What Is BiPAP Therapy?

Bi-Level Positive Airway Pressure

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

Certain medical conditions affecting the lungs can make it difficult for you to breathe easily, especially while sleeping. In some cases, your doctor may recommend that you start using bi-level positive airway pressure (BiPAP) at night to help ease the burden on your lungs, heart, and airways. BiPAP is a type of noninvasive ventilation that helps keep the upper airways of the lungs open by providing two levels of pressurized air delivered through a face mask. While it is often used at night, BiPAP may be used during waking hours, too, if needed.

Purpose of BiPAP

The process of normal breathing (respiration) involves the lungs and diaphragm. When the diaphragm contracts, the lungs expand and take in air (inhalation). When the diaphragm relaxes, the lungs contract and push air out of the body (exhalation). Several medical conditions can interfere with this process and make it hard for you to breathe, especially at night, and using a ventilator like BiPAP can help.

At night, weakened throat muscles can collapse, (often seen in people with COPD, obstructive sleep apnea, or obesity), worsening the airway obstruction that may be already occurring. When this happens, it can be hard for patients to keep their airways open enough to keep their oxygen saturation levels up, and at the same time keep their carbon dioxide levels in their blood down (avoiding hypercapnia, or CO2 retention).

It's thought that BiPAP may also help by allowing already weakened respiratory muscles to relax for a period of time at night.

How It Works

BiPAP can help with respiration by delivering constantly pressurized air through a mask, which decreases the work that must be done for adequate gas exchange of oxygen and carbon dioxide to take place in the alveoli, air sacs within the lungs.

BiPAP machines continually push air into your lungs using positive air pressure on inhalation and exhalation, but the air may be pressurized at two different levels. The air is pressurized by a machine, which delivers it to a face mask through long, plastic hosing. A higher pressure is used when breathing in (called inspiratory positive airway pressure, or IPAP) and a lower pressure is used when breathing out (called expiratory positive airway pressure, or EPAP). These unique levels are determined by your doctor or pulmonologist (lung specialist). Pressurized air forces your lungs to open up without a lot of reliance on the body to help.

In contrast to a BiPAP, continuous positive airway pressure (CPAP) provides air at the same amount of pressure on both inhale and exhale. Your doctor will help determine whether you'd benefit more from BiPAP or CPAP.

BiPAP machines used to be only accessible via in-patient services in hospitals, but now the devices are available for purchase to be used at home (along with CPAP machines).

Conditions that may benefit from BiPAP use include:

  • Chronic obstructive pulmonary disorder (COPD)
  • Obesity hypoventilation syndrome
  • Sleep apnea
  • Asthma flare-up
  • Pneumonia
  • Poor breathing post-operation
  • Neurological conditions that affect respiration


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, for example, when indicated, may reduce the number of COPD exacerbations someone experiences, and may decrease the need for mechanical ventilation (respirator support).


If you are in severe need of breathing support, a BiPAP may not be effective for your condition. You may need supplemental medical oxygen, a mechanical breathing tube inserted into your throat, or a tracheostomy—a procedure which creates an airway in your windpipe (trachea). BiPAP may also be used as a transitional tool for people coming off of these other breathing support methods.

Risks and Contraindications

Using a BiPAP machine usually has very few risks involved. There is a small chance of infection developing, but the risk is very small as compared to using other mechanical ventilation procedures. BiPAP should not be used in people who are medically unstable, who have å current infection or are at risk of serious infection. There may also be some minor side effects, most of which stem from the face mask—whether it's too tight or too loose.

Complications include:

  • Slight skin irritation from wearing the face mask
  • Dry mouth and/or dry nasal passages
  • Sinus congestion or pain
  • Eye irritation
  • Mild stomach bloating
  • Mask leakage, resulting in less air pressure being administered

Preparing for Use

Before using a BiPAP machine, you'll need to decide if you want a full-face mask or simply a nasal mask or nasal plugs, and you'll also need to have the mask fitted to avoid leaks. The mask should form a tight seal around your nose and/or mouth, but not be too tight. Work with a medical equipment professional to help you pick a mask and machine that best fit your unique needs. You'll also get information on proper care and cleaning techniques.

Prior to use, a respiratory therapist or doctor from your healthcare team will calibrate the machine and check the pressure levels. Your provider will also tell you if you need to wear the BiPAP machine only while sleeping or at other times during the day.

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

Cost and Health Insurance

The cost of a BiPAP machine may vary, with lower-end models running around $800 to higher-end machines upwards of $2800. 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 are often sold separately, which can run anywhere from $40 to $160.

There's also the option to purchase cleaning supplies, sterilizer unit, and travel cases, which could be several hundred dollars on top of the cost of the machine and face mask. You'll also probably need to buy distilled water if you're using a humidifier.

Luckily, most insurance plans—including Medicare—cover PAP therapy, whether CPAP or BiPAP, so you'll only likely be paying out of pocket for any extras you choose to buy, like travel cases. 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.

Some insurance companies cover PAP therapy for just the first three months, or longer if recommended by your doctor.

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. Additionally, check around for refurbished machines, which are certified to be in excellent working order (and cost a fraction of the price of new machines).

Follow-up and Other Considerations

After starting on a BiPAP machine, check-in with your doctor regularly to monitor how your condition is progressing. If things are improving, you may be able to reduce the air pressure on either inhale or exhale or both.


For COPD patients, BiPAP is the preferred method of treatment over CPAP (continuous positive airway pressure) because it's easier for these patients to exhale against the lower pressure. It can be difficult for anyone to exhale against pressure (this is why BiPAP is sometimes used instead of CPAP for sleep apnea), but this can be particularly difficult with COPD, in which exhalation is more of a problem than inhalation. BiPAP also allows for adjustments in time, which is very helpful for those with COPD in which exhalation is slowed.

A Word From Verywell

BiPAP is a noninvasive treatment method that can make a world of difference for many people with sleep apnea, COPD, and other conditions, although it might not be helpful for everyone. It shouldn't be used if you have a weakened immune system, low blood pressure, severe acidosis (low blood pH) or a rapid heart rate (tachycardia). Talk to your doctor about whether BiPAP is right for you.

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