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man with BiPap machine

BiPAP: Helping You Live Longer & Better with COPD

People with severe COPD are now living better and longer than ever before. One reason for this accomplishment is the use of BiPAP both in hospitals and at home.

So, what is BiPAP, and how might it benefit you?

Here’s what you need to know:

What is BiPAP?

It’s an acronym for Bilevel Positive Airway Pressure. Like CPAP (continuous positive airway pressure), It’s a form of Non-invasive Ventilation (NIV), meaning the pressure is applied by wearing a mask. The mask is connected to tubing that is connected to a machine. Like CPAP machines, BiPAP machines are small, easy to operate, and are relatively quiet. They offer pressure above what is in room air to help you breathe easier while sleeping or during flare-ups.

What’s the difference between CPAP and BiPAP?

CPAP applies a continuous pressure during inhalation and exhalation. This pressure acts as a “splint” to keep airways open when you exhale. This prevents soft tissue in your upper airway from collapsing and causing sleep apnea. It also keeps alveoli open so the next breath comes easier (kind of like blowing up a balloon that has already been blown up a few times). This helps keep your oxygen levels from dropping while sleeping. CPAP also reduces blood return to your heart so it doesn’t have to work as hard to pump blood through your body. So, CPAP can also be useful for treating heart failure, which is diagnosed in about 20% of COPD patients.

On the other hand, BiPAP offers two different pressures, one during exhalation called EPAP, and another during inhalation called IPAP.

What is EPAP and IPAP?

These are the two pressures BiPAP machines offer.

  • EPAP. This is an acronym for Expiratory Positive Airway Pressure. It’s basically the same thing as CPAP, only it’s called EPAP when referring to BiPAP machines. The difference in name is not meant to be confusing. In fact, quite the opposite. It’s meant so that when you say “EPAP” people know you’re referring to BiPAP machines, and when you say “CPAP” people know you’re referring to CPAP machines. But, essentially, they are the same thing. So, everything I wrote about CPAP above applies with BiPAP too. What’s unique to BiPAP machines is they also provide IPAP.
  • IPAP. This is an acronym for Inspiratory Positive Airway Pressure. It’s basically a pressure to assist with inhalation. Sometimes it’s referred to as pressure support. It supports or assists your effort to inhale to assure you take in breaths deep enough to effectively oxygenate and blow off carbon dioxide (a waste product of cellular respiration). It reduces the work you have to do to inhale, thereby making each breath come easier.

What are the benefits of BiPAP?

Some people with COPD have trouble exhaling against the CPAP, especially when the required setting is high. So, the addition of an expiratory pressure makes exhaling easier.

Can I use BiPAP at home?

Like CPAP machines, BiPAP machines can be used in the home setting. It has to be prescribed by a doctor, and usually involves participating in a sleep study. It is usually only needed at night time, or when you are sleeping.

What does the research show about home BiPAP?

It has long been suspected that daily use of BiPAP while sleeping improves the quality of life, and the length of life, for people living with severe COPD. Not only that, it also reduces hospital admissions due to flare-ups, and improves outcomes and reduces lengths of stays, for those who do require hospital admissions.

Is BiPAP used in the hospital setting to treat COPD flare-ups?

Sometimes. If you come to the emergency room with an exacerbation of COPD, doctors might order for you to try BiPAP. This works great for COPD exacerbations because it reduces the work you have to do to inhale, thereby making breathing easier. It also allows your muscles of inspiration and heart to relax, thereby preventing you from pooping out. This buys time for your caregivers to work their medicinal magic to get you feeling better.  As noted above, BiPAP can help both improve your oxygenation levels and normalize your carbon dioxide levels. So, it is a very nice tool for treating COPD in the clinical setting.

What do the studies show about hospital BiPAP?

Studies show that using BiPAP for those presenting to emergency rooms with severe COPD flare-ups significantly reduces the need for more invasive therapies, such as intubation and mechanical ventilation. It greatly improves outcomes and reduces the length of hospital admissions for those with COPD.

Will I tolerate home BiPAP?

While it may feel a little awkward at first, modern advancements in BiPAP therapy have greatly improved ease of use and comfort for patients.  In other words, improvements have greatly improved patient compliance.


Not every person with COPD needs BiPAP, and most certainly not every person who would benefit from it will tolerate it. However, for those who do, there is increasing evidence to show that BiPAP may help people with COPD live well for a long time.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Kacmarek, Robert M., James K. Stoller, Albert J. Heuer, “Egan’s Fundamentals of Respiratory Care,” 10th edition, 2013, Elsevier Mosby, pages 1134-5
  2. “Non-Invasive Ventilation in COPD Exacerbations,” Nursing Times, September 3, 2013,
  3. Criner, Gerard J., Rodger E. Barnette, Gilbert E. D’Alonzo, editors, “Critical Care Study Guide: Text and Review,” 2nd edition, 2010, Springer
  4. Respiratory Therapy Magazine: Noninvasive BiPAP Systems May Help COPD Patients, January 28, 2015,, accessed 3/31/17
  5. Maclntyre, Neil R., “Mechanical Ventilation: Noninvasive Strategies in the Acute Care Setting,” Medscape,, accessed 3/31/17
  6. Ankjærgaard, Kasper Linde , et al., "Home Non Invasive Ventilation (NIV) treatment for COPD patients with a history of NIV-treated exacerbation a randomized, controlled, multi-center study," BMC Pulmonary Medicine, 2016,, accessed 4/1/17
  7. Respiratory Therapy Magazine: Nocturnal BiLevel Ventilation for the COPD patient," February 7, 2007, accessed 4/1/17
  8. Lainscak, Mitja, Stefan D. Anker, "Heart failure, chronic obstructive pulmonary disease, and asthma: numbers, facts, and challenges," ESC Heart Failure, volume 2, issue 3, 2015, pages 103-107,, accessed 4/2/17


  • sridhar babu
    1 month ago

    this information is more useful. if i want to buy BiPaP, where can i look for it. and how much it costs in indian Rupees.

  • Leon Lebowitz, BA, RRT moderator
    1 month ago

    Hi sridhar babu and thanks for your post. Glad to hear you found this article about BiPAP, by our own John Bottrell, to be so helfpul.
    Here in the USA, BiPAP is only available by prescription. A physician would be responsible for order the device for a patient and then oversee the care by providing the recommendations for settings. Does it work the same where you are?
    There are a wide range of BiPAP machines to choose from and the prices can vary as well. This can be from several hundred dollars to several thousand dollars and everything in between. I’m sorry I do not know how that converts to the Rupee monetary system.
    I do hope this brief reply has provided you with helpful information.
    Wishing you well,
    Leon (site moderator

  • HITE1955
    2 months ago

    I have to give “ WARREN “ ResMed S7 — VPAP III & “ KREED “ ResMed VPAP Auto S9 / S, BOTH BiPAP DEVICES for My OSA & COPD!!

    ResMed had a VPAP COPD S9, Model: Circa: 2013, since has been DISCONTINUED!!

  • PhylissD
    2 years ago

    I recently went to the ER when I was having an exacerbation of my COPD. After numerous IV doses of steroids and oxygen therapy, my oxygen levels continuously reverted to very low numbers. At this point, the Respiratory Therapist put me on a BiPAP machine. As my oxygen levels would drop after some time off the machine, they decided to admit me for 24 hour observation. During this time, I was treated every 4 hours with the BiPAP machine. I also continued to receive steroids, oxygen and nebulizer treatments. I truly believe that the BiPAP machine helped me avoid being intubated or put on another mechanical ventilator.

  • HITE1955
    2 months ago

    AMEEN!! @phylissd, I agree 100% Me too!!
    Never been in HOSPITAL for My Stage 3; COPD!! Just OXYGEN & NEBULIZER In 2015!!!! APAP In 2017, and than VPAP / BiPAP In 2018.

  • John Bottrell, RRT moderator author
    2 years ago

    Thanks for your comment. I am so happy to hear that BiPAP helped you avoid a ventilator. It is a great instrument that has helped so many with COPD avoid ventilators. I have seen it work many times. So, love hearing about another BiPAP success story. Thanks for sharing. John. Site Moderator.

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