CPAP Ramp Time: What It Is and How to Use It With Your CPAP Device

Key Takeaways

• CPAP ramp time is a feature designed to make the initial stages of CPAP therapy more comfortable by starting at a lower air pressure and gradually increasing to the prescribed level.
• Using the ramp time feature can improve sleep quality and make it easier to adjust to CPAP therapy, especially for new users or users who find the initial pressure too intense.
• Most modern CPAP machines, such as the ResMed AirSense 10 and 11, come equipped with a ramp time feature, making it an industry standard.
• While the ramp time feature offers several benefits, there are potential drawbacks related to waking up and restarting your machine.

Sleep apnea is a condition that affects millions of Americans. Daytime fatigue, mood swings, and waking up with a headache can all be signs you have sleep apnea and indicate you’re not getting the nourishing sleep you need. ^[1]Johns Hopkins Medicine. The Dangers of Uncontrolled Sleep Apnea. Found on the internet at https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea According to the Centers for Disease Control and Prevention, adults who get less than seven hours of sleep a night are more likely to have health issues, including asthma, depression, heart attack, high blood pressure, Type 2 diabetes, and obesity—so addressing sleep apnea is critical to overall health. ^[2]Centers for Disease Control and Prevention. How Does Sleep Affect Your Heart Health? Jan. 4, 2021. Found on the internet at https://www.cdc.gov/bloodpressure/sleep.htm

The most effective treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. ^[3]Lee-Chiong, Teofilo L., Jr. Today’s Geriatric Medicine. Sleep Apnea Obstructs Elders’ Sleep. Found on the internet at https://www.todaysgeriatricmedicine.com/archive/0315p26.shtml If you’re new to the world of CPAP machines or find that using your CPAP machine is challenging, you’re not alone. Ramp time is a feature designed to make your CPAP experience more comfortable. Our Reviews Team put together this guide so you can better understand CPAP ramp time, its benefits, and how to adjust your CPAP machine ramp settings—because better sleep is key for health and longevity.

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What is CPAP ramp time?

CPAP ramp time is an optional feature found in most modern CPAP machines. This function allows you to start your CPAP therapy at a lower air pressure, which then gradually increases to reach your prescribed level after you’ve fallen asleep. The primary purpose of ramp time is to release less intense initial air pressure, making it easier for you to fall asleep. This feature is particularly beneficial for people new to CPAP therapy or with high air-pressure prescriptions.

What are the benefits of using CPAP ramp time?

CPAP ramp time provides several benefits to CPAP machine users:

1. Easier adjustment to CPAP therapy: The ramp time feature allows for a smoother transition into your prescribed air pressure. This makes the initial stages of sleep more comfortable, allowing you to adjust to the sensation of the air pressure. This helps new users get used to their machines and reduces the chance of CPAP usage “dropout,” which means the patient gives up and discontinues use. Increased compliance rates are an important goal, considering long-term studies have shown a “non-adherence rate” of around 34%. ^[4]Rotenberg, Brian, et. al. Journal of Otolaryngology–Head and Neck Surgery. Aug. 19, 2016. Trends in CPAP Adherence over Twenty Years of Data Collection: A Flattened Curve. Found on the internet at https://journalotohns.biomedcentral.com/articles/10.1186/s40463-016-0156-0
2. Improved overall sleep quality: Starting your therapy at a lower pressure can help you fall asleep more easily. This ensures you’re already asleep when the machine reaches the full prescribed pressure, contributing to a better overall quality of sleep.
3. Flexibility and customization: Most modern CPAP machines offer a high degree of customization regarding ramp time. You can generally adjust the ramp time in five-minute increments, usually up to 45 minutes. This flexibility allows you to tailor the ramp time to your specific needs and comfort level. Some machines even have a sleep sensor feature, which allows the machine to recognize when you’ve fallen asleep, so it can adjust the pressure accordingly.

When should I use ramp time?

The ramp time feature is beneficial if you find your prescribed pressure too intense or the sound of air rushing into your mask is too loud as you’re trying to fall asleep. It’s especially useful for people with higher therapy pressures, ranging from 15–20 centimeters of waterⓘ Centimeters of water (cmH2O) is a unit of pressure exerted by a column of water at 4 degrees Celsius. , or for those who are new to CPAP therapy and are still getting used to the sensation of air pressure. You should use the feature in the beginning part of your night when you’re trying to fall asleep—usually the first 20, 30, 45 minutes—depending on how long you usually take to fall asleep.

CPAP user Debby Rosenzweig of Denver, Colorado, told us, “When I first got started using my CPAP, it helped a lot to get used to the air blowing in my face. It’s really jarring at first and made it hard to fall asleep. Now I don’t really need it anymore, so I’d say it’s more like a training feature for new users—at least it was for me.”

How to set up ramp time

The process of setting up the ramp time on your CPAP machine can vary depending on the model you have, but it generally involves going into the machine’s settings and selecting the ramp time feature. From there, you can set your starting pressure and the duration of the ramp time. Most machines offer increments of five minutes for your ramp duration, allowing you to customize the feature to suit your needs.

What CPAP machines have ramp time?

In today’s market, it’s almost an industry standard for CPAP machines to come equipped with a ramp time feature. Whether you’re considering machines like the ResMed AirSense 11, the OxyGo ResPlus Auto, or a travel machine, like the ResMed AirMini Autoset Travel, you’ll find that they all offer some form of ramp time functionality.

Drawbacks of using ramp time

Although ramp time is helpful to many users, it’s not always beneficial or appropriate, especially in the following scenarios.

Waking up when the pressure reaches target

One of the potential drawbacks of using the ramp time feature is you may find yourself waking up when the machine reaches the full prescribed pressure. This could indicate you’re not accustomed to the higher pressure, or the pressure is set too high, making it uncomfortable and disruptive to your sleep. “It may feel like the pressure is set too high,” noted Elizabeth Lyda, RRT, a registered respiratory therapist and quality improvement specialist at the University of Rochester Medical Center in New York. “However, the pressure is determined by the sleep technologist who titrates the pressure during an overnight sleep study to get the ‘best’ results.”

Overusing pump

While ramp time offers benefits, overusing the ramp feature can reduce the effectiveness of your therapy, leading to insufficient pressure during crucial periods of sleep. If your ramp time is set for too long a period, you may be asleep and having apneic events before your machine gets to the prescription pressure. For instance, if your ramp time is set for 45 minutes but you fall asleep in 15, you may have 30 minutes of untreated sleep apnea.

Restarting the pump

If you wake frequently during the night and restart the ramp feature, you could have several bouts of untreated sleep apnea. If the ramp time is 45 minutes each time, this adds up and may affect your overall quality of sleep.

When asked if you can overuse ramp time, Michael Breus, PhD, a clinical psychologist and founder of The Sleep Doctor, noted: “As long as you eventually get to the correct pressure I would say no. But if you reset your ramp after 20 minutes or so, more than two times, then you will want to talk to your doctor about considering a lower pressure to start and then over time advancing it to the prescribed pressure.”

Tips from experts

The expert consensus is that ramp time can be a helpful feature for CPAP users—especially for new users. Joseph Krainin, MD, senior medical advisor at SleepApnea.org, told us, “Ramp can be a helpful comfort feature. The idea is that the CPAP pressure will slowly build up to where the patient needs it over a set period of time. Suppressing the pressure can help people fall asleep easier while using their CPAP machine.”

Krainin explained that the typical rule of thumb is to set the ramp time for however long it usually takes you to fall asleep. So, if it normally takes about 20 minutes to fall asleep, set the ramp for 20 minutes. “Many patients like this feature, but some don’t due to feeling like they’re not getting enough pressure,” he said. To offset this, some CPAP machines have an override feature that will let the machine increase the pressure before the ramp time is up if the machine senses the patient has fallen asleep and is having obstructive breathing events.

Lily Taylor, content manager at RespShop, told us, “The ramp feature is good for CPAP users who have trouble falling asleep and is a useful feature for those new to CPAP therapy. Many patients find it hard to fall asleep with the pressure of the CPAP machine when they start therapy. Ideally, if patients can use their CPAP without ramp, that’s the best case scenario. This is because ramp can cause some issues if set incorrectly.”

If the ramp pressure is too low or the ramp time too long, it can cause air hunger (not getting enough air) and result in breathing events. Patients experience air hunger or more apneas and/or hypopneas (shallow breaths that occur for 10 seconds or longer with airflow 30% lower than normal) because the pressure isn’t high enough. ^[5]WebMD. Hypopnea: What to Know About This Sleep Disorder. April 06, 2022. Found on the internet at https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-hypopnea-overview Of course, AutoRamp helps avoid this by automatically increasing pressure to the prescribed therapy setting once you fall asleep.

“Usually the ramp is a function that people use who are first put on a PAP device (CPAP or BiPAP), so they can get used to the pressure a little at a time,” said Breus. “This is especially true for people with moderate to severe sleep apnea, as they tend to need higher pressures for treatment. Many of my patients will continue to use the ramp feature, but about half seem to no longer use it, after the first six months or so.”

Bottom line

Understanding CPAP ramp time and how to adjust it can significantly improve your experience with CPAP therapy. Especially for new CPAP users, the ramp time feature offers a way to make your therapy more comfortable and effective, leading to better overall sleep quality and a higher likelihood of continued use. But the ramp feature is not for everyone, and you should never overuse it.

For more information on CPAP accessories, check out our guide on the best CPAP masks.

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Have questions about this article? Email us at reviewsteam@ncoa.org.

Sources

1. Johns Hopkins Medicine. The Dangers of Uncontrolled Sleep Apnea. Found on the internet at https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea
2. Centers for Disease Control and Prevention. How Does Sleep Affect Your Heart Health? Jan. 4, 2021. Found on the internet at https://www.cdc.gov/bloodpressure/sleep.htm
3. Lee-Chiong, Teofilo L., Jr. Sleep Apnea Obstructs Elders’ Sleep. Today’s Geriatric Medicine. March/April 2015. Found on the internet at https://www.todaysgeriatricmedicine.com/archive/0315p26.shtml
4. Rotenberg, Brian, et al. Trends in CPAP Adherence over Twenty Years of Data Collection: A Flattened Curve. Journal of Otolaryngology–Head and Neck Surgery. Aug. 19, 2016. Found on the internet at https://journalotohns.biomedcentral.com/articles/10.1186/s40463-016-0156-0
5. WebMD. Hypopnea: What to Know About This Sleep Disorder. April 06, 2022. Found on the internet at https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-hypopnea-overview