What Is Bi-Level Positive Airway Pressure (BiPAP) Therapy?

What is BiPAP, when is it used for COPD, what are the benefits, and how does it compare to CPAP?What is BiPAP, when is it used for COPD, what are the benefits, and how does it compare to CPAP?
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In This Article

Bi-level positive airway pressure (BiPAP) is a type of noninvasive ventilation (NIV) that helps you breathe with the assistance of pressurized air delivered through a face mask. The most unique characteristic of a BiPAP device is that it delivers a different intensity of air pressure during inspiration than during expiration. It can be used in a hospital setting or at home.

While most often recommended for use at night, when breathing is more severely impaired by some pulmonary diseases than during the day, BiPAP may also be used during waking hours if needed.

Purpose of Use

If you have a medical condition that affects your upper airways or your lungs, your oxygen levels can get too low. Your doctor may recommend that you use a BiPAP device to breathe easier and prevent health complications.

You might need to use a BiPAP machine for:

  • At-home management of a chronic pulmonary illness, such as chronic obstructive pulmonary disease (COPD)
  • A neuromuscular condition that impairs your respiratory muscles, such as spinal muscular atrophy (SMA), amyotrophic lateral sclerosis (ALS), or muscular dystrophy
  • Other conditions that can interfere with breathing, especially during sleep, such as obstructive sleep apnea (OSA) and obesity
  • Respiratory support when you are in the hospital for a lung infection or an asthma attack
  • Transitioning from invasive breathing support, such as after intubation for surgery or a severe illness

When used at home, BiPAP is an everyday treatment, so you should be sure to use it consistently as directed.

Benefits

BiPAP can make a positive difference in life expectancy and has been found to significantly reduce the risk of death from certain conditions and diseases.

The use of BiPAP for COPD may reduce the number of COPD exacerbations and may decrease the need for invasive mechanical ventilation.

BiPAP may also help reduce the effects of respiratory disease by allowing already weakened respiratory muscles to relax for a period of time at night.

Limitations

If you are in need of emergency breathing support, a BiPAP may not be right for you. For example, you may need supplemental medical oxygen treatment instead of airway pressure.

In some situations, you may need intubation, in which a mechanical breathing tube is inserted into your throat to help you breathe. A tracheostomy—a procedure that creates an airway directly in your windpipe (trachea)—is a more long-term solution that sends air to your airways during the day and at night.

BiPAP vs. CPAP

The choice between continuous positive airway pressure (CPAP) and BiPAP is not always straightforward. CPAP is similar to BiPAP, but it involves a consistent level of airway pressure, in contrast to the varying pressure of BiPAP.

If you have COPD—which is characterized by more trouble with exhalation than inhalation—BiPAP is typically the preferred option. Sometimes, BiPAP may be more helpful than CPAP for people who have sleep apnea as well.

When you are first starting your respiratory treatment, your doctor might advise you to try one type of respiratory support, and then re-evaluate to see if the other might be more helpful for your specific situation.

How It Works

At night, the muscles that control breathing can weaken. Additionally, when you lie down, you may need extra power to move your respiratory muscles. In general, hypercapnia (CO2 retention) helps drive breathing—but you may not be as responsive to this trigger during sleep. All of these factors make it more difficult to maintain your oxygen saturation levels at night.

BiPAP is designed to help with some types of impaired respiration by delivering pressurized air to the airways to overcome these breathing issues. The air pressure decreases the work that your body has to do for oxygen and carbon dioxide gases to exchange in the alveoli (air sacs within the lungs).

The BiPAP device continuously pushes air into your airways during both the inhalation and exhalation phases of your breathing. The air is pressurized to expand your lungs without a lot of reliance on your body for help.

With a BiPAP machine, air may be pressurized at two different levels:

  • Higher pressure is used during inspiration (inspiratory positive airway pressure, IPAP).
  • Lower pressure is used during expiration (expiratory positive airway pressure, EPAP).

Risks and Contraindications

Be sure to follow the instructions and do not recalibrate the machine on your own or use it differently than recommended.

Side effects associated with BiPAP use include:

  • Slight skin irritation from wearing the face mask
  • Dry mouth and/or dry nasal passages
  • Stomach bloating from breathing in too much air
  • Allergy to the mask's material, which can cause skin breakouts or respiratory issues

If the mask doesn't fit properly, air may leak. This can result in lower air pressure than you need, making the treatment less effective—or possibly not effective at all.

You should not use your BiPAP machine if you become medically unstable. The at-home device is not recommended if you have an acute infection or if you are at an increased risk of infection. If you begin to feel sick or if your breathing worsens, be sure to talk to your doctor.

Choosing Your Machine

Once you have a prescription for a BiPAP machine, you can work with a professional to help you pick a mask and machine that best suits your health needs, body size, and preferences. If you are buying one without a prescription, however, selecting the right device may be tricky. You won't have parameters set by a doctor or respiratory therapist for your specific condition to use as guidance.

You might opt for a nasal mask, nasal plugs, or a full-face mask. If you choose a mask, it's essential that you have it fitted to avoid leaks. The mask should form a tight seal around your nose and/or mouth, but it should not be too tight.

Cost and Health Insurance

The cost of a BiPAP machine may vary, with lower-end models running around $800 to higher-end machines costing upwards of $2,800. Prices vary depending on which features and add-ons are included, such as a heated humidifier attachment, Bluetooth connectivity, etc. Face masks and air humidifiers may be sold separately and can run anywhere from $40 to $160.

There's also the option to purchase cleaning supplies, a sterilizer unit, and travel cases, which could add several hundred dollars to the overall cost. You'll also need to regularly buy distilled water if you're using a humidifier (available in most drugstores; about $1 a gallon).

Most insurance plans—including Medicare—cover PAP therapy, whether CPAP or BiPAP. If you have coverage, you'll only likely be paying out of pocket for any extras you choose to buy.

You'll need a prescription for a BiPAP machine in order for it to be covered under your insurance, though you don't need a prescription to buy a machine if you're covering the cost yourself.

Renting a machine may be a good option to look into and, in fact, some insurance companies may require you to rent a BiPAP machine for a certain period of time from a medical supply company before purchasing one outright. You can also consider checking around for refurbished machines.

Before Use

Prior to use, your respiratory therapist or doctor will adjust the air pressure setting on your machine. Your provider will also tell you if you need to wear the BiPAP machine only while sleeping or at other times during the day.

If you will use your BiPAP device at home, you need to learn how to set it up. Each device should come with written or video instructions, or both. And you may be able to get a hands-on lesson on how to use it as well.

At first, wearing a nose or face mask to sleep may feel awkward and the pressurized airflow may feel strange, but you'll slowly get accustomed to it.

During Use

As you use your machine each day, you will power it, place the mask on your face, and make sure that you are feeling the air pressure. The face mask should be attached to the machine through a long plastic tubing. You should become familiar with the parts and be ready to reconnect tubing if it becomes detached.

Some BiPAP machines are battery-operated, while others are meant to be plugged in. If you have a battery-powered machine or a battery backup, you will need to monitor the battery's life and replace it if needed. You also need to periodically change the water if your BiPAP machine comes with a humidifier.

Your device may also include software that allows some data to be sent to your medical team so they can see readings such as your breathing rate, oxygen level, and heart rate. These values can help determine whether you need any change in your air pressure settings.

If you feel like you can't breathe while wearing the BiPAP mask, speak with your provider about adjusting the pressure levels. If the noise of the machine keeps you awake at night, earplugs may be helpful.

Follow-Up

After starting on a BiPAP machine, check-in with your doctor regularly to monitor how your condition is progressing. If your health is improving, you may be able to reduce the air pressure on either inhalation, exhalation, or both. Or you might be able to reduce the dose of medication that you take for your respiratory condition if it is improving.

A Word From Verywell

BiPAP is a noninvasive treatment method that is used in the hospital setting and at home for the management of respiratory conditions. It can help you sleep better at night, and it can also prevent your pulmonary illness from worsening. But it only works if you use it and do so properly. If you have any questions about using your BiPAP, speak with your healthcare team.

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