What Is A BiPAP Machine?

January 19, 2018 | CPAP Benefits |

Some patients who have been prescribed CPAP therapy may have difficulties tolerating it. Oftentimes, they experience difficulties breathing normally against their current pressure settings. If breathing becomes too difficult, the patient may require a BiPAP machine.

BiPAP, or Bilevel Positive Airway Pressure, therapy machine offers dual pressure settings. Offers two prescribed pressure levels – one for inhalation (IPAP) and a reduced pressure for exhalation (EPAP). These dynamic settings help patients move more air in and out of their lungs. 

The Bilevel machine’s inspiratory pressure makes breathing in easier while the expiratory pressure makes it easier to exhale. This is especially important when pressures are in the high teens or low twenties. Breathing against a pressure in those ranges can be very difficult. Pressure settings are determined by a sleep test and the BiPAP machine provider sets the pressure levels based upon the physician’s prescription.

About BiPAP Machines  – They Have Three Different Modes

Depending on the type of Bilevel machine, it may have up to three modes of operation. A Bilevel ST machine is the most advanced and acts similarly to a ventilator. It is used for more serious respiratory illnesses.

  • Spontaneous – switching between inspiratory and expiratory as the BiPAP machine senses the switch in breathing. (standard auto Bilevel)
  • Timed – switching between inspiratory and expiratory at a programmed rate to ensure the prescribed breaths per minute rate is maintained. (Bilevel ST)
  • Spontaneous/Timed – switches as it senses the change in breathing. Timed mode functions as a failsafe to ensure breathing at the required breathes per minute rate is maintained. (Bilevel ST)

Based on your sleep study, your physician will determine which mode your Bilevel machine should operate in.

We have created a quick BiPAP comparison chart so that you can make “at a glance” comparisons about BiPAP machines based on their size and features that are most important to you.

Example of ResMed's Vauto Aircurve BiLevel PAP (BiPap) machine on a beside table

What is the Difference Between a BiPAP Machine and a CPAP Machine?

Some sleep apnea patients cannot tolerate CPAP machines. Patients who have difficulty with continuous flow pressure or even the auto adjust flow option may need the more advanced BiPAP technology. BiPAP provides more precise settings for both inhalation and exhalation, providing a more comfortable therapy experience. 

What Do CPAP Machines Offer?What Do BiPAP Machines Offer?
Fixed Continuous Flow PressurePrecise Pressure for Inhalation (ipap)
Auto-Adjusting PressurePrecise Pressure for Exhalation (epap)

Are Refurbished BiPAP Machines Worth it?

There are certainly refurbished machines available and being sold by dealers on places like eBay. However, unless the manufacturer refurbishes the BiPAP machine, a warranty might not be available. If you purchase a BiPAP outside of the normal channels, you might end up being disappointed. As with any purchase for non-typical suppliers, buyer beware!

Do They Treat More Severe Sleep Apnea? Do Some People Graduate Down from BiPAP to CPAP?

In general, a BiPAP machine is for people who cannot tolerate a standard CPAP. There are a number of reasons that standard CPAP therapy is hard to tolerate, including difficulty breathing at the current pressure setting, or a more complex disorder. BiPAP users typically do not step down to a CPAP from a BiPAP machine unless there have been some significant changes in their diagnoses.

What Do BiPAP Settings Mean?

The settings for CPAP and BiPAP are slightly different. CPAP pressure starts much lower than BiPAP at around 5 cmH2O and increase in increments of 2 cmH2O. When patient comfort cannot be met with the limited settings of a CPAP machine, Sleep doctors usually prescribe a BiPAP. 

Initial settings on a BiPAP machine usually start around 8-10 (and can go up to 24) cmH2O for inhalation and 2-4 (up to 20) cmH2O for exhalation. With BiPAP, the inhalation pressure must be higher than the exhalation pressure so that the Bilevel air flow can be maintained.

Currently, Philips Respironics, one of the most trusted names in CPAP equipment, offers three BiPAP machines. The most popular Respironics BiPAP is the Philips Respironics DreamStation Auto BiPAP Machine with Bi-Flex & C-Flex. This machine was developed after many discussions with BiPAP patients, and won the 2016 iF design award as a result. This machine has an easy to use front facing display menu and weighs less than 4 pounds so it can be used for travel. Some of the things that make it unique include:

  • A hose swivel connected to a heated tube
  • A humidifier that detaches but is small and light enough for travel
  • Different modes make it very versatile for therapy because it can be used as a standard CPAP, Bi-level or Auto Bi-level device, delivering different pressure levels during inhalation and exhalation.
  • Mask check feature to identify leaks
  • Easy to track therapy progress using the DreamMapper therapy tracker
  • C-Flex and Bi-Flex functions improve breathing transitions
  • Pressure ranging from 4-25cm H²O.
  • Integrated Bluetooth® allows for remote data review and troubleshooting.
  • EZ-Start – this automatic, personalized pressure adjustment helps acclimate users to their prescribed pressure.
  • Advanced event detection
  • Mask fit check and resistance control
  • Oximetry capable
  • DreamMapper patient self-management system compatibility

This small, lightweight machine looks sleek and stylish on any bedside table, is easy to use, and meets the requirements of BiPAP users.

This machine is also available as a standard BiPAP as the Dreamstation BiPAP Pro: It has all the same state of the art features as the DreamStation Auto BiPAP Machine except that it is a fixed pressure machine with only one “mode”.

Philips Dreamstation Pro BiPAP with heated humidifier close up

There are three very popular ResMed BiPAP machines that work well for those who have trouble tolerating CPAP therapy.

The AirCurve 10 S BiPAP machine is a fixed pressure PAP device designed to make therapy more comfortable for non-compliant CPAP users.

ResMed AirCurve 10 S

• A premium BiLevel device for treating sleep apnea which features an integrated humidifier, heated tubing, and more

Shop Now

The AirCurve 10 VAuto is an auto pressure PAP device designed for added comfort with features like the quiet Easy-Breathe motor and waveform that provides a more peaceful therapy environment. Its sleek design and intuitive LCD screen make it easy to use and customize, including setting time limits. 

The VAuto algorithm adjusts the baseline pressure to always keep the airway open while also maintaining a fixed pressure, automatically adjusting pressure levels to deliver the lowest pressure necessary. Built in wireless communication helps patients stay connected to their sleep apnea care team.

ResMed-AirCurve 10-VAuto

This machine is also travel friendly and comes with an integrated, heated humidifier. Some of the other unique features of this machine include AutoRamp and Advanced Event Detection.

AutoRamp delivers a low pressure to help patients fall asleep easily. When it detects that the patient is sleeping, it gradually ramps or increases the pressure to the prescribed setting.

Advanced event detection: This BiPAP is very effective for people who also suffer from central apneas because it can differentiate between obstructive and central apneas and deliver the appropriate therapy.

The AirCurve 10 ST machine is not only a BiPAP machine, but it also provides ventilation in order to reduce the work of breathing. This makes it a very cost effective and reliable alternative when ventilation without alarms is required.

There are two Bilevel DeVilbiss machines on the market as of January 2018. The fixed pressure machine is the IntelliPAP Bilevel S with Heated Humidifier.  It can be used as a CPAP or BiPAP machine with a pressure range of 3-25 cmH20 and the ability to adjust the IPAP (inhale) and EPAP (exhale) up to 22 cmH20 for patients who require higher pressures. 

Patients can customize the pressure changes between inhalation and exhalation for added comfort. SmartCode allows users to log into a website and enter the code show on the device screen to monitor their therapy or provide the code so that their sleep apnea team can also monitor therapy. Some of the features that make this machine unique include:

  • Travel bag included
  • Heated humidifier included
  • No bulky power brick
  • Automatically starts air flow with a breath
  • Customizable apnea/hypopnea detection
  • Automatic Altitude Adjustment
  • Pressure Ramp makes it easy to fall asleep

The other DeVilbiss Bilevel machine includes all the features of the fixed pressure machine and offers Auto-detection as well. The IntelliPAP AutoBilevel comes with an optional integrated heated humidifier.  The additional features that set it apart from the IntelliPAP Bilevel S include:

  • Pressure support range of 0-12 cmH2O
  • Respiratory Event Detection
  • Automatic pressure adjustment
  • Among the quietest AutoBilevel units on the market – 26 dBA
  • Snoring and mask condition detection
  • Automatic Altitude Adjustment up to 8,500 feet

Are There Programs for People Who Need a BiPAP Machine and Have No Insurance?

While there are no specific programs we are aware of that provide free BiPAP machines, The CPAP Shop has partnered with Bread to help patients get the equipment they need with simple payment plans and financing options. You may also want to take a look at this post we have written on the subject.

Can you Use Breathe Right Nasal Strips with a BiPAP Machine?

There is no reason not to use nasal strips while on CPAP or BiPAP therapy. In fact, if you have nasal congestion, it can be difficult to use your nasal or nasal pillow mask. Using a nasal strip might help by opening up airways thereby reducing the negative impact from nasal congestion.

Which Masks Work Best with a BiPAP Machine?

All CPAP masks work with all CPAP and BiPAP machines. A CPAP mask is one of the most important aspects of CPAP therapy. If the CPAP mask is not comfortable, fitted properly or is the wrong style for your facial features, frustration will set in and compliance will drop. 

When choosing a CPAP mask, make sure you understand the choices and try many on your face. A CPAP mask is a personal preference. Although opinions from friends and suppliers are useful, understand that your facial features might not work with that particular mask. But whatever CPAP mask you choose, it will work on any CPAP or BiPAP machine.

What is the Cost of a BiPAP Machine?

A BiPAP machine is generally more expensive than a standard CPAP machine due to the technology within the machine. The BiPAP machine is a more complex and sophisticated machine which, in severe OSA cases, can actually assist the patient’s breathing. 

A BiPAP machine typically starts around $1000 and can rise as high as $5000 for the most sophisticated and essential machines.  Of course new technology is always being developed, so check our product pages for the most up-to-date pricing.

Which BiPAP Machines Come with Humidifiers?

All new CPAP and BiPAP machines have optional humidifiers which are quite sophisticated. Humidifiers are designed to deliver the optimal temperature and humidification for CPAP users to provide additional comfort during therapy. Humidifiers typically have a few settings which increase the warmth of the air. It can also be turned off so air remains at room temperature. Humidification has also been proven to significantly reduce dryness and soreness in the nasal passages

More recently, manufacturers have added a heated CPAP tube to their humidification systems. These heated CPAP tubes help to reduce rainout which is caused by the buildup of condensation within the tube itself. Rainout can become a nuisance as it typically runs into the face of the CPAP user. 

If you want to discuss which BiPAP machine is right for you, or if you have any questions not covered in this article, you can always email or call our knowledgeable customer service representatives!

Chris Vasta is the president of The CPAP Shop and an expert in sleep and respiratory therapy. He often provides insights on product design and functionality on various manufacturers’ prototypes and is frequently tapped to provide reviews on new releases.

Chris Vasta CPAP Expert & President at The CPAP Shop


Chris Vasta

Over a 10+ year career at PHH Mortgage managing a $100 million portfolio, Chris Vasta learned the ins and outs of the business world. He learned how to establish business relationships, lead a multi-prong team, and implement strategies for long-term growth. In 2007, Vasta used that experience to transition his role into president of The CPAP Shop. Over his tenure, Vasta has been involved in everything from website design to warehouse layout. His hands-on approach with customers has evolved into an in-depth understanding of the challenges of beginning and adhering to sleep therapy. He often provides his insights on product…