It's a learning process!  I had taken the "smart card" from my machine into the provider (a contractor for the VA) and my machine was changed from Auto CPAP to having the "Ramp" feature.  I didn't know what that was and I didn't understand their use of the word "titration" to describe the behavior of the machine.  Well now I know.The machine was originally in "titration" mode, in that it automatically (Auto CPAP) start at 4 cmH20 and progress up to a level that would represent the state of sleep, which was around 13 to 14 cmH20.  Well this could cause my mouth to blow open and I wasn't breathing.  I went in with the card and a different therapist changed the machine from "Titration mode" to the ramp feature so I could just hit the Ramp Button to bring it back down to 4 cmH20 any time I wanted.  (the ramp feature is supposed to take about 20 minutes to go from 4 to what ever level) Well this wasn't much fun either as when the machine would reach something above 12 cmH20 I would wake up because I wasn't breathing.  I was stuck with my lungs inflated and relaxing my diaphram wouldn't cause an exhale.  I would have to wake up and think about exhaling to exhale and then the next breath would be the same.  I would hit the ramp button and 20 minutes later I would be at the same stuck state!So again I went in and saw the original therapist who returned the machine to the titration mode.  I asked it the machine was going to go above 12 cmH20 and was told that it will peak out at some point.  This is still not what I want.  I thought the whole CPAP process was to be able to sleep not get woken up because I can't exhale!Does anyone know if an upper limit can be set so the machine doesn't wake me up?  I stay asleep at under 12 cmH20 just fine and I exhale just fine below that level.  Is there something magic about 14 cmH20?Also I can't wait to get rid of the middle-man contractor and communicate directly with the physician at the VA.Getting frustrated with complex beauracracy!-geomar