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Ramp off, but pressure is not fixed
#1
Ramp off, but pressure is not fixed
Hello,
Thanks in advance for taking the time to read and respond to my question.

I am a new Bipap user and noticed the Oscar data shows the pressure is fluctuating through the night, despite turning off the ramp setting which I thought should allow for fixed IPAP and EPAP. Smart start was also off.

I’ve used the machine for two weeks, and Oscar shows the pressure fluctuation issue occurred only on the past two days.  I thought this issue may be due to lowering the pressure (it was previously at 11 IPAP and 8 EPAP) or changing the humidity (I occasionally experienced condensation in mask). 

But, what’s confusing is that I set IPAP 9 and EPAP 6 at 12:30 am, but the Oscar data shows the IPAP was at 7 at 12:30 am and stays at this pressure for a few hours, before it begins fluctuating.  I am not sure if my mask being on too tight can cause the issue or what else may be happening.  
Please let me know if you have any ideas or suggestions, thank you.


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#2
RE: Ramp off, but pressure is not fixed
I'd like to help, but you clipped valuable information in your screenshot. Please use the F12 key while in OSCAR to capture your daily screen. For additional information on OSCAR and presenting it here, please see the links in my signature.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Ramp off, but pressure is not fixed
Yes please put in an OSCAR screenshot using the charts in my signature at the bottom of the post..

As far as fluctuations, that is what  a VAUTO does - it has a low and a high number and moves between them to stop obstructive events from happening.  But with the charts we can check to see if there is a problem.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Ramp off, but pressure is not fixed
I reuploaded the image, please let me know if it is cut off again.  Thank you.


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#5
RE: Ramp off, but pressure is not fixed
I also have a VAUTO it is a great machine and is issued when higher pressure than 20 is needed or you need mor pressure support. I mentioned this because you do not have either in your setup. 

Ps1 is your setting. Why is it set to 1?  Your numbers are not bad but I just don’t understand your settings.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#6
RE: Ramp off, but pressure is not fixed
First, If you want to drop the 30-minute session that is constraining the remaining sleep session, scroll down on the left side to the Session Information and uncheck the first 30-minute session.

You are in Auto mode and not S-Mode. You don't have a static pressure set. Your VAuto is set with an EPAP of 6.0, a Max IPAP of 9.0, and a PS=1. This will allow your pressure to run between a start of EPAP=6.0/IPAP=7.0 and can go as high as EPAP=8.0/IPAP=9.0. If you set it to the S-Mode, you will have an EPAP and IPAP setting and no PS. Were you wanting an EPAP of 6 and an IPAP of 9 and maintain the VAuto mode? If so, set the PS to a value of 3. This will then start your EPAP at 6 and, with a PS of 3, make your IPAP 9. Since you set the IPAP max to 9, it can not go any higher. Your IPAP pressure will always be a calculation of EPAP+PS=IPAP.

The CA came at the end of your sleep session, making me believe that this is sleep-wake-junk (SWJ). Your Flow Limit is relatively low but has room to improve. You can address this latter. With your AHI being so low, how do you feel?

Several people, myself included, have experienced problems with the Smart Start feature. I don't recommend using it.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Ramp off, but pressure is not fixed
Hey @StaceyBurke,

Thanks for the reply. Would you please recommend which settings to try? My RDI was 12.6/hr and AHI was 2.1/hr in the watchpat study (110 lbs, otherwise physically healthy).  I didn’t get my machine through a doctor, so I have basically been doing research on Reddit and playing around with the settings.  My original PS1 and possibly other settings may not be well suited for me.  Please let me know if you have any suggestions. Thank you.
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#8
RE: Ramp off, but pressure is not fixed
@Crimson Nape 
Thanks for the reply.  I understand now that the PS of 3 will keep the fixed pressures of IPAP 9 and EPAP 6 in Vauto mode or instead can use S mode, thanks for the information.

I am actually feeling quite tired upon waking (I tried the machine in CPAP mode EPR 3 with the fixed IPAP 9 and EPAP 6 and was feeling tired as well).  I am 29 years old, 110 lbs, and physically healthy, but typically feel tired upon waking and have had memory and brain fog issues for the past several years (and tmj). I was hoping the sleep apnea machine would help with feeling less tired, but I have not really noticed much improvement over the past two weeks.  

 Do you have any suggestions for settings/ modes that may help?  My RDI was 12.6 and AHI was 2.1 in the watchpat study.  Thank you.
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#9
RE: Ramp off, but pressure is not fixed
I would try min 4
Ps 4 max 15

That would give you an inhale pressure of 8

Exhale of 4

Max of 15 but it would not go higher than needed to stop apnea.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: Ramp off, but pressure is not fixed
Thanks for the suggestion.  Do you find it helpful to keep the ramp on or off?
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