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Positive airway pressure (PAP) therapy is one of the most common treatments for sleep apnea, a breathing disorder that affects millions of Americans. While continuous positive airway pressure (CPAP) treatment is the most common form, there are other types of PAP machines. Automatic positive airway pressure (APAP) machines automatically adjust the amount of air pressure depending on the user’s needs, while bi-level positive airway pressure (BiPAP or BPAP) machines have separate air pressure settings for inhalation and exhalation.
BiPAP treatment, like all PAP treatments, uses compressed air to keep the user’s airway open during sleep. Because the air pressure lowers for exhalation, many people find BiPAP machines easier to use than CPAP machines. The difference in air pressure also encourages the user to breathe, so a BiPAP machine can be used much like a ventilator for conditions other than sleep apnea.
Purchasing the right BiPAP machine is important for a user’s health, but its cost and complexity can make the buying one both stressful and confusing. Thankfully, all the factors one should consider before purchase can be broken down into several straightforward categories. There are also several BiPAP machines on the market that stand above the rest. By educating yourself about what to look for in a BiPAP machine, it’s far easier to find the right one for your needs.
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The Aircurve 10, made by ResMed, combines solid performance with advanced features like data tracking, automatic ramp, and a heated humidifier. With its easy-to-use design and the ability to differentiate between obstructive sleep apnea and central sleep apnea, the Aircurve 10 should appeal to a broad range of BiPAP users.
Many BiPAP users struggle to fall asleep even when using ramp settings, a problem that might be alleviated by the Aircurve’s automatic ramp feature. Sensors automatically detect when a user falls asleep, allowing the machine to offer the correct air pressure settings at the right time. Users can track their data and ensure its efficacy by using ResMed’s cloud-based AirView app, which provides data on everything from humidity levels to sleep quality in an easy-to-understand format.
The AirView app can also be used to adjust the Aircurve’s climate control features. Both temperature and humidity levels can be set to automatic or adjusted individually. The machine’s focus on comfort continues with its ability to adjust pressure depending on your moment-to-moment needs, ensuring you receive enough air pressure without discomfort.
The Aircurve 10 is designed with a front-facing screen that automatically dims when you turn off your bedroom lights. It has a pressure range of 3 to 25 cm H2O and runs at an average of 27 decibels, comparable to rustling leaves. ResMed stands behind their machine with a 2-year manufacturer’s warranty that covers manufacturing defects and other flaws.
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The Phillips Respironics DreamStation BiPAP machine has a number of advanced features — including an integrated heated humidifier, heated tubing, and a flexible pressure setting — at a lower price-point than many feature-rich competitors. It is also one of the quietest BiPAP machines on the market, clocking in at a truly whisper-quiet 25.8 dBA. These qualities should make the DreamStation an appealing choice for BiPAP users on a budget.
The DreamStation BiPAP machine includes all the features one would expect from a BiPAP machine in its price range, including ramp settings (up to 45 minutes in 5-minute increments), data collection on both the machine and an SD card, and automatic altitude compensation. However, it’s the machine’s additional features that set it apart from similarly priced competitors.
Customers looking for a full suite of climate control features are likely to be pleased by the Dreamstation BiPAP’s integrated heated humidifier and heated tubing. The Dreamstation BiPAP machine also includes Phillips Respironics’ “Flex comfort” setting, which automatically adjusts exhalation pressure to the lowest effective setting. This setting is meant to provide relief for people who struggle with higher exhalation pressure.
The Dreamstation BiPAP machine has a front-facing screen and a sleek white shell. It has a pressure range of 4 to 25 cm H2O and comes with a 2-year manufacturer’s warranty covering manufacturing defects and flaws.
Given their cost and importance to a user’s health, BiPAP machines can be a fraught purchase for many people. However, buying one is far less stressful when you understand how they function and know what to look for.
Despite their complexity, BiPAP machines are often quite similar. Their differences can be broken down into important categories, making it easier to decide between them. The buying process can also seem intimidating, but BiPAP retailers — both online and brick-and-mortar — have systems in place to make the decision making process easy for their customers.
Learning about BiPAP machines can be overwhelming regardless of whether or not you’re new to PAP treatment. We’ll break down the most important considerations in order to streamline the information and make it easier for you to find the right BiPAP machine. Individual categories might be more or less important to you depending on your needs, but each deserves your consideration before you make a purchase.
BiPAP therapy is a medical treatment, and your doctor’s recommendations and prescription are the most important factors when choosing a BiPAP machine. They may recommend a specific machine, provide guidelines about features your treatment requires, or otherwise guide you towards what will work best for you. If you have questions about which BiPAP machine you should buy, your doctor is in the best position to provide you with personalized answers.
While climate control options are considered a non-essential feature, they can eliminate some of the most common BiPAP side effects. Humidifiers add moisture to the pressurized air, which prevents it from drying out your airway. Some BiPAP machines have an integrated humidifier, but aftermarket humidifier accessories are available if your chosen machine does not come with one. Heated tubing warms the air, making it more comfortable and improving its ability to stay humidified. Like humidifiers, heated tubing can also be purchased as a separate accessory.
Unlike CPAP machines, which tend to range from 4 to 20 cm H2O (a measure of air pressure based on centimeters of water pressure), BiPAP machines usually have a pressure range of 4 to 25 cm H2O. Your doctor will advise you of the best pressure setting for your treatment.
PAP treatment is only required when you are asleep, and using a BiPAP machine can be uncomfortable while you are trying to fall asleep. Ramp settings slowly increase the air pressure over a set period, providing you with plenty of time to fall asleep before reaching its final pressure setting.
While PAP machines have a reputation for being noisy, modern models can be “whisper quiet”. Each BiPAP machine has an average sound level measured in decibels, and the best range from 25 to 30 dB — around the level of a whisper. Since even mild snoring is 40-50 dB, most BiPAP machines are relatively quiet and unlikely to bother all but the lightest of sleepers.
Data tracking serves two purposes for BiPAP users. Not only does it allow you and your healthcare team to chart the effectiveness of your treatment, but many insurance providers require you to prove that you are using your BiPAP machine and adhering to treatment. Most BiPAP machines have some degree of data tracking built in, but you can purchase a data tracking accessory if you choose a machine without this feature.
BiPAP machines do not come with everything you need to use them. At a minimum, BiPAP users must purchase a mask and headgear that are replaced on a regular basis. BiPAP filters must also be replaced several times a year. Whether or not you have to buy other accessories depends on your needs and your BiPAP machine’s integrated features.
BiPAP manufacturers differentiate their machines with a range of unique features. These are usually non-essential but may improve your treatment experience by automatically lowering the screen brightness when you turn your lights off, or by automatically starting when you breathe into your mask. While unique features are rarely the deciding factor in choosing a BiPAP machine, they are worth keeping in mind.
Running between $800 and $3000, BiPAP machines are significantly more expensive than CPAP machines (which usually cost between $350 and $1000). BiPAP machines require sensors so that the machine can time the two pressure settings to your breath, and the quick change in pressure also requires a more intricate design. As with all medical devices, it is crucial to purchase the BiPAP machine that fits your needs rather than a less-suitable model that may be less expensive.
The vast majority of BiPAP machines come with a warranty that covers manufacturing defects or other flaws. Most have a 2-year term, though some manufacturers back their product with a 3-year — or even a 5-year — warranty. In addition to their term length, warranty terms and conditions also vary between manufacturers. Before choosing a machine, double-check the warranty’s fine print to make sure it works for you. For example, the best warranties will immediately provide you with a replacement so that you do not have to go without your BiPAP machine while they investigate the claim.
Just as choosing a BiPAP machine has both similarities and marked differences to choosing any other expensive device, the purchase process is likely to be both familiar and unfamiliar in many ways. There are four stages you must go through: receiving your prescription, choosing a machine and retailer, providing your prescription to the retailer, and making your purchase. You must also navigate other considerations, like insurance coverage and whether or not you need BiPAP accessories.
All PAP machines, including BiPAP machines, require a formal prescription from a member of your healthcare team. This is true of all PAP retailers, whether brick-and-mortar or online. Purchasing at a brick-and-mortar retailer only requires handing over your prescription like at a pharmacy, while online retailers will have you upload or fax them your prescription before making a purchase.
CPAP, BiPAP, and APAP (automatic positive airway pressure) machines have many similarities, but their differences make choosing between them a job for your healthcare team. If your doctor has prescribed CPAP treatment, you should not use a BiPAP machine unless you have spoken to them and they have changed your prescription. Your doctor may also recommend a specific model, accessories, or features. If you have concerns or questions about your prescription or the products your doctor has recommended, it is important to speak to them about these issues rather than make a decision on your own.
Insurance coverage of BiPAP machines can be a complicated topic. Not all insurers cover PAP machines, and those that cover BiPAP machines often require patients to prove that CPAP therapy is ineffective (or contraindicated) for them before they will provide coverage. Most insurance providers also require users to enter into a kind of rental contract with them rather than owning their machine outright, paying monthly towards their machine and providing data proving that they are adhering to treatment. Depending on your insurance provider, financial situation, and needs, it may be easier and more cost-effective to purchase your BiPAP machine out-of-pocket. To learn more about your insurance provider’s BiPAP coverage, look under the “durable medical equipment” category in your insurance benefits literature.
CPAP accessories are usually compatible with BiPAP machines, and BiPAP accessories may be sold as CPAP accessories. All BiPAP users must purchase their mask and headgear separately from their machine, though both items are bought together. Masks and headgear can range dramatically in price, but most people can find a good choice that works well with their budget. Users should also replace their BiPAP machine’s filter regularly, as covered by its instructions. Other accessories may be more or less critical depending on your needs, your BiPAP machine’s features, and your lifestyle. When deciding on accessories, keep in mind that some require regular replacement or daily cleaning.
Where to Buy
Most people buy their BiPAP machine from a sleep specialist, a brick-and-mortar shop, or an online PAP device retailer. All require a formal prescription from your doctor, and each has its own upsides and downsides. Sleep specialists tend to have the highest prices and smallest selection, but buying from your healthcare team may allow for better treatment oversight. Brick-and-mortar retailers allow you to bring your new BiPAP machine home immediately, but their prices and selection are unlikely to be as good as online retailers. In turn, online retailers are a great choice for comparison shoppers, but some people may be put off by the extra steps of submitting their prescription and waiting for their machine to be delivered.
A vast array of accessories are available for BiPAP machines. Some of these are essential, such as the mask and headgear you must purchase in order to use your BiPAP. Other accessories, like climate control items or external batteries, are non-essential purchases that can dramatically improve your treatment experience. This category also includes replacement parts, such as filters and hoses, and external items like mask-friendly pillows and cleaning devices.
Deciding on what accessories to purchase should involve considering your needs and budget. If you have any questions about what accessories might work best for you, your healthcare team is in the best position to provide answers and advice.
|BiPAP Accessory||Description||Cost (est.)|
|Masks||All BiPAP users must purchase a mask to use with their machine. Choosing the right mask depends on your treatment needs, face shape, preferred sleep position, and other factors. For more information on what mask is right for you, speak to your healthcare team. Masks must also be replaced every 3 to 6 months depending on the model.||$30-$150|
|Headgear||Most BiPAP masks come with headgear, but other types of headgear — including chinstraps to keep the mouth closed — are available to purchase. You may need to experiment with different types of headgear before finding one that is comfortable and effective. Headgear must also be replaced when it loses its elasticity, usually every 6 months.||$20-$100|
|Hosing||BiPAP machines come with the hosing used to deliver pressurized air to your mask. These hoses may need to be replaced over time, and some people choose to buy a new hose that has a more convenient shape or length. Heated hoses, which warm air before it is delivered through your mask, are also available.||$5-$70|
|Humidifier||Many BiPAP machines now have integrated humidifiers to help users avoid drying out their airway. If your machine does not have a humidifier, you can purchase one as an accessory. Humidifiers can be heated or unheated, though heated models are usually more expensive and may be larger.||$100-$250|
|Filters||BiPAP filters catch the dust, pet dander, pollen, and other particles that would otherwise be sent into your airway all night. Filters can be reusable or disposable, though even reusable filters must be replaced regularly. Disposable filters should be replaced monthly, and most reusable filters should be cleaned on a similar schedule.||$5-$25|
|External Battery||External batteries allow you to use your BiPAP machine in places without outlet access. They can also function as backup power sources in case of a power outage. Not all BiPAP machines are compatible with an external battery, so double-check with your machine’s manufacturer before buying a battery.||$200-$900|
|Cleaners||PAP machines require very regular cleaning to remain hygienic and effective. Products marketed as CPAP cleaners promise to make cleaning easy through the use of UV light or ozone (activated oxygen). However, the FDA has not approved any devices for this purpose and has shared concerns about the safety and efficacy of CPAP cleaners.||$300-$400|
|CPAP Pillows||Despite their name, CPAP pillows are equally useful for BiPAP users. These pillows are designed to provide supportive comfort while providing room for a mask, making them an excellent choice for many people who struggle to get comfortable while using a mask. Different designs are available for different styles of mask and a variety of sleeping positions.||$50-$200|
Purchasing a BiPAP machine can be a confusing process, and you may have additional questions about choosing the right model for your needs. As with all medical decisions, your healthcare team should be able to answer your questions and address your concerns.
Bi-level positive airway pressure (BiPAP or BPAP) machines keep a user’s airways open during sleep through the use of pressurized air, with higher pressure levels for inhalation and a lower level for exhalation. The difference between the two settings can improve comfort, but it can also be used to encourage normal breathing in much the same way as a ventilator. BiPAP machines are used by some sleep apnea patients, as well as some people with neurological or lung conditions.
Continuous positive airway pressure (CPAP) and BiPAP machines both offer forms of PAP therapy, but CPAP machines have only one air pressure setting instead of the two pressure settings used by a BiPAP machine. CPAP is the frontline treatment for obstructive sleep apnea (OSA), whereas BiPAP is used as a treatment for OSA patients only when CPAP treatment has proven ineffective or is contraindicated. If your doctor has prescribed a specific type of PAP treatment, it is critical to follow their prescription and only change your PAP type under their direct advice.
BiPAP machines usually cost between $800 and $3,000. This is significantly higher than a comparable CPAP machine, as BiPAP machines have a more complex design with additional sensors and settings. Some insurance providers provide coverage for BiPAP machines, but those that do often restrict coverage to certain patients and may require users to lease their machine rather than purchase it outright. If your insurance provider covers BiPAP machines, the terms are usually found under “durable medical equipment” in their coverage literature.
Almost all BiPAP machines come with a manufacturer’s warranty that covers manufacturing defects and other flaws. The most common term length is for 2 years, though some manufacturers offer 3-year and even 5-year terms. It is important to read the fine print of your BiPAP machine’s warranty, as some manufacturers will require you to send your faulty machine in for inspection before they provide you with a replacement.
BiPAP machines can be purchased from online retailers in much the same way as any other product, but customers must first submit their prescription either by fax or by uploading it to the retailer’s website. Each retailer has its own system, but most are easy to navigate even for people who do not consider themselves tech savvy. You should always double-check a retailer’s prescription-acceptance system, as well as their privacy policies, before deciding to purchase from them.
The components of your BiPAP machine should be cleaned regularly — daily is best, though weekly is also acceptable for most people — with mild soap and warm water. This is a relatively simple process that ensures your machine is free from mold, harmful microbes, and contaminants. It is important to follow the manufacturer’s instructions for your specific machine, but most components can be cleaned by removing them from the unplugged machine, cleaning them with a mild soap, rinsing them, and leaving them to air-dry. Cleaning your humidifier tank may also require the use of vinegar to dissolve residue.
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