Mask breathing support (CPAP / BiPAP)

What it means to be given breathing support through a tight-fitting mask (CPAP or BiPAP) in hospital, why it is used, and how it differs from a breathing machine with a tube.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

Non-invasive ventilation supports breathing through a tight mask, so there is no tube and the person stays awake.
CPAP holds the lungs open; BiPAP also helps clear carbon dioxide in conditions like a COPD flare-up.
It is often used to try to avoid a full breathing machine, but it is not suitable for everyone.
It can feel claustrophobic at first and needs the person to tolerate the mask; the team monitors closely.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeBreathing support through a mask in hospital

AnaestheticNot needed — the person is usually awake

How long it takesFrom hours to a few days, often on and off

Hospital stayInpatient, often in HDU, a respiratory ward or intensive care

Time off workDepends on the underlying illness

When you'll see resultsOften reviewed within hours; blood tests check how breathing responds

On the NHS?Provided by the NHS in hospital, usually as urgent care

A general guide. Your specialist will give you advice for your situation.

Best fit

Supports breathing without needing a tube in the windpipe

Pause if

Someone too drowsy or confused to protect their own airway, or who cannot keep the mask on, may need a tube instead.

Main recovery point

The team checks how breathing responds, often with a repeat blood test, and adjusts the settings. The person gets used to the mask and airflow.

Good aftercare

Close monitoring with repeated blood tests and a clear, agreed back-up plan.

First hours

The team checks how breathing responds, often with a repeat blood test, and adjusts the settings. The person gets...

Over the first day or two

If breathing improves, time on the mask is gradually reduced, with longer breaks. Skin over the nose and cheeks is...

Coming off the mask

Once breathing is stable without it, the mask is stopped, though it may be kept available overnight or for...

Continuing recovery

Recovery from the underlying illness — such as a chest infection, COPD flare-up or heart failure — continues with...

Medical line illustration of cpap sleep apnoea therapy for Mask breathing support (CPAP / BiPAP). — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is non-invasive ventilation (CPAP / BiPAP)?

Non-invasive ventilation (NIV) means helping someone breathe using a tight-fitting mask over the nose and mouth (or sometimes a hood), connected to a machine — without needing a tube in the windpipe. Because it works through a mask, the person is usually awake and can often have short breaks to talk, drink or have the mask adjusted.

There are two main types used in hospital. CPAP (continuous positive airway pressure) holds the airways and lungs open with a steady pressure, which helps when the lungs are stiff or filling with fluid, such as in some types of heart failure. BiPAP (bilevel positive airway pressure, sometimes called BPAP) gives a higher pressure when breathing in and a lower one when breathing out, which helps when someone is struggling to clear carbon dioxide, such as in a flare-up of COPD (a long-term lung condition).

Mask support is often used to try to avoid putting someone on a full breathing machine with a tube, or to help during recovery from one. It is not suitable for everyone — for example, if someone is too drowsy, cannot protect their airway, or is too unwell, a tube and ventilator may be safer.

Mask breathing support can be uncomfortable and takes some getting used to, but it can make a real difference to breathing and, for the right person, can avoid more invasive treatment. Note that home CPAP for sleep apnoea is a different, milder treatment — this guide is about CPAP and BiPAP used for acute breathing problems in hospital.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

CPAP (continuous positive airway pressure)

A steady pressure that holds the airways and lungs open. Helpful when the lungs are stiff or filling with fluid, such as in some heart failure or low oxygen levels.

BiPAP / BPAP (bilevel pressure)

Higher pressure breathing in and lower pressure breathing out, which supports each breath and helps clear carbon dioxide — used in flare-ups of COPD and some other conditions.

Face mask or hood

The support is usually given through a mask covering the nose and mouth, or sometimes a clear hood, chosen for comfort and a good seal.

Trial to avoid a tube

Mask support is often tried first in suitable people to see if it can avoid the need for a full breathing machine, with a clear plan if it does not work.

CPAP vs BiPAP in hospital

Feature	CPAP	BiPAP
Pressure	One steady pressure	Higher in, lower out
Mainly helps	Oxygen / stiff or wet lungs	Clearing carbon dioxide
Common use	Some heart failure, low oxygen	COPD flare-up, type 2 failure
Awake?	Usually yes	Usually yes

The team chooses CPAP or BiPAP based on the breathing problem, often guided by a blood test that measures oxygen and carbon dioxide.

Preparing for your treatment

Non-invasive ventilation is usually started urgently, so there is rarely time to prepare.
Knowing the mask feels tight and forceful at first helps — most people get used to it within a short while.
Tell the team if the person feels very claustrophobic, sick, or cannot clear their own saliva.
If the person wears dentures, the team will advise whether to keep them in for a better mask seal.
Ask the team whether mask support is being used to avoid a tube, and what the plan is if it does not work.
For people with long-term lung conditions, ask whether a plan exists for how far treatment should go.

What happens

A mask is fitted over the nose and mouth and connected by tubing to the machine, which delivers pressurised air and oxygen. At first the airflow feels strong and the mask tight, which can be uncomfortable or feel claustrophobic, but most people settle as they get used to the rhythm of breathing with it.

The team watches closely — checking oxygen levels, breathing, comfort and the mask seal — and adjusts the pressure and settings. A blood test, often from the wrist or an existing line, measures oxygen and carbon dioxide and shows whether breathing is improving. This may be repeated after an hour or two.

Short breaks are usually possible for sips of water, to talk, to take medicines or to rest the skin where the mask presses. Nurses protect the skin over the nose and cheeks, which can get sore from the mask.

If breathing improves, the time on the mask is gradually reduced. If the person is too drowsy, too unwell, cannot tolerate the mask, or breathing does not improve, the team will discuss the next step, which may be a full breathing machine with a tube or, for some, a change of plan towards comfort-focused care.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Someone too drowsy or confused to protect their own airway, or who cannot keep the mask on, may need a tube instead.
Recent face or upper-airway surgery, severe facial injury, vomiting or a blocked gut can make a mask unsafe.
An untreated collapsed lung (pneumothorax) usually needs treating before mask pressure is used.
For some with very advanced lung disease, mask support may not be the right choice, and a comfort-focused plan may be kinder.

Delay or rearrange if…

Mask support is usually started promptly in a breathing crisis and is not something to postpone.
If the person is rapidly deteriorating, the team may move straight to a full breathing machine rather than a mask.
A collapsed lung or other specific problem may need treating first.
For people with long-term conditions, agreeing a ceiling-of-treatment plan beforehand helps guide care.

Alternatives to discuss

Oxygen alone, or high-flow oxygen through the nose, for some people who need extra oxygen but not pressure support.
A full breathing machine with a tube for the most severe breathing failure.
Treating the cause directly — inhalers and steroids, fluid removal, or antibiotics — which may reduce the need for the mask.
Comfort-focused or palliative care to ease breathlessness when other treatment is unlikely to help.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Benefits

Supports breathing without needing a tube in the windpipe
The person usually stays awake and can often talk and drink with breaks
Can improve oxygen levels and help clear carbon dioxide
May avoid the need for a full breathing machine in suitable people
Can be used to help wean someone off a ventilator or to ease breathlessness

Risks & complications

More common

Feeling claustrophobic or panicky from the tight mask and strong airflow
A sore, red or dry nose, mouth and eyes from the mask and air
Pressure marks on the face from the mask
A bloated, windy stomach from swallowing air

Less common

Skin breakdown over the nose or cheeks if the mask is worn for a long time
Drying of secretions, making them harder to clear
Vomiting, with a risk of it going into the lungs (aspiration)
The mask support not working well enough, so a breathing tube is needed

Rare but serious

A drop in blood pressure from the pressure of the machine
A small air leak from the lung (pneumothorax)
Serious deterioration of the underlying illness despite support

Mask support is gentler than a tube but is not without risks or suitable for everyone — it needs someone awake enough to protect their airway and tolerate the mask. The biggest issue is knowing when it is not working and a tube is needed, so close monitoring and a clear plan matter. For people with advanced lung disease, it is also important to agree how far treatment should go.

Published figures to discuss

Whether non-invasive ventilation succeeds depends on the cause of the breathing problem, how severe it is, and how early it is started. For some conditions, such as COPD flare-ups, it works well for many people; for others it is less reliable, and a proportion still need a breathing tube. Because this varies so much by condition and severity, a single success or failure figure is not meaningful, and the team's monitoring over the first hours is the most useful guide.

Figure	Reported range	How to interpret it	Source / confidence
NIV failure requiring intubation or a different plan	Varies; often around 20 to 30% in many acute-care cohorts, depending on cause	Early blood-gas response, breathing effort and mental state guide whether NIV is working.	NHS — Chronic obstructive pulmonary disease (COPD)nhs.ukPublished figure
Pressure damage from the mask	Common with prolonged use unless fit and skin checks are good	Nasal bridge soreness, leaks and claustrophobia should be addressed quickly.	Guide sourcesClinical context
Aspiration or vomiting while on NIV	Uncommon but important	Reduced consciousness, active vomiting or inability to protect the airway may make NIV unsafe.	NHS — Chronic obstructive pulmonary disease (COPD)nhs.ukSource-linked context
Delayed intubation when NIV is not working	High-impact safety risk	A clear escalation plan should be agreed before starting NIV.	NHS — Chronic obstructive pulmonary disease (COPD)nhs.ukSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

For many people, mask support is a short-term treatment during a breathing crisis. As the underlying illness improves, the time on the mask is reduced and then stopped, though recovery from the illness itself continues.

First hours

The team checks how breathing responds, often with a repeat blood test, and adjusts the settings. The person gets used to the mask and airflow.

Over the first day or two

If breathing improves, time on the mask is gradually reduced, with longer breaks. Skin over the nose and cheeks is checked and protected.

Coming off the mask

Once breathing is stable without it, the mask is stopped, though it may be kept available overnight or for flare-ups at first.

Continuing recovery

Recovery from the underlying illness — such as a chest infection, COPD flare-up or heart failure — continues with treatment, and sometimes longer-term breathing support is arranged.

What's normal — and not a worry

A sore or dry nose, mouth and eyes for a short while after using the mask
Pressure marks on the face that fade
Tiredness from the effort of breathing during an illness
Needing the mask on and off rather than constantly
Slow improvement in breathlessness as the underlying illness is treated

Aftercare

Follow the treatment plan for the underlying lung or heart condition.
Use any prescribed inhalers, medicines or oxygen as directed.
Tell the team if the mask is causing sore skin so it can be adjusted or padded.
Stay as upright as comfortable, which often helps breathing.
If a long-term breathing condition led to this, ask about a plan for future flare-ups.
Stop smoking if you smoke — this is one of the most helpful things for the lungs.
Keep follow-up appointments with the chest or heart team.

Before your treatment

Understanding of whether mask support is to avoid a tube, and the back-up plan
Inhalers, medicines or home oxygen list shared with the team
Mask comfort and skin checked and padded if needed
A plan agreed for future flare-ups if a long-term condition is involved
Smoking-cessation support arranged if relevant
Follow-up with the chest or heart team booked
GP told once home, for ongoing breathing support

⚠ Get urgent help if…

While in hospital, the team monitors breathing closely — but tell a nurse straight away if the person becomes more breathless, drowsy or distressed on the mask.
After going home, seek urgent help (call 999) for sudden severe breathlessness, gasping, or blue or grey lips.
Get same-day advice for worsening breathlessness, a high temperature with shivering, or coughing up discoloured phlegm — signs of a chest infection.
For a known lung condition, follow your personal flare-up (action) plan and seek help early if it is not working.
Get help if you feel increasingly confused or drowsy, which can be a sign of rising carbon dioxide.
Seek advice for a sore that is breaking down where the mask pressed.

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good result is that mask support improves breathing during a crisis — raising oxygen or clearing carbon dioxide — so that a full breathing machine can be avoided, and the underlying illness can be treated while the person recovers.

Mask support does not work for everyone, and for some it is a bridge while the team decides whether a tube is needed or whether to focus on comfort. Blood tests and the person's breathing over the first hours show whether it is helping, and the team's close assessment guides what happens next.

How long it lasts

Non-invasive ventilation in hospital is usually a short-term treatment for an acute breathing problem. Some people with long-term conditions, such as certain neuromuscular diseases or severe COPD, go on to use a form of NIV at home long term; this is arranged and supervised by a specialist team. How well breathing recovers depends mainly on the underlying condition.

Related tests, treatments or support

Mask support is used alongside treatment of the cause — for example inhalers and steroids for a COPD flare-up, or medicines for heart failure. It can be a step before a full breathing machine (see the mechanical ventilation guide) or used to help wean someone off one. It is one part of breathing support in critical care and on respiratory wards.

Follow-up & long-term care

Follow-up is usually with the chest (respiratory) or heart team for the underlying condition. People with long-term breathing conditions may be reviewed about a flare-up plan or home breathing support. Where NIV is needed long term, a specialist service supervises the equipment and settings.

Use prescribed inhalers, medicines or home oxygen as directed.
Attend chest or heart follow-up appointments.
If using NIV at home, keep equipment clean and attend specialist reviews.
Have a clear action plan for future flare-ups of a long-term condition.

Repeat, follow-on and what comes next

Some people need to move from mask support to a full breathing machine if breathing does not improve.
The mask, settings or type (CPAP or BiPAP) may be changed to find what works and is tolerable.
Treatment may be stepped down and the mask used only at night or for flare-ups as the person improves.
Needing more support later does not mean the mask trial was wrong — it is a recognised next step.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

Close monitoring with repeated blood tests and a clear, agreed back-up plan.
Skin protection over the nose and cheeks and attention to mask comfort.
Treatment of the underlying condition and a flare-up plan for long-term conditions.
A named contact and clear advice on when to seek urgent help after discharge.
Specialist respiratory follow-up, and supervised equipment if home NIV is needed.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Acute mask ventilation in hospital is usually NHS-funded urgent care, so most families will never see a bill for it.
Where private care provides it, the length of treatment and the level of monitoring affect cost.
Whether care is on a ward, in HDU or in intensive care changes the intensity and cost.
Drugs (such as inhalers and steroids), oxygen, blood tests and scans are usually billed in addition.
Any step up to a full breathing machine and intensive care would increase cost.
Long-term home NIV involves equipment, servicing and specialist follow-up, usually arranged on the NHS.

Make sure your written quote includes

For NHS care, there is no charge — ask about practical support such as travel and parking.
If care is private, ask what the daily fee covering mask ventilation includes.
Ask whether consultant fees, drugs, oxygen, blood tests and scans are billed separately.
Ask what happens, clinically and financially, if a full breathing machine and intensive care are needed.
Ask how follow-up for the underlying lung or heart condition is arranged.
Ask who to contact about any insurance or billing questions.

On the NHS? Non-invasive ventilation for acute breathing problems is provided by the NHS in hospital, usually as urgent care; long-term home NIV is also NHS-arranged through specialist services.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

Is this CPAP or BiPAP, and why is that the right choice for my breathing?
Is the mask support being used to try to avoid a breathing tube?
What is the plan if my breathing does not improve on the mask?
How will you keep me comfortable and protect my skin from the mask?
If I have a long-term lung condition, how far should treatment go?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my treatment, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this treatment not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is CPAP/BiPAP in hospital the same as a home CPAP machine for sleep apnoea?

No. Home CPAP for sleep apnoea is a milder, long-term treatment for breathing pauses during sleep. The CPAP and BiPAP described here are used in hospital for acute breathing problems and at higher, closely monitored settings.

Why does the mask feel so tight and forceful?

The pressure is what holds the lungs open or supports each breath, so the airflow is meant to feel strong. It can feel claustrophobic at first, but most people get used to it. Tell the team if it is unbearable so they can adjust it.

What happens if the mask support does not work?

The team monitors closely and repeats blood tests. If breathing does not improve, or the person becomes too unwell or drowsy, they will discuss the next step — often a full breathing machine with a tube, or, for some, a change towards comfort-focused care.

Can my relative talk and drink while on it?

Usually there can be short breaks for sips of water, to talk, take medicines and rest the skin, as long as breathing allows. The mask is needed for much of the time during a breathing crisis, though.

Is mask support better than a breathing tube?

It is gentler and avoids sedation and a tube, which suits many people. But it is not always enough, and for the most severe breathing failure a tube and ventilator can be safer. The team chooses based on the situation.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: British Thoracic Society / ICS — Guideline for acute non-invasive ventilation in adults ICUsteps — Intensive care: a guide for patients and relatives NHS — Chronic obstructive pulmonary disease (COPD)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.