Some OSA patients complain that they cannot tolerate the starting PAP pressure which affects their compliance to therapy. If CPAP pressure is set >4cmH2O then RAMP function can be enabled to provide comfort to the patient. RAMP allows the machine to start at a lower pressure than the set pressure so that the patient can initiate sleep at a lower pressure.

Different manufacturers call this function by different technical names. Some manufacturers have enabled RAMP function by default and for others patient need to press the RAMP button to activate this setting.

Setting the RAMP function– Usually one has to input two settings into the machine- “RAMP start pressure” and “RAMP time” for machines in which this function is not activated by default (Philips, Loewenstein and BMC).

RAMP start pressure is set according to patients comfort but lower than the therapy pressure. RAMP time is usually set equal to the time patient takes to fall asleep. RAMP time settings are from 05-45min. RAMP time an be increased in increments of 5min.

Resmed Auto RAMP- How it works? (Accessed on internet on 17 Jan 2025- https://www.resmed.com/en-us/sleep-apnea/sleep-blog/fall-asleep-faster-with-lower-cpap-pressure/)

AutoRamp is only available on ResMed’s new AirSense™ 10 CPAP machines.

Your AirSense 10 will know you’re asleep no more than three minutes after. That’s because the moment you turn on your machine, AutoRamp is looking for three things:

1. 30 breaths of stable breathing (roughly 3 minutes)
2. 5 consecutive snore breaths
3. 3 obstructive apneas or hypopneas within 2 minutes

Once any of those signs occurs, AutoRamp steadily ramps up your air pressure at a slow, comfortable rate until you reach your prescribed level.

Plus, no matter when you fall asleep, AutoRamp makes sure you reach your prescribed pressure no later than 30 minutes after you turned on your machine. This ensures that you get effective sleep apnea treatment, based on research that on average, most people on CPAP fall asleep in 20–25 minutes.

Philips Smart RAMP- How it Works? (Accessed on internet on 17 Jan 2025- https://junnimed.com/image/catalog/files/DreamStation%20Provider%20Manual%20International%20English.pdf)

When SmartRamp mode is enabled, the therapy device’s ramp function utilizes an Auto titrating algorithm during the ramp period. It allows patients the ability to stay at lower pressures during the ramp period, to improve their acclimation to therapy.
The SmartRamp period will terminate in either of two ways:
1) If SmartRamp pressure reaches the minimum pressure of the therapy mode selected, then SmartRamp ends, and the device continues to deliver therapy under the selected therapy mode, or:
2) If SmartRamp pressure does not reach the minimum pressure of the therapy
mode selected by the end of the Ramp Time, then pressure is increased at a rate
of approximately 1 cm H2O per minute. Once the pressure reaches the minimum pressure of the therapy mode selected, then the device will continue to delivertherapy for that mode.
If SmartRamp mode is not enabled, then the standard, linear pressure ramp mode is active.

In Loewenstein and BMC machine, we need to input RAMP time to activate the RAMP function. When patient presses RAMP button on the machine, it will start at 4cmH2O and slowly go to therapy pressure over the set RAMP time.

Every patient will not need the RAMP function to be activated. Use this comfort feature only in patients who find it difficult to tolerate the starting pressure.