If you are one of the 3-7% of the population affected by sleep apnea, you may use a medical device with pressurized air to breathe better, sleep better, and feel better. Doctors commonly prescribe a BPAP (BiPap or Bi-level positive airway pressure) for sleep apnea. A CPAP machine is another type of positive airway pressure device prescribed for sleep apnea. 

Depending on your comfort level and the type of sleep apnea you suffer from, your doctor may prescribe one over another. Let’s look at when BPAP is better than CPAP.

Sleep Apnea and CPAP

If you have mild to moderate sleep apnea, the gold standard of treatment is CPAP. Continuous positive air pressure machines work by keeping the positive air pressure the same while breathing in and out. 

A doctor sets your machine up at the pressure level that works best for your respiratory system. Pressure levels are sometimes also adjustable at home, depending on the device. You may feel more comfortable and get the therapeutic benefit of your CPAP at a low setting of 4, while someone else may need a positive pressure of 20.

When is BPAP preferred?

Sometimes patients don’t tolerate the same pressure well as they breathe in and out. When a patient finds it hard to breathe out against the positive air pressure, a doctor may prescribe a BiPap machine instead. 

BPAP adjusts itself to a higher pressure when you breathe in and a lower pressure when you breathe out. This dual pressure system helps some patients to feel more relaxed and less like they are fighting a machine to breathe. Often, insurance won’t cover a BPAP unless your doctor prescribes one for a medical reason.

A doctor often prescribes a BPAP machine for more serious sleep conditions. Someone suffering from severe complex sleep apnea may try a BPAP first instead of starting with a CPAP. Complex sleep apnea is more difficult to treat because it involves both central nervous system sleep apnea and obstructive sleep apnea. 

Patients with severe breathing issues may use a BPAP because the:

  • Pressure is adjustable
  • Pressure can go up to 25 (vs.20 with a CPAP). 

For a severely breathing-disabled patient, a BPAP may be the first line of defense.

How Do Positive Air Pressure Machines Work?

CPAP machines exert 4 to 20 cm H2O. This number is a measure of how much air pressure could move water in cm. 

The pressure level stays at the same setting with a CPAP whether you are breathing in or out. Air pressure for your inhalation and exhalation is the same. According to the Sleep Foundation, while CPAP machines have only one setting, some models now have sensors that allow for gentler air pressure on the exhale. Unlike the BPAP, you can’t set the exhalation pressure yourself on a CPAP. And, even when your doctor places the exhalation pressure lower, it is only slightly less than the overall pressure setting.

However, BPAP machines have two pressure settings:

  1. Inhalation positive airway pressure (IPAP)
  2. Exhalation positive airway pressure (EPAP)

These settings allow for lower pressure levels during exhalation. Depending on the BPAP machine’s settings, the switch between IPAP and EPAP may be timed or automatically based on the user’s breathing patterns. BPAP machines have a typical pressure range of 4 to 25 cm H2O. (1)

You may easily find CPAP machines designed for travel. However, BPAP use generally occurs at home. BPAP devices often cost you twice as much to purchase as CPAP, although your insurance may cover the entire cost.

BiPap Settings

BiPAP machines have up to three settings for switching between IPAP and EPAP: 

  • Spontaneous: senses the breathing pattern and switches between the two pressure levels when you naturally inhale and exhale. This setting is the standard for a BPAP. 
  • Timed: On this setting, you can program how long each IPAP and EPAP phase should last. Setting your BPAP on timed switching can help you take the correct number of breaths per minute.
  • Combination of spontaneous and timed: This setting follows your natural breathing patterns, but the timed IPAP and EPAP setting turns on when the machine senses you breathing below your set number of breaths per minute.

BPAP vs CPAP: Which is Best for You?

CPAP machines are less expensive and more often covered by insurance. CPAP may work well for you if you struggle with snoring from obstructive sleep apnea. However, if you go through an adjustment period with your CPAP and find that you cannot use it because it is too uncomfortable, talk with your doctor about your options. 

A BPAP machine is often a good choice if you cannot regularly use your CPAP or suffer from severe sleep apnea. Whatever treatment you use for sleep apnea, you must use it as directed to receive the benefits. If you don’t use your CPAP as you should, it is time to discuss your issues with your healthcare provider.

Issues to Talk Over with Your ENT Sleep Specialist

Sometimes you can fix issues with your CPAP. For example, you can use humidity to increase your tolerance with the machine. Or, a different type of mask could prevent you from pulling it off while sleeping. Sometimes heated tubing can make the experience with your CPAP more comfortable. Also, work with your doctor to adjust pressure settings to the lowest level that works best for you. 

Whether your doctor prescribes a BPAP or CPAP, continuous air pressure devices can make a significant difference if you suffer from sleep apnea. A whole new world of vitality and energy may open up for you with dedicated use. There are also cutting-edge treatments such as Inspire that an ENT doctor may implant to help you breathe without a mask or machine. Working with your healthcare team to find the best solution for you is the goal.

We Can Help

At Enticare, we work with you to find the best possible solutions for your sleep apnea. Our sleep specialists’ experience with treating sleep disorders means that we understand your struggle and how to find you the help you need. We want to enable a good night’s sleep for you again so that you wake up refreshed and feel energetic throughout each day. Contact us today and find out how we can help you. 




  1. Sleep Foundation 
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