BiPAP Machine Reviews

As research continues to highlight the importance of sleep for almost all aspects of health, more focus has come to serious sleep disorders. In particular, a growing number of people are being diagnosed with sleep apnea. An apnea is a temporary pause in breathing, and when apneas occur frequently during sleep, the condition is known as sleep apnea.

The two most well-known types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA). In OSA, the tissues in the back of the throat physically block the airway, preventing normal breathing. In CSA, breathing halts temporarily because the brain stops sending the appropriate signals to the muscles that regulate breathing. CSA is less common than OSA, but it is also possible for people to have both conditions. Untreated CSA can cause excessive daytime drowsiness, fatigue, headaches, and cardiovascular complications.

Positive airway pressure (PAP) devices can play a critical role in promoting quality sleep and overall health in people with sleep apnea. Continuous PAP (CPAP) and bi-level PAP (BiPAP) machines work to prevent apneas and have started to be used with increasing frequency with the greater number of patients being diagnosed with sleep apnea.

Both CPAP and BiPAP machines work by pumping pressurized air into the airway to promote stable breathing. In a CPAP, the pressure of the stream of air stays the same the whole time (continuous) while in a BiPAP, the pressure is different for when you are exhaling versus when you are inhaling (bi-level). BiPAP machines are more commonly prescribed for treatment of CSA.

In this guide, we’ll offer additional background about sleep apnea and CSA in particular. We’ll review how a BiPAP works and what you should look for when shopping for a BiPAP. You’ll find our list of the top 5 best BiPAP machines as well as suggestions for alternative means of addressing CSA.

How Do BiPAP Machines Work?

What causes sleep apnea and CSA?

Sleep apnea can be caused by physical blockage of the airway (OSA) or by interruption of brain signals involved in controlling the muscles that help you breath (CSA). It is not always clear why one person develops CSA and another person’s doesn’t, but there are some known risk factors for this disorder.

Often CSA is related to an underlying medical condition. For example, neurological problems that affect the brain stem (such as a prior stroke or an infection of the brain) can lead to CSA. Medications, like opioid painkillers, may also increase the risk of CSA. As with OSA, obesity can contribute to one’s risk. In addition, CSA is more common in men and in people over age 65.

Some people have both OSA and CSA, and a BiPAP machine can work to resolve sleep disruptions from both.

What are the main functions and features of a BiPAP machine?

A BiPAP treats sleep apnea by ensuring a steady supply of air even if the airway is blocked (as in OSA) or if the brain’s breathing signals are disrupted (as in CSA). To do this, the BiPAP device draws in air, filters it, pressurizes it, humidifies it, and then pumps it into the airway. Each step of this requires a different component of the BiPAP, and these components may at times be sold separately. These key components include:

Airflow generator

The generator is inside the BiPAP. This is the workhorse of the device that takes in air and pressurizes it to be pumped into the airway.

Filter

To avoid excess exposure to dust or allergens, a BiPAP has a filter that helps purify the air that is drawn into the device before it is pressurized in the airflow generator.

Humidifier

A humidifier allows moisture to be added to the pressurized air from the BiPAP. Having this moisture added to the airflow can reduce irritation or dry throat that can occur during many hours of using the machine. The humidifier may be built-in to the machine or it may be a separate piece that is attached to it.

Hose

The hose is the means by which the air gets from the BiPAP machine to your mouth and/or nose where a mask can deliver it to your airway. A hose for a BiPAP is usually made of a heavy-duty plastic and in the range of 3-6 feet long.

Mask

The mask connects to the hose and is the way that the BiPAP ultimately gets the pressurized air into your respiratory system. The mask must fit well and be worn correctly in order for the BiPAP to work most effectively.

There are many types of masks that are compatible with BiPAP machines, and you can try out several to find the one that works best for you. Most masks will fit correctly with the hose of a BiPAP. Masks are normally purchased separately from the rest of the BiPAP machine.

There are three primary types of masks used with BiPAP devices:

  • Full face: a full face mask goes over your nose and mouth. This type of mask includes a plastic insert and straps that go around the head to hold it in place. If you breathe through your mouth, this type of mask is likely to be recommended. Because of its larger profile, a full face mask may also be the hardest for people to adjust to wearing.
  • Nasal: instead of covering the nose and the mouth, a nasal mask only goes over the nose. It is a better fit for people who breathe through their nose and not their mouth, and some users may wear a chin strap to keep the mouth closed as well.
  • Nasal cradle or pillow: this type of mask also is tailored for people who breathe through the nose, but it goes beneath the nose with prongs to pump air into the nostrils. It may be preferred by people who dislike the feeling of wearing a nasal mask that goes over the bridge of the nose.

Shopping Considerations

When shopping for a BiPAP machine, it is helpful to know about the most meaningful features and design elements. If you want to just see the top picks for the best BiPAP machines, you can just jump to the next section. But if you want to do your own research, this section can introduce you the most important terminology and the key considerations when shopping for a BiPAP.

Type of sleep apnea

BiPAP machines are more often used with CSA than with OSA. Though they may also be helpful for OSA, usually people with OSA try a CPAP first since it is normally a less expensive option. A doctor or sleep specialist can provide specific guidance about the type of machine that you may need.

BiPAP dimensions (size and weight)

The profile of different BiPAP machines can vary quite a bit. Some machines are both lighter and smaller than others. If you have limited space (such as on your nightstand adjacent to your bed), then a smaller BiPAP may be a priority. It may also be important to you to get a smaller and lighter BiPAP if you travel regularly and need to take your machine with you. Virtually all BiPAP devices are sold with a carrying case, so you may also want to look at the dimensions for the carrying case if you expect to travel regularly with your BiPAP.

Pressure range

The pressure range refers to how high or low the air can be pressurized by the BiPAP machine. Most people need pressure between 4 and 16 centimeters of water (cmH20), the unit used to measure pressure. Generally look for a BiPAP that has a range of at least 4-20 unless a health professional tells you that you need pressure outside of that wide range.

Noise

BiPAP and CPAP machines have gotten much quieter with recent improvements to the motors used to power them. However, they can still be noisy and disruptive, and you will want to look for a quieter machine if you or your partner are sensitive to noise when sleeping. Nose from a BiPAP machine is measured in dbA (a-weight decibels).

Humidifier

The humidifier in a BiPAP can add moisture to the pressurized air so that your mouth and throat are less likely to get irritated or dried out from the use of the machine. This can be important since you’ll use the BIPAP for multiple hours every day. Humidifiers can be built directly into the machine or may be a separate piece. If it is separate, then you can take it to the tap and fill it, while built-in reservoirs require you to pour in water. The larger the reservoir of the humidifier, the longer it can be used without having to be refilled.

Power source

Virtually any BiPAP machine that you purchase in the U.S. will come with a power cord that can be plugged into a standard outlet. Some BiPAP machines also have the ability to operate on battery power which can be useful if you need to take it with you when traveling or use it in a place where there are not easily accessible power outlets.

Automatic controls

Making automatic adjustments is a feature of some BiPAP devices. An example of these types of adjustments is modifying the level of pressure generated based on the altitude at which the machine is being used. These kinds of automatic controls are not vital to the operation of a BiPAP, but they can simplify some aspects of the operation of the machine and may make life easier for some users.

Ramp time

The ramp time describes how much time must elapse before the BiPAP reaches the full programmed pressure. A range of 30-60 minutes is most common.

Sleep data collection

If you want to have data about the performance of your BiPAP device, look for one that keeps records or tracks and stores data about the machines use. This type of information can be helpful for better understanding your sleep, the severity of your sleep apnea, and how well your BiPAP is working.

Warranty

A BiPAP machine can be a significant financial investment. Because it has a number of internal parts that must be working properly for the machine as a whole to work, having a warranty can help protect you from premature malfunction of the BiPAP. We recommend looking for a warranty that is at least 2 years long and protects you against these kinds of defects.

Best BiPAP Machines

It’s natural to feel a little overwhelmed when you start searching online for a BiPAP machine. There are a lot of choices and details to sort through. You may find it helpful to start with a shorter list that’s already been reviewed so that you don’t waste time looking at poor options. For that reason, we’ve prepared our list of the top 5 best BiPAP machines as listed in the table below.

Brand ResMed 3B Medical DeVilbiss DeVilbiss ResMed
Model AirCurve 10 S ReSmart BPAP 25A IntelliPAP AutoBiLevel Machine with SmartCode IntelliPAP BiLevel Machine with SmartCode S9 VPAP Auto BiLevel Machine
Price $1,725 $875 $1,145 $945 $2,100
Dimensions 10"L x 4.5"W x 5.9"H 6.4"L x 6.5"W x 8.4"H 6.4"L x 6.5"W x 8.4"H 6.4"L x 6.5"W x 8.4"H 11.25"L x 6.25"W x 3.25"H
Weight 2.75 lbs 4.5 lbs 4.5 lbs 4.5 lbs 6.4 lbs
Pressure Range 4 - 25 cmH20 3 - 25 cmH20 3 - 25 cmH20 3 - 25 cmH20 3 - 25 cmH20
Ramp Time 0-20 minutes 0-45 minutes 0-45 minutes 0-45 minutes 20 minutes
Humidifier Built-In? Yes No No No No
Humidifier Capacity 380 mL 300 mL 400 mL 400 mL 380 mL
Sound 27 dbA 26 dbA 26 dbA 26 dbA 26 dbA
Hose Length 6 feet 6 feet 6 feet 6 feet 6 feet
Max Altitude 8,500 feet 8,500 feet 8,500 feet 8,500 feet 8,500 feet
Sleep / Machine Data? Yes Yes Yes Yes Yes
Warranty Length 2 years 5 years 5 years 5 years 2 years
Customer Rating 4.9 (17 reviews) 4.5 (11 reviews) 4.9 (7 reviews) 4.8 (21 reviews) 5.0 (7 reviews)

Other Strategies for Sleep Apnea Treatment

BiPAP devices have been demonstrated to be effective at reducing sleep disruptions from sleep apnea. However, they don’t necessarily work for everyone. In addition, some people may find that the BiPAP mask is too uncomfortable or that the machine is too loud to be able to sleep soundly. Or a BiPAP could be too expensive for some people. For any number of reasons, you may be looking for other strategies for managing CSA, and in this section, we’ll review some of those strategies. Note that if you’ve been prescribed a BiPAP machine to use, it’s necessary to talk with your doctor about any alternatives before discontinuing the use of your BiPAP.

Treating underlying conditions

Central sleep apnea often occurs as a result of another medical issue. For example, if someone is taking strong doses of narcotic painkillers, these may affect the signals from the brain that control breathing. In that case, a treatment for CSA may be to adjust or reduce the dosage of those painkillers. If you are diagnosed with CSA, you can ask your doctor if there is a known underlying condition, and if so, can work with your doctor on developing a treatment plan for that condition.

Medications

Some drugs can be used to try to stimulate breathing, and if you’ve been diagnosed with CSA, you can ask your doctor whether these might be appropriate for you. Examples include acetazolamide (Diamox) and theophylline (Theo-24).

Oxygen

Because CSA results in the body not getting sufficient oxygen, one way of trying to treat this condition is providing a person with supplemental oxygen. There are different ways of delivering oxygen to the lungs, but many of these are likely to require wearing a mask similar to those required when using a BiPAP.

Non-mask devices

If wearing a mask is too uncomfortable to make using a BiPAP an option, you can ask your doctor about whether Provent is an option for you. Provent is a small, disposable device that is inserted into the nostrils and kept there using a mild adhesive. Each Provent device has a micro-valve in the center that opens and closes as you inhale and exhale. The valve creates pressure that can help maintain an open airway. The benefit of Provent is that it does not require wearing a mask, and the device itself is small and easy to use and travel with.

Provent has been approved by the FDA and shown in clinical trials to be a useful treatment for OSA. It is not regularly advertised or offered as a treatment for CSA although some research indicates it may be useful. Provent can only be used with a prescription, so it is necessary to talk to a health professional if this treatment is of potential interest to you.

Losing weight

Severe obesity can contribute to the risk of CSA, so weight loss may be a helpful lifestyle change for people with this condition. It can also help reduce OSA in people who are diagnosed with both conditions. That said, weight loss alone may be limited in addressing CSA especially without the use of other treatments.

Adjustable bed frames

An adjustable bed frame allows the top (and in some cases the bottom) of the mattress to be inclined. This can help hold the body up at an angle that helps reduce obstruction of the airway. This does not help address CSA, but for people who have OSA and CSA, the added tilt from an adjustable bed may help keep the airway open, especially for those who sleep on their back.

Pillows

As with adjustable bed frames, choosing better pillows can help some people who have both CSA and OSA. Getting more tilt to the neck by using proper pillows can reduce blockages of the airway that cause OSA.

Oral appliance therapy (OAT)

Oral appliance therapy (OAT) uses dental equipment to adjust how the mouth is positioned and can help prevent blockages of the airway. As with adjustable frames and pillows, this is more helpful for people who have OSA and CSA than people who have CSA alone. Even for people with OSA, OAT is usually not enough to resolve more severe cases, and in some cases, OAT may need to be used alongside a BiPAP or CPAP.

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