Use NPPV in the daytime first, with the primary aim of establishing tolerance, but also with control of blood gases and vital parameters including blood pressure.

Start with assisted NPPV first. For this purpose, the lowest back-up respiratory rate and most sensitive trigger threshold are typically used in addition to low IPAP levels, normally ranging between 12–16 cmH₂O. EPAP levels are low at this time.

Once assisted NPPV is tolerated, carefully increase IPAP in a step-wise approach until maximal tolerance is reached, usually up to 30 (range 20–40) cmH₂O. The individually tolerated maximum may differ greatly between individuals.

Next, increase the respiratory rate just beyond the spontaneous rate (not more) to establish controlled ventilation, but avoid excessively high respiratory rate settings that cause dynamic hyperinflation.

Then, set EPAP in order to avoid dynamic hyperinflation according to subjective comfort (usually 3 and 6 cmH₂O), and similarly, set the inspiratory:expiratory ratio to 1:2 or lower. EPAP settings may be higher when upper airway obstruction is simultaneously treated (COPD + obstructive sleep apnoea syndrome).

Once daytime tolerance is acceptable, apply nocturnal NPPV. Do not apply nocturnal NPPV too early when the patient is not comfortable with daytime NPPV.

Adjust ventilator settings according to subjective tolerance and nocturnal monitoring of blood gases. Sometimes settings can be modified considerably at the first control visit in hospital after the patients has been acclimatised to NPPV at home for some weeks.