A bilevel machine, often called a BiPAP, is a prescription sleep therapy device that delivers two levels of positive airway pressure: a higher pressure when you breathe in (IPAP, inspiratory positive airway pressure) and a lower one when you breathe out (EPAP, expiratory positive airway pressure). The gap between the two is the pressure support. That two-pressure design makes exhaling feel easier than the single constant pressure of a CPAP, which is why a bilevel machine is often prescribed when standard CPAP is hard to tolerate or when higher pressures are needed.

CPAP vs BiPAP: what is different

A CPAP delivers one continuous pressure all night. A bilevel machine splits therapy into the higher IPAP and lower EPAP, so the work of breathing out is reduced. Your prescribing clinician decides which is right for you based on your sleep study. For a full side-by-side, read BiPAP vs CPAP: what is the difference and what is a BiPAP machine.

Bilevel therapy modes

Bilevel machines come in several modes, each set by your prescription:

• Auto-adjusting bilevel (VAuto): automatically adjusts both the inhale and exhale pressures within a prescribed range, for obstructive sleep apnea patients who need greater pressure support.
• ASV (adaptive servo-ventilation): a specialized mode for central and mixed apneas or periodic breathing, in addition to obstructive sleep apnea. ASV is not for everyone: it is contraindicated for certain patients with chronic heart failure, so it is prescribed only after specialist evaluation. See everything you need to know about ASV machines.
• ST and ST-A (spontaneous-timed): bilevel devices with a backup respiratory rate that delivers a timed breath if you do not breathe within a set interval, used for respiratory support under specialist care.

Who is prescribed a bilevel machine

Bilevel therapy is prescribed by a physician. It may be considered for people who cannot tolerate CPAP exhalation pressure, who need higher pressures, or who have certain conditions your clinician will assess, such as central or complex sleep apnea, COPD, or hypoventilation. Bilevel machines are a form of noninvasive ventilation and are prescription medical devices: we cannot diagnose or prescribe. If you are unsure whether bilevel therapy is right for you, talk to your sleep specialist or pulmonologist.

BiPAP machines we carry

Sleeplay stocks bilevel machines from ResMed and React Health, all prescription and all FDA-cleared:

• ResMed AirCurve 11 and AirCurve 10 VAuto: auto-adjusting bilevel for obstructive sleep apnea.
• ResMed AirCurve 11 and AirCurve 10 ASV: adaptive servo-ventilation.
• ResMed AirCurve 10 ST and ST-A: spontaneous-timed with a backup rate.
• React Health Luna G3 25A: a bilevel device for obstructive sleep apnea in adults, with pressures up to 25 cmH2O.

See each product page for full specifications.

Comfort and therapy data

The ResMed AirCurve models include an integrated HumidAir heated humidifier, with optional ClimateLine heated tubing to reduce dryness, plus a ramp feature that starts at a lower pressure while you fall asleep. AirCurve 11 machines connect by built-in cellular and Bluetooth to the myAir app; the React Health Luna G3 25A records therapy data to an SD card with an optional cellular module.

Buying a bilevel machine

A valid prescription is required to buy any BiPAP or bilevel machine in the US. These machines are FSA and HSA eligible. Insurance and Medicare may cover bilevel therapy, but coverage is criteria-based, so check with your provider. Bilevel machines generally cost more than CPAPs; see each product page for current pricing. To compare every therapy type, visit the CPAP Machines hub.