Why the “hate” on the ramp feature?

[Kmar13]

Newbie here. I’ve been reading through lots of posts, and I’ve noticed some general dislike of the ramp feature on the Airsense 10 Autoset and suggestions for eliminating it from therapy. As a slightly claustrophobic CPAP user, I find the 30 minutes of ramp time helps me to calm down and settle into my breathing. I put it on, read or do a crossword, and am off to sleep as it transitions from the gradual pressure increase (4 to start) to my set pressure (12). Is there some impairment to therapy doing this?

[staceyburke]

Yes there is.  While you are on ramp you are not getting therapy and the apnea events are not scored on the pap machine.  If you have a 30 minute ramp and get up 2 times during the night for rest room, you have 1:30 minutes you are not getting therapy.  4 is the lowest the machine can go and many people with 7 or 8 as a min and using EPR 3 are already at 4 or 5 at the start of therapy.  That makes an hour and 30 minutes a night they will be missing.

[Geer1]

The reason is two fold.

1) Most people use low minimum pressures (4-8 cm) and ramp is unnecessary at those low pressures. Your set pressure of 12 is getting to the point where ramp can be beneficial (imo anything over 10 cm) especially early in treatment when getting used to the mask/machine.

2) It postpones treatment leaving a portion of your sleep inadequately treated and because the machine knows it is operating at a inadequate pressure it does not record apnea, hypopnea or even flow limitations that occur when ramp is active. If you are using 30 minute ramp to reach your required set pressure that means you have 30 minutes below your set pressure during which apnea can occur (and as mentioned the machine does not flag these apnea). Then lets say you have a bathroom break and turn machine off now so you have 2 ramp periods meaning you now have 1 hr of being undertreated (10-20% of sleep time).

2b) If you are using EPR (say 3 setting) and ramp starting at 4 cm then your pressure has to ramp up to 7 cm before you get full EPR effects which again is delaying treatment. This can be changed by adjusting ramp start pressure to 4 + EPR setting though.

My recommendations are always to only use ramp if you have to and if doing so you should use the shortest ramp period possible. If you feel you need longer ramps try using the auto setting. Auto tries to determine when your breathing has transitioned to sleep breathing so as to minimize the undertreated time. My other recommendation is that if your set pressure is 12 then use a higher ramp start pressure (say 8 or whatever is comfortable) to improve the treatment received while in ramp.

[Melman]

What Stacey says is correct if you can relax and fall asleep without using ramp. But it you are so uncomfortable starting at a higher pressure that you can't fall asleep at your therapy pressure not using ramp probably has a greater negative effect. Your not getting effective therapy and even less sleep if you spend a longer time lying awake. In time you will probably get more comfortable with your therapy pressure and at that time you should quit using ramp. It may be helpful to gradually reduce the ramp time or gradually increase the ramp pressure.

[staceyburke]

Why are you using a stagnant pressure of 12?  Have you tried the autoset with a min and max pressure and used EPR?  We can help with your therapy if we can see what your night looks like.  We use OSCAR to get the data.  It is free download from this site.  You need a SD card no larger than 32 GB.  find the cheapest one out there. and post your oscar charts.

[hensem]

can't you set it to auto? i am not sure what it will but most probably the machine will detect when you fall asleep. but there were many time while i m still awake the machine start to increase pressure. so i am not sure what auto would do. i'm on cpap for more than 2 years it does not bother me anymore.

[Ratchick]

The auto setting for Ramp seems like a good idea, but it relies on the machine trying to guess when you are asleep, and it's often not very good at it. So either (as often happened when I tried it at the start of therapy) it would just push my pressure up when I was awake (which is why I turned it off, as I didn't need it to fall asleep) or you could be asleep and still not receiving therapy because the machine doesn't realise it needs to do its thing.

Just, in reality, the ramp is better off not being used unless it's ABSOLUTELY the only way someone can fall asleep. and if you CAN fall asleep at therapeutic pressure, then there's zero point in using it anyway.

[desaturator]

While I understand the problems with the ramp feature, I also understand why people like to use it. Personally, if I needed a minimum pressure > 10cm or so, I'd have to use the ramp. Even at the 4cm minimum I currently have (7cm - 3cm EPR), the first few minutes are still disagreeable.

As a new CPAP user, I find that there's an awful lot I have to tolerate that isn't very nice. The equipment is noisy, the mask uncomfortable and fills up with cold condenstation, the hose gets in the way, my sleep positions are limited, yadda, yadda, yadda. And don't even get me started on the effect this has had on my sex life.

I fully understand why it's best to limit use of the ramp, but I also understand why it could be a make or break thing for some CPAP users.

Best wishes, DS

[SleepyCPAP]

If you need it to fall asleep and tolerate CPAP therapy then Ramp is helpful.

Maybe you can try reducing the amount of time in Ramp. You say 30 minutes currently, so try a lower number and see if you can still fall asleep.

If you use OSCAR you can set up custom user flagging to show events not scored by the machine, or you can just scroll through your breath waves (zoomed in) to see if you are having untreated events.

I’m a weird outlier on this forum in my attitude towards Ramp. In my case I set ramp to 10 minutes not because I need it (I don’t, and Ramp is set to my min-EPAP or close to it so my therapy is handled well enough), but because I hate the machine scoring CA’s that are just sleep/wake junk. I’m using Ramp for that brief period exactly because it means I won’t get treated/scored. I’ve learned my body does a little pause signal just as I fall asleep (or a few in a row when I am close to sleeping, or just waking), I don’t breath for the briefest of moments (sometimes up to 10 seconds, which is score worthy any other time), and there is nothing good about scoring those pauses.

[Kmar13]

Aha! Since starting my therapy, I haven’t been getting up in the night so I hadn’t experienced this aspect of what I can see would be a negative to the ramp. I should say that I am awake through nearly all of the ramp time, because I’m reading to unwind before sleep. I usually close up my book at the 25 minute mark and fall to sleep. I guess my DME technician had suggested that as a way to fend off my claustrophobia and obsession with my breathing.

Thank you for your advice!