During BiPAP titration for adults, when should only I PAP be increased?

The choice of only increasing the inspiratory positive airway pressure (IPAP) during BiPAP titration is most appropriate in situations involving obstructive sleep hypopneas (OSH), respiratory effort-related arousals (RERAs), and snoring. Each of these conditions is related to incomplete airway obstruction or partial airway collapse rather than total obstruction, which suggests that augmenting the inspiratory pressure would assist in overcoming resistance and improving airflow.

In patients with OSH, the airway is obstructed periodically during sleep, resulting in decreased airflow despite continued respiratory effort, which can lead to significant airflow limitation and hypoxemia. Increasing the IPAP will enhance the positive pressure during inspiration, thereby supporting effective ventilation and potentially mitigating these events.

RERAs involve arousals related to respiratory events but without complete apnea. Increased IPAP helps alleviate these pressures, allowing for a smoother respiratory cycle. Snoring is often a result of vibration of soft tissues during airflow in narrowed airways. By heightening the IPAP, the airway can be stabilized, potentially reducing or eliminating snoring.

The other choices may involve combinations of events where the response should be more balanced between IPAP and expiratory positive airway pressure (EPAP). Conditions like obstructive sleep apneas