What is the appropriate action if a patient is restless and continues to have frequent obstructive respiratory events during CPAP titration at 15 CM H2O?

In the context of CPAP titration, when a patient exhibits restlessness and experiences frequent obstructive respiratory events despite being set at a pressure of 15 cm H2O, changing to bi-level therapy is a reasonable and appropriate action.

Bi-level therapy, also known as bilevel positive airway pressure (BiPAP), allows for two different pressure settings: one for inhalation (IPAP) and a lower pressure for exhalation (EPAP). This can be particularly beneficial for patients who are struggling with higher pressures, as the lower expiratory pressure may enhance comfort and compliance while still effectively treating obstructive events. The ability to breathe out against a lower pressure often alleviates feelings of suffocation or discomfort that patients may experience at a fixed higher pressure.

Potentially increasing CPAP pressure may not address the underlying issue of patient discomfort and could exacerbate their restlessness, while simply delaying titration would not resolve the patient’s ongoing respiratory events. Switching to supplemental oxygen doesn't address the root cause of the obstructive events and may lead to complications without treating the need for airway pressure support. Therefore, initiating bi-level therapy can provide a more suitable balance of airway support and patient comfort in this situation.