Maximizing CPAP Sleep and Keeping It Clean in Between

Oct 3, 20195 min read

Breathe in. Breathe out. Breathe in. Breathe out.

Sounds simple enough, however for almost a billion people worldwide(1) the picture becomes more complex once they have finally closed their eyes to find those fleeting minutes and hours of sleep every night. Their in and out process of breathing is rudely interrupted by periods of blocked airways (Obstructive Sleep Apnea) or a brain that forgets to signal the muscles to breathe (Central Sleep Apnea). Some even have a combination of the two (Complex Sleep Apnea). As a result the brains of these individuals have to force them to partially wake up to resume proper breathing more often than normal, creating fragmented sleep of very poor quality. As we grow older the chance increases to develop some form of sleep apnea, but thankfully the technology now exists to overcome this life threatening situation.

But this creates the issue: How to properly take care of and use this technology safely, in order to maximize its benefit.

CPAP, short for Continuous Positive Air Pressure, is the industry leader in sleep apnea solutions. Given the prevalence of this condition, you likely know several friends and family members who are currently using this device. Initially invented in 1980 by Dr. Colin Sullivan, who had long theorized that positive air pressure would help keep your airways open to avoid the excessive episodes of sleep apnea, this machine has now become a household name in our lives. There is also a lot of scientific literature on the links between sleep apnea and several fatal heart conditions, though the CPAP itself is not a heart device and does not eliminate the chance of heart related episodes.(2) Untreated sleep apnea is also associated with increased risk for cognitive decline and dementia(3), and treating sleep apnea with a CPAP machine may delay the cognitive decline in such patients(4). Again, the CPAP itself is not a brain device either, but as these conditions are affected by and worsen with the presence of sleep apnea, a CPAP machine can still be beneficial.

(5)

As seen in the pictures below, the CPAP is a relatively simple medical device with a mask that ensures the air goes directly into the respiratory system, a hose that transports the air to the mask, a humidification chamber to ensure there is enough water vapor in the air being pumped into your lungs, and a pump or flow generator to push the air through the tubes into the mask. Some versions of the device also offer the option to have the air heated, which can help increase the comfort while you sleep. Newer versions also remove the reservoir and use a special filter to remove and then reuse the humidity in your breath, making for a much smaller unit. Others provide a control pad for adjusting other parameters such as airway pressure, humidity, tube and chamber temperature etc., or even monitor and track the number of apnea events you have per hour during your sleep cycles.

So far everything about this device sounds magical as it transforms zombies on limited poor sleep into rejuvenated, well rested human beings. Most people that I have spoken to find that they feel clearer in the morning and more rested as a result of using the CPAP. One person said that without it they wake up feeling as if they have been “hit by a truck”. You could call the CPAP another factor in life support for some. However, the CPAP user manual contain several instructions that are often ignored by its users, and society is starting to realize there may be negative consequences to the casual usage practices by the end users.

Firstly, the CPAP is intended to be used with distilled water. Why distilled? To not only reduce the hard, white mineral deposits in the chamber that regular water can leave behind (such as what happens in your household humidifier), but also to reduce the probability of any pathogens (bacteria, germs…) or other particulates from growing in the device and entering your lungs. Tap water is not as clean and germ free as distilled water, which means the mineral deposits it leaves in the system may allow pathogens/germs/mold to grow and even flourish. This may not be a big issue if you are going on a short local vacation and have no access to distilled water, but not all tap water is the same and some countries have lower regulations on the quality of their tap water. Also, this water should be changed after every use.

Secondly, the CPAP has filters in the system that need to be changed monthly. Much like the air filter on your furnace or car, the filters on these machines remove pathogens and particulates from the air that it is going to pump into your lungs. The longer the period between changing filters, the worse the air quality it provides can become, and the greater the risk for sinus and lung infections due to the lower air purity.

Finally, and most importantly, too many CPAP users do not properly, nor frequently, clean their CPAP machine, as outlined in the user manual. Discussing this with some colleagues, it was easy for me to confirm how common it is for users to not even clean their device weekly, let alone monthly. It’s one thing to use sources of water with more contaminants, but it’s a completely different hazard to allow those pathogens and germs to percolate over time and grow into bigger bacteria, germ and mold colonies within the device. This can lead to common side effects like rashes or acne build up near the skin surface in contact with the mask, respiratory irritation and the unit/air within the unit smelling funky, but these are symptoms of the bigger underlying problem of a dirty CPAP machine(6).

Long term, this constant exposure to excessive pathogens in your airways, whether due to improper water usage, infrequent filter changes or inadequate cleaning, could be problematic. As most users are generally on the CPAP for life, it is easy to see how the colonies of bacteria and mold can grow from an amount your body can manage without serious side effects, to a germ infestation that may require medical intervention or cause other illnesses or health issues(7).

The masks have to be cleaned daily, either with a soapy solution or special wipes. The entire mask, tubing and humidification system must be washed on a weekly basis using an odorless soapy solution, or a vinegar and water solution and then rinsed thoroughly. A lot of work you say, but the downside of not doing this is possible mold or other organic material contamination(8) and the upside is healthy, restful sleep on a nightly basis.

I have not seen any direct links to heart complications but when I read the definition of endocarditis from the Mayo Clinic I become a little concerned: "Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. If it's not treated quickly, endocarditis can damage or destroy your heart valves and can lead to life-threatening complications. Treatments for endocarditis include antibiotics and, in certain cases, surgery.”(9)

This article is not meant to scare you, but instead I am writing this story because often when I talk to CPAP users they will declare that they do not clean the device as often as recommended, and that is very concerning. Like all other life changing devices, the CPAP requires regular maintenance, and the full benefits of this device will only be properly realized when the users adhere to the usage, maintenance and cleaning instructions for it.

As more research is done on the side effects of poorly cleaned CPAP machines, we will continue to investigate and pursue this issue with the experts. Stay tuned!

For some tips on cleaning your CPAP device - https://www.jcer.info/how-to-clean-cpap-machine/