BiPAP

What is BiPAP?

BiPAP refers to bilevel or two-level positive airway pressure.

Like CPAP, this OSA treatment works by sending air through a tube into a mask that fits over the nose.

While CPAP generally delivers a single pressure, BiPAP delivers two: an inhale pressure and an exhale pressure. These two pressures are known as inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP).

BiPAP machines are sometimes also called BPAP machines. BiPAP was originally a brand name, but it has become synonymous with the machine itself and is now more common than BPAP.

BiPAP machines have similar low range pressure zones as APAP and CPAP, but they offer a higher peak pressure flow of 25 cmH2O. Thus, this machine is best if you need moderate- to high-pressure ranges.

NIV is often described as BiPAP, however, BiPAP is the trade name. As the name suggests provides differing airway pressure depending on inspiration and expiration. The inspiratory positive airways pressure (iPAP) is higher than the expiratory positive airways pressure (ePAP). Therefore, ventilation is provided mainly by iPAP, whereas ePAP recruits under ventilated or collapsed alveoli for gas exchange and allows for the removal of the exhaled gas. In the acute setting, NIV is used in type 2 respiratory failure (for example in a COPD exacerbation), with respiratory acidosis (pH < 7.35)

If you have sleep apnea or another condition that affects your breathing, your doctor might have mentioned a bilevel positive airway pressure machine, or BiPAP, to you. Sometimes called a BPAP, it’s a device that helps you breathe.

Some medical problems can make it hard for you to breathe. In these cases, you might benefit from bilevel positive airway pressure. It is commonly known as “BiPap” or “BPap.” It is a type of ventilator—a device that helps with breathing.

During normal breathing, your lungs expand when you breathe in. This is caused by the diaphragm, which is the main muscle of breathing in your chest, going in a downward direction. This causes the pressure to drop inside the tubes and sacs of your lungs. This decrease in pressure sucks air into your lungs. They fill with oxygenated air.

If you have trouble breathing, a BiPap machine can help push air into your lungs. You wear a mask or nasal plugs that are connected to the ventilator. The machine supplies pressurized air into your airways. It is called “positive pressure ventilation” because the device helps open your lungs with this air pressure.

BiPap is only one type of positive pressure ventilator. While using BiPap, you receive positive air pressure when you breathe in and when you breathe out. But you receive higher air pressure when you breathe in. This setting is different from other types of ventilators. For instance, continuous positive airway pressure (CPAP) delivers the same amount of pressure as you breathe in and out. Different medical problems may respond better to BiPap versus CPAP.

Who Uses a BiPAP?

You may benefit from a BiPAP if you have a medical condition that makes it hard for you to breathe sometimes. BiPAPs can be helpful for obstructive sleep apnea, a serious condition where your breathing stops and starts repeatedly while you’re sleeping. In some cases, it can be life-threatening.
BiPap may help you if you have a medical problem that impairs your breathing. For example, you might need BiPap if you have any of the following:

Your doctor may also recommend a BiPAP if you have:

• Pneumonia
• An asthma flare-up
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure or coronary artery disease
• Neurological disease that disturbs breathing
• Obesity hypoventilation syndrome
• Poor breathing after a medical procedure or because of another medical condition

If you have trouble breathing most or all of the time, or have trouble swallowing, a BiPAP probably isn’t for you. Instead, your doctor may recommend another device to help you get enough air.

BiPap may not be a good option if your breathing is very poor. It may also not be right for you if you have reduced consciousness or problems swallowing. BiPap may not help enough in these situations. Instead, you may need a ventilator with a mechanical tube that is inserted down your throat. Or you may benefit from a tracheostomy—a procedure that creates an airway in your windpipe.

In some cases, people can move off such ventilator support to BiPap as their breathing improves. People who do not want a breathing tube but want some assistance with breathing may also use BiPap.

Will I Always Have to Use BiPAP?

It’s important to follow your doctor’s instructions on how and when to use your BiPAP. If your health problems and breathing improve, you may be able to lower the pressure on your machine or use it less often. Your doctor will work with you to figure out when it’s time for a change.

If your medical problem gets better, you may be able to start using less pressure on your BiPap machine. Or you might be able to use the machine less frequently. Work with your healthcare team to help get the best treatment.

What are the risks for BiPAP use?

BiPAP is usually very safe. It has a lower risk of complications, such as infection, compared with ventilator support like a tracheostomy. Most problems from BiPAP involve the facemask. It may fit too tightly.

Some other risks include:

• Local skin damage from the mask
• Mild stomach bloating
• Dry mouth
• Leaking from the mask, causing less pressure to be delivered
• Eye irritation
• Sinus pain or sinus congestion

Your own risks may differ depending on your age, the amount of time you need BiPap, and your medical problems. Talk with your healthcare provider about any concerns.

What happens during BiPAP use?

You might receive BiPAP therapy while at the hospital for a breathing emergency. You also might use it at home for a chronic condition.

Follow your healthcare provider’s instructions about when to use BiPAP. You might need to use it only while you sleep. Or you might need to use it all the time. You will not receive the full benefits from your BiPap therapy if you don’t use it as directed.

When you first start using BiPAP, you may feel uncomfortable. It may feel odd wearing a mask and feeling the flow of air. Over time, you should get used to it. If you feel like you really can’t breathe while using BiPap, talk with your healthcare provider. He or she may need to adjust the pressure settings on your machine.

It’s important not to eat or drink anything while using BiPAP. You might inhale food or liquid into your lungs if you do so.

The noise from most BiPap machines is soft and rhythmic. If it bothers you, try using ear plugs. If the device is very loud, check with the medical supplier to make sure it is working correctly.

Talk with your healthcare provider if you are having any symptoms or problems while using BiPAP. He or she can help you figure out how to address them. Here are some general tips:

A humidifier may help reduce nasal dryness. Using a facial mask instead of a nasal mask may also help lessen any eye or sinus symptoms. If you get headaches, they could be due to sinus congestion. In some cases, your healthcare provider might prescribe an antihistamine for these symptoms.
If you have a leaky mask, skin irritation, or pressure lines, you may need a different size or type of mask. You may also find that adjusting the straps around your mask helps.
Your healthcare provider may be able to help you avoid stomach bloating by reducing the pressure setting on your machine.
Your healthcare provider may give you other instructions about the best way to use your machine.

BiPAP Parts

You should be familiar with the parts of your BiPAP machine.

They include:

A face mask, nasal mask, or nasal plugs
The machine’s motor, which blows air into a tube
The tubing that connects the machine’s motor to the mask or plugs
Your BiPAP machine might also have other features, such as a heated humidifier.

If you are buying a BiPAP machine for home use, you may want to talk with a professional who sells home medical equipment. This person can help you pick the type of BiPAP machine best suited to your needs. He or she can also give you instructions about how and when to clean the masks, tubing, and other parts of the machine.

You might want to try several types of masks before deciding on the one you like best. If your mask feels tight, you may need to have it refitted.

Before you start BiPAP therapy, your machine may need to be calibrated. Someone from your medical team will adjust the settings. That person is often a respiratory therapist. The settings need to be correct so that you receive the appropriate therapy. You may also get other instructions on how to prepare for your BiPap therapy.