How BiPAP Therapy Can Help Treat Sleep Apnea (2024)

Bilevel positive airway pressure (BiPAP) or BPAP machine is a mechanical breathing device with a mask that is used to treatsleep apneaand other health conditions that affect your breathing. BPAP machines use positive pressure ventilation to help you breathe if you’re struggling to do so by yourself.

This article explains how BiPAP is used to treatobstructive sleep apnea(OSA) andcentral sleep apnea (CSA). It also covers how to get used to wearing a BiPAP machine and the possible risks of the treatment.

How BiPAP Therapy Can Help Treat Sleep Apnea (1)

How Does a BiPAP Machine Work?

A BiPAP machine is used when you can breathe on your own, but still need some help pushing air into your lungs to maintain healthy oxygen levels in your body. BiPAP can be used in medical settings (like hospitals) and at home.

There are a couple of pressurized air settings your provider can prescribe for your BiPAP machine. These settings alternate just like your breathing pattern:

  • Inspiratory positive airway pressure (IPAP): This is the pressure the machine provides as you inhale. When you inhale, the BiPAP supports your breath as you take it in.
  • Expiratory positive airway pressure (EPAP): This is the pressure the machine provides when you exhale. The BiPAP offers a lower pressurethat allows you to breathe out comfortably.

There are also a few other important BiPAP settings:

  • Bilevel ST: This setting is for the timed delivery of a breath if the machine detects a pause in your breathing (which often happens if you have CSA).
  • Auto or adaptive servo-ventilation (ASV): These advanced settings vary the timing, length, and volume of the breaths the machine delivers.

1:35

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This video has been medically reviewed by Sanja Jelic, MD.

When BiPAP Therapy Is Used

BiPAP with a backup respiratory rate is a form of breathing support used to treat CSA—a condition that happens when the brain does not send signals to the muscles that control breathing. The result is prolonged gaps in breathing.

The cause of CSA is not always known but is sometimes seen in people who have:

  • Sleep-disordered breathing related toopioid drug use
  • Congestive heart failure (CHF)
  • A history of stroke

Providers may prescribe it for severe cases of OSA, a more common type of sleep apnea that happens when your upper airway is partially or completely blocked.

As opposed to CSA which is related to the brain, OSA is caused by a mechanical problem that blocks the airways, including conditions likechronic obstructive pulmonary disease (COPD)andpulmonary edema.

BiPAP is beneficial when there is mixed sleep apnea, meaning that there are components of both CSA and OSA.

In certain cases of COVID-19, BiPAP can be used to delay mechanical ventilation.

In addition to treating central sleep apnea, BiPAP is also helpful for:

  • People who have trouble with continuous positive airway pressure (CPAP): People who find it difficult to breathe out against CPAP pressure may benefit from BiPAP. This is especially true if they need higher pressure—typically higher than 15 centimeters of water pressure (CWP)—to keep their airways open.
  • People who are hospitalized: BiPAP is a non-invasive treatment for people who are in respiratory distress but who do not need to be on a mechanical ventilator.
  • People with neuromuscular disease: BiPap might be helpful for people with conditions that cause nerve and muscle weakness, such asamyotrophic lateral sclerosis (ALS).

What Is a Sleep Study (Polysomnogram)?

BiPAP vs. CPAP

A BiPAP machine is similar to a standardCPAP machine—for example, it requires a face mask and tubing connected to the device. However, there are some differences betweenBiPAP and CPAP:

  • Benefits: BiPAP is a less common alternative toCPAP, but in some cases, it is more beneficial. For example, CPAP provides consistent air pressure while BiPAP offers varying pressure during inhalations and exhalations. This can be helpful for people who have trouble exhaling against CPAP's continuous pressure.
  • Cost: BiPAP is more expensive than a standard CPAP machine—up to three times the cost. The ASV models can cost more than $4,000. Insurance will usually cover the cost if a BiPAP machine is specifically indicated for treatment.

BiPAP vs. Bilevel vs. VPAP

There is often confusion about the words “BiPAP,” “bilevel,” “biphasic," “BPAP,” and “variable positive airway pressure” or “VPAP."All these terms basically mean the same thing, but the names of the devices are different depending on who makes them:

  • Respironics: One of the major manufacturers of these devices, Respironics, has registered BiPAP as a trademark name for the technology generically called bilevel.
  • ResMed: The other major competitor, ResMed, calls similar devices VPAP.
  • AirCurve: ResMed also markets AirCurve which is a bilevel device.

How to Use BiPAP

Here is how to use a BiPAP machine step-by-step:

  1. Decide where you will place the machine so you can use it while you sleep. It needs to be put in a safe, stable place near an electrical outlet.
  2. Make sure the filter is clean and ready to use.
  3. Connect the mask to the hose.
  4. Make sure the machine’s humidifier is clean and ready to use. Remember that you have to use distilled water. Tap water has minerals that can damage your BiPAP machine.
  5. Put the mask on and check the fit. Lay down in bed and make adjustments until you’re comfortable.
  6. Check the BiPAP’s pressure setting. Your provider will let you know what setting your machine needs to be on, and how long you will need to use it during the night.
  7. Turn on the machine and check that it’s working normally.
  8. Get comfortable and relax. It might take some time to find a sleeping position that works best for you while you’re wearing a BiPAP.
  9. When you wake up, turn off the machine and clean it. This means emptying the humidifier and wiping down your mask every day. You’ll also need to do a weekly cleaning and change the filters. Your provider will go over regular BiPAP machine maintenance with you; it’s important that you follow the directions and get into a routine to keep the machine working correctly.

If you’re just starting with a BiPAP machine, you might want to try using it during the day while you’re resting so you can get used to how it feels, looks, and sounds. If you can get more comfortable with it while you’re awake, that can help you adjust to sleeping with it. Running it while you’re taking a nap can also help, even if it’s just for an hour.

What Are the Side Effects of BiPAP Use?

There are some side effects that can happen with a BiPAP, including:

  • Sinus symptoms (e.g., congestion, irritation in the nose and eyes, runny nose)
  • Dry mouth
  • Gas and burping
  • Skin irritation from the mask
  • Feelings of discomfort, anxiety, or claustrophobia

It’s also possible that a BiPAP machine can leak or not work correctly, which means you won’t be getting the help breathing that you need. If you notice any problems with the machine, let your provider know right away.

Summary

BiPAP machines can help you if you’re struggling to breathe well on your own, especially while you’re asleep. BiPAP can be an alternative to CPAP for people with conditions like OSA and CSA who either do not benefit from or do not want to be on a ventilator.

Working with asleep specialist can help you find out if BiPAP would be a beneficial option.

Frequently Asked Questions

  • How long can you stay on BiPAP?

    In theory, you can be on BiPAP indefinitely. Even so, the device is not intended to be used full-time in the same way as supplemental oxygen therapy for people with COPD. Using BiPAP continuously for longer than 24 hours can cause pressure ulcers, severe nasal tissue injury, and even tissue death.

  • Can BiPAP damage the lungs?

    Lung injury is not a recognized complication of BiPAP.

  • What is the difference between BiPAP and a ventilator?

    BiPAP is a machine used to treat sleep apnea and other conditions in which a person is still able to breathe but needs assistance. Mechanical ventilation is used when a person cannot breathe well enough on their own to support the body's need for oxygen.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Moga AM, de Marchie M, Saey D, Spahija J. Bi-level positive airway pressure (BiPAP) with standard exhalation valve does not improve maximum exercise capacity in patients with COPD. COPD.2015;12(1):46-54. doi:10.3109/15412555.2014.908830

  2. Guan L, Wu W, Huo Y, et al. Efficacy of bilevel positive airway pressure and continuous positive airway pressure therapy in patients with obesity hypoventilation syndrome: protocol for systematic review and meta-analysis. BMJ Open.2018;8(5):e020832. doi:10.1136/bmjopen-2017-020832

  3. Mansukhani MP, Kolla BP, Olson EJ, Ramar K, Morgenthaler TI. Bilevel positive airway pressure for obstructive sleep apnea. Expert Rev Med Devices. 2014;11(3):283-294. doi:10.1586/17434440.2014.900435

  4. Berbenetz N, Wang Y, Brown J, et al. Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019;4(4):CD005351. doi:10.1002/14651858.CD005351.pub4

  5. Carter C, Aedy H, Notter J. COVID-19 disease: non-invasive ventilation and high frequency nasal oxygenation. Clin Integr Care.2020;1:100006. doi:10.1016/j.intcar.2020.100006

  6. BMC BPAP. How to use BiPAP machines correctly.

  7. University of Rochester Medical Center. BiPap.

  8. Johns Hopkins. BiPap.

  9. Rathore FA, Ahmad F, Zahoor MUU. Case report of a pressure ulcer occurring over the nasal bridge due to a non-invasive ventilation facial mask. Cureus.2016 Oct;8(10):e813. doi:10.7759/cureus.813

  10. Katira BH. Ventilator-induced lung injury: classic and novel concepts. Respir Care. 2019;64(6):629-637. doi:10.4187/respcare.07055

How BiPAP Therapy Can Help Treat Sleep Apnea (2)

By Brandon Peters, MD
Dr. Peters is a board-certified neurologist and sleep medicine specialist and is a fellow of the American Academy of Sleep Medicine.

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