Can My CPAP Make Me Sick? Routine Cleaning Can Help Avoid Illness

Risks of Infection Reduced with Regular Cleaning, Distilled Water Use

Proper cleaning, filters, and new equipment can help you to avoid illness and ensure your CPAP doesn't make you sick
Proper cleaning, filters, and new equipment can help you to avoid illness and ensure your CPAP doesn't make you sick. Getty Images

It is common when initially starting the use of continuous positive airway pressure (CPAP) to treat sleep apnea to worry about the risk of infection from the device. You might ask, “Can CPAP make me sick?” Learn about whether you might be at risk of infection, including sinus infections and pneumonia, from using a CPAP machine. Review how to avoid this with proper cleaning steps on a regular basis and the use of filters, distilled water in a heated humidifier, and heated tubing.

Discover also whether you need to purchase an expensive sanitizer device to avoid the risks of getting sick.

The Dangers of Infection with CPAP Machines

First, the CPAP itself is initially a sterile device. The plastic and metal parts will not cause illness on their own, and germs will not be present there when the machine is new. Once you start using it, any germs inside the mask, tubing, or device are your germs. Therefore, you are at low risk of acquiring a new infection from a CPAP if you are the only one using your device. The bugs—whether they are bacteria or viruses—are ones that you put there via breathing, and your body has already reached a truce with them.

Though there may be a reasonable concern for potential infection from the use of CPAP equipment, there is little research in adults supporting such an association. Modern devices with the use of heated humidifiers, heated tubing, hypoallergenic filters, and improved design have not been well studied.

In fact, there are currently zero—yes, zero—case reports by doctors found in the scientific literature of CPAP use contributing to an increased risk of upper respiratory infection like sinus infections or pneumonia.

There have been a few reports of eye irritation and ulceration occurring, possibly related to masks leaking air into the eyes, but the cause-and-effect relationship is not clear.

Moreover, research actually suggests that regular CPAP use in fact reduces inflammation and the risk for infection in the nasal passage. Cells associated with these phenomena are seen less often in the noses of compliant users of the therapy.

In conclusion, it is very likely that CPAP therapy simply does not cause higher rates of infection.

The Potential Risk of Warm, Humid Environments and Mold

The CPAP has some "creature features" to make it more comfortable to use. In particular, the heated humidifier and heated tubing may make the air more warm and moist. This decreases mouth and nose dryness, which may actually reduce the risk of potential infection, and improves tolerance to the therapy. (Inflammation along the airway often improves with CPAP use, in fact.) However, there are organisms that also love a warm, humid environment. In particular, fungus, yeast, and mold would love to hang out in such a place.

If your CPAP is not kept clean and excess moisture is allowed to sit in the tubing or humidifier, you might be at risk of developing a fungal or yeast colonization. Dangerous molds could also establish themselves in the equipment. These organisms could potentially be harmful to you.

This may lead to irritation of the airways and lungs, contributing to cough or possibly even an infection like bronchitis, pneumonia, or inflammation of the lungs called pneumonitis.

Large studies have not been performed, and cases of this occurring have not been reported in the literature, but the risk is likely extremely low. The use of a humidifier and adequate hygiene seems to reduce these risks. If water is left in the device for an extended period of time without use, mold is more likely to form. Therefore, the device should not be stored with water left in it, especially in an environment that might promote such growth (like leaving the CPAP in a shed or garage for months or years and then resuming its use).

How to Avoid Infection When Using CPAP

In order to reduce the theoretical risk of infection or exposure to unwanted fungi or molds, there are certain steps that you can take.

  • Make sure to clean your CPAP as often as you should with hot water and soap. The equipment manufacturers suggest daily cleaning. It is recommended that this be done at least weekly, depending on your environment. It is not necessary to use an expensive CPAP sanitizer device to reduce the risk of infection that is simply not there.
  • If you are sick with a cold or flu, clean your mask, tubing, and device thoroughly to remove mucus and other undesirable residual discharges from the illness. This basic hygiene can help to avoid any unpleasant smells from developing.
  • Do not let water or moisture remain in the equipment for prolonged periods and use a heated humidifier and heated tubing to reduce condensation. If you decide to stop using the treatment for longer than a few days, clean and dry it out completely. Modern devices are also able to circulate air to help dry out the tubing after use has concluded.
  • Use distilled water in the humidifier to reduce your risk of infection by amoeba in certain regions such as Lousiana. If you don't trust the local water supply, always err on the side of using distilled water.
  • Replace your supplies, including machine filters, as often as you should. Filters have been shown to reduce the spread of bacteria within the device. Masks should be replaced at least every 3 months and filters should be changed from every 2 weeks to monthly.
  • Do not share your equipment with others to prevent the spread of infection. Do not purchase or accept used equipment, especially used masks and tubing.

By taking these simple steps, you can further reduce the risk of infection and ensure that you get the healthful benefits you expect from your treatment.

Sources:

Aly H et al. “Nasal colonization among premature infants treated with nasal continuous positive airway pressure.” Am J Perinatol. 2011 Apr; 28(4):315.320.

Gelardi M et al. "Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome." Sleep Med. 2012 Aug;13(7):859-63.

Harrison W et al. "Anterior segment complications secondary to continuous positive airway pressure machine treatment in patients with obstructive sleep apnea.Optometry. 2007 Jul;78(7):352-5.

Ortolano, GA et al. “Filters reduce the risk of bacterial transmission from contaminated heated humidifiers used with CPAP for obstructive sleep apnea.” J Clin Sleep Med. 2007 Dec 15; 3(7)700-5.

Sanner BM et al. “Effect of continuous positive airway pressure therapy on infectious complications in patients with obstructive sleep apnea syndrome.” Respiration. 2001; 68(5):483-7.

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