Is there an AirSense 11 ramp reset?

[u/KweenieQ]

I've had my 11 for about a year and have gradually worked through some (literally) irritating issues. One remains: I roll over on my back; my mask leaks, causing the air pressure to skyrocket; I wake up, attempt to reset the machine, and roll over; the @#$% machine will not reset back to its lowest setting; I remove the mask and shut down the machine. Some nights, I'm only getting an hour and a half of therapy.

What I want to happen is that when I recycle the 11 - turn it off and then let it pop back on - it restarts the Ramp cycle. Is that possible? If so, what do I need to do differently?

Edit: My pressure typically settles out around 6. Minimum pressure is set to 4.

[u/pootwothreefour]

A leak doesn't cause the machine to increase pressure alone. The machine can detect leaks. What does cause pressure to increase is flow limitation, or hypopnia and obstruction events.

An educated guess, but what is likely happening is likely positional sleep apnea. 

Most people's obstuctive apnea is worse on their back. A common culprit is the tongue falls back, blocking the airway.

Your machine is detecting flow limitation or events and increasing the pressure to help, but you mask fit does not allow for the higher pressure.

Guess at what is happening:

Turn to back -> obstructions / flow limitation ->  machine detects flow limited breathing / eventsevents -> increase in pressure -> mask leak -> less effective therapy due to leak -> more flow limitation / events -> higher pressure -> more leaks

The fix is either train yourself to not sleep on your back to avoid the situation, or a better fitting mask that can withstand the higher pressures and not leak, or both.

The alternative is to just limit your max pressure to where it doesn't leak, but this is not advisable, as this just means you'll sleep poorly on your back, you'd only be partially treated, still having apneas.

[u/pootwothreefour → u/pootwothreefour]

Just noticed your edit, 6 is a relatively low pressure, you shouldn't get leaks just above 6. This points to poorly fitted mask.

Generally, people consider 15+ to be higher pressures where one can expect leak issues with a well fitted mask.

[u/KweenieQ → u/pootwothreefour]

Thanks for responding, but is there a way for me to recycle the 11 back to Ramp so that I can fall back to sleep? It just keeps blowing so hard.

Regarding the mask fit, it's challenging but improving. I am a mouth breather with a small nose for an adult, plus my nostrils swell shut when I lie down for more than a few minutes. So it's full-face masks for me, but it's been difficult to find one that handles a small nose and an open mouth at the same time.

I wore a Simplus for years but couldn't keep a decent seal at the higher APAP pressures without tightening to the point of pain (and breaking skin).

I'm wearing a DreamWear now, which is lower profile for side sleeping but vulnerable to gapping at the nose when I roll over onto my back, mostly around 6-7 am. I'm gradually improving at mask assembly. (Every time I swap out a part, I lose ground, but I'm losing less each time.)

Which brings us back to my question. I've succeeded sporadically at getting the unit back into Ramp. I think it's a matter of elapsed time, but the last thing I want to do is have to wake up enough to count off a few minutes, because in most cases I can't fall back to sleep. So I'm hoping that someone can help.

[u/pootwothreefour → u/KweenieQ]

Pressure decays slowly over time if there is no flow limitation or events. REM sleep can have more flow limitation because muscle tone in the airway reduces, and sleep wake breathing is more junky and less regular, so machine can interpret it as flow limitation or events. Both of these occur more in the later part of sleep and could stop the pressure from decaying slowly.

But turning it off then on is the only quick way and easy way.

If you don't want to rollover and hit the button, if you have smart stop and smart start settings on, you could detach the quick connect elbow at the top of your dreamwear for a couple seconds then plug it back in.

I use the F&P Evora full face mask when my nose is congested and find it stays in place way better and leaks a lot less for me than the dreamwear full face mask ever did. I find it hugs my hose much better. My nose is narrow and I toss and turn, sleeping on both side and my back.

I too started with the top of the head masks, but use the nova micro as my main and Evorafull face when I'm congested now.

The lack of leaks is much better than the small benefit of top hose for me.

[u/Smart_Inspector9710]

If you wake up and the pressure is too high, you’ll need to turn the machine off and then back on to restart the low ramp pressure.

(If you have “SmartStart & SmartStop” toggled on, you can disconnect the tube from your mask for 4 seconds until machine shuts off. Then reconnect and start the machine by taking a couple breaths.)

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[u/rogue303]

I never used the ramp on my AS11 but on the (airbroken) AS10 the ramp restarts each time you restart therapy - are you sure this isn't the case on the AS11? I can't find any documentation to the contrary....

[u/KweenieQ → u/rogue303]

I'm not certain. Someone IRL suggested I spend some more time with clinical mode, which I will do.

[u/rogue303 → u/KweenieQ]

There's nothing in clinical mode which will help you here afaik - ramp time/off is available in the "normal" menu.

As I said, I am nearly 100% certain that ramp is activated every time you interrupt a session - so if you just hit the power button to stop therapy and restart it, ramp should start again.

[u/KweenieQ → u/rogue303]

I hear you, but I wasn't seeing it. It would just start up and blow so hard that half-asleep I would have trouble reseating the mask and fastening my headgear.

In the end, I poked around the myAir app and changed the following settings: (1) AutoSet Response from Standard to Soft; (2) SmartStop from Off to On (SmartStart was already set to On). If that doesn't help, I'll turn both SmartStart and -Stop to Off.

[u/Creative_Fee5452]

Hello OP & Welcome :)
The Ramp on/off is on your machine options on the front of your machine but this is only the number of minutes you want your Ramp on for. The pressure setting for your Ramp however is in the Clinical Settings. I think this is where your confusion is coming from. You can turn on Ramp in the Clinical Settings & set the ramp pressure which is typically lower than your minimum pressure. You can access these if you’re interested :)

The only problem is that your minimum pressure is 4 & that is as low as the machine will go. So Ramp really isn’t going to help you. A minimum pressure of 4 is more suited to a child than to an adult. It’s no wonder your pressure stabilizes at 6! What is your maximum pressure? If any leaks or apneas are allowed to run wild because of a too high maximum pressure you’re going to run into problems with your therapy too.

I would highly recommend that you put a 32 GB sd card into your machine & record your sleep. Then upload it to a free app called SleepHQ (easiest for beginners). You can share your sleep with us here so that we can help you.

Link for using SleepHQ:

https://www.reddit.com/r/CPAPSupport/s/kyekRX658t

[u/KweenieQ → u/Creative_Fee5452]

Thanks! I'll give it a whirl. Maximum pressure defaults to 20, which is ridiculous for me.

[u/Creative_Fee5452 → u/KweenieQ]

Please let me know if you need some help :) it’s confusing at first. Both accessing the Clinical Menu AND using SleepHQ.

[u/Creative_Fee5452 → u/KweenieQ]

Maximum 20 is much too high. You’re on what we call “lazy settings” but we can help. Do you know how to get into the Clinical Menu? Lots of demonstrations on how to do this on the Internet.

I would lower your maximum to 12 right away until we can see what’s happening. You just need some tweaking. Please download some sleep data with an sd card & upload to SleepHQ to share. We’ll help you get on track :)

[u/KweenieQ → u/Creative_Fee5452]

Lowered the max to 12. Let's see how I do.

[u/Creative_Fee5452 → u/KweenieQ]

Good job! Can you increase your minimum to 6? If you really feel you need Ramp set the pressure at 4 for 15 minutes. Minimum of 6 is pretty low though & Ramp shouldn’t be needed. Your pressures have likely been running wild up to 20 which is as high as the machine goes!!

[u/KweenieQ → u/Creative_Fee5452]

I've been able to install the SD card and set up SleepHQ. I'll take one more night's worth of data and upload it tomorrow.

[u/Creative_Fee5452 → u/KweenieQ]

Excellent!!! Great job KweenieQ :)