CPAP/BiPAP Therapy

CPAP/BiPAP therapy is a non-surgical breathing treatment that uses a mask and a small air-pressure machine to keep your airway open while you sleep or rest.

CPAP stands for Continuous Positive Airway Pressure — it delivers a steady, gentle stream of pressurised air through a mask worn over the nose or nose and mouth. BiPAP stands for Bilevel Positive Airway Pressure — it works the same way but delivers two different pressure levels: a higher one when you breathe in and a lower one when you breathe out, making it easier for people who find a constant pressure uncomfortable. Both devices stop the throat and upper airway from collapsing, which is what causes breathing to pause or become shallow during sleep.

Doctors prescribe CPAP or BiPAP most often for sleep-related breathing disorders, but BiPAP in particular is also used for certain lung and breathing-muscle conditions. The choice between CPAP and BiPAP depends on the underlying condition and how well the patient tolerates each device.

• Obstructive sleep apnoea (OSA) — repeated episodes where the throat partially or fully closes during sleep, causing the person to stop breathing briefly.
• Central sleep apnoea — a condition where the brain does not send the right signals to the breathing muscles during sleep.
• Obesity hypoventilation syndrome — when excess body weight makes breathing too shallow during sleep, causing a build-up of carbon dioxide in the blood.
• Chronic obstructive pulmonary disease (COPD) — a long-term lung disease that narrows the airways and makes it hard to breathe, especially at night.
• Neuromuscular diseases (conditions affecting the nerves and muscles used for breathing), such as muscular dystrophy or motor neurone disease.
• Respiratory failure — when the lungs cannot supply enough oxygen or remove enough carbon dioxide on their own, and the patient needs breathing support without a ventilator tube.
• Severe snoring or upper-airway resistance syndrome, when lifestyle measures have not been enough.

CPAP or BiPAP may not be suitable in some situations. A doctor will review each patient carefully before recommending the therapy.

• Patients who cannot tolerate a face mask due to severe claustrophobia (fear of enclosed spaces) or facial injuries.
• Certain types of chronic lung disease where positive pressure may worsen air trapping in the lungs.
• Patients with a recent facial, nasal, or skull-base surgery, until the surgical site has healed.
• Patients who are vomiting or have a significantly reduced level of consciousness, because of the risk of inhaling stomach contents.

CPAP and BiPAP are generally considered low-risk therapies because they do not involve surgery or injections, but some people do experience discomfort or side effects, particularly in the early weeks of use.

• Mask discomfort or pressure sores — the mask can feel tight and may leave red marks or small skin sores on the nose or face, especially at first.
• Dry or blocked nose and dry mouth — pressurised air can dry out the lining of the nose and throat; most machines have a built-in humidifier (a device that adds moisture to the air) to help.
• Aerophagia (swallowing air) — some people accidentally swallow air during therapy, leading to bloating, burping, or mild stomach discomfort.
• Nasal congestion or a runny nose — increased airflow can irritate the nasal passages.
• Difficulty breathing out against the pressure — more common with CPAP; BiPAP is often switched to if this becomes a problem.
• Claustrophobia or anxiety — wearing a mask over the face during sleep can feel uncomfortable for some people, particularly at the start.
• Noise from the device — modern machines are quiet, but the sound of airflow can disturb light sleepers or bed partners.
• In rare cases with BiPAP used for lung disease, incorrect pressure settings could worsen carbon dioxide levels — which is why settings are always determined by a specialist.

Unlike surgery, CPAP or BiPAP therapy usually does not require fasting or stopping medications beforehand. However, there are important steps a patient typically goes through before the first night of therapy begins.

Before starting therapy, doctors usually run one or more of these tests to confirm the diagnosis and choose the right device and pressure settings:

• Polysomnography (a sleep study) — an overnight test, usually done in a sleep clinic, where sensors monitor breathing, brain activity, heart rate, oxygen levels, and body movement during sleep.
• Home sleep apnoea test — a simpler version of the sleep study that monitors breathing and oxygen levels at home; suitable for straightforward cases.
• Blood gas analysis — a blood test that measures oxygen and carbon dioxide levels in the blood; more common when BiPAP is being considered for a lung or muscle condition.
• Lung function tests — breathing tests that measure how well the lungs work; often done for patients with COPD or neuromuscular disease.
• Pulse oximetry (a clip placed on the finger to measure blood oxygen levels) — sometimes done overnight to screen for low oxygen during sleep.

Once the tests are done and therapy is recommended, here is what usually happens when the device is set up:

• 1. A respiratory therapist or specialist nurse fits different mask styles to find the one that seals well and feels comfortable on the patient's face.
• 2. The machine is programmed with a starting pressure based on the sleep study results. For some patients, an auto-adjusting machine is used that finds the right pressure on its own each night.
• 3. The patient practises wearing the mask and breathing with the machine switched on while still awake, so the sensation feels familiar before sleep.
• 4. The humidifier setting is adjusted to suit the patient's nose and throat comfort.
• 5. The patient — and where relevant, a family member or caregiver — is shown how to put on and remove the mask, how to clean it, and how to check that the machine is working correctly.
• 6. In some hospitals, a titration night (an overnight stay in the clinic where staff fine-tune the pressure settings while the patient sleeps) is arranged before the patient takes the machine home.

Patients are usually advised to avoid alcohol and sedatives (medicines that cause drowsiness) in the evening before a sleep study, as these can change natural breathing patterns and affect results. Smoking can worsen nasal congestion and throat inflammation, so doctors often advise patients to reduce or stop smoking as part of overall care.

Because CPAP and BiPAP are non-invasive (no cuts or needles), there is no surgical recovery period. Instead, aftercare focuses on helping the patient use the device consistently and comfortably every night, and on monitoring whether treatment is working.

• Nightly use: Doctors usually recommend wearing the mask for the full sleep period from the very beginning. Benefits — such as less daytime sleepiness and better concentration — often become noticeable after a few weeks of consistent use.
• Follow-up appointments: A review is usually scheduled within the first few weeks to check how well the patient is coping, adjust pressure settings if needed, and troubleshoot any discomfort with the mask or machine.
• Monitoring device data: Most modern CPAP and BiPAP machines store data about how many hours the device was used and whether breathing pauses are still occurring. The doctor reviews this data at follow-up visits.
• Mask and equipment cleaning: The mask, tubing, and water chamber of the humidifier need to be cleaned regularly — usually with mild soap and water — to prevent bacteria and mould from building up. The manufacturer's cleaning guide should be followed.
• Filter and part replacement: Filters, masks, and tubing have a lifespan and need replacing at intervals recommended by the equipment provider.
• Weight management: For patients whose sleep apnoea is related to excess weight, losing weight can reduce the pressure needed or, in some cases, mean the device is no longer required. Doctors guide this process over time.
• Avoiding alcohol and sedatives at night: These relax the muscles of the throat and can reduce the effectiveness of the therapy.
• Positional advice: Some patients are advised to avoid sleeping flat on their back, as this position tends to worsen airway collapse.
• Long-term use: For most conditions — especially obstructive sleep apnoea — CPAP or BiPAP is an ongoing therapy, not a short-term fix. Stopping the device usually means symptoms return. Any changes to therapy should be discussed with the treating doctor.