Using BiPAP therapy to treat sleep apnea


Bi-level positive airway pressure (BiPAP) is a breathing procedure to treat sleep apnea and other conditions that affect breathing. This treatment is less common than continuous positive airway pressure (CPAP) . However, in some situations this is more beneficial.

For example, where CPAP provides a constant air pressure, BiPAP offers a variable pressure. The BiPAP air pressure difference can be helpful for people who have difficulty exhaling due to the constant pressure of CPAP.

This article explains how BiPAP is used to treat obstructive sleep apnea and central sleep apnea.

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What is BiPAP or bilevel therapy?

Most of the BiPAP machine is similar to a standard CPAP machine. For example, this still requires a mask and tube attached to the device. But there are some differences between BiPAP and CPAP .

BiPAP compressed air settings include:

  • Inspiratory Positive Airway Pressure (IPAP) – This is the pressure that the ventilator delivers when you inhale. BiPAP provides a higher IPAP than CPAP. In this way, when you inhale, BiPAP supports your breath as you inhale.
  • Expiratory Positive Airway Pressure (EPAP) – This is the pressure that the ventilator delivers when you exhale. BiPAP offers a lower pressure, allowing you to breathe comfortably.

These pressure values are established with a medical prescription. They alternate, just like your breathing.

Apart from these default settings, there are several other options available. They include:

  • Bilevel ST : allows synchronized inspiratory delivery if the device detects a pause in breathing. These pauses often occur with central sleep apnea.
  • Automatic or Adaptive Servo Ventilation (ASV) – These advanced settings change the time, duration, and volume of inspiratory breaths produced by the device.


BiPAP's key differentiator is that it delivers compressed air at two different levels. While CPAP provides the same level of constant air pressure, BiPAP offers more air pressure for inspiration and less pressure for expiration.

When is BiPAP therapy used?

BiPAP is a respiratory support that treats central sleep apnea. The cause of this condition is now always known, but it can sometimes be seen in people who have:

Doctors may also prescribe it for more serious obstructive sleep apnea . BiPAP is useful in the presence of mixed sleep apnea events, suggesting a component of central sleep apnea.


BiPAP is more expensive than a standard CPAP machine. This can be two to three times the cost of CPAP. ASV models can cost more than $ 4,000.

In addition to treating central sleep apnea, BiPAP is also useful in the following situations:

  • People with CPAP problems : People who have difficulty breathing due to the pressure of CPAP can benefit from BiPAP. People are more likely to have CPAP problems when higher pressure is required to keep the airway open. For example, at pressures greater than 15 centimeters of water (CWP), BiPAP can help improve compliance among those struggling with CPAP therapy.
  • Hospitalized patients: BiPAP is a non-invasive treatment for people with respiratory distress who do not wish to receive mechanical ventilation.
  • People with neuromuscular disease : This can be helpful for conditions that cause nerve and muscle weakness, such as amyotrophic lateral sclerosis (ALS) .


BiPAP is most often used to treat central sleep apnea. But doctors can also prescribe it when someone does not tolerate CPAP well and when someone needs respiratory support but does not want to be ventilated.

BiPAP, bi-level and VPAP

There is some confusion about the words BiPAP, Bilevel, and VPAP. Basically, they are all the same. However, the names of the devices differ slightly depending on the manufacturer. They include:

  • Respironics – One of the leading manufacturers of these devices, Respironics, has registered BiPAP as a trademark of what is commonly known as two-layer technology.
  • ResMed : Another major competitor, ResMed, calls similar devices VPAP (variable positive airway pressure).
  • AirCurve : ResMed also offers a two-level AirCurve unit.

Although the names may vary, the basic principles are the same.


In most cases of obstructive sleep apnea, CPAP alone is sufficient as therapy. However, BiPAP can be a good alternative in more complex settings or when CPAP is difficult to carry.

Get the word of drug information

BiPAP is an alternative to CPAP for the treatment of patients with central sleep apnea. Additionally, patients who cannot tolerate CPAP and hospitalized patients with respiratory distress who do not wish to receive mechanical ventilation may choose BiPAP.

If you are wondering if BiPAP is right for you, talk to your sonographer. After evaluating your risk factors and conducting a sleep study, they can recommend the appropriate treatment.

Frequently asked questions

  • Bi-level positive airway pressure (BiPAP) is a type of ventilator used to treat sleep apnea and other conditions in which a person can still breathe on their own but needs help. BiPAP is called a positive pressure ventilator. This is because the person using the BiPAP machine will receive positive air pressure when inhaling and exhaling, but the air pressure is higher when inhaling.

  • Amyotrophic lateral sclerosis (ALS) is a disease that affects the motor neurons that control our muscles. Over time, ALS weakens muscles and can ultimately make a person unable to move their arms, legs, mouth, or the entire body. This can affect your ability to breathe, which means that a ventilator, such as a BiPAP machine, may be necessary to make breathing easier.

  • Variable Positive Airway Pressure (VPAP) machines are ventilators similar to BiPAP machines. VPAP is manufactured by ResMed and BiPAP is manufactured by Respironics. Both machines work to achieve a similar result.

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