the Clinicians manual and familiarize yourself with your machine. It almost sounds to me like your ramp isn't on at all. Again, I think you are confusing "ramp" with minimum pressure.
Do you have a friend with a computer that you can download software to?
My comments in blue. I'm not sure what "target" pressure is either. You mentioned it first in the fifth paragraph of your first reply. That's why I was asking about it.
I do not know of someone that would feel comfortable with me downloading unfamiliar software and spending hours (I'm a technical moron) trying to figure out how to use it. I understand that using OSCAR is most helpful, but since I don't have access, I was trying to word my question to ask just for general information and not specific recommendations on my pressure range needs. I did order the clinicians manual and will try to learn what I can from that.
I currently have the ramp on auto set and it appears to start up at 6, but maybe I should look elsewhere for a setting that may be set to 4. I know for sure that I do not want a timed ramp because with the max ramp time of 45 mins. I would definitely still be awake. I want to avoid a situation where I get blasted wide awake when I'm trying to drift off.
|
