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[Treatment] May be Too Late for Me Too
RE: May be Too Late for Me Too
Should I be concerned about the "CA" events I seem to be getting more frequently?

Thanks, Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
(06-10-2019, 03:58 PM)Tubaman Wrote: Should I be concerned about the "CA" events I seem to be getting more frequently?

Thanks, Carl

Your #'s look great already!  Your ca is only showing .5....  CA's only become a concern when they're above 5.0 regularly, perhaps even 7.0.  

Having a 3 cmw ps would in theory help with CA's if they were problematic...but in your case, they really aren't. 

It appears based on your settings that "ramp is turned off", but your charts seem to show ramp on for a little less that 30 mins...???
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RE: May be Too Late for Me Too
I have the machine set @ "AutoRamp".  I received an ad from ResMed describing the "AutoRamp" feature.  It's supposed to wait until I go to sleep before ramping up.  It rarely works right.  It usually starts ramping up prematurely while I'm still awake -- I think ResMed needs to do a little work on this feature.

I'm bad with abbreviations (my mind won't cooperate).  What is "3 cmw ps"?  What do you mean by "#s"?

I noticed after I posted that my CA events mostly happened while I was still awake.  My respiration rate was down around 10 and that usually means I'm awake.  It rises into the 20s (and higher) when I am sleeping.  Always been that way since I started CPAP in June 2016 and probably long, long before CPAP.  Pulmonologist wasn't concerned during my recent visit so I live with it.  Another forum member recently stated my respiration rates are typical for people in nursing homes.  That still bothers me.  I'm not quite at that stage yet (still mowing lawn, running errands, repairing & servicing lawn mower, etc. with no problems except getting up when I get down on my hands & knees).

Thank you, Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
# is an abbreviation for “number”

Autorampmends either when you fall asleep, or after a set amount of time (mine is set at twenty minutes), whichever comes first

3cmw ps would be 3 centimeters of water (the pressure setting) or pressure support.  Someone else will need to really explain pressure support to, although I can say that it involves a reduced pressure while exhaling

Sorry - I can’t seem to edit my post

3cmw of ps should say “of pressure support”
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RE: May be Too Late for Me Too
(06-10-2019, 06:24 PM)Tubaman Wrote: I have the machine set @ "AutoRamp".  I received an ad from ResMed describing the "AutoRamp" feature.  It's supposed to wait until I go to sleep before ramping up.  It rarely works right.  It usually starts ramping up prematurely while I'm still awake -- I think ResMed needs to do a little work on this feature.

I'm bad with abbreviations (my mind won't cooperate).  What is "3 cmw ps"?  What do you mean by "#s"?

I noticed after I posted that my CA events mostly happened while I was still awake.  My respiration rate was down around 10 and that usually means I'm awake.  It rises into the 20s (and higher) when I am sleeping.  Always been that way since I started CPAP in June 2016 and probably long, long before CPAP.  Pulmonologist wasn't concerned during my recent visit so I live with it.  Another forum member recently stated my respiration rates are typical for people in nursing homes.  That still bothers me.  I'm not quite at that stage yet (still mowing lawn, running errands, repairing & servicing lawn mower, etc. with no problems except getting up when I get down on my hands & knees).

Thank you, Carl


Why Me- Thanks for explaining.  You are spot on!


Carl-

When I first started cpap I turned ramp on since I thought it was a feature I needed.  I soon learned that I didn't need it and have turned it off.  Everyone is of course different and must rely on one's own comfort level.  

Your ca's, coming on the heels of waking, would be false flags... meaning, they aren't real.  As the number of your ca's are quite low, they are nothing to be concerned about... 

 ps = pressure support which is the difference between your inhalation and exhalation pressure or EPR as Resmed calls it:  Expiratory Pressure Relief.  Yours is presently set at "3".   This is also a "comfort thing".   When I started, I believe I may have had it at around 3, but then later decided I really didn't need it at all, so I merely turned it off.

I hope the above helps some Carl! - -  And don't pay any mind to the person who said your respiration rates are like someone in a rest home...if you're out and about mowing lawns and fixing lawn mowers, you're doing better than many people!  Thumbs-up-2
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RE: May be Too Late for Me Too
Mr. "Why Me":
Does the 'AutoRamp' feature have a default time out?  You mentioned 20 minutes.  If I understand you correctly, this means that when set on "AutoRamp" (as my machine is), it will wait a maximum of 20 minutes for me to go to sleep.  At that point, it will start ramping up, whether or not I'm sleeping.

If so, how do I set this default value to something larger, like 60 minutes maybe, and still be set on 'AutoRamp', to account for my unpredictable insomnia?  This would mean it could start ramping up in 5 minutes (or less on times when I quickly go to sleep), or 60 minutes maximum 'ready or not' when my insomnia is doing a number on me.

Musings:
I've always thought of "#" as being an abbreviation for weight, i.e. pounds.  Then again, I have seen it used to mean 'number'.  Sometimes hard to differentiate because of the context it is used in.  Hmmmm.
Thank you!

Mr. "S. Bear":
Thank you!  I really appreciate your advice on the previous comments on my high respiratory rate.  That has been really bothering me personally.

Both of you:
Thanks for the explanations, especially on EPR.  Also your explanations of my CA events which have started worrying me since it seems they are increasing as of lately.
Tubaman/Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
I have the feeling (probably mistakenly) that folks don't really understand how the ResMed 'AutoRamp' option works.  Maybe a picture will help explain how it's supposed to work (see attached).  The period before the initial pressure ramp (left side of picture) is about 30 minutes -- the time it took me to initially get to sleep and the ResMed machine (set for AutoRamp) correctly sensed when I fell asleep.  The machine then correctly started the pressure ramp process, increasing pressures up to my current set therapy pressures.

When I took a sandbox break around 0800 h and got back to bed, the period before the ResMed machine started increasing the pressures to my therapy pressures (ramp up) only took about 5 minutes before the machine correctly sensed that I had quickly fallen back asleep (very rare for me but happens occasionally).

This is how the ResMed 'AutoRamp' system is supposed to work and, this time anyway, it did work.  That is frequently not always the case.  The ResMed machine erroneously decides I am asleep even though I am still awake and starts ramping up the pressures prematurely.

If anybody would like to see a chart where the pressures have prematurely / erroneously started ramping up (while I am still awake, using AutoRamp setting), please let me know.  I have some that I can post if desired.

FYI, Carl / Tubaman


Attached Files Thumbnail(s)
   
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
There are three modes for ramp - off, auto (senses when you fall asleep) or timed (adjustable, between 5-45 minutes).  In auto mode, if you don’t fall asleep within 30 minutes, the pressure starts to ramp up to the preset minimum anyway.  As far as I know, that 30 minutes is not adjustable.

Edit: Actually, I may have interpreted that wrong, so I will just quote from the clinician manual

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
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RE: May be Too Late for Me Too
And, as with all technology related to the human body, the CPAP machine set @ autoramp sometimes starts prematurely ramping up the pressures.  The included chart demonstrates that quite well -- startup after 24 minutes 12 seconds even though I was definitely still awake.  My respiration rate is never as low as a steady 12 bpm when I am sleeping.  The 10 to 15 bpm range only happens to me when I am awake.  My respiration rate will be a minimum of 20 bpm, or higher when asleep -- always.

Calculation:
Started CPAP 0949.51 -- Ramp started 1014.03  = about 24 minutes 12 seconds later, unless I calculated wrong (I don't think so).  I was still awake when the ramp-up began and for some time after.  This example isn't the only time this has happened.

I'm not disputing the non-adjustability of the autoramp's default 30 minute start time maximum delay (somebody else said it was adjustable and I asked how to adjust it at that time -- I've received no reply).  I'm only trying to demonstrate that autoramp sometimes starts prematurely (when I'm still awake).  Also, I've tried the manual adjustable ramp settings many times in the past (they only set the time gap between the ramp start to the ramp end, not the delay before ramp start -- which is what I would like to be able to adjust -- and cannot).  They don't provide any delayed start period as the autoramp setting does.  I therefore find the autoramp much preferable because of the variable start delay period even though it's not always reliable.  Frequently even 30 minutes delayed ramp start is inadequate for me because of my chronic insomnia.  Because of the large disparity between my awake and sleep respiration rates, it's easy to tell whether I'm awake or asleep, ergo, whether the delayed ramp start time is actually working as advertised, and sometimes it doesn't (as seen below in the chart I've included).

I was never given a manual for my ResMed machine so thank you for the manual information.  If I had a manual I might have saved us all some time.  Maybe this forum has digital copies of the manual -- I've never checked (my bad).

FYI, for what it's worth (probably nothing),
Carl/Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
Short addendum.  I went back and located 2 more instances of premature ramp start ups under the autoramp setting.  Both of them happened while I was still awake (slow respiration rates around 10 - 12 bpm) and both of them happened at approximately 24 minutes (as with my example above).  Too consistent for being coincidental.  Looks like my ResMed machine's autoramp default of ~30 minutes delay is more like ~24 minutes -- if that's what is happening.  Probably a defect in my machine, I suppose.

FYI,
Tubaman/Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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