From the Guidelines
BiPAP and CPAP are both non-invasive ventilation devices used to treat breathing disorders, but they function differently, with CPAP delivering a single, constant air pressure and BiPAP providing two different pressure levels, and the choice between them should be based on the individual patient's needs and tolerance, with CPAP being suggested over BiPAP for routine treatment of obstructive sleep apnea (OSA) in adults, as stated in the 2019 American Academy of Sleep Medicine clinical practice guideline 1. The main difference between BiPAP and CPAP lies in their pressure delivery systems. CPAP delivers a single fixed pressure throughout the breathing cycle, making it simpler and primarily used for obstructive sleep apnea. BiPAP, on the other hand, provides two different pressure levels - a higher pressure during inhalation (IPAP) and a lower pressure during exhalation (EPAP), making it more comfortable for some patients and better suited for conditions requiring greater breathing support, such as COPD, congestive heart failure, and central sleep apnea. Some key points to consider when choosing between BiPAP and CPAP include:
- The pressure settings for CPAP usually range from 4-20 cmH2O, while BiPAP settings might include an IPAP of 8-25 cmH2O and an EPAP of 4-10 cmH2O, as noted in the clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea 1.
- BiPAP is typically prescribed when patients cannot tolerate CPAP or have more complex respiratory needs, and the decision to use BiPAP should be based on the clinician's judgement and the individual patient's needs, as stated in the 2019 clinical practice guideline 1.
- The potential benefits of BiPAP over CPAP include improved comfort and increased adherence, but the overall quality of evidence for this recommendation is very low due to publication bias and imprecision associated with small sample size, as noted in the treatment of adult obstructive sleep apnea with positive airway pressure guideline 1.
- The American Academy of Sleep Medicine suggests that clinicians use CPAP or APAP over BiPAP in the routine treatment of OSA in adults, unless the patient requires higher therapeutic pressure requirements or has previously failed CPAP or APAP, as stated in the 2019 clinical practice guideline 1.
From the Research
Overview of BiPAP and CPAP
- BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) are both used to treat obstructive sleep apnea (OSA) and other respiratory conditions.
- The main difference between BiPAP and CPAP is the type of air pressure delivered to the patient 2, 3.
Key Differences
- CPAP delivers a constant stream of air pressure into the airways to keep them open during sleep.
- BiPAP, on the other hand, delivers two different levels of air pressure: a higher pressure when the patient inhales and a lower pressure when the patient exhales 3, 4.
- BiPAP is often used for patients who have difficulty tolerating the constant pressure of CPAP or who have other respiratory conditions such as chronic obstructive pulmonary disease (COPD) 2, 5.
Treatment Outcomes
- Studies have shown that BiPAP can be effective in treating OSA and improving sleep quality, especially for patients who are nonadherent to CPAP therapy 4, 6.
- However, BiPAP may not always be superior to CPAP, and the choice of device depends on individual patient needs and preferences 3, 5.