Bilevel PAP Titration


Your doctor might have mentioned Bilevel as an alternative to CPAP (continuous positive airway pressure) for the treatment of sleep apnea. If you did not tolerate CPAP because of a high CPAP pressure for example, the bilevel (2 levels) mode might be better tolerated.

Before explaining bilevel, it helps to describe CPAP. CPAP machine pumps a constant pressure when you inhale and exhale. Let’s say a pressure of 16. If you are switched to the Bilevel machine, you go through a Bilevel titration study to determine your correct pressure where 2 different pressures are offered: an inhalation pressure (let’s say 16) and an exhalation pressure which is typically reduced 4 numbers down (so it would be 10). So with bilevel PAP, your pressure is 16/10. Bilevel PAP with a special back up rate is used for those who have a special type of apnea called central sleep apnea.

A CPAP or Bilevel PAP machine is an apparatus which takes room air and pumps it through a plastic tube into a nasal and oral passages (throat) through the face mask to alleviate the collapse of the throat that causes sleep apnea. CPAP or Bilevel titration study refers to a sleep study that is performed with the apparatus for the purpose of finding the optimal airway pressure that the machine has to pump to correct the obstructed throat during sleep (apnea). At home, you would place the machine on a table at your bedside. You can turn side to side and sleep on your side if you wanted. CPAP and Bilevel are effective ways to treat sleep apnea. The challenge is adjustment and patience with the mask and getting used to it. It takes time.

The Bilevel titration study is performed at the sleep laboratory, likely the same place you had your first diagnostic sleep study where you were diagnosed with sleep apnea. There will be a technician working with you to get you fitted a comfortable mask; then you get wired with belts. The technician will increase your pressure until the apneas and snoring are eliminated, your blood oxygen is normal level, and your sleep looks restful.

The sleep medicine doctor who ordered the study will then read the study and choose the right pressure and recommended mask. The doctor or his office will likely set you up with a home-health company which delivers the Bilevel equipment and work with you to make sure you are comfortable with your mask or perhaps consider another one.