Expiratory positive airway pressure (EPAP) devices create backpressure from a user’s own breath to keep airways open for obstructive sleep apnea (OSA) patients. Unlike CPAP, which delivers a constant stream of air throughout the respiratory cycle, EPAP devices only resist airflow during expiration. EPAP is most commonly delivered via small devices using a valve system to create resistance upon exhalation while allowing unobstructed inhalation. Also, EPAPs do not require a power source and typically fit in the palm of a hand.
However, EPAPs efficacy tends to be lower than CPAP. Ideal candidates are often those with positional or mild OSA who cannot tolerate CPAP. Additionally, EPAP may be considered for use in combination therapy or for patients with residual OSA despite other treatments.
This guide compares EPAP devices on specifications including sizes, materials, warranty, payor coverage, cleaning instructions, and supporting studies.
The EPAPs compared are:
AirAvant Medical Bongo Rx
BRYGGS Medical LLC ULTepap 2
CPAPNEA Medical Supply Optipillows EPAP Mask
| Company: | AirAvant Medical | BRYGGS Medical LLC | CPAPNEA Medical Supply |
|---|---|---|---|
| EPAP: | Bongo Rx | ULTepap 2 | Optipillows EPAP Mask |
| Website: | www.bongorx.com | www.bryggsmedical.com | www.optipillows.com |
| FDA-Cleared Indications: | FDA 510(k) K180619 for mild to moderate OSA in adults >66 lbs | FDA 510(k) K191728 for mild to moderate OSA in adults >66 lbs | FDA 510(k) K181219 for use during sleep to alleviate snoring in adults |
| Description: | FDA-cleared, clinically tested, prescription EPAP device for OSA. Soft nasal seals also create nasal dilation. Reusable. Requires no machine or power. Very small, simple to use and requires no assembly. Can be worn with or without headgear. User-friendly option for noncompliant CPAP patients or for travel. Comes with drying stand and travel case. Designed & made in the USA. | The ULTepap 2 allows the user of this reusable EPAP device to adjust the therapeutic back pressure between two settings. Caps on the end of each valve deliver the same back pressure of the original ULTepap (standard resistance). If that pressure appears to be too high, remove the caps to expose larger exhalation holes, which deliver lower, but still therapeutic, pressure (lower resistance). | Optipillows EPAP Mask allows users to adjust the resistance to fit their specific pressure requirements (1.5-14.5 cm H2O). Optipillows was designed by a sleep physician, is comfortable, quiet, reusable, optimal for travel, economical, and requires no prescription. Kits include the patented valve, adjustable headgear, and 3 sizes of nasal pillows. Replace annually. |
| Available Through Prescription: | Yes | Yes | No |
| Available Over-the-Counter: | No | No | Yes |
| Sizes: | S, M, L, XL included in starter kit | S, M, L | 3 sizes of nasal pillows + adjustable headstrap included in kit |
| Pressure (cm H2O): | up to 15 (fixed) | 0-20 (standard pressure; user adjustable to lower pressure by removing caps) | 1.5-14.5 (adjustable via side vent) |
| Materials: | silicone nasal seals with polycarbonate valve housings | silicon nasal pillows and polycarbonate valves | nonallergenic plastic and silicone |
| Warranty (days): | 90 | 90 (pillows); 1,095 (valves) | 30 |
| Payor Coverage: | cash pay; FSA/HSA covered | cash pay | MSRP/MAP $119 |
| Reusable: | Yes | Yes | Yes |
| How to Clean: | Clean with mild soap and water. No disassembly required. | Clean with warm, soapy water. Rinse and air dry. | Clean with mild soap and water. |
| Supporting Study: | Clinically studied with patients using Bongo at home and in-lab PSGs, with and without Bongo, to demonstrate AHI reduction. Study reviewed by FDA and presented at SLEEP 2019. | Sleeper G, Rashidi M, Strohl KP, et al. Comparison of expiratory pressures generated by four different EPAP devices in a laboratory bench setting. Sleep Med. 2022 Aug;96:87-92. | Hakim TS, et al. EPAP devices Optipillows, Bongo Rx, and Theravent: Flow resistance and the pressures they generate. J Sleep Med Disord. 2021;7(1):1119. |
Information in this guide based on data submitted by EPAP marketers. Sleep Review strives for accuracy in all data but cannot be held responsible for claims made by marketers. All devices may not be included. Email editor[at]sleepreviewmag.com to be considered for the next update.
