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Continuous positive air pressure, or CPAP, is a therapy treatment widely prescribed for individuals with sleep apnea. Although there is no cure for sleep apnea, CPAP therapy eases breathing and alleviates snoring for people with the condition. The therapy involves a machine that humidifies and pressurizes air until it reaches a prescribed setting, then delivers the air through a connective hose and breathing mask. CPAP air pressure is measured in centimeters of water, or cmH20.
In recent years, many people with apnea have transitioned to bi-level positive air pressure, or BiPAP, therapy. This therapy involves the same hardware, but sleepers receive air pressurized at two different levels, one for inhalation and the other for exhalation. As a result, many sleepers – particularly those with CSA – find BiPAP therapy more comfortable for breathing than CPAP therapy.
Read on to learn more about BiPAP machines, how they work, and where to find them, as well as prescription requirements for these medical devices. Our picks for the four best BiPAP machines sold today are outlined below. Our choices are based on a combination of verified customer and owner reviews and intensive product analysis.
DeVilbiss IntelliPAP AutoBiLevel
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Philips Respironics DreamStation BiPAP Pro
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Most Compact/Easiest to Use
ResMed AirCurve 10 S
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ResMed S9 VPAP S BiLevel
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Our Editor’s Pick, the IntelliPAP AutoBiLevel from DeVilbiss, is a standout BiPAP machine for several reasons. For one, it is an automatic bi-level machine; the device automatically adjusts both the inhalation and exhalation pressure levels based on the sleeper’s breathing patterns. Many sleepers find automatic bi-level breathing much easier and more comfortable on a nightly basis.
Another helpful addition is the integrated, heated humidifier with a larger-than-average reservoir capacity of 400 milliliters (mL), which results in fewer late-night refills due to water shortage. The device has a pressurizing range of 3 to 25 cmH20; the pressure support range, or difference between inhalation and exhalation pressure, can be set in 0.5 increments up to 12 cmH20. The machine also automatically shuts off whenever the user removes his or her breathing mask.
The IntelliPAP AutoBiLevel is exceptionally quiet compared to similar devices; its operating volume is about 26 decibels (dB). It also includes SmartCode sleep tracking software, which measures time asleep, respiratory rates, and other metrics related to sleep apnea. The DeVilbiss IntelliPAP AutoBiLevel has an above-average price-point. However, DeVilbiss backs this product with a five-year warranty.
Our Runner-Up Pick is the Philips Respironics DreamStation BiPAP Pro, which builds on the flagship DreamStation BiPAP machine in several key ways. The device is engineered with EZ-Start Technology, which reduces the pressure levels for first-time users, then gradually increases pressure to the prescribed rates after 30 nights or so. This feature allows BiPAP users to acclimate to the settings without breathing difficulties.
The DreamStation BiPAP Pro also has Bi-Flex Pressure Relief, which eases breathing by toggling pressure rates during inhalation, the transition between inhalation and exhalation, and exhalation. Customers can choose to include or forgo the 325-mL integrated humidifier. In the event of a mask leak, the device will automatically increase pressure to compensate for the lost air.
The DreamStation BiPAP Pro is also compact and lightweight, weighing less than three pounds, and its noise output is lower than 26 dB, making it exceptionally quiet. Users can generate nightly progress reports based on time awake, time asleep, and other factors that affect sleep quality and duration. Philips Respironics backs this product with a two-year warranty.
The AirCurve 10 S BiPAP machine from ResMed is exceptionally small and compact; with the humidifier included it weighs about five pounds, and the device comes with a handy travel bag for easier transport. The machine is also very easy to use, thanks in part to the TiControl system that allows users to adjust inhalation and exhalation pressure settings based on their individual breathing patterns.
This system is particularly helpful for those with other forms of disordered breathing, such as COPD, in addition to sleep apnea. Additionally, the Easy-Breathe Comfort Feature modifies pressure settings between breaths for easier inhalations and exhalations. Users can adjust settings using a bright, easy-to-read LCD color display.
The AirCurve 10 S comes with a built-in humidifier with a larger-than-average water capacity of 380 mL, along with an SD Card that tracks and records sleep data for users. The automatic on/off controls are also helpful; the machine powers on when the user correctly wears their breathing mask, and then shuts off when the mask is removed. The AirCurve 10 S has an above-average price-point, making it a good choice for shoppers with bigger budgets. ResMed backs the product with a two-year warranty.
Although most BiPAP machines are relatively expensive, the ResMed S9 VPAP S BiLevel is a notable exception; even with the optional humidifier included, the device is widely available for less than $600, but it offers the same levels of quality and performance as many higher-cost competitors.
The machine includes Easy-Breathe Waveform Technology, which adapts to the sleeper’s breathing patterns for less pressure and more comfort during inhalation and exhalation. In addition to the optional 380-mL humidifier, which is larger than average, the machine also comes with ClimateLine heated tubing, which maintains warmth regardless of bedroom temperatures.
Using SmartStart and SmartStop features, the device will power on whenever the user breathes into their mask, then powers off as soon as the mask is removed. A Vsync control also increases pressure if mask leaks are detected. Owners can adjust settings and track sleep data using the easy-to-read display, and at 26 dB, the machine is relatively quiet. The ResMed S9 VPAP S BiLevel is backed by a two-year warranty.
Continuous positive air pressure (CPAP) therapy is a leading treatment for sleepers with sleep apnea. However, CPAP delivers air at a fixed pressure rate throughout the night; this can be problematic for sleepers who struggle with inhalations and exhalations at the same pressure level.
Bi-level positive air pressure (BiPAP) therapy, which pressurizes air at a higher setting for inhalation and a lower setting for exhalation, is a suitable alternative for those who struggle with breathing during CPAP therapy. However, BiPAP also has some notable downsides, including equipment that can be very expensive.
Read on to learn more about what BiPAP machines are, how they work, and what shoppers should consider when purchasing one of these devices. Our buying guide also delves into prescription requirements for BiPAP machines and accessories, and explores alternate strategies for people with sleep apnea.
BiPAP therapy involves humidifying and pressurizing air, then delivering it to sleepers through a connective hose and breathing mask. Unlike CPAP therapy, which delivers air at a single, fixed pressure setting, BiPAP therapy delivers a higher setting during inhalation and a lower setting during exhalation. Pressure settings for BiPAP machines are measured in centimeters of water (cmH20). The average machine offers a pressure range setting of 3 cmH20 to 25 cmH20.
Most people who use BiPAP therapy have been diagnosed with sleep apnea, a condition characterized by temporary loss of breath during the night. The condition is normally not life-threatening, but some experience more than 100 apnea-related breathing episodes per night, which can reduce sleep quality and duration.
Heavy snoring is a common symptom of sleep apnea, as well. BiPAP therapy, when properly administered, can reduce apnea-related breathing episodes and minimize snoring.
Sleep apnea symptoms vary, but the condition is frequently categorized into one of two types.
Sleepers with OSA and/or CSA can choose from three general types of positive air pressure therapy: continuous PAP (CPAP); bi-level PAP (BiPAP); and automatic PAP (APAP). The table below breaks down key differences and similarities of these three therapy types.
|Therapy Type||Function||Air Pressure Levels||Typical Air Pressure Range||Best Used for...||Average Price Range|
|CPAP||Air pressure increases until it reaches the prescribed setting.||One fixed level||4 cmH20 to 20 cmH20||People with OSA (most people with CSA prefer at least two pressure settings).||$200 to $800|
|BiPAP||Air pressure is delivered at a higher setting during inhalation and a lower setting during exhalation.||At least two fixed levels. Some machines fix the pressure levels based on the user’s prescription, while others automatically adjust levels based on breathing patterns.||3 cmH20 to 25 cmH20||People with CSA. BiPAP may also be suitable for people with OSA who have not responded well to CPAP and/or take medications that make breathing more difficult.||$800 to $1,700|
|APAP||Air pressure automatically adjusts based on the sleeper’s breathing patterns||No fixed levels. The machine will continuously adjust throughout the night.||4 cmH20 to 20 cmH20||Since it doesn’t remain at a fixed rate, APAP can be suitable for people with OSA or CSA.||$600 to $800|
BiPAP machines are distinct from CPAP machines because they offer more than one pressure rate; most BiPAP machines also have a wider range of pressure levels, typically 3 cmH20 to 25 cmH20.
Traditional BiPAP machines deliver the air at two pressure rates, a higher setting for inhalation and a lower setting for exhalation; these devices cannot be manually adjusted. In recent years, variable PAP (VPAP) therapy has also become popular.
While a BiPAP machine delivers the two pressure settings based on the user’s prescription, VPAP machines adjust the rates for inhalation and exhalation throughout the night based on the sleeper’s breathing patterns. This results in bi-level air pressure that matches the individual more closely.
Like CPAP and APAP machines, BiPAP and VPAP machines require a sleep apnea diagnosis and a doctor’s prescription. Next, we’ll take a look at some common BiPAP machine components.
Like CPAP and APAP machines, BiPAP and VPAP devices typically include the following components:
BiPAP therapy also requires a breathing mask. Most masks fall into one of three categories: full face, nasal cradle, and nasal pillow. The next table includes key details about these three breathing mask types.
|Mask Type||Full Face||Nasal Cradle||Nasal Pillow|
|Appearance/Coverage||Mask covers the bridge of the nose to the bottom of the mouth, forming a tight seal to prevent air leakage||Mask covers the bridge of the nose to the upper lip, forming a tight seal||Mask fits into both nares, or nostril openings, covering the tip of the nose to the upper lip|
|Other Features||Adjustable straps wrap the face to keep the mask in place||A chinstrap is often included; this helps the sleeper’s mouth remain closed||A cushion reduces irritation around the nares|
|Most Suitable for...||Those who need high air pressure settings Mouth breathers or people who struggle to breathe through their nose Back sleepers||Those who need high air pressure settings People who toss and turn Side sleepers||Those who need lower air pressure settings People who wear glasses and/or have thick facial hair Side sleepers|
|Not as suitable for...||Side or stomach sleepers Those who wear glasses and/or have thick facial hair||Mouth-breathers People who experience nasal blockage due to allergies or other conditions||Those who need high air pressure settings Mouth breathers People who experience nasal blockage due to allergies or other conditions|
|Average Price Range||$80 to $150||$80 to $110||$50 to $75|
Most BiPAP machines are compatible with all three mask types, allowing owners to select the design that best meets their needs and preferences.
One thing to note: the BiPAP mask, humidifier, and breathing mask all require a doctor’s prescription. Other machine components, such as the connective hose and air filters, do not require a prescription. For more information about specific prescription criteria, please scroll down to the ‘BiPAP Prescription Requirements’ FAQ below.
Follow this simple process to operate a BiPAP machine:
The BiPAP machine will likely need a few minutes to reach the prescribed pressure rates for inhalation and exhalation; this period is known as ramp time.
When shopping for a new BiPAP machine, here are a few factors shoppers should take into account:
Another important consideration for BiPAP machine shoppers is their doctor’s prescription. In the next question, we’ll go over prescription requirements for these devices.
Some of the most common prescription-related questions about APAP therapy are answered below.
Absolutely. The U.S. Food and Drug Administration (FDA) regulates the sale of BiPAP machines, humidifiers, and breathing masks, all of which are classified as Class II medical devices. Other BiPAP parts do not require a prescription.
The FDA requires a prescription to reduce medical liability for physicians. Doctors write BiPAP prescriptions after observing sleep apnea patients and recording their symptoms. The BiPAP machine is calibrated for two fixed pressure settings.
VPAP machines are not calibrated the same way, but they deliver a pressure range that matches the user’s prescription. BiPAP users should never try to recalibrate the machine themselves. Otherwise, they may not receive the right air pressure rate, which potentially leads to other health problems.
Insurance purposes are another reason why BiPAP machines require a prescription. Sleep apnea patients can purchase BiPAP generators, humidifiers, and breathing masks, but insurance companies mandate the prescription to cover patients who cannot afford out-of-pocket costs for these components.
Yes. Merchants who sell BiPAP machines, humidifiers, breathing masks, and other Class II medical devices can only do so after receiving FDA approval; as a condition of this approval, merchants must sell these products to purchasers with a prescription.
BiPAP machines may be available for sale without a prescription, but both the seller and buyer are breaking the law during these transactions. Legality aside, these transactions are discouraged because they often involve used, refurbished, and/or modified machines that have not specifically been calibrated based on the buyer’s prescription.
If the machine is used, then the buyer may also come into contact with germs and bacteria from the previous user(s). And without warranty coverage, buyers have no financial recourse if the machine breaks down and needs repairs.
In order to receive a prescription for BiPAP machines and FDA-regulated components, buyers must receive a sleep apnea diagnosis. One or more of the following certified professionals must perform this diagnosis:
Also, please note most BiPAP device sellers will not accept sleep apnea prescriptions from chiropractors, optometrists, or psychologists.
The diagnostic process may vary by patients. Prescribing physicians may issue a home sleep test (HST) before diagnosing sleep apnea. Others may instead refer their patient to a sleep disorder specialist for polysomnography sleep tests, which record brain waves, eye movement, and other data metrics.
An HST is less invasive but the results are frequently inconclusive; many patients undergo both the HST and polysomnography tests to receive their diagnosis.
A prescription for FDA-regulated BiPAP equipment must include:
For a more in-depth look at the requirements discussed above, please visit our CPAP, BiPAP, and APAP Prescriptions guide.
For some people with sleep apnea, BiPAP therapy alone may be insufficient. In this final section, we’ll look at some other medical devices, medical procedures, and lifestyle/sleep adjustments that can reduce apnea-related breathing episodes and cut down on snoring.
Mandibular Advancement Devices (MADs): MADs are anti-snoring mouthpieces that fit inside the user’s mandible, or lower jaw. The MAD physically forces the jaw forward to open up the sleeper’s airway and decrease snoring.
A MAD may be custom-molded, which requires the owner to bite into the material and form an impression before mailing it to the manufacturer; other MADs, known as ‘boil-and-bite’ devices, allow owners to boil the mouthpiece and form the impression without assistance. Most MADs are available over-the-counter, but some require a prescription.
Tongue Retaining Devices (TRDs): TRDs, like MADs, are anti-snoring mouthguards. Rather than repositioning the jaw, TRDs physically pull the tongue forward to increase the gap between the tongue and the throat. Many TRDs resemble baby pacifiers and come in one-size-fits-all designs that don’t need custom fitting. Most TRDs are available over-the-counter.
Provent: Provent therapy is a relatively new, FDA-approved treatment option for people with sleep apnea. The therapy involves two small valves with air filters that are placed in each nostril using a non-toxic adhesive. The valves open when the user inhales, and then they close during exhalation. Provent therapy requires a prescription.
Oral Surgery: Sleep apnea symptoms may be severe enough to warrant oral surgery. Several types of surgery can help correct sleep apnea; in most cases, the physician makes a recommendation based on patient criteria.
Common procedures include uvulopalatopharyngoplasty (UPPP), which removes the uvula to reinforce the soft palate; genioglossus advancement (GGA), which permanently stretches tongue tendons to reduce airway blockage; and maxillomandibular advancement (MMA), which permanently adjusts the angle of the upper and lower jaw. Because oral surgery is fairly expensive, this should be considered a last-ditch measure.
Consider Side Sleeping: Sleep position is crucial for people with sleep apnea. Most doctors and sleep specialists consider side sleeping the best position for alleviating apnea-related symptoms; this position helps the tongue fall out of the throat, which in turn allows the esophagus to expand and more air to circulate.
Back sleeping is considered the worst position for sleep apnea because the tongue falls back into the throat much more easily. Stomach sleeping may be suitable for sleep apnea, as well, but most experts advise against this position because it carries high potential for neck, shoulder, and back pain.
Optimize Pillow Loft: Pillow loft, or thickness, is an important factor for those with sleep apnea – heavy snorers, in particular. Pillow loft is generally divided into three categories: low loft (thinner than 3 inches); medium loft (3 to 5 inches); and high loft (thicker than 5 inches). The ideal loft often depends on physiological factors, such as head size and shoulder width, along with mattress firmness and sleep position.
Please visit our Pillow Buying Guide for more information about loft considerations.
Buy an Adjustable Bed: Adjustable beds feature electric motors that allow owners to elevate the head of the bed to different angles. Much like increasing pillow loft, raising the head can alleviate heavy snoring and minimize apnea-related breathing episodes throughout the night.
Modern adjustable beds offer a wide range of angle options; some are also split down the middle, enabling dual-elevation for couples with different angle preferences.
Adjustable beds can be very pricey. Some lower-end models that offer basic controls are available for roughly $1,000 in a Queen size, but newer and flashier beds often come with features that drive up the price-point; expect to pay at least $2,000 for one of these models. For more information, please visit our Adjustable Bed Buying Guide.
Lifestyle Changes: According to the Mayo Clinic, people with sleep apnea may be able to reduce their symptoms through these lifestyle changes:
To learn more about sleep apnea, PAP therapy, and other related topics, please visit the following pages on Tuck.com.