Difference Between CPAP and BiPAP - Complete Guide

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Dr Rubanti Sengupta, BDS

8 minutes Read. 31st Aug 2024

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bilevel Positive Airway Pressure) machines are both used to treat sleep apnea, a condition where breathing repeatedly stops and starts during sleep. The primary purpose of a C-PAP machine is to provide a continuous stream of air to keep the airway open, thus preventing apnea episodes. It maintains a constant pressure throughout the breathing cycle. In contrast, a Bi-PAP machine offers two levels of pressure: a higher pressure when you inhale (IPAP) and a lower pressure when you exhale (EPAP). This dual-pressure mechanism can make breathing easier and more comfortable for some users, especially those with complex or central sleep apnea. The key difference between CPAP and BiPAP lies in their pressure delivery. CPAP provides a single, constant pressure, while BiPAP adjusts the pressure based on the phase of the breathing cycle, making it more suitable for individuals with more complex breathing issues or higher comfort needs.

What is CPAP?

A CPAP (Continuous Positive Airway Pressure) machine is designed to treat sleep apnea by delivering a steady stream of air through your mouth and/or nose to keep your airways open during sleep.

Components of a CPAP machine include:

Mask: Covers your nose or both your nose and mouth.

Straps: Secure the mask on your face.

Tube: Connects the mask to the machine's motor.

Motor: Pumps air into the tube.

Air Filter: Cleans the air before it enters your airway.

Some CPAP machines feature additional elements like heated humidifiers and adjustable pressure settings.

CPAP is one type of Positive Airway Pressure (PAP) device, with several variations:

Auto CPAP: Adjusts pressure automatically within a set range.

Bi-level PAP: Provides different pressures for inhalation (higher) and exhalation (lower).

Auto-bilevel PAP: Self-regulates both inhalation and exhalation pressures.

Adaptive Servo-Ventilation (ASV): Tailored for central sleep apnea, adjusting pressure and sometimes providing breaths to stabilize breathing.

What is BiPAP?

Bilevel Positive Airway Pressure (BiPAP) is a non-invasive ventilation machine used to assist breathing. Unlike invasive mechanical ventilation, which involves a tube inserted into the throat, BiPAP machines deliver air through a mask worn over the nose and mouth.

Key features of BiPAP include:

Positive Airway Pressure: The device maintains higher air pressure to keep the airway open and facilitate airflow into and out of the lungs.

Bilevel Pressure: Provides two different pressures—one for inhalation (Inhalation Positive Airway Pressure, IPAP) and a lower one for exhalation (Exhalation Positive Airway Pressure, EPAP). These pressures can be set manually or adjusted automatically based on your breathing patterns.

BiPAP is used in emergency or intensive care settings and can also be prescribed for chronic conditions where breathing support is needed at home.

Key Difference Between CPAP and BiPAP:

Feature	CPAP (Continuous Positive Airway Pressure)	BiPAP (Bilevel Positive Airway Pressure)
Air Pressure Type	Typically 8 to 10 cm H2O	Typically 4 to 30 cm H2O
Pressure Adjustment	Fixed pressure setting that remains constant during both inhalation and exhalation.	Adjustable pressure settings for both inhalation and exhalation; can be manually set or automatically adjusted.
Indications for Use	Primarily used for obstructive sleep apnea (OSA) to keep the airway open.	Used for more complex conditions, including central sleep apnea, or when CPAP is insufficient or uncomfortable.
Comfort Level	Can be less comfortable for those with difficulty exhaling against constant pressure.	More comfortable for some users, as the lower pressure during exhalation reduces resistance.
Complexity	Generally simpler with a single pressure setting, making it easier to use.	More complex due to dual pressure settings and potential for automatic adjustments.
Breathing Support	Provides consistent airflow, which may be less effective for patients with varying breathing needs.	Offers tailored support by varying pressures according to the patient’s breathing patterns.
Examples of Devices	Standard CPAP machines and Auto CPAP (self-regulating).	Standard BiPAP machines and Auto-Bilevel PAP (self-regulating with automatic adjustments).
Patient Adaptability	May be less adaptable for patients with high or variable respiratory needs.	Better suited for patients who require different pressures for inhalation and exhalation.
Cost	Generally less expensive than BiPAP machines.	Usually more expensive due to advanced features and dual pressure settings.

Uses and Applications for CPAP and BiPAP machines:

CPAP Machines: Treats obstructive sleep apnea (OSA). In OSA, you briefly stop breathing while you sleep due to relaxed airways that narrow or completely close. This can occur hundreds of times a night, leading to a lack of oxygen. The CPAP machine keeps airways open during sleep to prevent interruptions in breathing. In Neonatal care CPAP is used for preterm infants in the neonatal intensive care unit (NICU) to support underdeveloped lungs.

Risks of Untreated OSA:

Heart disease
High blood pressure
Stroke
Type 2 diabetes
Cognitive impairment
Increased risk of vehicle accidents

BiPAP Machines: BiPAP provides breathing support for ongoing conditions or emergency situations. It is used for preterm infants in the neonatal intensive care unit (NICU) to support underdeveloped lungs.

Conditions Treated:

Heart failure
Chronic obstructive pulmonary disease (COPD)
Obstructive and central sleep apnea
Hypercapnic respiratory failure (excess carbon dioxide in the blood due to ineffective exhalation)

Understanding How CPAP and BiPAP machines work:

A CPAP (Continuous Positive Airway Pressure) machine operates by using a compressor to generate a steady stream of pressurized air, which is filtered for purity and then delivered through a flexible tube to a mask worn over the nose or mouth. This continuous airflow keeps the airways open by pushing against any obstructions, ensuring that breathing remains uninterrupted throughout the night and that the lungs receive a consistent supply of oxygen.

In contrast, a BiPAP (Bilevel Positive Airway Pressure) machine employs a different mechanism by providing two distinct levels of air pressure: Inspiratory Positive Airway Pressure (IPAP) for inhalation, which is higher to assist in drawing air into the lungs, and Expiratory Positive Airway Pressure (EPAP) for exhalation, which is lower to make breathing out easier. This dual-pressure approach helps improve oxygen levels in the blood and reduces carbon dioxide. Some BiPAP machines may also include a timer to regulate the number of breaths per minute, facilitating a more tailored breathing support.

Benefits of using Introduction to C-PAP and Bi-PAP machines:

Consistently using a CPAP (Continuous Positive Airway Pressure) machine to manage sleep apnea offers both short- and long-term benefits. In the short term, CPAP use improves sleep quality, reduces snoring, decreases daytime sleepiness (hypersomnia), and enhances mood. Over the long term, it can lead to improved blood pressure, a reduced risk of cardiovascular events such as heart attacks and strokes, and better cognitive function, including memory and thinking abilities.

BiPAP (Bilevel Positive Airway Pressure) machines also provide significant benefits. They are noninvasive, which means they don’t require internal insertion and generally pose fewer risks than invasive ventilation. BiPAP can assist in transitioning patients off life support systems and serves as an alternative for those with sleep apnea who cannot tolerate or do not benefit from CPAP therapy.

Choosing between C-PAP and Bi-PAP machines:

The choice of PAP (Positive Airway Pressure) machine depends on the specific type of sleep apnea you have and how you respond to various treatments. Your doctor or sleep specialist will guide you in selecting the most appropriate PAP therapy based on your individual needs.

Generally, CPAP (Continuous Positive Airway Pressure) therapy is considered the most effective treatment for obstructive sleep apnea, especially when not complicated by other health conditions affecting breathing during sleep.

For individuals with more complex sleep-related breathing issues, such as certain types of central sleep apnea, BiPAP (Bilevel Positive Airway Pressure) is often recommended. BiPAP can also be a suitable option for those who either cannot tolerate CPAP or whose obstructive sleep apnea does not improve with CPAP treatment.

Similarities Between CPAP and BiPAP:

CPAP and BiPAP machines share several similarities in their design and functionality. Both types of machines are used to provide positive airway pressure to keep the airways open during sleep, thus preventing interruptions in breathing. They both include a motor that generates pressurized air, a hose that channels the air from the motor to the mask, and a mask that covers the nose and/or mouth to deliver the air. Both CPAP and BiPAP machines are equipped with accessories such as data collection features and climate control options like humidifiers and heated tubing. These machines are crucial in managing sleep disorders and supporting proper respiratory function during sleep.

C-PAP and Bi-PAP Machine in India:

Machine	Type	Price (INR)	Description
DeVilbiss SleepCube BiLevel ST BPAP Machine	BiPAP	₹85,000	Provides two pressure settings (IPAP and EPAP) for better management of complex breathing issues. Suitable for both home and hospital use.
BMC CPAP Machine - With Humidifier (Resmart GII)	CPAP	₹50,000	Features a built-in humidifier to enhance comfort. Ideal for treating obstructive sleep apnea with a continuous airflow.
Ventox BPAP Machine - DS-8 (ST30)	BiPAP	₹75,000	Offers dual pressure settings for inhalation and exhalation. Suitable for users with complex respiratory conditions.
Respro Auto CPAP Machine with Humidifier and Mask (Aer series) - AC20	CPAP	₹65,000	Automatic CPAP machine with pressure adjustments, integrated humidifier, and mask. Designed for ease of use and comfort during sleep.