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A bilevel (also referred to as a BiPAP) is a breathing machine used primarily during sleep that delivers pressurized air through a mask or interface to assist you with both inhaling and exhaling.
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A bilevel can help you sleep better, wake up feeling more rested, and have more energy during the day. In addition to improving your quality of life, research has shown that using a bilevel early and regularly can help you live longer.
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How do bilevel machines work?
When the diaphragm muscles weaken and your body is unable to fully inhale oxygen and exhale carbon dioxide, your mind can begin to feel foggy and you can get morning headaches. The bilevel machine helps you get more oxygen and prevents a buildup of carbon monoxide.
The bilevel is noninvasive, which means you can take it on and off and use it whenever you wish. You will not become dependent on it, but you will probably want to use it because you feel better when you do.
The bilevel is noninvasive, which means you can take it on and off and use it whenever you wish. You will not become dependent on it, but you will probably want to use it because you feel better when you do.
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Your neurologist will prescribe the right pressure settings for you, and a respiratory therapist from a durable medical equipment (DME) company will visit to set up the machine and train you and your caregiver(s) how to use it. The respiratory therapist will try to find a face mask or interface that lets you sleep in your normal position, whether on your stomach, back, or side.
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The respiratory therapist will also show you and your caregiver how to use and refill the humidifier chamber, which humidifies the air to help prevent dryness in your mouth, nose, throat, and airway.
Can I use it during the day?
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Yes. If you are having difficulty breathing during the day, or simply feel like you could use a little more breathing support, you can use your bilevel while you are awake with the same mask or interface you use when you sleep. This can give your diaphragm a break and increase your energy level. You can also use your bilevel during naps, just as you do when sleeping at night.
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If you find that you are needing to use your bilevel more and more throughout the day, you may want to talk with your neurologist or respiratory therapist about getting a portable ventilator, which can also be used as a bilevel. Ventilators also have a sip-and-puff mode, which allows you to take occasional breaths through a mouthpiece instead of putting on a mask.
When should I get one?
Your ALS clinic team or neurologist should monitor your breathing every visit and let you know when you will qualify for and can benefit from a bilevel. Ideally, you will get a bilevel before you experience breathing difficulties so you can have time to get used to it.
How can I get one?
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Your neurologist must submit your pulmonary function test results and documentation that demonstrate you need breathing support during sleep. The durable medical equipment company will process the order through your insurance, deliver the bilevel to you, and train you how to use it. Insurance companies do not usually require ALS patients to do a sleep study to qualify for a bilevel.
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How much will I have to pay?
Bilevels are considered rentals for the first 13 months and are covered through Medicare, Medicaid, and most private insurance plans. After 13 months, the machine becomes yours and your supplies will continue to be covered by your insurance.
Medicare will cover 80% of the cost of your monthly rental. Medicaid, supplemental plans, and secondary private insurance should pay for the remaining 20%. If you have Medicare but do not have Medicaid, a supplemental plan, or secondary private insurance, you will likely have to pay the remaining 20% out of your own pocket.
If you do not qualify for Medicare—but have Medicaid and/or private insurance—find out what your durable medical equipment (DME) benefits will cover. If you have a Medicare Advantage Plan, be sure to ask about your DME benefits.
If you are facing out-of-pocket expenses that you cannot afford, talk with your DME provider and/or local ALS organization about financial assistance options. Respiratory equipment is not generally available from loan closets, but you can always ask.
If you have questions about any of this, the social worker at your ALS clinic or someone from your local ALS organization can help guide you through the process.
Military veterans: Your coverage for equipment, including respiratory devices, is different than what is listed here. Learn more.
Medicare will cover 80% of the cost of your monthly rental. Medicaid, supplemental plans, and secondary private insurance should pay for the remaining 20%. If you have Medicare but do not have Medicaid, a supplemental plan, or secondary private insurance, you will likely have to pay the remaining 20% out of your own pocket.
If you do not qualify for Medicare—but have Medicaid and/or private insurance—find out what your durable medical equipment (DME) benefits will cover. If you have a Medicare Advantage Plan, be sure to ask about your DME benefits.
If you are facing out-of-pocket expenses that you cannot afford, talk with your DME provider and/or local ALS organization about financial assistance options. Respiratory equipment is not generally available from loan closets, but you can always ask.
If you have questions about any of this, the social worker at your ALS clinic or someone from your local ALS organization can help guide you through the process.
Military veterans: Your coverage for equipment, including respiratory devices, is different than what is listed here. Learn more.
What if I’m having trouble using my bilevel?
Some adjustments may be needed when you first start using a bilevel. If you are having trouble, schedule another visit with your respiratory therapist. Together, you should be able to resolve the issue. The pressure may need to be adjusted, your mask may be leaking, or you might simply need more time to get used to it. Whatever the problem, the benefits you’ll receive from your bilevel are too great to give up and stop using it.
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