Sleep apnea breathing machines

Different Types of Sleep Apnea Machines: CPAP, BiPAP, and APAP

If you’re new to the idea of having sleep apnea and treating it with some form of continuous positive airway pressure (CPAP), you may be confused by seeing different terminology for apnea treatment therapies on websites like this one. CPAP, BiPAP, and APAP, for example—what do all of these acronyms mean?

All three are forms of airway pressure therapy for obstructive sleep apnea (OSA). All three describe machines that, in conjunction with a CPAP mask and tubing, provide a gentle flow of pressurized, filtered air to keep your airway splinted open. All three use this air to keep obstructions from blocking your ability to breathe when you’re asleep.

However, the acronyms themselves stand for variations in how the air pressure is used to help keep your airway open and to assist sleep breathing.

The acronyms for the different types of sleep apnea machines, and what they stand for:

CPAP: Continuous Positive Airway Pressure. With CPAP, an air pressure level is prescribed by your physician, and this pressure maintains itself constantly, without variation, throughout the duration of your sleep.

You breathe in with the assistance of this pressure setting, and you exhale against this same pressure setting (if your mouth and nose are both covered by your mask, that is). CPAP remains the gold standard for treating OSA and is the most popular choice of apnea therapy machine.

BiPAP: Bi-level Positive Airway Pressure. As the name implies, a BiPAP machine offers two levels of airway pressure, so you can have two different settings. For example, your inspiratory setting, or the pressure level at which you inhale (called IPAP) can be set at a higher pressure than the pressure at which you exhale, a.k.a. your expiratory pressure setting (EPAP).

We’ll discuss why you might want BiPAP, or why your doctor may suggest it, below.

APAP: Automatic Airway Pressure. An APAP is automated to work within a pre-set pressure range. Your physician programs the machine for a high and a low pressure and the machine fluctuates between these throughout your sleep as needed. Read on for more details on why the APAP therapy option may be the right one for certain users.

CPAP: Why Choose Continuous Positive Airway Pressure Therapy?

If you have apnea, why choose a CPAP machine? If you snore or have the indications for obstructive sleep apnea or upper airway resistance syndrome, CPAP therapy may be a reasonable choice for you.

CPAP therapy can treat obstructive sleep apnea by keeping the airway open. If you have apnea, you likely have excess throat tissue that loses tone and relaxes during sleep, falling backward and blocking your ability to breathe. These moments when you gasp yourself awake to get a breath are called Apneas. Using a CPAP keeps your airway open throughout the night, preventing these Apnea events.

CPAP can also treat Upper Airway Resistance Syndrome (UARS). UARS is a precursor to obstructive sleep apnea. Instead of experiencing a full blockage, you have a reduction in your air intake because your airway is crowded due to a buildup of loose tissue. (Similar to the way arteries get clogged due to a buildup of plaques.)

You may not gasp yourself awake due to a total loss of oxygen, but you will experience labored breathing; your lungs need to work harder to suck in air as you sleep. And although you are breathing and taking in some oxygen, it may not be enough; sometimes your brain will wake you up anyway, so you can breathe more freely. Without treatment (CPAP or otherwise), UARS will usually progress into full-blown OSA.

If you’re an otherwise healthy individual with no history of lung or respiratory disease, and if your obstructive sleep apnea is moderate, CPAP is likely to be your first step when treating apnea. Most apnea patients who are prescribed an airway pressure therapy start here.

If you’re unable to tolerate CPAP for some reason, for example, due to difficulty exhaling against the continuous air pressure, your doctor may then look at alternatives: either BiPAP or APAP. For more on the .

BiPAP: Why Is Bi-level Pressure Helpful?

First, it’s important to note that “BiPAP” is a trademarked brand name for a Philips Respironics product; however, it’s become popular and many physicians and suppliers use the term as a generic. You may also see BPAP. Both acronyms are different terms for the same therapy: bilevel positive airway pressure therapy.

Why would someone with apnea require two airway pressure settings instead of one?

A lower expiratory setting is helpful if you have difficulty exhaling against the pressure setting you use to inhale. An example of when this might happen is if you have severe apnea and your inspiratory setting needs to be high in order to keep your airway open. If you wear a full face mask that goes over the mouth and nose, exhaling against such a high setting may be difficult.

Over time, not being able to exhale carbon dioxide can be as dangerous for your health as not being able to inhale enough oxygen. The CO2 can build up in your system, throwing off your blood gas levels and leading to severe health problems like organ damage. In the shorter term, having trouble exhaling may disturb your sleep and wake you up.

Other reasons a doctor may prescribe a BiPAP rather than CPAP include if you have breathing issues that may affect your ability to exhale against a higher air pressure. These include conditions like:

  • Central Sleep Apnea
  • COPD
  • Overlap Syndrome
  • Obesity Hypoventilation
  • Health condition with an obstructive or restrictive component that affects your breathing during sleep

For more on .

APAP: Advantages to Automated Pressure

Why might someone prefer to use, or need, an APAP, or apnea machine that offers automated pressure? An APAP machine (sometimes referred to as an “automatic” or “autoset” machine) uses computer algorithms to determine what air pressure you require at any given moment, depending on variables such as your body position or how your breathing changes during various sleep stages.

If you have sleep breathing patterns that vary over the course of the night, this type of therapy may be more comfortable for you.

While most people with Obstructive Sleep Apnea do fine with a CPAP, others may get better results with an APAP because the APAP may feel more like natural breathing. For example, you may prefer APAP if:

Your apnea events increase during REM sleep and decrease during other sleep stages. Some people need a higher air pressure during REM sleep only. If that high pressure remains high during other sleep stages when they don’t really need it, they may wake up due to discomfort. The APAP, with its automation, can adjust pressures accordingly.

You toss and turn during sleep. If you spend part of the night on your back and part on your side, your snoring and apnea events may change depending on position. You may need a higher inspiratory pressure when you’re on your back, due to gravity pulling the loose tissue downward toward the back of your throat.

When you’re on your side, your apnea events may decrease. The APAP can adjust the air pressure depending on your sleep position, so you don’t need to use the higher pressure at all times.

APAP is also a good choice for people who want to get started with therapy right away, without the delay of a titration study to determine the ideal single air pressure for their needs. Some users appreciate using an APAP or AutoSet machine because of its flexibility; whereas a CPAP cannot function like an APAP, an APAP machine can be set to perform like a CPAP, using a single continuous air pressure setting.


What’s the difference between a CPAP, BiPAP (BPAP) or APAP? All three help to open your airway and enable breathing. All three offer positive airway pressure to help reduce apnea events when you sleep. While CPAP is the standard therapy for most people with apnea, BiPAP and APAP may offer greater comfort if you have variable breathing patterns or respiratory conditions that make exhaling against a higher pressure uncomfortable.

David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the blog and has received formal training in CPAP machines, masks, and equipment.

The most common treatment for sleep apnea is positive airway pressure therapy, PAP. A PAP machine is usually about the size of a shoebox but can be smaller. A flexible tube connects the machine with a mask or other interface device that is worn over the nose and/or mouth. PAP works by pushing air through the airway passage at a pressure high enough to prevent apneas and can be prescribed for both obstructive and central sleep apnea. The pressure is set according to the patient’s sleep apnea.

Because PAP is a medical device, all PAP units must have Food and Drug Administration (FDA) approval before they can be sold. For the same reason, you must have a physician’s prescription in order to obtain a PAP. (In this publication, “PAP,” considered a generic term and not a brand name, can refer to any positive pressure device.)

There are several PAP manufacturers that offer different types of machines with different features. Once you have been diagnosed with sleep apnea and have been prescribed PAP therapy, you may be able to choose one machine among the many offered. A PAP, typically covered by insurance as a durable medical equipment benefit, is most often rented or purchased through a home health care company, also known as a durable medical equipment company. PAPs may also be purchased over the Internet. However, before buying a machine, it is generally a good idea to rent one first (on a rent-to-own plan if possible) for several weeks to make sure that the machine has all the features you need, and to determine if PAP is working as it should.

Talk to your doctor and your home care company representative about which machine is best for you and your lifestyle. Keep in mind the restrictions on cost and/or provider which your insurance company may impose. Some insurance companies will cover only certain types of PAP devices. In deciding which PAP machine to use, think about what features you want or need. Options include a carrying case, the ability to convert to foreign currents (automatically or with additional equipment), the capability to adjust for different altitudes, an attached heated humidifier, ramping (which allows for a gradual increase in pressure), DC (direct current) operations via a car or boat battery, and bright colors. Bi-level devices with two different pressures–one for inhalation and a lower pressure for exhalation–are also available. In addition, the Food and Drug Administration has approved some auto-adjusting devices for the market; these machines are designed to sense varying pressure needs as you sleep and to change the pressure automatically as needed. The latest type of machine to receive FDA approval is equivalent to a PAP with continuous or constant pressure for inhalation, but it has flexible lower exhalation levels. The exhalation pressure is determined partly by the machine, which responds to the user’s exhalation patterns, and partly by the user, who selects one of three settings.

More sophisticated machines with higher costs are not always automatically covered by insurance but may be covered with a specific physician prescription and documented failure to respond to standard PAP treatment.

Some machines can monitor how often you use the PAP, while others can also record if you had any apneas while using the machine (this can indicate a need to adjust the pressure). Your doctor may want to download this data periodically to verify the adequacy of your treatment, and the compliance monitor can also be an important feature if you need an objective verification that you are obtaining sufficient amounts of sound sleep. For the data to be downloaded, you may have to take the machine in to the sleep center or home care company. If the data are imbedded in a small, thin card, you may be able to take or to mail the card to the sleep center or home care company. You may be able to send the data via a telephone modem (supplied with the machine) that does not require Internet access.

In addition to the machine, you will need a mask or some type of interface. The mask fit is also critical to you. Again, talk to your doctor and home care company representative about your choice of interfaces, and keep in mind that the mask may be manufactured by one company and the PAP by another. For more on this topic, read “Choosing a Mask.” Participation in an A.W.A.K.E. support group for people with sleep apnea and their friends and family may also be helpful in adjusting to the PAP and mask. To learn if there is a group meeting in your area, contact the ASAA by calling 888-293-3650 or by sending an e-mail to [email protected]

Discover The Best Types Of CPAP Machines

You can also get a CPAP equipped with Bluetooth to record and track this information. It will correspond with an app on your smartphone making it easy to send reports to your doctor and instantly see your sleep data.

Air Filter

Your CPAP air filter is an essential part of both your personal health and the health of your machine. It helps to catch dust, pollen, allergens, and other contaminants that can cause lung function. Without an air filter, it becomes easier for these particles to collect inside of the machine where bacteria can collect and multiply.


A CPAP with humidifier can make a major difference when increasing comfort because it adds moisture to the ambient air drawn in from the room to make it easier to inhale. This helps you be able to breathe more comfortably without dry coughing or waking with a dry nose and mouth. Humidifiers can also heat the air, break up congestion, and reduce allergy symptoms.

Choose The Best CPAP

Picking the right CPAP machine is important for treatment compliance. It’s important to use your CPAP machine as prescribed to get full advantage of all of the benefits necessary to improve your health. Remember that looking at CPAP machine reviews can help you make an informed decision and take the time to read the manual to understand how your machine works before using it.

If you are struggling to decide which type of CPAP to get, we will be more than happy to help. Will will match you with the best CPAP for your budget and lifestyle.

Get started now!

“It’s like wearing shoes. You buy a new pair of shoes, they’re initially going to chafe or hurt you. Or a new pair of glasses — you become very conscious of them,” says Sairam Parthasarathy, MD, medical director of the Center for Sleep Disorders at the University of Arizona. “But after a while, it becomes second nature. You put it on without thinking.”

Noise: In the old days, CPAP machines were clunky and loud. Instead of a whoosh, it was more of a WHOOSH. Some made metallic, clicking sounds.

But that was then. Machines today are smaller, quieter, and much less noticeable. Many brands are near-silent. That’s a bonus not only to CPAP users, but to their bed partners too.

Pressure: Machines have different air pressure settings. Some of them vary it depending on whether you’re inhaling or exhaling. Your doctor will help you figure out the level that’s comfortable for you and helps you the most.

Dryness: Some CPAP users say all that forced air dries out the nose and mouth. Many machines have humidifiers to fix that. Some even heat the moist air.

Trouble breathing through your nose: If you feel stuffed up from allergies, sinus problems, or a physical issue with your nose, you may have trouble using a CPAP machine. But the problem usually goes away when you treat your congestion, whether with medicine, allergy treatments, or sometimes surgery.

“A lot of people have nasal obstruction or congestion and they don’t even know it.” Parthasarathy says. Treatment for those problems makes CPAP work much better for them.

What Is A Cpap Machine?

Everything you need to know about this sleep apnea treatment.

After being diagnosed with sleep apnea, there’s a chance that your doctor may give you a CPAP machine as a form of treatment. It’s a little more unusual than, say, popping a pill, so understanding how it works may answer any questions that you might have and/or ease any concerns.

Q: What is a CPAP Machine?

A: CPAP stands for continuous positive airway pressure. The machines help people with sleep apnea breathe more easily and regularly every night while they are sleeping. A CPAP machine increases the air pressure in your throat to prevent your airway from collapsing when you inhale. It also decreases snoring (which will help your partner snooze better at night, too!). The machine has a filter and small tank of water, which essentially works as a humidifier. There is a tube that connects the unit to a mask that you place over your face while you sleep, and a chin strap keeps it in place.

Q: What Type of CPAP Machine Will I Get?

A: Most have a mask that covers your nose and mouth, but other options include a mask that covers only your nose (called nasal continuous positive airway pressure, a.k.a. NCPAP), or prongs that fit into your nose. After your doctor prescribes CPAP, a home equipment provider will help you select the best option, and your doctor will decide the right machine settings. Your doctor may also recommend undergoing an overnight sleep study in a lab to help determine what, exactly, you will need from your CPAP machine. Adjustments can be made until you feel comfortable in it.

Q: What are the Benefits of Using a CPAP Machine?

A: Well, it’s the most effective nonsurgical treatment for sleep apnea, and it’s also the most popular. With use over time, it reduces daytime sleepiness, lowers blood pressure during the day and night, and reduces heart problems for those with heart disease.

Q: Are There any Side Effects?

A: Using a CPAP machine can potentially lead to a dry nose and sore throat, increased dreaming and nightmares, abdominal bloating, nasal congestion, sneezing, and irritation on the skin and in the eyes. It can also simply take time to simply feel comfortable sleeping with a mask on your face. However, if you don’t treat sleep apnea, the condition can have serious and sometimes fatal complications, including high blood pressure, stroke, heart disease, diabetes, depression, and car accidents due to drowsy driving. So be sure to weigh all the pros and cons with your doctor.

PAP Therapy

Is the PAP machine difficult to use?

It will take some time for you to get used to the new equipment and it may take a while for you to begin to feel the benefits of PAP therapy. If you are having problems adjusting to your machine, please contact us for help.

Frequently Asked Questions

What are the benefits of PAP therapy?
PAP therapy will increase your energy levels; improve your mental alertness, your mood, your quality of sleep, and your quality of life.

Is the PAP machine difficult to use?
It will take some time for you to get used to the new equipment and it may take a while for you to begin to feel the benefits of PAP therapy. If you are having problems adjusting to your machine, please contact us for help.

If I lose weight, will I cure my OSA?
That depends. Some people have shown decreased symptoms from OSA after losing weight and were removed from their PAP machine; others have not. However, if you are overweight, losing weight will always improve your health and decrease your risks of developing other health issues.

How long will I need to use this machine?
PAP therapy is just that—therapy. As long as you have OSA, you need to do something to improve your quality of sleep. Today, after many years of experimenting with surgeries, oral appliances, special bed pillows, etc, positive airway pressure is the gold standard for relieving and improving symptoms of OSA.

Is this covered by my insurance?
At CCHCS, upon receiving your PAP order, we contact your insurance company to verify that they will cover your machine. Based on your plan, you may have a co-payment every month or not. The insurance company also informs us at to how many months they will pay before the equipment is converted to a purchase.


The PAP-Nap is a daytime procedure offered to patients expressing resistance or hesitation toward the diagnosis of a sleep related breathing disorder and treatment with Positive Airway Pressure (PAP) therapy.

PAP therapy is improved with increased individual or group education, close clinical follow-up, sleep technologist/technician coaching, telephone calls, and objective data monitoring. The PAP-Nap is an abbreviated in-lab, cardio-respiratory recording which is attended by a technologist geared toward improving patients’ PAP compliance.

This procedure is offered as an adjunct option in the setting of PAP therapy and is intended for patients who suffer from sleep related breathing disorders and co-morbid conditions such as insomnia, anxiety, panic attacks, and claustrophobia.

The procedure itself can range from 60–180 minutes in length, during which the patient has individual coaching and counseling by a sleep technologist to overcome emotional or imagery barriers with PAP therapy and to desensitize the patient to masks and pressure sensations.

The patient is given the opportunity to sleep with PAP therapy after going through this desensitization period. The goal of this procedure is to expose and acclimate the patient to this therapy method which will then improve their overall compliance on a nightly basis when using PAP therapy at home.

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Continuous Positive Airway Pressure (CPAP) is the leading therapy for sleep apnea. Patients wear a face or nasal mask during sleep. The mask, connected to a pump, provides a positive flow of air into the nasal passages in order to keep the airway open. Most insurance companies now pay for sleep testing and for CPAP treatment.

Dental appliances can be prescribed for mild sleep disordered breathing, but they are not effective for everyone with OSA. Doctors recommend weight loss for overweight people who snore or have sleep apnea, since weight loss may eliminate or significantly improve breathing during sleep. However, people who are not overweight can also be afflicted with sleep apnea due to the structure and makeup of their upper airway.


The majority of people who use CPAP find immediate symptom relief and are delighted with their increased energy and mental sharpness during the day. Many patients have said, “CPAP changed my life!” But some patients find CPAP masks uncomfortable, even though it may control their sleep apnea. Many need extra assistance to get a mask that fits correctly. Side effects are usually mild and temporary, and include nasal congestion, sore eyes, headaches and abdominal bloating. Many people get used to CPAP over two-to-twelve weeks, and according to some research studies, less than one-half of CPAP patients discontinue treatment.

CPAP also provides a benefit for bed partners. According to a study published in Chest (Kiely and McNicholas, Vol. 111, 1997), many bed partners are driven away from the bedroom due to the harsh sounds of snoring and apnea, but CPAP silences these noises and the partner comes back to the bedroom.

Follow-up is the most important factor in patient compliance. Health professionals have advanced technology and compliance reporting tools available that allow them to help patients with CPAP treatment soon after they begin making use of it. These methods complement compliance when coupled with patient education and a positive first experience with CPAP.

5 Alternative Sleep Apnea Treatment Options

Key Takeaway:

  • If your patients don’t want to wear a CPAP mask, then you can try recommending alternative sleep apnea treatment options.
  • Five alternative sleep apnea treatment options include:
    • Wearing an oral/dental appliance to help prevent the airway from collapsing.
    • Getting surgery to potentially reduce or eliminate the extra tissue in your patient’s throat.
    • Undergoing a weight management program to potentially improve or eliminate your patient’s sleep apnea symtpoms.
    • Partaking in positional therapy to treat positional sleep apnea.
    • Considering changing some everyday habits, such as negative behavioral actions.

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