- How Sleep Works
- Sleep Disorders
- Sleep Resources
- Sleep Health
- Sleep Medicine
Continuous positive air pressure machines, or CPAP machines, are widely used to treat sleep apnea, a medical condition that causes temporary loss of breath during the night. CPAP machines are electronic devices that draw in outside air using an internal fan, humidify the air and pressurize it, and then deliver it to users via a connective hose and breathing face mask.
CPAP pressurizes air to one constant level, depending on the user’s prescription. The pressure rates are measured in centimeters of water, or cmH20; standard CPAP machines can pressurize air anywhere between 4 and 20 cmH20 in 1 or 0.5 increments. A physician’s prescription is always required to purchase a CPAP machine, as well as the breathing mask and humidifier components.
When shopping for a CPAP machine, buyers should consider several factors. Price-point is particularly important; while most CPAP machines cost at least $200, some models are priced higher than $800. Size and volume are other key variables, particularly for buyers who plan to travel with their CPAP machine. Other factors, which we will discuss below, include ramp time, humidifier capacity, and built-in features like sleep data tracking and preset alarms.
Read on to learn more about CPAP machines, including our choices for the five best CPAP machines sold today. Our picks are based on verified customer and owner experiences, as well as intensive product research and analysis.
The DreamStation CPAP Machine from Philips Respironics is our editor’s pick because it is stocked with helpful high-tech features. These include C-Flex Technology, which reduces pressure during expiration (exhalation) for more comfortable breathing. The machine is also Bluetooth-compatible and connects with DreamMapper, a wireless app used to track sleeping data. Data is displayed on the machine’s crisp LCD interface.
The DreamStation is also compact, lightweight, and relatively quiet, making it a good option for travelers with sleep apnea. Customers have the option of including a built-in humidifier with a 325-mL capacity, as well; a preheat function begins warming water in the chamber for up to half an hour in advance. Owners can customize the ramp time to anywhere from five to 45 minutes for added convenience. The Philips Respironics DreamStation is backed by a two-year warranty.
The AirSense 10 Elite from ResMed is one of the most high-tech CPAP machines on the market today. Included with the machine is full humidifier customization, allowing owners to choose from eight different humidification levels. In addition to adjustable ramp time, the machine has an ‘auto-ramp’ feature that starts pressurizing air when it senses the owner is sleeping. The machine also has a mask fit sensor indicating when the user’s mask is sufficiently sealed, which can help prevent air leaks.
Owners can track apnea episodes per hour, leak rates, and other sleep data using a clear, colored LCD interface that automatically adjusts its tint based on the room’s light settings. Another beneficial feature is the Expiratory Pressure Relief (EPR), which reduces pressure and eases breathing during exhalation. The AirSense 10 Elite has an above-average price-point, making it a good option for shoppers with bigger budgets. The machine comes backed with a two-year warranty.
The IntelliPAP Standard CPAP Machine from DeVilbiss is loaded with helpful features. The device is lightweight – 2.8 pounds for the machine, and about 6 pounds with the humidifier – and produces 26 dB of noise, making it reasonably quiet compared to other CPAP machines. Ramp speed is another strength of the IntelliPAP, which can reach its prescribed pressure delivery within 20 minutes. The device is designed with Smart Flex technology, which reduces pressure during exhalation for easier breathing.
The IntelliPAP also includes a heated, integrated humidifier with a 400-mL capacity – much larger than the average CPAP humidifier. For travelers, the machine offers automatic altitude adjustment (with a max altitude of 9,000 feet) and will automatically turn off based on timer presets. The machine has an 8-foot power cord, as well. The DeVilBiss IntelliPAP Standard CPAP Machine is backed by a 3-year warranty, which covers both the machine and the integrated humidifier.
Positive air pressure therapy, or PAP therapy, is a process for delivering airflow through a ventilation system to individuals who have a hard time breathing on their own. PAP therapy is delivered in one of two forms. Continuous positive air pressure, or CPAP, provides airflow at a fixed pressure rate; and bi-level positive air pressure, or BiPAP, delivers airflow at a variable pressure rate based on the user’s breathing patterns. PAP machines feature a generator attached to a humidifier that pressurizes the air, and a connective hose that links the generator to a mask placed over the user’s nose and/or mouth.
PAP therapy can be a highly effective treatment for people with sleep apnea; CPAP is normally reserved for people with obstructive sleep apnea (OSA), while BiPAP works best for people with central sleep apnea (CSA). This CPAP machine guide includes shopping considerations, our picks for the top CPAP models, and some additional strategies for people with OSA. First, let’s explore how CPAP machines work.
CPAP machines are considered the most effective treatment for obstructive sleep apnea (OSA), which is caused by partial or complete physical obstructions that block an individual’s airway. These obstructions lead to shallow breathing episodes throughout the night that can result in temporary loss of breath until the episode passes. Most shallow breathing episodes for people with OSA last 20 to 40 seconds, but more than 100 may occur over the course of a single night. Heavy snoring is a common symptom of OSA.
The other common type of sleep apnea, central sleep apnea (CSA), occurs when the brain cannot transmit proper signals to muscles that control breathing; there is no physical obstruction that affects breathing. However, CPAP machines are not as effective at treating CSA because they do not provide variable air pressure.
The table below details the key differences between CPAP and BiPAP machines.
|Machine||Type of Apnea Targeted||Function||Average Price|
|Continuous positive air pressure (CPAP)||Obstructive sleep apnea (OSA)||Pressure increases until it reaches prescribed rate||$200 to $800|
|Bi-level positive air pressure (BiPAP)||Central sleep apnea (CSA)||Pressure increases or decreases at variable rates, depending on the user’s breathing||$800 to $1,700|
CPAP machines operate using the same core components:
Another key component is the mask, which is sold separately from the machine itself. Masks are sold in different shapes and styles to accommodate different user preferences. Any style of mask can be used with a modern CPAP machine, provided the connective hose is compatible. Generally speaking, four primary types of mask are available:
To properly use a CPAP machine, follow this step-by-step process.
1.) Place the machine on a level surface where it isn’t at risk of falling or moving during the night.
2.) Plug the machine into a wall outlet.
3.) If available, insert the chamber humidifier filled with distilled water.
4.) Secure the connective hose that links the generator and the face mask.
5.) Put on the mask and adjust it to a comfortable setting.
6.) Turn on the machine.
7.) Adjust settings as needed during the night.
The output of a CPAP machine is usually measured in centimeters of water (or cmH20). Most sleep apnea patients require an airflow of at least 6 to 14 cm420, and CPAP machines usually deliver at least 4 to 20 cmH20. To determine how much is needed, apnea patients will typically undergo a sleep study before a CPAP machine is prescribed. It’s important to note that a prescription is required for all CPAP machines.
Benefits of using a CPAP machine for obstructive sleep apnea include the following:
Downsides of using a CPAP machine may include the following:
Type of sleep apnea: The choice between a CPAP or BiPAP machine is largely determined by the patient’s type of sleep apnea; CPAP is normally prescribed for OSA, while BiPAP is more suitable for CSA. However, BiPAP may be used to treat OSA if CPAP therapy has failed.
Price: The price of a new CPAP machine typically falls between $200 and $800. BiPAP machines tend to be more expensive than CPAP models.
Size and weight: Most CPAP machines are fairly compact, but some are larger than others — and users with limited bedroom space may wish to select a smaller model. Lighter machines are also more suitable for long-distance travel. Most CPAP machines come with a carrying case of some kind, regardless of size.
Operating pressure range: Apnea patients usually require airflow that falls between 6 and 14 cmH20. Most CPAP machines are designed to deliver an airflow of anywhere from 4 to 20 cmH20. That being said, purchasers should research the operating pressure range to determine if the device will meet their individual needs.
Ramp time: ‘Ramp time’ refers to the amount of time needed to reach the prescribed operating pressure after the PAP machine is turned on. Ramp time for most CPAP machines typically falls within 30 to 60 minutes.
Humidifier: Some PAP machines have built-in humidifiers that require owners to pour in water, while others have detachable humidifiers that can be removed from the machine and filled with water. Humidifier capacity is another important consideration, since larger humidifiers that hold more water may operate longer than those with smaller humidifiers.
Volume: CPAP machines almost always produce some noise, but certain models are quieter than others. Volume for CPAP machines is measured in a-weight decibels, or dbAs, which are used to express the relative loudness of air-based sounds.
Hose length: Most connective hoses that link CPAP machines to face masks are at least six feet in length, but users who are unable to set up their machine next to their bed may want a hose that measures even longer.
Power Source: Most CPAP machines operate on a voltage range of 100 to 240V AC. The power input requirements will be included in the product specs.
Operating altitude: CPAP machines are normally designed to properly function at certain altitudes; exceeding this altitude will compromise the delivery of properly pressurized air. This information is usually included in the product specifications.
Automatic controls: In addition to automatic on and off controls, some CPAP machines will adjust to the user’s shifting breathing patterns, as well as changes in altitude (which can affect the amount of pressure needed).
Alerts: Some CPAP machines will alert users if the pressure is turned off (due to issues such as power outage or dead batteries), if the mask leaves the user’s face, or if a leak develops in the connective hose. These alerts may take the form of audible alarms and/or LCD backlighting.
Sleep data: Like many electronic devices manufactured today, some CPAP machines are equipped with smart technology that monitors sleep patterns in users and provides readable data. This data may include how much pressure (in cmH20) is delivered each night, how long the machine is used, and how many days the owner has used the machine per week or month. CPAP machines may display this data on a built-in screen or via a mobile app.
Warranty: In most cases, a CPAP machine will come with a warranty that covers the product for two to five years, depending on the manufacturer.
Prescription requirements for CPAP machines are somewhat confusing. In this next section, we’ll answer some of the most common questions about CPAP prescriptions.
|Do I need a prescription for CPAP machines?||Technically, you don't need a prescription for the entire machine – just three key parts. Sleep apnea patients need a doctor's prescription to legally purchase CPAP airflow generators, humidifiers, and face masks. These three components are categorized as Class II medical devices, meaning the U.S. Food and Drug Administration (FDA) regulates their sales. Other CPAP machine components, such as connective hoses and air filters, do not share this FDA classification; they can be purchased over the counter.|
|Why do I need a prescription for these CPAP components?||Prescriptions for CPAP equipment are important for two primary reasons. First, CPAP machines – as well as BiPAP and APAP devices – are customized for individual users. Doctors write prescriptions based on evaluations that determine the patient's optimal pressure delivery setting(s). If that same patient uses a machine that is not calibrated to the correct level, he or she may not experience relief from their sleep apnea symptoms. In some cases, symptoms may actually worsen. The second reason is straightforward: insurance purposes. Although patients don't need medical insurance to buy FDA-regulated CPAP equipment, but insurance companies require a prescription to cover the costs of these devices for those who can't afford them out-of-pocket.|
|Will anyone sell me a Class II medical device without a prescription?||Yes, but they are breaking the law – and so are you. The FDA regulates the sale of medical devices, and those who sell these devices must receive FDA approval to do so. Per FDA regulations, medical device sellers must require a prescription for CPAP generators, humidifiers, or face masks. Most non-prescription CPAP transactions are coordinated through private online sales. In addition to being illegal, transactions of this nature typically involve used, refurbished, and/or modified machines that can pose health risks to the purchaser. These risks include complications due to using improperly calibrated equipment, as well as exposure to germs and bacteria from previous users. Quality assurance is another consideration; buyers have no guarantee the machine is in working condition, nor will they qualify for warranty coverage since they've bought the machine second-hand.|
|How do I obtain a prescription for FDA-regulated CPAP equipment?||In order to qualify for a CPAP prescription, patients must receive a sleep apnea diagnosis from one of the following licensed or certified professionals:
|What does my CPAP prescription need to say?||In order to legally purchase a CPAP machine, the prescription must include the following:
If you’d like more detailed information about the process for receiving a sleep apnea diagnosis and obtaining a prescription for CPAP machines, please visit our CPAP prescription guide.
If a CPAP machine does not treat a patient’s sleep apnea or proves insufficient, people with OSA or CSA may be able to reduce their nighttime sleep disruption through the following means.
Try side sleeping: Sleep position is important for people with sleep apnea. Side sleeping is considered best for this condition. In this position, the sleeper’s esophagus expands while the tongue falls away from the throat. This expands the airway and allows the sleeper to breathe more easily. As a result, many sleepers experience fewer apnea symptoms in this position.
Back sleeping is considered the worst position for apnea because it can cause the tongue to fall back in the throat; it can also cause the esophagus to constrict, which makes breathing more difficult. Stomach sleeping may be helpful for apnea symptoms, but this position is generally discouraged because it frequently leads to added aches and pains, especially around the neck, shoulders, and lower back.
Find the optimal pillow loft: Many people with sleep apnea — particularly those with OSA — are more susceptible to snoring when they sleep on their backs with their head at an elevated position. For this reason, people with sleep apnea are often encouraged to sleep on their sides, but this may not be suitable for certain individuals. Those who wish to continue sleeping on their backs may be able to reduce snoring by optimizing their pillow ‘loft,’ or thickness.
‘High-loft’ pillows are thicker than five inches (5″), ‘medium-loft’ pillows are three to five inches (3″ to 5″) thick, and low-loft pillows are thinner than three inches (3″). When determining the best pillow loft, it’s important to consider the following factors:
The table below provides a detailed breakdown of the three general pillow loft categories.
|Loft||Thickness||Optimal Head Size||Optimal Height||Optimal Shoulder Width||Optimal Mattress Firmness|
|Low||Less than 3"||Small||More than 230 lbs.||Narrow||Soft to Medium Soft|
|Medium||3" to 5"||Average||130 to 230 lbs.||Average||Medium|
|High||More than 5"||Large||Less than 130 lbs.||Broad||Medium Firm to Firm|
For more information, please check out our Best Pillows — Buying Guide and Information page.
Obtain an adjustable bed: Adjustable beds allow sleepers to adjust the angle of their sleep surface at the head and, in some cases, the feet as well. As is the case with optimal pillow loft, inclining the head at the right angle can help reduce snoring in people with sleep apnea. Additionally, some adjustable beds come with dedicated ‘anti-snore’ presets.
An adjustable bed may have manual, remote, or app-based controls. Most adjustable beds support anywhere between 600 and 800 pounds, making them suitable for most adults and their sleep partners. Models with dual-firmness may be most suitable for couples that have different firmness preferences.
Most adjustable beds cost at least $1,000, and some are priced at $3,000 or higher. For more information, please visit our Adjustable Bed Reviews page.