People who use CPAP are 32% more likely to get pneumonia, in part due to poor CPAP maintenance.
More than 22 million people in the United States suffer from sleep apnea. We know that the most common form of this condition — obstructive sleep apnea (OSA) — is more than just a nuisance; multiple studies show that disrupted sleep is connected to greater risks of dangerous diseases and conditions, including:
- Heart disease
- High blood pressure
- Type 2 diabetes
There are many other diseases that OSA is associated with, and it plays an outsize role in seemingly unrelated issues, too. For example, those with OSA are five times more likely to have an auto accident than people who don’t have OSA. And it’s not just the patient who endures interrupted sleep; often their partners are sleep deprived, as well, and then end up suffering from some of the same complications of sleep deprivation.
Why cleaning the CPAP is important
In my Sleep Medicine practice, almost all of my patients with OSA are prescribed a CPAP to treat their condition. It’s one of the most reliable and effective sleep apnea treatments available, and patients can see a vast improvement — if they comply with the protocol and use it regularly. So, that’s the first hurdle; effectively getting the message across as to how vital it is that the CPAP is used every night. They see the best results when they use it for the entire night, but, in my observation, even using it just four to five hours a night on a regular basis makes a marked difference in improving their health and the adverse effects of untreated OSA.
The second hurdle — after getting them to consistently follow their CPAP protocol — is to help them understand the importance of cleaning their machine regularly. I recommend daily cleaning of the mask and hose since using a machine that has not been effectively sanitized puts patients at greater risk of infection and disease. The reasons for regular cleaning are simple:
- Oil, sweat and dead skin cells can accumulate in the CPAP mask every time it’s used.
- The water in the machine and the moisture in the mask and hose are potential breeding grounds for bacteria and germs.
A study from Brigham and Women’s Hospital and Harvard Medical School found 2,000+ bacteria counts evident after just 48 hours on 48 percent of samples from CPAP masks they collected. Another study showed that patients who use CPAP are 32 percent more likely to get pneumonia, in part due to poor CPAP maintenance.
In my practice, I see patients who will complain of respiratory infections many times per year — and when I dig down into what could be a contributing factor, more often than not I find that they are in the group that doesn’t clean their CPAP regularly. Once I convince them of the importance of that step, and then they comply, their incidence of respiratory infections goes down markedly.
I have had patients in my practice admit to me that not only do they neglect to clean their machine regularly, but they are also using the same water for several days without changing it. When I talk to those patients who are not cleaning their machines regularly, there are a few common themes:
- It’s too much trouble.
- It’s too hard to keep it clean.
- It takes too much time.
Today, with so many CPAP cleaning options available, patients should have no excuse for putting off this important step in their OSA treatment.
CPAP cleaning options
Some of the cleaning methods they can choose from include the following:
Soap and Water
The old method of disassembling the mask and hose and cleaning it with soap and water can, in fact, be time consuming and inconvenient. If it’s not performed with extreme attention to detail, it can also be ineffective, since hard-to-reach surfaces in the humidifiers, masks, and hoses may be potential breeding grounds for bacteria. Another consideration that makes this method suboptimal is that the very means of cleaning — tap water — can be a potential source of germs.
Though cleaning CPAP equipment with specially designed wipes may seem, at first glance, more convenient for users, it actually may be more dangerous than beneficial. However, wipes cannot clean inside the hose, and when researchers looked at this method just a few years ago, they found that rather than eliminate pathogens, the wipes — though formulated expressly for the purpose of cleaning CPAP equipment — tended to just transfer bacteria from one surface to another.
Vinegar and water
Similar to the soap-and-water method, this way of cleaning requires users to, first, disassemble their CPAP. Then the equipment must be soaked for at least 20 minutes, rinsed thoroughly and, finally, allowed to dry completely. So, for CPAP patients who choose this method — which in itself is a time-consuming process — there is the chance of introducing bacteria to the equipment at multiple points.
Because it doesn’t introduce moisture into the equipment, this method is an improvement over soap and water. But some studies have shown that the light may not reach shadowed parts of the mask and hose, and thus it potentially leaves bacteria and germs intact in those areas where the light may not get to. Also, UV light will not kill bacteria in the hose, the inside of the machine or the water in the reservoir.
Used in cleaners like SoClean, activated oxygen (ozone) has been shown to have multiple benefits over other ways of cleaning the CPAP. A naturally occurring gas, ozone is extremely safe when it is used properly. It has been used to purify water since the 1800s. Today, it’s the method that hospitals, food handlers and the hotel industry use for sanitizing, as it’s been proven to kill virtually all known forms of bacteria in air and water. As a CPAP cleaner, SoClean kills 99.9 percent of germs, without introducing moisture that could then become a breeding ground for more germs. SoClean is designed to safely use ozone, rather than sending it directly out into the room.
So, when I am working to ensure that my OSA patients comply with their treatment protocol by consistently using their CPAP machines, I also emphasize the importance of cleaning the equipment regularly. I lay out the pros and cons of each cleaning method, and an ozone device with proven efficacy rates and multiple safety features is the one that I usually recommend because it is superior on many counts.
Editor’s note: Although this story promotes a commercial product, we were not paid to publish it.
Originally published at thedoctorweighsin.com on October 26, 2018.