What's a Ramp???
The Ramp feature, every modern CPAP machine has one, not everyone understands it. So we will be discussing what the heck a Ramp is and whether you want to use it or not.
The Ramp feature is related to the amount of pressure you initially receive from your machine. It is mostly a setting for comfort, and ultimately doesn't increase or decrease your prescription pressure settings. The Ramp feature isn't the same on every machine but the overall the concept is the same. When the Ramp feature is enabled, that means your machine will start at a pressure that is usually lower than your prescription settings. The purpose of this is for comfort. Perhaps your prescription settings are set between 8-18 cm/H2O, and your normal nightly pressure hangs out around 14 cm/H2O. Without the ramp feature your machine would immediately go to the pressure of 14 which might feel like a wind tunnel to the face. People generally find it easier and more comfortable when the machine starts off at low pressure that slowly increases over time. So to put it in simple terms, the Ramp feature on your machine will set your pressure low, and gradually increase it over time.
Setting your Ramp
If you have played around with your machine you will find that you can adjust the Ramp settings on your machine, depending on your model of course. The two most popular models currently are the AirSense10 and the DreamStation so we'll focus on those two.
The AirSense10 Auto Set Ramp feature comes preset on Auto. When the Ramp feature is on Auto, that means that your machine will stay at a low pressure, and won't ramp up until it sense that you've fallen asleep. Once you fall asleep, the machine will increase the pressure to overcome your sleep apnea. If you select the Ramp feature in the options menu you can set your Ramp to a time frame. For instance if you set the Ramp Time to 30 minutes, that means that your pressure will start out low and increase over the course of 30 minutes. The drawback of setting the ramp to a time frame, is if you were to fall asleep before the 30 minute mark, your pressure is still ramping up. So in a sense you're limiting the amount of pressure you're getting until you reach the 30 minute mark, and you might be preventing yourself from getting the pressure needed to overcome your sleep apnea. The Ramp also restarts every time you go to bed so if you wake up twice to go to the bathroom, your machine will reset and Ramp up again over a time frame of 30 minutes. So if you do that twice that's a total of one hour that you weren't receiving full therapy from your machine. For this reason I recommend leaving it on automatic or setting your Ramp time to a short time frame.
The DreamStation Ramp feature is different than what is found on the AirSense10 machine, but the concept is still exactly the same. When you select the ramp feature on your DreamStation it will show you a number. The number may vary depending on your prescription settings, but for a lot of people, the DreamStation will let you choose a number between 4 - 6. What ever number you choose will be the starting pressure for when you turn your machine on. For example, if you choose the number 5.5, that means when you turn your machine on it will start at a pressure of 5.5 cm/H2O and Ramp up from there. If you like less pressure when you initially turn your machine on then set it to the lowest number you can, in this case it would be 4, and your machine will start a low pressure of 4 cm/H2O and ramp up. Different from the AirSense 10 Auto Set, you don't have the option of altering the time frame for the Ramp. I've tried to look up to see how it is determined and wasn't able to find much information on it. What I did find is that the DreamStation has 2 Ramp features, one being the standard Ramp and the other being the Smart Ramp. The Smart Ramp will keep your machine at a low pressure and only increase the pressure when it senses that more pressure is needed. In other words, it will wait til you fall asleep and increase the pressure once it senses you having sleep apnea events. This setting can only be changed in the clinical menu so your provider/Dr. would have to make the change or determine which setting they feel is best for you.
On a final note I will mention, if you're the type of person who feels comfortable with the pressure from your CPAP and wants the therapeutic level of pressure to kick in right away, then turn off the Ramp setting. This will tell your machine to bypass the gradual increase of pressure phase and will automatically give you the pressure that is needed to fix you sleep apnea. I find more seasoned CPAP users start to turn off the Ramp as they get more comfortable with their CPAP and don't mind higher pressures as soon as they put their mask on. I'm sure as you go through your CPAP journey, you'll find what type of Ramp setting works best for you.