What is BiPAP therapy?

Bilevel positive airway pressure (BiPAP) therapy is often used in the treatment of chronic obstructive pulmonary disease (COPD). COPD is an umbrella term for lung and respiratory diseases that make breathing difficult.

Initially, the therapy was only available as an in-patient treatment within hospitals. Now, it can be done at home.

Modern BiPAP machines are tabletop devices fitted with tubing and a mask. You simply put the mask over your nose and/or mouth to receive two levels of pressurized air. One pressure level is delivered when you inhale, and a lower pressure is delivered when you exhale.

BiPAP machines often feature a “smart” breath timer that adapts to your respiratory patterns. It automatically resets the level of pressurized air when needed to help keep your breathing level on target.

This therapy is a type of noninvasive ventilation (NIV). That’s because BiPAP therapy doesn’t require a surgical procedure, such as intubation or tracheotomy.

Keep reading to learn how this therapy helps manage COPD and how it compares to other treatment options.

If you have COPD, your breathing is likely labored. Shortness of breath and wheezing are common symptoms of COPD, and these symptoms can worsen as the condition progresses.

BiPAP therapy targets these dysfunctional breathing patterns. By having a custom air pressure for when you inhale and a second custom air pressure when you exhale, the machine is able to provide relief to your overworked lungs and chest wall muscles.

This therapy was originally used to treat sleep apnea, and for good reason. When you’re sleeping, your body relies on your central nervous system to lead the breathing process. If you’re resting in a reclined position, you experience more resistance when breathing.

Depending on your individual needs, BiPAP therapy can take place when you’re awake or asleep. Daytime use can limit social interactions, among other things, but may be necessary in certain situations.

Typically, you’ll use a BiPAP machine at night to help keep your airways open while you’re sleeping. This aids the exchange of oxygen with carbon dioxide, making it easier for you to breathe.

For people with COPD, this means less labored breathing during the night. The pressure in your airway encourages a steady flow of oxygen. This allows your lungs to more efficiently transport oxygen to your body and remove excess carbon dioxide.

Research has shown that for people who have COPD and higher carbon dioxide levels, regular nighttime BiPAP use can improve quality of life and breathlessness, and increase long-term survival.

The most common side effects of BiPAP therapy include:

If your mask is loose, you may also experience a mask air leak. This can keep the machine from maintaining the prescribed pressure. If this happens, it can affect your breathing.

To prevent an air leak from happening, it’s crucial that you purchase a mask properly fitted to your mouth, nose, or both. After you put the mask on, run your fingers over the edges to ensure that it’s “sealed” and fitted to your face.

Complications from BiPAP are rare, but BiPAP isn’t an appropriate treatment for all people with respiratory problems. The most concerning complications are related to worsening lung function or injury. Talk with your doctor about the individual risks and benefits you may have with BiPAP therapy. They can help you weigh your options and provide further guidance.

Continuous positive airway pressure (CPAP) is another type of NIV. As with BiPAP, CPAP expels pressurized air from a tabletop device.

The key difference is that CPAP delivers only a single level of preset air pressure. The same continuous pressure is delivered during both inhalation and exhalation. This can make exhaling more difficult for some people.

The singular air pressure can help keep your airways open. But researchers found it isn’t as beneficial for people with COPD unless they also have obstructive sleep apnea.

BiPAP machines provide two different levels of air pressure, which makes breathing out easier than it is with a CPAP machine. For this reason, BiPAP is preferred for people with COPD. It lessens the work it takes to breathe, which is important in people with COPD who expend a lot of energy breathing.

CPAP has the same side effects as BiPAP.

BiPAP can also be used to treat sleep apnea, especially when CPAP hasn’t been helpful.

Although some researchers have hailed BiPAP as the best therapy for COPD, it isn’t your only option.

If you’ve already exhausted your list of potential lifestyle changes — and kicked the habit if you were a smoker — your updated treatment plan may include a combination of medications and oxygen therapies. Surgery is typically only performed as a last resort.


Depending on your needs, your doctor may recommend a short-acting or a long-acting bronchodilator or both. Bronchodilators help relax the muscles within your airways. This allows your airways to better open, making breathing easier.

This medication is administered through a nebulizer machine or an inhaler. These devices allow the medicine to go directly into your lungs.

In severe cases, your doctor may also prescribe an inhaled steroid to complement your bronchodilator. Steroids can help reduce inflammation in your airways.

Learn more: A list of medications to help relieve your COPD symptoms »

Oxygen therapy

Similar to BiPAP therapy, oxygen therapy often delivers oxygen to your lungs through a face mask. Oxygen may also be administered through tubes resting in your nose or a tube placed in your windpipe.

This oxygen is contained in a portable tank, which you must refill once levels become low. You can use oxygen therapy day or night, whenever is beneficial for you.

Unlike with BiPAP therapy, oxygen therapy only delivers a set level of oxygen. Oxygen from an oxygen tank isn’t customized to your individual needs, there isn’t any pressure applied to your airways, and the machine can’t adapt to your particular breathing patterns.


If you have severe symptoms and aren’t responding well to other therapies, your doctor may recommend surgery. This is usually a last resort.

Depending on your individual needs, your doctor may recommend:

  • bullectomy to remove bullae, which form over damaged air sacs, from the lungs
  • lung volume reduction to remove damaged lung tissue
  • lung transplant

Work with your doctor to figure out the best treatment plan for you. Your individual symptoms will help your doctor decide on therapies and make personalized recommendations.

Many people with COPD often find that sleeping is uncomfortable. In these cases, BiPAP could be the way to go. Your doctor may also recommend a combination of medication and oxygen therapies.

When exploring your options, ask your doctor:

  • What is the best therapy for me?
  • Are there any alternatives?
  • Will I need to use this daily, periodically? Is it a temporary or permanent solution?
  • What kinds of lifestyle changes can I make to improve my symptoms?
  • Will insurance or Medicare cover this?

Ultimately, the therapy you choose will depend on the effect that your lung function has on you and what methods will best get the air you need to your lungs.