Bilevel CPAP, or BiPAP, is a respiratory therapy system that delivers oxygen to the airways to promote normal breathing. CPAP machines are primarily for sleep apnea patients and must be prescribed by a doctor. Two-level CPAP systems have different pressure settings for inhaling and exhaling and are more expensive. Advanced systems have an S/T mode to force inhalation if the patient stops breathing during sleep.
Bilevel CPAP, also known as BiPAP, refers to a respiratory therapy system that delivers oxygen to the airways by mechanical means to promote a normal breathing pattern. In fact, CPAP stands for Continuous Positive Airway Pressure. CPAP machines are primarily intended for patients with obstructive or central sleep apnea for use during sleep and must be prescribed by a physician.
The doctor also determines the correct amount of air pressure to be exerted by the machine based on an overnight observation of the patient in a sleep laboratory and the results of a polysomnogram. This quantity is called the titrated pressure, which is measured in centimeters of water and expressed as cm H2O. This is the amount of compressed air that will be pushed by the CPAP machine through a tube connected to the patient’s nose via a mask. Most patients with sleep apnea respond to a pressure titrated between 6 and 14 cm H2O. However, some CPAP machines, including a two-level CPAP system, can exceed these levels by up to 30 cm H2O.
There is another distinction between regular CPAP machines and two-level CPAP systems. In the first, the patient is instructed to exhale against the same amount of titrated pressure used to force compressed air into the air passages. In other words, the rate of pressure remains the same with both events and the patient often has to work a bit to exhale against it. With bi-level CPAP systems, however, there are two titrated pressure settings, one for inhaling and one for exhaling, the latter being an exact setting. This is an adaptation of CPAP machines with C-Flex, which are very similar to regular CPCP systems but have an added feature that automatically reduces pressure slightly when the patient begins to exhale.
As you might expect, two-level CPAP systems are typically more expensive than regular CPAP machines. They also come with another set of terminology. For example, the titrated pressure setting for inhalation is referred to as inspiratory positive airway pressure, or IPAP. Similarly, the pressure setting for exhaling is known as expiratory positive airway pressure, or PEEP. The difference between IPAP and EPAP is called pressure support.
There have been recent advances in bilevel CPAP machines. These advanced systems have an S/T mode, which stands for “timed spontaneous”. Its purpose is to activate the machine to force inhalation in case the patient stops breathing for a certain period of time during sleep. This ensures that the patient receives the required number of breaths per minute to carry sufficient oxygen to the blood. In some cases, this feature may even save your life.
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