Positive airway pressure (PAP) is one of the most common treatments for sleep apnea, a breathing disorder that affects approximately 3% to 7% of the population. The most common PAP treatment is continuous positive airway pressure (CPAP), but bi-level positive airway pressure (BiPAP) is a better option for some people.
While both forms of PAP therapy work in similar ways, their differences mean that each has distinctive upsides and downsides to consider. Because of this, the decision to switch PAP treatments should always be made under the advice of your healthcare team.
CPAP and BiPAP machines are both forms of positive airway pressure therapy, which uses compressed air to open and support the airway during sleep. A portable machine generates the pressurized air and directs it to the user’s airway via a hose and mask system. Both systems use the same masks, hoses, and other accessories.
CPAP machines have an adjustable pressure setting that delivers between 4 to 20 cm H2O (a measure of air pressure that stands for centimeters of water pressure) regardless of whether the user is inhaling or exhaling. BiPAP machines have two pressure settings — inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP) — that allow for lower pressure levels during exhalation. Depending on the BiPAP machine’s settings, the switch between IPAP and EPAP may be timed or automatically based on the user’s breathing patterns. BiPAP machines have a typical pressure range of 4 to 25 cm H2O.
While CPAP machines have only one setting, some models now have sensors that allow for gentler air pressure on the exhale. Unlike the EPAP setting on BiPAP machines, the exhalation pressure cannot be set by the user and is only slightly less than the overall pressure setting.
There are portable CPAP machines designed for travel, while BiPAP machines are designed for at-home use. Because BiPAP machines require additional sensors and settings, they are usually twice the cost of an otherwise similar CPAP machine.
Different types of PAP therapy work better for different conditions, though there is some overlap. CPAP is generally recommended for obstructive sleep apnea (OSA), and sleep specialists are unlikely to place an OSA patient on BiPAP unless they cannot tolerate CPAP. While some insurance providers cover both CPAP and BiPAP for OSA, those that do usually require proof that CPAP treatment is inadequate before reimbursing for a BiPAP machine. BiPAP is primarily used to treat central sleep apnea (CSA), as well as heart, lung, and neurological disorders that require structured airway support during sleep.
Both CPAP and BiPAP machines are available with a range of accessories, both integrated and after-market. The most common are data collection features and climate control features like humidifiers and heated tubing.
|Typical Pressure Range||4 to 20 cm H2O||4 to 25 cm H2O|
|Medical Applications||Obstructive sleep apnea (OSA), preterm infants||OSA patients who respond poorly to CPAP, central sleep apnea (CSA), COPD, congestive heart failure, Parkinson’s disease, ALS|
|Insurance Coverage||May be covered||May be covered if CPAP therapy fails or is contraindicated|
Continuous airway pressure machines direct pressurized air — usually set between 4 and 20 cm H2O — into a user’s airway while they sleep. This pressure keeps air passages open and ensures the user can breathe properly, allowing them to avoid the pauses in breathing (or apneas) that are the primary symptom of sleep apnea.
CPAP machines continuously pump air at one pressure setting rather than varying in pressure between the inhale and exhale, which can cause some people to feel as though they cannot exhale properly or that they are choking. Most users adjust to CPAP relatively quickly, while others find BiPAP easier to tolerate.
Unlike BiPAP machines, CPAP machines are available in a range of sizes. The most common type is intended to be used at home and is slightly smaller than a shoebox, while travel versions may be small enough to fit in the palm of your hand. Travel models sometimes have backup batteries for use while camping, and FAA-approved models are available for use on planes.
BiPAP machines have up to three settings for the switch between IPAP and EPAP:
Although CPAP and BiPAP machines may seem similar, their differences can make a significant difference to your treatment. Because of this, the decision to switch from one to another should always be made by your healthcare team.
CPAP users usually have an adjustment period before they feel comfortable using their machines. Discomfort can be managed by adjusting settings, experimenting with climate control accessories or different mask types, or using a machine that slightly reduces air pressure on the exhale. BiPAP is available for patients who do not tolerate CPAP therapy, but this switch must be decided on and supervised by a sleep specialist.