BIPAP Buyers’ Guide: Which is the Best BIPAP Machine for you? 

This guide aims to clarify the principles of BiPAP therapy, outline practical considerations, and compare leading devices. The goal is to simplify selection and provide confidence that the chosen solution is both clinically appropriate and aligned with patient needs.

What is a BiPAP Machine?

A Bilevel Positive Airway Pressure (BiPAP) machine is a non-invasive ventilatory support device widely used in sleep and respiratory medicine. Unlike single-pressure systems, it delivers two distinct pressure levels: a higher inspiratory positive airway pressure (IPAP) during inhalation and a lower expiratory positive airway pressure (EPAP) during exhalation.

This two-level approach reduces the work of breathing, supports alveolar ventilation, and allows the respiratory muscles to rest while maintaining effective gas exchange. The result is improved oxygenation, reduced hypercapnia, and greater comfort for patients who struggle with constant positive pressure therapy.

It is important to emphasise that BiPAP is not simply a “stronger CPAP.” While Continuous Positive Airway Pressure is designed to keep the upper airway open, BiPAP provides active ventilatory assistance. This makes it particularly valuable in conditions where breathing effort itself is compromised, such as COPD with hypercapnia, obesity hypoventilation, neuromuscular weakness, or central sleep apnoea.

For clinicians, understanding this distinction ensures appropriate prescribing and optimised patient outcomes. For patients and carers, recognising why BiPAP may be recommended over CPAP helps reinforce confidence in the treatment plan and supports long-term adherence.

Conditions Treated

BiPAP therapy is indicated across a broad range of respiratory and sleep-related disorders. Its application varies from enhancing adherence in obstructive sleep apnoea to providing life-prolonging ventilatory support in neuromuscular disease. 

Obstructive Sleep Apnoea (OSA)

CPAP remains the first-line treatment for OSA, given its proven effectiveness in maintaining airway patency during sleep. However, a proportion of patients are unable to tolerate the constant pressure it delivers. Common complaints include difficulty exhaling, a sensation of suffocation, or discomfort at higher therapeutic pressures. AIHW

BiPAP provides relief by delivering a lower expiratory pressure, making breathing feel more natural. This reduction in expiratory resistance improves tolerance and adherence, which in turn restores treatment efficacy. For patients who abandon CPAP due to intolerance, escalation to BiPAP often represents the difference between untreated disease and sustained therapy. Clinically, this translates into reduced risks of hypertension, arrhythmia, stroke, and impaired daytime function.

Central Sleep Apnoea (CSA)

Unlike OSA, where the airway collapses, central apnoea is characterised by the absence of respiratory effort. The brain fails to trigger breathing, leading to repeated pauses in ventilation. Standard CPAP cannot address this mechanism.

BiPAP devices with advanced modes, such as adaptive servo-ventilation (ASV), compensate by initiating breaths during apnoeic events. These systems continuously monitor ventilation and adjust support dynamically, preventing prolonged hypoventilation. In patients with Cheyne–Stokes respiration or those with heart failure, ASV has demonstrated improvements in sleep stability, nocturnal oxygenation, and quality of life.

Clinically, this technology reduces arousals, alleviates sympathetic overdrive, and can contribute to stabilisation of left ventricular function. Correctly identifying central apnoea is therefore essential, as BiPAP may be the only effective option for these patients. Cochrane

Chronic Obstructive Pulmonary Disease (COPD)

The role of BiPAP in COPD is well established across both acute and chronic care. During acute exacerbations with hypercapnic respiratory failure, non-invasive ventilation reduces intubation rates, shortens ICU stays, and improves survival. BiPAP lowers the work of breathing, reduces dynamic hyperinflation, and improves alveolar ventilation, making it a cornerstone of emergency management.

In chronic, stable COPD with persistent hypercapnia, long-term nocturnal BiPAP has been shown to improve survival, reduce hospital admissions, and enhance exercise tolerance. Patients often experience fewer exacerbations, improved sleep quality, and better overall function. From a health system perspective, regular nocturnal BiPAP reduces readmission rates and alleviates demand on critical care resources.JAMA

Obesity Hypoventilation Syndrome (OHS)

OHS is characterised by chronic hypercapnia in obese individuals, typically accompanied by sleep-disordered breathing. Symptoms include morning headaches, persistent fatigue, and hypersomnolence. Untreated, OHS carries significant morbidity, progressing to pulmonary hypertension, cor pulmonale, and premature mortality.

BiPAP reduces nocturnal carbon dioxide retention by supporting ventilation and decreasing the workload of the respiratory muscles. Over time, this prevents the sequelae of chronic hypoventilation, improves oxygenation, and alleviates daytime somnolence. Patients frequently report rapid improvements in alertness and cognitive function, reinforcing adherence. Clinicians should prioritise early recognition and treatment, as delayed intervention allows irreversible complications to develop. Sleep Medicine

Neuromuscular Disorders

In conditions such as motor neurone disease, muscular dystrophy, or spinal muscular atrophy, respiratory failure develops as inspiratory and expiratory muscle strength declines. BiPAP provides essential ventilatory support, compensating for weakened muscles and maintaining adequate alveolar ventilation.

The aim is not crisis management but preservation of quality of life and survival. Early initiation, before advanced respiratory failure, improves tolerance and allows patients to adapt gradually. This approach prolongs independence, reduces hospitalisations, and supports meaningful activities such as communication, nutrition, and mobility. Frontiers

For families and carers, BiPAP can significantly reduce the burden of care, as stabilised breathing patterns improve sleep quality for both patients and households. For clinicians, proactive initiation represents best practice in palliative and supportive respiratory care.

Acute or Chronic Type 2 Respiratory Failure

BiPAP plays a pivotal role in both acute and chronic type 2 respiratory failure. In the acute setting, it rapidly corrects hypercapnia and reduces the work of breathing, frequently avoiding the need for invasive ventilation. Early initiation in the emergency department or ward setting is associated with improved survival and shorter hospital stays.

In chronic type 2 respiratory failure, particularly when secondary to advanced COPD or OHS, nocturnal BiPAP stabilises blood gases and reduces symptom burden. Regular use lowers the risk of recurrent hospitalisation and prevents gradual deterioration. Long-term adherence requires careful follow-up, with adjustments to pressure settings and modes as the underlying condition evolves. Agency for Clinical Innovation

Modes of BiPAP

Modern BiPAP devices are equipped with a variety of modes designed to meet the diverse needs of patients. Selecting the appropriate mode is a clinical decision that must take into account the underlying condition, the patient’s ability to generate spontaneous breaths, and the therapeutic objectives. The goal is not to use “more features,” but to align the mode with the patient’s physiology and clinical context. SpringerLink

Spontaneous (S) Mode

In spontaneous mode, the device senses when the patient initiates a breath and delivers inspiratory pressure support accordingly. Exhalation then occurs against the lower expiratory pressure. This mode is best suited for patients with an intact and reliable respiratory drive who require assistance in overcoming airway obstruction or respiratory muscle fatigue.

Clinical example: Patients with obesity hypoventilation syndrome or obstructive sleep apnoea who cannot tolerate CPAP often benefit from spontaneous mode, as it provides ventilatory support without overriding their natural breathing rhythm.

Timed (T) Mode

In timed mode, the device delivers breaths at a preset respiratory rate, regardless of whether the patient initiates inspiration. This ensures consistent ventilation even if the patient’s spontaneous effort is absent.

Clinical application: Timed mode is particularly useful in advanced neuromuscular disorders, where progressive weakness leads to unreliable or absent spontaneous breathing. It provides a safety net by guaranteeing a minimum level of ventilation.

Spontaneous/Timed (S/T) Mode

The S/T mode combines the benefits of both spontaneous and timed operation. The device allows the patient to breathe independently but intervenes with a backup rate if spontaneous effort falls below the set threshold. This ensures that apnoeas or prolonged pauses do not compromise gas exchange.

Clinical application: This mode is commonly used in central sleep apnoea, where patients may have irregular or absent respiratory drive during the night. It is also valuable in conditions where respiratory effort fluctuates, providing both flexibility and security.

Advanced Modes

• Volume-Assured Pressure Support (VAPS): Combines pressure support with a guaranteed minimum tidal volume, ensuring adequate ventilation even when respiratory effort varies.Indications: COPD with nocturnal hypoventilation, neuromuscular weakness.Advantage: Balances comfort with reliability by automatically adjusting pressure to achieve target volumes.
• Adaptive Servo-Ventilation (ASV): Continuously analyses breathing and dynamically adjusts support on a breath-by-breath basis.Indications: Central sleep apnoea, Cheyne–Stokes respiration, sleep-disordered breathing in heart failure.Advantage: Stabilises breathing patterns, reduces arousals, and improves sleep continuity.

Key Considerations in Mode Selection

• Underlying diagnosis – obstruction, impaired effort, or unstable breathing.
• Respiratory drive – intact, unreliable, or absent.
• Therapeutic goal – comfort, adherence, or life-sustaining ventilation.

A mode mismatched to physiology risks poor adherence, ineffective ventilation, or unnecessary complexity. Correct selection ensures both clinical effectiveness and patient confidence.

How it Works

BiPAP machines function by delivering pressurised air through a circuit and mask interface, providing two distinct pressure levels: a higher inspiratory positive airway pressure (IPAP) during inhalation and a lower expiratory positive airway pressure (EPAP) during exhalation. The inspiratory pressure reduces the muscular effort required to take a breath, while the lower expiratory pressure prevents airway collapse and maintains oxygenation. Together, these mechanisms support gas exchange, reduce hypercapnia, and decrease the overall workload of the respiratory system.

Masks and Fit

The effectiveness of BiPAP therapy depends heavily on mask fit. A poorly fitted mask can result in air leaks, which not only reduce therapeutic benefit but also disturb sleep and increase machine noise. Patients should be offered the opportunity to trial different interfaces—commonly nasal masks, oronasal (full-face) masks, and nasal pillows—to find the most comfortable and effective option.

Over-tightening straps should be avoided, as this often leads to facial pressure sores or skin breakdown. Clinicians should instead ensure the cushion is properly seated and straps are secure but comfortable.

Humidification

Heated humidification is frequently underestimated in its contribution to therapy success. Without humidification, patients commonly experience nasal dryness, sore throat, congestion, or airway irritation, particularly at higher pressures or in low-humidity environments. Incorporating a heated humidifier alleviates these problems, making therapy more comfortable and significantly improving adherence.

Cleaning and Maintenance

Routine cleaning and maintenance are essential for both hygiene and device longevity. Masks should be cleaned daily using mild soap and water, tubing rinsed and dried weekly, and filters replaced according to manufacturer guidelines. Providing patients with written or visual instructions at initiation greatly improves compliance with cleaning protocols.

Troubleshooting Common Issues

• Claustrophobia: Use gradual desensitisation, such as wearing the mask while awake for short periods.
• Aerophagia (air swallowing): Adjust pressures, enable pressure relief features, or switch mask type.
• Dryness or congestion: Add or optimise humidification.
• Noise: Most noise is leak-related; re-fit or change mask.

Difference between BIPAP and CPAP

BiPAP and CPAP machines are both forms of non-invasive ventilation, but their mechanisms and clinical applications differ in important ways. Sleep Apnea

Continuous Positive Airway Pressure (CPAP)

CPAP delivers a single, constant level of positive pressure throughout the breathing cycle. Its primary role is to splint open the upper airway, preventing collapse during sleep. This makes it the first-line therapy for obstructive sleep apnoea (OSA).

CPAP is effective in reducing apnoea–hypopnoea index scores, improving oxygenation, alleviating daytime somnolence, and lowering cardiovascular risk. Despite its efficacy, some patients find the constant pressure uncomfortable, particularly when high settings are required, or when exhalation feels difficult.

Bilevel Positive Airway Pressure (BiPAP)

BiPAP delivers two levels of pressure: a higher inspiratory positive airway pressure (IPAP) during inhalation and a lower expiratory positive airway pressure (EPAP) during exhalation. This dual-level system lowers the work of breathing, assists ventilation, and provides greater comfort.

BiPAP is particularly suited to patients with complex or advanced conditions such as COPD with hypercapnia, obesity hypoventilation syndrome, central sleep apnoea, or neuromuscular weakness. It is also an alternative for OSA patients unable to tolerate CPAP. JAMA

Clinical Perspective

CPAP is best regarded as a therapy for airway obstruction, while BiPAP extends beyond airway splinting to provide true ventilatory support. The flexibility of two pressure levels allows BiPAP to address a wider range of respiratory disorders.

Simplified Analogy

• CPAP: like a snorkel with constant airflow—effective at holding the airway open, but fixed in pressure.
• BiPAP: like having assistance with both inhalation and exhalation—supporting ventilation as well as airway patency

How to choose the right BIPAP Machine

Selecting the right BiPAP machine requires more than a quick comparison of models. It is a structured clinical process that begins with accurate diagnosis, continues with a clear prescription, and extends through careful setup and follow-up. When done well, this approach ensures therapy is safe, effective, and sustainable in the long term.

Clinical Indication

The starting point is the patient’s underlying diagnosis. The nature of the condition determines not only whether BiPAP is indicated but also which features are essential. 

• COPD or type 2 respiratory failure: Devices with integrated alarms, backup respiratory rates, and volume-assured ventilation provide both safety and stability. Agency for Clinical Innovation
• Neuromuscular disorders: Machines that offer advanced modes, such as volume-assured pressure support, are critical to deliver consistent ventilation as muscle strength fluctuates.
• Obstructive sleep apnoea (OSA): In cases where CPAP is not tolerated, simpler BiPAP models may be sufficient, provided ventilatory failure is not present.

Diagnostic Assessment and Prescription

Before prescribing, a comprehensive diagnostic assessment is mandatory. This typically includes polysomnography to evaluate apnoea severity, spirometry to assess lung mechanics, and arterial blood gases to confirm hypercapnia or hypoxaemia. These investigations ensure BiPAP is clinically justified and guide the prescription. MBS Australia

A high-quality prescription should specify:

• Inspiratory and expiratory pressures (IPAP and EPAP) based on the patient’s ventilatory needs.
• Backup respiratory rate where there is a risk of apnoea or hypoventilation.
• Mode selection, from spontaneous or spontaneous/timed to advanced settings such as volume-assured pressure support or adaptive servo-ventilation.

The prescription should be clear, evidence-based, and aligned with local and international guidelines. JCSM

Budget and Funding

Financial considerations play a significant role. Entry-level devices can provide safe and effective therapy but may lack advanced monitoring or adaptive modes. Higher-end machines offer broader functionality, designed for complex or progressive conditions. Clinicians should weigh medical necessity against cost, factoring in government schemes, insurance rebates, or hospital support programs where available.

Comfort and Usability

Even the most advanced machine will fail if the patient cannot tolerate it. Features such as low operating noise, easy-to-navigate menus, ramp functions that gradually build to therapeutic pressure, and comfortable mask interfaces are all central to adherence. Patient comfort should be seen not as an optional extra but as an integral part of effective therapy.

Setup and Initiation

Once prescribed, BiPAP therapy should be introduced under the supervision of a trained sleep or respiratory technician. Key steps include: AAST

• Mask fitting, ensuring both comfort and an adequate seal.
• Humidifier adjustment, preventing dryness, congestion, or airway irritation.
• Patient education, covering device use, cleaning, and troubleshooting common issues.
• Initial monitoring, to confirm correct function and patient tolerance.

Connectivity and Monitoring

Modern devices frequently include remote monitoring functions. These allow clinicians to review adherence data, detect leaks, and adjust settings without requiring repeated clinic visits. This is particularly beneficial for patients in rural areas or with limited mobility, where face-to-face follow-up may be difficult.

Mask Compatibility

Because the mask is the point of contact between patient and machine, compatibility is crucial. Having access to a range of mask types (nasal, oronasal, or nasal pillows) allows adjustments if leaks, discomfort, or skin breakdown occur. A flexible approach reduces troubleshooting time and helps sustain therapy over months and years.

Follow-Up and Oversight

Follow-up should occur within the first days to weeks of therapy, allowing pressures, masks, and humidification to be fine-tuned. Long-term oversight by GPs and specialists ensures that therapy remains effective as the patient’s condition changes. Regular reviews also reinforce adherence and provide an opportunity to address practical barriers before they result in abandonment of therapy. RACGP Lancet

Common Pitfalls

Three recurring errors undermine BiPAP therapy:

1. Prescribing without structured follow-up, leading to poor adherence.
2. Inadequate mask fitting, resulting in leaks, discomfort, and loss of efficacy.
3. Neglecting humidification, one of the most common and easily preventable causes of treatment failure.

ResMed BIPAP Overview

Löwenstein BIPAP Overview

BMC BIPAP Overview

Philips BIPAP Overview

Our Top Picks for BiPAP Machines

The following devices are frequently selected for their performance across different patient groups and clinical contexts. Rankings are presented to illustrate relative strengths in overall function, feature set, and affordability.

Best Overall

• ResMed AirCurve 10 CS PaceWave – Widely used in complex sleep apnoea and Cheyne–Stokes respiration; adaptive servo-ventilation provides responsive support.
• ResMed Lumis 150 VPAP ST-A 4G – Suitable for patients requiring advanced ventilation with backup rates and hospital-grade monitoring.
• Löwenstein Prisma CR – Commonly employed in hospital settings for patients with central sleep apnoea or unstable breathing patterns.
• BMC G3 B30VT – Provides volume-assured pressure support at a more accessible price point, making it a practical option for broader use.
• Philips DreamStation Auto BiPAP + Cellular – Combines auto-adjusting support with remote monitoring, suited for patients who value comfort and connectivity.

Best Features

• ResMed AirCurve 10 CS PaceWave – Incorporates adaptive servo-ventilation with dynamic adjustment to irregular breathing.
• ResMed Lumis 150 VPAP ST-A 4G – Offers intelligent backup rates and volume-assured pressure support for patients with more complex requirements.
• Löwenstein Prisma 30 ST – Multi-mode ventilation with integrated alarms and humidification, providing versatility in clinical use.
• Philips DreamStation Auto BiPAP + Cellular – Compact device with remote data reporting, making follow-up more convenient.
• BMC G3 B30VT – Delivers a broad feature set, including volume assurance, at a mid-range cost.

Best Budget

• BMC G3 B20A – Entry-level device offering spontaneous mode with integrated humidification.
• BMC G3 B25A – Adds spontaneous/timed mode for patients needing a backup rate, while remaining affordable.
• Löwenstein Prisma 25 Auto – Auto-adjusting pressure system at a lower cost compared with advanced hospital-grade models.
• Philips DreamStation with Humidification – Comfort-focused option, providing integrated humidification without premium pricing.
• ResMed Lumis 100 VPAP S 4G – Streamlined device suitable for CPAP-intolerant OSA patients requiring bilevel support.

Conclusion: 

Choosing the right BiPAP machine is not only a matter of clinical matching but also of ensuring patients and clinicians have the right support throughout the process. The device must provide effective ventilation, promote adherence, and remain sustainable in everyday life. When these elements are aligned, BiPAP therapy becomes more than equipment—it becomes a reliable tool for long-term health and independence.

For healthcare professionals, prescribing BiPAP carries both technical and therapeutic responsibility. The prescription defines pressures, modes, and safety features, but outcomes depend on proper setup, patient education, and structured follow-up. For patients and carers, reassurance comes from knowing that support is available at every stage—from choosing the right machine, to learning how to use it, to ongoing monitoring that ensures therapy remains effective.

To make this pathway seamless, BiPAP machines can be obtained either directly through our website or via our clinic. In both scenarios, trained sleep technicians complete the initial setup based on the detailed prescription provided by the treating physician. This ensures that therapy begins safely and correctly. Where appropriate, clinicians can be granted access to the device’s cloud portal, allowing them to remotely review adherence, monitor sleep data, and adjust settings without requiring patients to travel. This is particularly valuable for those in rural areas or with limited mobility. JCSM

Affordability remains a key consideration. By combining expert setup, physician access to cloud monitoring, and the guarantee of the lowest available price, patients and clinicians can be confident that therapy is both clinically effective and economically sustainable.

Ultimately, BiPAP therapy is about restoring energy, improving sleep, and reducing the burden of disease. With the right prescription, professional setup, remote monitoring, and cost certainty, the chosen device becomes not just equipment but a bridge between illness and wellbeing, between limitation and renewed possibility.