Sleep - Bi-Level Ventilation

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is Bi-Level Ventilation?

Bi-Level therapy (or BiPAP) is a type of breathing support that assists your child’s ability to breathe. It involves the use of a mask and a Bi-Level machine. The Bi-level machine delivers pressure via the mask to the airway and lungs. This opens the airways to allow normal breathing to occur.

Normal breathing is important as it helps deliver oxygen and get rid of carbon dioxide. The pressure in Bi-Level therapy is delivered at 2 levels – inspiratory (breathing in) pressure and expiratory (breathing out) pressure.

Why does your child need Bi-Level Ventilation?

Your doctor has told you that your child has a breathing disorder called Central Sleep Apnoea (CSA) or hypoventilation. In CSA the body “forgets” to breathe for periods when asleep. Hypoventilation happens when your child does not breathe enough.

CSA and hypoventilation are only a problem when your child sleeps. For this reason your child will be required to use Bi-Level when sleeping. Bi-Level provides pressure during sleep to prevent the airways closing. It also helps with your child’s breathing rate.

If your child sleeps during the day it is important to also use Bi-Level for these naps.

What will we do?

If you have seen your sleep doctor in clinic and it has been decided that your child needs Bi-Level support you will be booked into the “sleep clinic” which is held every Friday. During this appointment your child will be fitted with a mask. Your child needs to get used to wearing the mask before Bi-Level therapy can start. You will take the mask home and over the next few days encourage your child to wear the mask for short periods. This can be when your child is either awake or asleep, as the objective is to make sure that your child is not fearful of the mask. You will also be given information about hiring the mask and machine for use at home. We will take a 3D photograph of their facial bones before starting treatment. This will help us to monitor the growth of the bones and make sure that the mask is not pressing on the top teeth. With continuing mask and pressure treatment, this 3D photograph should be repeated every 2-3 years.

Your child will need to come into hospital for 3-4 nights while we alter the pressures on the machine and they get used to using Bi-Level. During this time you will meet the Clinical Nurse Consultant (CNC) or Clinical Nurse Specialist (CNS) and get education and information about the Bi-Level machine so you can confidently use the machine when you go home. You will also be given contact details in case there is a problem with the Bi-Level machine at home. If your child is already in the hospital and your sleep doctor decides that your child needs to start Bi-Level ventilation, you will meet the Clinical Nurse Consultant or Clinical Nurse Specialist the same day. They will fit your child with the right size mask, start education and give you information on hiring the equipment to take home.

How do you get the mask and machine?

The Children’s Hospital at Westmead has a limited supply of Bi-Level machines which we are able to hire out to families for a fee. Hire costs vary depending upon the type of machine your child needs. Please tell us if you have a health care (concession) card, so we can help with any application for purchase or funding. 

When your child is first established on Bi-Level you pay a fee for the mask at The Children’s Hospital at Westmead. This fee is a single payment of $100 and must be paid at the Cashier (next to the Emergency Department). With the exception of children under the age of 6 months, any additional masks must be bought at retail outlet centres.

The retail price of a mask is approximately $250 - $300.  We will give you the details you need to purchase future masks from a retail outlet.

How long will your child need to use Bi-Level Ventilation?

In most cases Bi-Level therapy is a long term treatment. For this reason it is important to have regular follow-up appointments with your Sleep/Respiratory Doctor. Your child will also need to have regular sleep studies to monitor their progress.

Other comments

When your child is discharged home on Bi-PAP, you are eligible for the ‘Essential Medical Equipment Payment’ at Centrelink. This is an annual payment of $140. An application needs to be completed by you and your doctor to take to Centrelink.

Most Bi-PAP machines do not have internal batteries. You must be aware of this as it will stop working in the event of a blackout. It is advisable to contact your electricity supplier and notify them that a family member is on Bi-PAP. We will provide you with a form for this as you will also be eligible for a discount on your electricity bill.

What if your child becomes unwell at home?

If your child gets sick and needs to come to the Emergency Department you will need to bring all Bi-Level equipment with you.

If your child is breathing rapidly, noisily or seems to be having difficulty breathing you should see a doctor urgently.

If the problem is very severe you may see a dusky or blue colour around your child's lips or there may be pauses when they stop breathing. You should call an ambulance (000) if this occurs.


  • Clinical Nurse Consultant                                                                     (02) 9845 2572
  • Clinical Nurse Specialist                                                                              (02) 9845 0230
  • Biomedical Engineering Department                                                     (02) 9845 2602


  • Your child will need to use Bi-Level every time they sleep.
  • Your child will need to get used to wearing the mask before we start Bi-Level in hospital, if it is planned.
  • You will be required to rent or purchase the Bi-Level machine.
  • You will be required to purchase a Bi-Level mask for long term use.
  • Children using Bi-Level will need regular assessment and follow up.

Acknowledgement for images                  

Philips Home Healthcare

Devilbiss  Healthcare Australia

The Children's Hospital at Westmead

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