Last updated: October 26, 2026  |  By Air Voel Sleep Care Specialists, Toronto  |  Checked against AASM titration guidelines and ResMed clinical specifications

If your sleep physician has mentioned a BiPAP machine, or you are struggling with high CPAP pressure, you have probably wondered what actually separates the two. Both are positive airway pressure (PAP) devices, both use the same masks, and both look almost identical on a nightstand. The difference is in how they deliver air, and that difference decides who should use which.

This guide explains BiPAP vs CPAP in plain language: how each one works, who genuinely needs a bilevel machine, the different types of BiPAP devices, what they cost in Canada, and how to get one with a prescription. It is written by the team that programs and supports these machines for Canadians every day.

In this guide: What is CPAP? · What is BiPAP? · BiPAP vs CPAP table · Who needs a BiPAP? · Types of BiPAP machines · How settings work · Cost in Canada · How to get one · FAQ

What is a CPAP machine?

A CPAP (continuous positive airway pressure) machine blows a gentle, constant stream of pressurized air through a mask. That air acts like a splint, holding the soft tissue of your throat open so it cannot collapse while you sleep. Collapse of the airway is what causes the pauses in breathing, oxygen drops and loud snoring of obstructive sleep apnea (OSA), which is by far the most common form of the condition. Statistics Canada reported that 6.4% of Canadian adults had been diagnosed with sleep apnea in 2016 and 2017, and that roughly 15% of undiagnosed adults were at high risk.

Two kinds of machine fall under the CPAP umbrella:

• Fixed CPAP delivers one pressure all night, for example 9 cm H₂O.
• APAP (auto-adjusting CPAP), such as the ResMed AirSense 11 AutoSet, monitors your breathing and raises or lowers that single pressure within a range your physician sets. ResMed lists the AirSense 11 operating range as 4 to 20 cm H₂O.

Many CPAP machines also include an exhale comfort feature. ResMed calls it EPR (Expiratory Pressure Relief), and it briefly drops pressure by up to 3 cm H₂O as you breathe out. EPR makes CPAP feel softer, but it is not true bilevel therapy: the drop is small and fixed, and the machine is still treating you with one prescribed pressure.

What is a BiPAP machine?

A BiPAP (bilevel positive airway pressure) machine delivers two distinct pressures in every breath:

• IPAP (inspiratory positive airway pressure): the higher pressure delivered as you breathe in.
• EPAP (expiratory positive airway pressure): the lower pressure delivered as you breathe out. EPAP is what keeps the airway from collapsing.

The gap between the two is called pressure support (IPAP minus EPAP). Pressure support actively helps each breath in, which is why bilevel devices are also used as a form of non-invasive ventilation. The American Academy of Sleep Medicine (AASM) titration guideline recommends a minimum IPAP-to-EPAP difference of 4 cm H₂O and a maximum IPAP of 30 cm H₂O for adults and children 12 and older.

A note on names: "BiPAP" is a Philips Respironics trademark that has become the everyday word for any bilevel machine. Clinicians often write "BPAP" or "bilevel PAP". ResMed's bilevel family is called AirCurve, and it is what most Canadians are prescribed today. You can browse the current models in our BiPAP machines collection.

BiPAP vs CPAP: side-by-side comparison

The short version: CPAP is the first-line treatment for obstructive sleep apnea, and it works for most people. BiPAP is a more capable, more expensive tool that your physician reaches for when a single pressure is not enough or when the breathing problem is not purely obstructive.

Who needs a BiPAP machine?

Your physician makes this decision, usually after a sleep study. These are the most common reasons a bilevel device is prescribed.

1. You cannot tolerate high CPAP pressure

Some people need a CPAP pressure in the high teens to keep their airway open, and breathing out against that pressure feels like pushing against a wind. The AASM titration guideline states that a patient who is uncomfortable or intolerant of high pressures on CPAP may be tried on BPAP. Lowering the exhale pressure while keeping the inhale pressure high often resolves the problem.

2. Obstructive events continue at higher CPAP pressures

During an in-lab titration study, technologists raise CPAP step by step until breathing events stop. The same AASM guideline notes that if obstructive events continue at 15 cm H₂O of CPAP, the patient may be switched to BPAP. The guideline also sets a recommended maximum CPAP of 20 cm H₂O for adults.

3. Central or complex sleep apnea

In central sleep apnea, the brain intermittently stops sending the signal to breathe, so holding the airway open does not fix it. Complex sleep apnea combines obstructive and central events. Specialised bilevel devices called ASV (adaptive servo-ventilation) machines, such as the AirCurve 11 ASV, are designed for these patterns. ASV is not suitable for everyone: ResMed states it is contraindicated in patients with chronic, symptomatic heart failure with reduced ejection fraction (LVEF of 45% or less) and moderate to severe predominant central sleep apnea, based on the SERVE-HF trial. That is why ASV always requires a specialist assessment.

4. Hypoventilation, COPD and neuromuscular conditions

Some people do not move enough air while they sleep, for example with obesity hypoventilation syndrome, COPD (sometimes alongside OSA, called overlap syndrome) or neuromuscular conditions such as ALS. For them, the pressure support of a bilevel device helps every breath, and ST models add a backup breath rate if breathing slows or pauses.

Who usually does not need a BiPAP

If CPAP feels uncomfortable because of mask leaks, dryness or claustrophobia, a bilevel machine is rarely the answer. These problems are usually solved by a better-fitting mask, heated humidification, a ramp setting or EPR. A mask change is often the simplest fix. Our guide to full face CPAP masks is a good place to start if you breathe through your mouth.

Types of BiPAP machines

"BiPAP" covers several therapy modes. Knowing which one your prescription names makes choosing a machine straightforward.

• S (spontaneous): the machine switches between IPAP and EPAP in time with your own breathing. There is no backup rate.
• VAuto (auto bilevel): ResMed's auto-adjusting bilevel mode. The machine adjusts pressure automatically within limits your physician sets, combining CPAP-style automation with bilevel comfort. It is the most common choice for obstructive sleep apnea patients who need bilevel therapy.
• ST (spontaneous/timed): works like S mode but delivers a backup breath if you do not breathe within a set time. Used for hypoventilation, COPD and neuromuscular conditions.
• ST-A: an ST device with added alarm support for patients who need monitored non-invasive ventilation.
• ASV (adaptive servo-ventilation): varies pressure support breath by breath to stabilise breathing in central sleep apnea, complex sleep apnea and periodic breathing (Cheyne-Stokes respiration).

Here is how those modes map to the ResMed and Philips bilevel machines we carry:

*Prices as listed on airvoel.ca in October 2026 and subject to change. ST, ST-A and ASV models are dispensed by phone with a valid prescription; call 1 (844) 688-2727.

The ResMed AirCurve 11 VAuto, the auto-bilevel machine most often prescribed for obstructive sleep apnea.

How BiPAP settings work

A bilevel prescription has more numbers than a CPAP prescription, and every one of them matters. The main settings are:

• EPAP: the baseline pressure that keeps your upper airway open. Think of it as the equivalent of your CPAP pressure.
• IPAP: the higher pressure delivered on each breath in.
• Pressure support: the difference between IPAP and EPAP. More pressure support means more help with each breath.
• Backup rate (ST, ST-A and ASV models): the minimum number of breaths per minute the machine guarantees.
• Rise time and inspiratory time: how quickly pressure climbs at the start of a breath and how long it is held. These fine-tune comfort and are set by your clinician.

As an illustration only, a prescription might read "EPAP 8, IPAP 14", which means a pressure support of 6 cm H₂O. On an auto-bilevel machine such as the AirCurve 11 VAuto, your physician instead sets a minimum EPAP, a maximum IPAP and a pressure support value, and the machine works within those limits. Never change bilevel settings yourself; send us your prescription and we will program the device to match it exactly.

BiPAP vs CPAP cost in Canada

Bilevel machines cost roughly two to five times as much as CPAP machines because they contain more sophisticated pressure control and, on ST and ASV models, ventilation features. Here is what the most common devices cost at Air Voel in October 2026:

• ResMed AirSense 10 AutoSet Card-to-Cloud (APAP): about $799
• ResMed AirSense 11 AutoSet (APAP): from about $1,435
• ResMed AirCurve 11 VAuto (auto bilevel with heated humidifier and ClimateLineAir heated tubing): about $2,623
• ResMed AirCurve 10 ST, ST-A and ASV models: about $2,980 to $3,950

Every machine purchased from Air Voel includes free programming to your prescription, complimentary therapy data readings, on-demand support appointments and free communication with your physician. Orders over $150 ship free across Canada.

Is a BiPAP machine covered by insurance in Canada?

PAP devices, including bilevel machines, are usually covered by private health insurance plans, and Air Voel is recognized by most private insurers. Coverage amounts, waiting periods and paperwork vary widely, so ask your insurer three questions before you order: how much they reimburse for a bilevel device, whether they need a sleep study report as well as a prescription, and how often they will cover a replacement. Our insurance quote page can help you prepare the request.

Some provinces fund PAP equipment through programs such as Ontario's Assistive Devices Program. Air Voel is an online retailer serving all of Canada and does not bill provincial funding programs, so check whether you qualify for provincial funding before buying.

How to get a BiPAP machine in Canada: step by step

1. Get diagnosed. Sleep apnea is diagnosed with a sleep study. If obstructive sleep apnea is suspected, a home sleep apnea test can provide a diagnosis. Bilevel settings, however, are usually determined in an in-lab titration study or by your physician reviewing your therapy data.
2. Get a bilevel prescription. It should name the therapy mode and pressures (for example, EPAP, IPAP or pressure support, and any backup rate).
3. Choose the machine your prescription calls for. VAuto prescriptions match the AirCurve 11 VAuto; ST and ASV prescriptions need the corresponding ST or ASV model. Our Sleep Care Specialists can confirm the right device by phone.
4. Send us your prescription. Email it to care@airvoel.ca or use our prescription upload page. We program the machine to your settings at no charge.
5. Follow up on your data. AirCurve 11 machines work with the myAir app. Book a complimentary data reading with our team after your first few weeks so your physician can fine-tune your therapy.

Masks and accessories for BiPAP therapy

Bilevel machines use the same masks, tubing and filters as CPAP machines, so there is no special "BiPAP mask". Because bilevel users often run higher pressures, mouth leaks are more common, and many find a full face CPAP mask gives the most reliable seal. If you breathe through your nose, a nasal or nasal pillow mask from our CPAP masks collection also works. AirCurve 11 machines pair with ClimateLineAir 11 heated tubing to reduce condensation at higher humidity settings.

Frequently asked questions

Is BiPAP better than CPAP?

Not in general. BiPAP is better for specific situations, such as intolerance of high pressure, central or complex sleep apnea and hypoventilation. For most people with obstructive sleep apnea, CPAP or APAP is effective, simpler and far less expensive.

Can I switch from CPAP to BiPAP on my own?

No. Bilevel therapy needs a prescription with bilevel settings, and the wrong settings can make breathing worse. If CPAP feels too strong, talk to your physician about a titration study or a trial of bilevel therapy.

Do I need a different mask for a BiPAP machine?

No. BiPAP machines use standard CPAP masks and tubing. Full face masks are popular with bilevel users because they handle higher pressures and mouth breathing well.

Is EPR on my CPAP the same as BiPAP?

No. EPR lowers pressure by up to 3 cm H₂O when you exhale, purely for comfort. A BiPAP delivers two separately prescribed pressures and provides real pressure support on every breath.

Does a BiPAP machine treat central sleep apnea?

Standard bilevel modes are not designed for central sleep apnea. ASV machines such as the AirCurve 11 ASV are, but they are not suitable for people with certain types of heart failure, so a sleep specialist must prescribe them.

Is a BiPAP the same as a ventilator?

Bilevel devices are a form of non-invasive ventilation because they help you breathe in. ST and ST-A models with backup rates are used for ventilatory support at home, but they are not life-support ventilators.

Can I travel with a BiPAP machine?

Yes. AirCurve machines are bedside-sized but travel well in a carry bag. Carry the machine on board as a medical device, bring a copy of your prescription, and check your airline's rules if you plan to use it in flight. For CPAP users who travel often, our guide to the best portable CPAP machines in Canada covers smaller options.

Is a BiPAP machine covered by insurance in Canada?

Usually, by private health insurance, with a prescription and often a sleep study report. Coverage limits vary by plan, so confirm with your insurer before buying.

Sources

• Kushida CA, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4(2):157–171. PMC2335396
• Cowie MR, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure (SERVE-HF). N Engl J Med. 2015;373(12):1095–1105. doi:10.1056/NEJMoa1506459
• ResMed. Air11 Series device comparison (operating pressure ranges, indications and ASV contraindication).
• National Heart, Lung, and Blood Institute (NIH). Sleep Apnea Treatment.
• Statistics Canada. Sleep apnea in Canada, 2016 and 2017.