Important Considerations for BiPAP Machine Shoppers
When shopping for a new BiPAP machine, here are a few factors shoppers should take into account:
- Size: Most BiPAP machines are lightweight and compact enough for any bedroom space. However, shoppers should measure available surfaces in their room to make sure the device they want will fit.
- Pressure Range: BiPAP machines offer wider air pressure ranges, which typically fall between 3 cmH20 and 25 cmH20. Be sure to check the range, though, as some models will be more limiting. Most people with sleep apnea require pressure rates of 6 cmH20 to 14 cmH20.
- Humidifier: The humidifier may be built onto the BiPAP machine or ‘integrated,’ which makes it detachable and, in some cases, interchangeable. Humidifier reservoirs usually offer capacities between 300 and 450 mL. Keep in mind that larger reservoirs (380 mL and up) do not need to be refilled during the night as often.
- Noise Potential: Those who awaken easily due to noise should check the device’s decibel levels. The quietest BiPAP machines produce 25 to 27 dB of sound, while the loudest may produce up to 35 dB.
- Hose Length: Most connective hoses included with a BiPAP machine measure six feet in length. If this is insufficient, some brands sell hose extensions or extra-long hoses.
- Power Requirements: To accommodate U.S. sleepers, BiPAP machines usually operate on 100 to 240 volts. Many machines have a backup battery if power outages occur or if electricity is not available.
- Operating Altitude: BiPAP machines usually list a maximum altitude at which the device will properly pressurize air. This altitude generally falls between 5,000 and 9,000 feet.
- Alerts: Modern BiPAP machines frequently include alerts that inform users of air leaks in the connective hose and/or breathing mask; the mask slipping out of position; or pressure loss due to power outage or dead batteries. Alerts may take the form of beeps and/or LCD backlighting.
- Sleep Data Tracking: Another modern feature of BiPAP machines is sleep tracking software that records sleep patterns, respiration rates, and other metrics related to BiPAP therapy and sleep quality. Many machines allow owners to access this data using the interface controls, as well as wireless apps.
- Price: The average BiPAP machine costs between $800 and $1,300, but some machines can cost $1,800 or more. Financing is frequently available from sellers. Patients may also have insurance policies that minimize out-of-pocket costs.
- Product Warranty: Most BiPAP machine manufacturers back offer a warranty, which covers the product for one to five years. Longer warranties are rare.
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.
BiPAP Prescription Requirements
Some of the most common prescription-related questions about APAP therapy are answered below.
Is insurance required to purchase a BiPAP machine?
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.
Is it illegal to buy BiPAP machines without a prescription?
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.
How do I get a prescription for BiPAP equipment?
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:
- Medical physician or physician’s assistant
- Doctor of osteopathy
- Naturopathic physician
- Nurse practitioner
- M.D. psychiatrist
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.
What does the BiPAP prescription need to say?
A prescription for FDA-regulated BiPAP equipment must include:
- Name, signature, and contact details for the prescribing professional
- The patient’s legal name
- The patient’s specific sleep apnea diagnosis (OSA or CSA) and optimal inhalation and exhalation pressure settings
- At least one of the following terms verbatim: ‘BiPAP’ or ‘Bi-level PAP’
For a more in-depth look at the requirements discussed above, please visit our CPAP, BiPAP, and APAP Prescriptions guide.
Additional Strategies for People with Sleep Apnea
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.
Other Devices and Procedures
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.
Sleep and Lifestyle Changes
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:
- Lose Weight: Sleep apnea is strongly correlated to obesity and excess weight. Losing substantial weight has, for many, resulted in less snoring and fewer nightly breathing episodes.
- Exercise: Daily physical activity can help sleepers lose weight, and may also alleviate some apnea-related symptoms. The Mayo Clinic recommends at least 30 minutes of moderate physical activity each day.
- Don’t Drink Alcohol or Take Sleeping Pills Before Bed. These substances induce sleep, which can cause throat muscles to relax and, in turn, disrupt breathing patterns.
- Quit Smoking. The Mayo Clinic notes smokers are three times as likely to develop sleep apnea compared to non-smokers.
To learn more about sleep apnea, PAP therapy, and other related topics, please visit the following pages on Tuck.com.