Bilevel Preferred Over CPAP

One thing that continues to puzzle us in our work at our sleep center is how frequently patients are prescribed CPAP when we suspect they should have been initiated with bilevel therapy. We work on 2nd opinion patients quite a bit, and in nearly 90% of cases, the patient presents with a failed response to CPAP. Few if any of these patients ever report that their physicians discussed the potential to use bilevel instead of CPAP. Some had been exposed to auto-CPAP, Cflex, and other expiratory relief systems, but very few had even heard of the term bilevel.

In our clinical experience, where we specialize in mental health patients with insomnia and SDB, we quickly transition the patient to bilevel once they have failed CPAP therapy either initially during the desensitization procedure before the overnight titration or during the titration when it becomes apparent that they are struggling to breathe out against pressurized airflow coming in (expiratory intolerance).