A BiPAP machine can be used in a hospital setting or at home to assist with sleep apnea and other respiratory issues.

By James Heilman, MD

What is a BiPAP machine? First, let’s look at the BiPAP itself. It’s a type of ventilation treatment for people with sleep apnea and other respiratory problems. You may have already heard of continuous positive airway pressure (CPAP), which has been around for many years. BiPAP, or bilevel positive airway pressure (two levels), is an adaptation of CPAP and falls into a group of treatments called noninvasive ventilation (NIV).

What Is Noninvasive Ventilation?

According to Medscape, “Noninvasive ventilation” refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube).” It is used in the patient’s home or in a hospital setting for patients with sleep apnea, chronic obstructive pulmonary disease (COPD), pulmonary edema, and respiratory failure. Most well-known is the CPAP device, invented by Dr. Colin Sullivan, M.B.B.S., Ph.D, FRACP in the early 1980s.

What’s the Difference between CPAP and BiPAP?

According to the American Sleep Association, in CPAP the air flows with continuous pressure. The air pressure is “generated by a machine, delivered through a tube into a mask that fits over the nose or mouth.” In BiPAP, there is “bilevel or two-level positive airway pressure… BiPAP delivers an inhale pressure and an exhale pressure.” In BiPAP the machine also monitors breathing.

BiPAP—sometimes written as “BPAP”—is a trademark of Respironics. BiPAP comes with a higher price tag and is usually reserved for those who cannot tolerate CPAP.

What Does BiPAP Involve?

Both BiPAP and CPAP require you to sleep with a mask or “interface” attached to a ventilation machine. Equipment can vary from smaller nasal masks, which cover only the nose, and orofacial masks, or full-face masks, which cover the nose and mouth.

Other interfaces available include nasal prongs, mouthpieces, nasal pillows, and helmets. It all comes down to what provides a good seal and what you, the patient, can tolerate.

The mask, or interface, is attached via a tube to a ventilation machine, which in the case of the BiPAP monitors breathing and adjusts both the inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). These machines used to be very noisy but are now much quieter.

Your physician will work with you to determine the correct settings, a process that may involve pulse oximetry and/or serial arterial blood gas measurements. Pulse oximetry involves a small device being placed on a finger or toe to measure the amount of oxygen in the blood. Arterial blood gas involves blood being taken from an artery in the wrist (normal blood tests are from veins).

Maintenance of Your BiPAP

Because your BiPAP is blowing air into your lungs, it’s essential to keep it clean and well-maintained. Cleaning is fairly quick and simple. Your doctor or machine provider should advise on a maintenance schedule.

The cleaning-and-maintence process also may involve replacing parts such as the humidifier, mask, tubing, and filters. The ventilator should be serviced from time to time. Err on the side of caution and ask at your clinic if you have any concerns about your equipment.

Do I Need a BiPAP Machine?

Essentially, BiPAP and CPAP aim to provide good airflow into the lungs and enhance oxygenation of the blood, during sleep, for people who cannot reliably do this alone.

A physician usually prescribes a BiPAP machine after a thorough assessment for:

• Sleep apnea —particularly obstructive sleep apnea (OSA), the major indication for BiPAP.
• Post-operative patients after surgeries on the mouth, throat, esophagus, and stomach, including tonsillectomy and adenoidectomy, turbinectomy, and bariatric surgery (for weight loss).
• COPD and pulmonary edema: For people with severe disease whose oxygen levels drop significantly during sleep.
• Cystic fibrosis (CF).
• Severe asthma, rib fracture, or pneumonia (usually managed in hospital).
• Other causes of respiratory failure, such as heart failure, terminal cancer or neurodegenerative diseases.

Your physician will advise you on whether you are a good candidate for BiPAP.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) affects 25 million Americans. It can strike anyone, young and old, men and women, and although it’s more common in people who are overweight, it can affect slim people too. (See our article “What Causes Sleep Apnea?“)

Sleep apnea sufferers experience frequent, brief pauses in breathing caused by blockage of the airway by the muscles in the back of the throat. Many people are unaware that they have OSA initially, as the symptoms are vague at first and progress slowly.

According to the experts at Weill Cornell, OSA presents with some or all of these symptoms:

• Not feeling rested after a night’s sleep
• Feeling sleepy during the day
• Waking up with a headache
• Your bed partner may notice that while you sleep you: Stop breathing, snore loudly, gasp or choke or toss and turn
• High blood pressure.
• An abnormal heart rhythm, heart failure, coronary artery disease (CAD), or stroke
• Depression
• Diabetes

In children, sleep apnea symptoms are steady:

• Snoring
• Hyperactivity or attentional problems during the day.
• Restless during sleep and wake up often. May experience bed-wetting.
• Failure to thrive: Slow growth for age, with no obvious reason.

Testing for Obstructive Sleep Apnea

An assessment at a local sleep clinic is warranted if you think you may have sleep apnea. They will most likely schedule an overnight sleep study, during which a sleep technician, using a “polysomnogram test,” monitors your breathing. This involves the attachment of sensors to your body to detect sleep abnormalities. (See our article “Sleep Apnea Symptoms: How a Sleep Study Test Can Help.”)

Treatment of Sleep Apnea

The first line of treatment for OSA is lifestyle change: Lose weight, sleep on your side, reduce alcohol intake, stop smoking, and avoid sedatives. See our article How to Cure Sleep Apnea: 4 Non-CPAP Remedies for more ideas on how to manage sleep apnea.

Untreated obstructive sleep apnea can cause serious health problems including:

• Cardiovascular disease

Dangerous daytime tiredness, which can be dangerous in school, work or when driving.

• Obesity
• Diabetes
• Eye and vision problems
• Depression, anxiety and more severe psychiatric disorders.

If lifestyle changes do not improve sleep apnea, you may be evaluated to see if you would benefit from CPAP or BiPAP or whether you should be considered for surgery.