What is Bi-Level Ventilation?

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  • Originally Written By: N. Swensson
  • Revised By: C. Mitchell
  • Edited By: Angela B.
  • Last Modified Date: 17 March 2019
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Bi-level ventilation, often called bi-level positive airway pressure (BiPAP) ventilation, is a medical treatment that delivers oxygen to people through a fitted face mask. The mask is designed to keep the person’s airways open, as well as to deliver a controlled amount of air over a set amount of time. Machines in this category have a number of uses, but are perhaps most commonly prescribed in cases of sleep apnea or in the early stages of lung disease. In both of these instances the airways can collapse in on themselves, making breathing labored and difficult. BiPAP ventilators are typically considered “non-invasive” to the extent that they don’t actually interfere with the body’s internal workings, though patients often find that they can interfere with daily life since, in most cases, they involve not only a mask but also tubes and a sizable ventilator machine.

How Ventilators Work

There are typically three main parts to these devices: a face mask, tubing, and the actual ventilator machine, which often looks like a small computer console. The majority of the work of regulating and controlling airflow is done by the machine, but the air is actually delivered to the patient through the mask. Masks can usually be adjusted to fit individual faces, and they usually cover both the nose and mouth. They’re often secured with flexible straps, creating something of a seal.


The main goal of this apparatus is to automatically adjust the flow of air when a patient is inhaling and exhaling. In most cases, the ventilator machine will reduce airflow during a person’s exhale, which makes it easier for him or her to breathe normally. This is where the “bi-level” name comes from: there are two “levels” or airflow, one for the inhale and another for the exhale. The precise measurements of airflow can usually be adjusted and individualized depending on a person’s particular needs.

Primary Uses

Bi-level ventilation is very frequently used as a treatment for sleep apnea in adults and children both. Sleep apnea is a condition in which the brain may temporarily stop sending signals to the muscles that control breathing, which can cause a person to stop inhaling and exhaling for certain periods during sleep. It can be a symptom of brain damage or other illnesses, and can cause serious problems including death if left untreated. Sleep apnea patients usually use their ventilators during the night, but aren’t typically required to use them when they’re up and about in the daytime.

People who are using the devices for the treatment of certain lung conditions may have to wear the mask more regularly. BiPAP machines are fairly common in the treatment of chronic obstructive pulmonary disease, for instance, which is basically an inflammation of the lungs that is so severe it causes them to restrict or close off, which makes taking adequate breaths really difficult. In the early stages of the disease people may be benefited by spending a few hours a day on the machine, but as time wears on they may need to be on it more and more. The goal of the ventilation isn’t usually to cure problems, but rather to alleviate their symptoms as much as possible.

Comparing Different Options

Bi-level ventilation is often compared to constant positive airway pressure machines (CPAP), and the two are similar in many respects. Both are medically non-invasive, for instance, and both are also designed to be more or less independent. The biggest difference comes in terms of how the air is actually delivered. In a BiPAP situation, the air is regulated and usually reduced for the exhale, whereas in a CPAP mask it is kept constant no matter what. Medical experts often use the machines for pretty much the same conditions, though; a lot depends on individual needs and what feels comfortable.

Noninvasive ventilation of either type is most often used for patients who have some ability to breathe on their own or can go for periods of time without using the machine, and it works really well for this purpose. People who find that they need breathing regulation more or less constantly may be better served with a different, usually more invasive, sort of device.

Invasive ventilation is typically administered through a tracheotomy tube that is inserted directly into a patient's throat. This type of ventilation is usually appropriate for patients who are unable to breathe on their own and will need the ventilator permanently. People in these situations often don’t have to deal with bulky ventilator machines or the discomfort of strapping a mask onto their face, but there are other downsides.


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Post 2

@JaneAir - I'm glad bi-level ventilation has been helpful for your friend, despite the inconveniences.

It sounds like it would be kind of difficult to date when you have to use one of these things! I mean, you probably couldn't spend the night elsewhere because your machine would be at your house. Also, having to explain it to someone could be a little awkward.

Then again, something like this could help a single lady weed out losers. If a guy isn't accommodating about the sleep mask, he probably wouldn't make a very good partner!

Post 1

I would hardly call having to sleep with a mask on non-invasive! A friend of mine has sleep apnea and she uses bi-level ventilation.

She had a really hard time getting used to it at first. She used to sleep on her stomach, but obviously sleeping with a mask on doesn't allow that.

However, despite the drawbacks to the machine, she is sleeping much better. She used to be really tired all the time because sleep apnea really interrupts your sleep. But now she has much more energy! She said having to wear the mask when she sleeps is well worth it.

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