CPAP/BiPAP Therapy

Doctors prescribe CPAP or BiPAP when a patient's airway repeatedly closes or when the breathing muscles cannot sustain enough ventilation (the movement of air in and out of the lungs) on their own.

• Obstructive sleep apnea: the most common reason, where the throat muscles relax and block the airway during sleep.
• Central sleep apnea: the brain fails to send the correct signals to the breathing muscles.
• Obesity hypoventilation syndrome: excess weight around the chest makes breathing shallow and slow, especially at night.
• Chronic obstructive pulmonary disease (COPD): a group of lung diseases, including chronic bronchitis and emphysema, that make it hard to move air out of the lungs.
• Acute respiratory failure: when the lungs suddenly cannot keep up with the body's oxygen and carbon dioxide needs, BiPAP is sometimes used as an alternative to a breathing tube.

CPAP and BiPAP are among the safer treatments in respiratory medicine, and serious complications are uncommon, but patients do experience a range of manageable side effects.

• Mask discomfort or pressure sores: the mask can leave marks or cause soreness on the nose, cheeks, or bridge of the nose, especially with poor fit.
• Dry nose and throat: the pressurised air can dry out the mucous membranes (the moist lining of the nose and throat); most machines have a built-in humidifier to reduce this.
• Nasal congestion or runny nose: some patients develop increased mucus in response to the airflow.
• Claustrophobia: some patients feel anxious or trapped when wearing the mask, particularly at first.
• Aerophagia (swallowing air): pressurised air can enter the stomach, causing bloating and discomfort.

For long-term home use, preparation focuses on the diagnostic work that leads to the prescription and on learning to use the device correctly. For in-hospital use during an acute illness, the clinical team handles most of the setup.

Before a CPAP or BiPAP machine is prescribed for home use, a sleep study (polysomnography, an overnight test that records brain activity, breathing, and oxygen levels) is usually required to confirm the diagnosis and measure how severe the problem is. Blood tests and lung function tests (spirometry, which measures how much air you can move) may also be requested. There is no fasting required for the sleep study itself, though some sleep centres ask patients to avoid caffeine and alcohol on the night of the test.

Patients who already take medications for blood pressure, heart conditions, or sleep should tell their doctor, as these can interact with sleep apnea or affect pressure settings. No medications are routinely paused for this therapy.

Once therapy is approved, the steps typically run as follows.

• A respiratory therapist or nurse fits the patient with the correct mask type, which may be a nasal pillow (small inserts that sit at the nostrils), a nasal mask covering just the nose, or a full-face mask covering nose and mouth.
• The machine is programmed to the pressure level determined by the sleep study or by a titration night (a second overnight study where pressure is adjusted in real time until the right level is found).

For most patients using CPAP or BiPAP at home, there is no recovery period in the traditional sense; the main work is building the habit of using the device every night and keeping it clean. Patients hospitalised for acute respiratory failure who were on BiPAP are typically monitored closely before being moved to a general ward or discharged.

• Use the device every time you sleep, including naps, to get the full benefit. Partial use is significantly less effective.
• Clean the mask cushion and headgear daily with mild soap and warm water to prevent skin irritation and infection.
• Clean the tubing and humidifier chamber weekly, or as directed by the manufacturer.
• Replace mask parts, tubing, and filters on the schedule recommended by the device supplier, as worn parts reduce the seal and therapy effectiveness.
• Keep a record of any symptoms that persist, such as snoring, morning headaches (which can signal low oxygen overnight), or daytime sleepiness, and bring these to your follow-up appointment.

The cost of CPAP or BiPAP therapy varies considerably depending on whether the patient needs a short hospital-based course of treatment or a long-term home device, and on a range of clinical and logistical factors.

• Type of device: a fixed-pressure CPAP machine is generally less expensive than an auto-adjusting APAP (automatic positive airway pressure) machine or a BiPAP unit, and BiPAP machines with backup rate features for neuromuscular disease cost more still.
• Mask type and accessories: full-face masks, heated tubing, and integrated humidifiers each add to the upfront cost, as do replacement parts over time.
• Diagnostic testing: the sleep study required before prescription, whether done in a laboratory or with a home sleep test, is usually billed separately from the device itself.
• Hospital class and country: the same device titration (pressure-setting process) can cost very differently at a private specialist sleep centre compared with a public hospital.
• In-hospital BiPAP for acute illness: costs are shaped by the length of time on the machine, the ward or ICU level of care, monitoring equipment, and any concurrent treatments for the underlying condition.