Sleep apnea, a prevalent breathing disorder affecting around 10% to 30% of individuals, is often treated with positive airway pressure (PAP). While continuous positive airway pressure (CPAP) stands as the most common form of PAP therapy, some may find bilevel positive airway pressure (BiPAP or BPAP) more suitable.

Although both PAP therapies function similarly, their nuances entail distinct advantages and disadvantages. Therefore, transitioning between PAP treatments should be done in consultation with your healthcare team.

What Sets CPAP Apart from BiPAP Devices?

Both CPAP and BiPAP Devices constitute positive airway pressure therapy, employing pressurized air to sustain and open the upper airway during sleep. These portable devices deliver pressurized air through a hose and mask setup, utilizing similar accessories like masks and hoses.

CPAP Devices typically offer an adjustable pressure setting, delivering air pressure ranging from 4 to 20 cm H2O irrespective of inhalation or exhalation. The standard setting usually falls between 8 to 10 cm H2O. While CPAP Devices maintain a single setting, some models now incorporate pressure relief features for gentler exhalation.

In contrast, BiPAP Devices feature two pressure settings—Inhalation-Positive Airway Pressure (IPAP) and Exhalation-Positive Airway Pressure (EPAP)—permitting lower pressure levels during exhalation. The transition between IPAP and EPAP may be timed or automated based on the user’s breathing patterns. BiPAP Devices typically offer a pressure range of 4 to 30 cm H2O. Both CPAP and BiPAP settings necessitate determination through an overnight sleep study or polysomnography.

While portable CPAP Devices cater to travel needs, BiPAP Devices are tailored for at-home usage. Due to the additional sensors and settings required, BiPAP Devices generally come at a higher cost compared to CPAP Devices of similar specifications.

Different PAP therapies exhibit varying efficacy for distinct conditions, albeit with some overlap. CPAP therapy is typically recommended for obstructive sleep apnea (OSA), with sleep specialists seldom resorting to BiPAP unless CPAP treatment proves intolerable. Although some insurance providers cover both CPAP and BiPAP for OSA, reimbursement for a BiPAP machine usually mandates proof of inadequate CPAP treatment or intolerance. BiPAP therapy is predominantly employed for central sleep apnea (CSA) and conditions such as heart, lung, and neurological disorders necessitating structured airway support during sleep.

Both CPAP and BiPAP Devices offer a range of accessories, including integrated and aftermarket options such as data collection features and climate control elements like humidifiers and heated tubing.

CPAP Basics

Fundamental to CPAP therapy is a device known as a continuous positive airway pressure (CPAP) machine. This apparatus administers pressurized air—typically ranging between 4 and 20 cm H2O—into the user’s air passages during sleep. By maintaining a steady pressure, it prevents airway obstruction, ensuring uninterrupted breathing and averting the primary symptom of sleep apnea: breathing pauses, or apneas.

Unlike BiPAP Devices, CPAP Devices deliver air consistently at a single pressure setting, eliminating fluctuations between inhalation and exhalation pressures that may cause discomfort, such as feelings of inadequate exhalation or suffocation. While most individuals adapt swiftly to CPAP therapy, some may find BiPAP therapy more manageable.

CPAP Devices come in various sizes, with the most common type designed for home use, resembling a compact shoebox. Travel-friendly versions are even smaller, some compact enough to fit in the palm of one’s hand. Certain models are equipped with backup batteries for travel convenience, and FAA-approved variants are available for use during air travel.

BiPAP Basics

Bilevel positive airway pressure (BiPAP) Devices offer a distinct approach, featuring separate pressure settings for inhalation (IPAP) and exhalation (EPAP). Typically, the EPAP pressure is notably lower than the IPAP pressure, promoting a more natural breathing experience and reducing the sensation of resistance during exhalation. The pressure range for BiPAP Devices typically spans from 4 to 30 cm H2O.

BiPAP Devices offer various settings for the transition between IPAP and EPAP:

  1. Spontaneous: This mode automatically detects the user’s breathing pattern, seamlessly transitioning between pressure levels as the user naturally inhales and exhales. It is the preferred setting for most BiPAP users and is standard in BiPAP devices.
  2. Timed: Users can program the duration of each IPAP and EPAP phase, ensuring a specific number of breaths per minute. This setting mimics ventilator functionality and supports precise respiratory management.
  3. Spontaneous/timed: Primarily operating in spontaneous mode, this setting incorporates timed switching when the machine detects a drop in the user’s breathing rate below a predetermined threshold.

Furthermore, BiPAP Devices can be categorized as fixed or auto-adjusting:

  1. Fixed: The IPAP and EPAP settings remain constant throughout the night, predetermined and unchanging.
  2. Auto-adjusting: With a predefined range for both IPAP and EPAP, this type of BiPAP machine automatically adapts pressure levels based on the user’s breathing patterns during sleep.

While CPAP and BiPAP Devices might appear similar at first glance, their distinctions can profoundly affect your treatment outcomes. Therefore, any decision to transition between the two should be carefully deliberated with your healthcare team.

CPAP users typically undergo an initial adjustment phase before feeling at ease with their Devices. Discomfort can often be alleviated by tweaking settings, exploring climate control add-ons or alternative mask styles, or opting for a machine that slightly reduces air pressure during exhalation. BiPAP therapy serves as an alternative for individuals who struggle with CPAP treatment, but the decision to make this transition must be made under the guidance and supervision of a sleep specialist.