Noninvasive ventilation can improve your breathing

Noninvasive Ventilation (NIV) machines deliver air into the lungs and make breathing easier for those struggling to breathe for a variety of medical reasons. Noninvasive means that there is no tube inserted into a person’s mouth (also known as intubation) or throat (called a tracheostomy tube).

Instead, noninvasive ventilation uses a face mask with a tight seal. This allows pressurized air to flow into the lungs.


One type of NIV is bilevel positive airway pressure, which uses two different levels of positive pressure, flipping between a higher pressure on inhalation and lower pressure on exhalation. A common machine that delivers bilevel positive airway pressure is called BPAP.


Ultimately, BPAP helps a person’s fatigued breathing muscles and lungs take in more air and properly get rid of trapped air and excess carbon dioxide.

How does it look like?

At Hospital and Home
<div class="title">NIV / BPAP<br />
At Hospital and Home</div>

When is BPAP required?

BPAP is commonly used to help people with moderate to severe chronic obstructive pulmonary disease (COPD).

People with COPD can have low levels of oxygen in the blood, which is known as hypoxemia. COPD can also lead to hypercapnia, a condition that happens when the lungs cannot get rid of carbon dioxide because of the trapped air in the lungs, and the excess levels begin to harm the body.


BPAP therapy can be used for short periods for people experiencing a COPD flare-up. It is used long-term for some people with COPD who have persistently high levels of carbon dioxide in their bodies, which is known as the medical term “chronic hypercapnia”.

BPAP makes their breathing easier and also improves their oxygen levels.

How it works?

Initially, BPAP therapy was only available as a treatment within the hospital, but now it can also be used at home. BPAP machines are tabletop devices that are fitted with tubing and a mask that deliver two levels of pressurized air. A sealed face mask is used to maintain the positive pressure.


BPAP machines fluctuate between a high pressure (for inhale) and a slightly lower air pressure (for exhale). They are programmed and monitored by a healthcare professional.

People with moderate to severe COPD may use BPAP therapy to help them breathe more easily while they sleep, during the day, or when their symptoms flare up.

How does BPAP help with COPD?

For many people with COPD, breathing is difficult. BPAP therapy pushes a high pressure of air into the lungs to inflate them to their maximum potential, similar to blowing up a balloon. It then switches to a lower pressure to help the person exhale.

This increases the amount of oxygen delivered to the lungs and helps remove trapped carbon dioxide. BPAP provides relief to overworked lungs and tired chest wall muscles. The ongoing pressure helps to maintain open airways for easier breathing.

Many people use BPAP therapy while sleeping to help combat the increased resistance they experience to breathing while lying down. This means that they will have less difficulty breathing at night, giving them a better sleep.
BPAP can also help reduce infections and flare-ups—which are both unwanted complications since they can speed up the disease process.

Therefore, avoiding these setbacks is an important part of managing COPD. It also means fewer trips to the hospital.

Side effects and complications

Common side effects of BPAP therapy include:

• Dry nose
• Runny nose
• Nasal congestion
• Claustrophobia
• General discomfort


The most common side effects are often related to the lack of humidity or the irritation caused by the high amount of air that flows into the upper airways. Some BPAP machines don’t come with good humidification systems, leading to irritated mucous membranes (the tissues inside your mouth and nose) as a result of breathing dry air. People with COPD tend to produce more mucus than those without COPD. BPAP therapy with suboptimal humidity can dry out this mucus making it sticky, which can lead to mucus plugs.
To work properly and prevent leaks, the mask needs to be tightly sealed to the face. This naturally affects eating, talking, and drinking and can impact a person’s social life if they use BPAP during the day.


The tightness of the mask may also cause feelings of claustrophobia.

Additionally, if the pressure is too high, people may feel some stomach discomfort or bloating.


Complications from BPAP are very rare, although there is a potential risk of it damaging the lungs if the wrong pressures are used. However, with proper assessment, support, and monitoring from your healthcare team, the benefits of this form of therapy far outweigh the risks.

How is BPAP therapy different from other therapies?

There are various medical device systems available for patient use—the right one for you will depend on your condition and symptoms.

Oxygen therapy is prescribed when the oxygen levels in the blood are too low, and it helps maintain safe levels of oxygen in the body.

Oxygen therapy is commonly delivered via small silicon tubes in the nostrils called nasal cannulas.

Although it can help with feeling less out of breath, oxygen therapy alone will not help with mucus and coughing.

Bilevel Positive Airway Pressure (BPAP) is especially helpful for people with COPD who have high levels of carbon dioxide in the blood because the air they need to breathe out gets trapped in the lungs.

BPAP therapy pushes a high pressure of air into the lungs to inflate them to their maximum potential, similar to blowing up a balloon. It then switches to a lower pressure to help push trapped air out of the lungs. This increases the amount of oxygen available and forces out trapped carbon dioxide.

BiPAP is more cumbersome than oxygen therapy with nasal cannulas as it requires a sealed mask around the mouth and/or nose.

Humidified high-flow therapy (HHFT) is usually prescribed for patients who tend to struggle with cough and excess mucus. This therapy hydrates the airways—which can’t be done as effectively with BPAP or oxygen therapy. It also provides a little bit of pressure to open the airways.

Patients often describe the therapy as more comfortable than BPAP because it doesn’t require a sealed mask on the face, just nasal cannulas. Because of this, you can eat, drink, and talk while using it. It can be used anytime, whether you’re awake or asleep, and it is portable.

How to properly use a BPAP machine

It’s been highlighted by multiple clinical studies that the key to successful therapy depends a lot on the mask.

It is essential to choose a mask that best fits your needs and is properly fitted to your nose, mouth, or both. Your mask needs to be adequately adjusted to limit discomfort and decrease the chance of leakage.


A mask air leak can prevent the machine from maintaining the prescribed pressure, which can affect your breathing.


You can test the fit of your mask when wearing it by running your fingers over the edges to ensure that it’s properly sealed and fitted to your face.

Don’t skip your medications! They are key in controlling your COPD.

Find out more — in this article.


Frequently Asked Questions

CPAP (continuous positive airway pressure) and BPAP are both types of noninvasive ventilation that bring air into the lungs with positive pressure. The main difference between the two is that there is only one level of positive pressure with CPAP, whereas BPAP uses two levels. BPAP machines deliver a high inhalation pressure (higher than what many CPAP machines can deliver) and rapidly switch to a lower exhalation pressure.

CPAP therapy is commonly used to treat obstructive sleep apnea, while BPAP therapy is commonly used to treat moderate to severe COPD as well as other types of medical conditions that cause difficulty breathing, such as heart failure and lung infections. CPAP machines have an algorithm that detects sleep apnea. Most BPAP machines, however, are programmed by a health care provider with inhalation and exhalation pressures according to the user’s needs for optimal oxygen and carbon dioxide levels.

Want to learn more about COPD therapies? See how oxygen therapy and humidified high flow therapy can make a difference in the day-to-day life of people with COPD.