During BiPAP titration for adults, when should both I and E PAP be increased?

During BiPAP titration, the goal is to optimize pressure settings to effectively address obstructive sleep apnea (OSA) and mixed apneas. When both inspiratory positive airway pressure (I PAP) and expiratory positive airway pressure (E PAP) are increased, it often directly improves the airway patency during instances of apnea and hypopnea.

In the context of OSA, the condition is characterized by repetitive blockages of the upper airway during sleep, typically presenting as apneic episodes. Mixed apneas, which involve a combination of central and obstructive events, can also benefit from increased pressures to ensure that the airway remains open while addressing variations in respiratory effort.

Increasing both I PAP and E PAP can enhance the therapeutic effect for these conditions, as higher pressures may alleviate airway obstruction more effectively and provide more stable ventilation. This titration method is crucial in managing airway dynamics, thereby improving overall respiratory mechanics during sleep.

Conditions like RERAs (respiratory effort-related arousals) involve partial airway obstruction rather than complete blockage, and while they can be problematic, they may not necessitate both pressures to be increased in the same way that OSA and mixed apneas do. Therefore, focusing on the more severe and obstructive phenomena