Ramp Feature in BiPAP Settings
The ramp feature is a comfort setting that temporarily resets the pressure to a low starting level (typically 3-4 cm H₂O) and then gradually increases it to the prescribed therapeutic pressure over a period of up to 45 minutes, allowing patients time to fall asleep before experiencing the full prescribed pressure. 1, 2
Purpose and Function
The ramp feature serves as a patient comfort mechanism designed to improve tolerance and adherence to BiPAP therapy 1, 2. The key characteristics include:
- Initial pressure reduction: The device starts at a minimal pressure (usually 3-4 cm H₂O) when activated 1
- Gradual pressure escalation: Pressure slowly increases over a preset time period (typically 15-45 minutes depending on device settings) 1, 2
- Patient-controlled activation: Most devices allow patients to manually activate the ramp feature via remote control 1
Clinical Rationale
The ramp addresses a common barrier to BiPAP adherence by allowing patients to fall asleep at lower, more comfortable pressures before the therapeutic pressure is delivered 1. This is particularly important because:
- Higher therapeutic pressures can feel uncomfortable or claustrophobic when patients are awake 3
- The sensation of high pressure may prevent sleep onset in some patients 1
- Gradual pressure increase is better tolerated than immediate full pressure 2
Important Clinical Pitfall: Ramp Abuse
A critical caveat is that patients can misuse the ramp feature by repeatedly activating it throughout the night, which severely limits effective therapy despite proper mask placement and machine operation. 1 This phenomenon, termed "ramp abuse," represents a form of non-compliance where:
- Patients repeatedly reset the pressure to low levels when they briefly awaken 1
- Therapeutic pressure is never maintained for adequate duration 1
- The machine appears to be in use (good compliance hours), but effective treatment is minimal 1
Practical Considerations
When prescribing BiPAP with ramp capability, clinicians should:
- Educate patients that ramp should only be activated at sleep onset, not repeatedly throughout the night 1
- Monitor device data for patterns suggesting ramp abuse (frequent pressure resets, inadequate time at therapeutic pressure) 1
- Consider disabling ramp in patients who demonstrate repeated misuse 1
- Recognize that ramp is a comfort feature, not a therapeutic setting—the prescribed IPAP and EPAP levels remain the therapeutic targets 3, 2
The ramp feature differs from the therapeutic pressure settings (IPAP and EPAP) which should be determined through proper titration to eliminate obstructive respiratory events including apneas, hypopneas, RERAs, and snoring 3.