Cage Match - Sleep Apnea vs. Upper Respiratory Infections

[Julie]

The more you 'sanitize' the more open you'll be to bad bugs - because you've santized the good ones out of existence. You don't live in a back alley do you? You don't routinely drag your mask, etc. through the cat's litter do you? Why would it get any dirtier than e.g. dishes, food (outside of the fridge), or furniture, the phone receiver, walking down the street? All of which impact your life. Sheesh.

[49er]

jbt1125,

As one who is not a pap success story (another post), I am not one who thinks that cpap therapy isn't infalible. Every therapy no matter how harmless it may seem will have side effects even if they rarely occur. It is just common sense.

Also, because most doctors will blow off side effects of any medical therapy or drugs, the fact that your doctor is saying that your URI is due to your pap therapy is quite interesting.

Anyway, I wish you all the luck in the world in sorting things out.

49er

Well, a few things. I have read many posts on this board during my research. I have found that a certain segment gets very defensive about how infalible CPAP therapy is...to the point that in my mind they lose credibility, because they are unwilling to listen to or accept that anyone would have problems with it. Some of us genuinely want very bad to make it work, but have problems. I have read about them - infections, leaks, whatever. And when you come here and the only answer is - you are wrong, your dr. is wrong, etc., its not very helpful. Sorry - that was my vent

My dr. went out of her way to say that she is very supportive of CPAP. But she just mentioned to me, in a very matter of fact way, that her CPAP patients on average have more chest and sinus infections. She is a very well regarded dr. with decades of experience and I trust her. My answer is not to stop therapy, but I am trying to find a way to get my equipment more sterilized. Without going too deeply into science here, there is a big difference between "good bacteria", the type we get if our apple drops in some dirt and we eat it. And the kind of viruses that grow in the millimeter space between the rings on the inside of CPAP hosing, that got there because I coughed junk in there and it was impossible to reach, etc.

My AHI has been very low and I have felt very good on CPAP prior to the infections. So I don't think that this is about leaks.

Does anyone have an opinion about the box you hook up to that is supposed to sanitize all of your equipment? I definitely plan to try all this again. But in my mind I have very little doubt about the cause. I have traveled all over the world for 20 yrs without chest infections and since starting my CPAP 3 or so months I go, I am on my third, this one based on Xray bad enough to need antibiotics. I think its that my equipment is not getting clean enough.

[Pugsy]

My personal opinion FWIW...I think that for most people going to extreme (usually means lots of work or lots of money in my mind) measures to actually disinfect or clean their equipment is unnecessary.

Maybe there are some people who seem to have more illness due to cpap use. Nothing in medicine is 100% absolute. Seems like there is always an exception out there somewhere with someone about something.
I don't think it is very common though..if it were I think we would see a lot more complaints in that area...and we don't.
I would be more apt to think that a person picked up a bug in the general population and that bug got a chance to grow by maybe the cpap machine helping it on its ride into the nasal mucosa or respiratory system than I would think that a bug resides on the equipment itself.
But maybe there is some sort of environmental situation that leads to pathogens being in greater numbers in one persons house ...I don't know...I was thinking along the lines of mold spores maybe. I just don't see a pathogen arriving out of the blue in the middle of the night into the bedroom to make a person sick. That bug has to come from somewhere.
There's a big long skinny limb to go out on and while I don't know for 100% certainty, I don't think there is much of a chance...doesn't mean that some people who might already have a compromised immune system for whatever reason would have it totally impossible for cpap use to make the situation worse. Unlikely yes, impossible no because there are no 100% absolute certainties in life.

If someone wants to go to extraordinary measures to clean or disinfect their equipment...hey, whatever floats your boat and lets you sleep better is fair game. That's why I brought up the SoClean device...not because I feel there is a need for it but because someone else feels the need and it's their opinion that is important in this situation and not mine.

It would be interesting to have follow up from this OP in say a year if they choose to use something like the SoClean and find that frequency of illness has perhaps been reduced or not. That would speak louder to me than someone who is normally healthy anyway and they report they stayed healthy.
Like me...in 4 plus years on the cpap machine I have had 2 or 3 very minor short lived "colds"...nothing serious so if I were to use a SoClean device for a year and report no major illness it means nothing because I most likely wouldn't have had a problem anyway and everyone knows that I don't do anything extraordinary in terms of cleaning much less disinfecting my equipment.

So jbt1125...if you elect to try the SoClean device (or something similar) could you maybe report back to us in say a year or so as to whether your frequency of illness or severity has changed any???

[jbt1125]

1) I really appreciate all the opinions, even the ones I disagree with. My experience with online forums - whether health related, leisure related, whatever, is that its the diversity of perspectives that add value.

2) I will take my internists opinion on what good vs. bad bacteria is, etc. If it was better to not have sanitized equipment when dealing with lungs, they wouldn't do so in the hospital. Your body is complex. And certain parts of it were meant to deal with bacteria, others not. You can "sheesh" all you want, but biological evolution isn't "built" for pressurized air pushing bacteria into the smallest lobes of your lungs/bronchi. To suggest that you wouldn't want THAT air sanitary is just silly. Its different than the good germs we get from not over sanitizing our hands, etc. I agree with that notion. But there are lots of mechanisms in place to handle that bacteria before it makes its way into the body - on the hands themselves, in saliva, in the mucosal membranes, etc. So sorry no one is going to convince me that having a sanitary CPAP machine and equipment is a bad idea!

3) I purchased the SoClean and I will absolutely report back on whether or not it seems to take care of the issue.

Again, thanks so much for all the different opinions. Maybe I am in the minority, maybe its even something in the air of my house, who knows? I am a healthy individual though, so I don't think that this is anything about fragility on my part. Maybe its rare to have these complications. My doctor didn't seem to think so, and a little search on the web yields a lot of info.

Will end the thread by repeating that I feel WONDERFUL when I sleep on my CPAP and I very much hope that these were isolated incidents.

[chunkyfrog]

Hospitals have lots worse bugs floating around than most homes do.
This is why they try to disinfect everything.
The SoClean will not remove the good bugs from your system--that's what antibiotics do.
I wish you well, and please keep in touch.

[BlackSpinner]

For what it is worth, personally I feel it is your sinuses that are the culprit here. If they are reacting to cpap air they become inflamed which means they create sealed little pockets of moist warm environment with bacteria sealed in them. This is the perfect breeding environment for them. You have germs in your body, we all do. Normally they are kept in control by your own defences but in those hidden pockets they get to breed out of control and they migrate.

I don't think it is your actual cpap cleanliness that is involved here. Up north here where in the summer it is humid and due to heating in the winter, it is drier then the desert, when the heat first goes on is when we get our sinus infections, the sudden change to dry, dry air inflames or cracks the sinuses and the germ population explodes. So I would play with the humidity settings and be very active with nasal rinses.

[Mgsnorer]

This is just my own experience, but here it is.  I have a pulmonary fibrosis from radiation treatment, and I am on immune suppressants for an autoimmune disorder.  Before starting CPAP therapy in July, I had 6 lung infections during 2013.  Since starting CPAP, I have had only one, & I know where I caught that one, and it wasn't the CPAP.  

Because I am prone to infections, I am very careful cleaning the machine.  I use the Soclean thing, along with washing out the cleanable parts with Control III.  This is overkill for most folks, but not for me.

What I have noticed since CPAP is that I get better much faster.  I turn the humidity way up, my AHI goes up a bit, but I recover from URIs and pneumonia much more quickly than I used to.  No more hacking all night and feeling like the walking dead in the morning.

Since I have been on antibiotics so many times (not to mention chemo and radiation) I try to restore the good bacteria with pro and pre biotics.

My sleep doc (pulmonologist) tells me that when I am sick, I need my CPAP more than ever.  

Good luck to you,

Maureen

[Bill44133]

Since the machine is only sucking in room air I was thinking that maybe you have the machine in a room where the air is not so clean, Do you have smokers in the house?
I would try getting a room air cleaner and run that a while before you sleep and during sleep. I have had 4 sinus infections this year since July, that is more then normal; my allergies
always kick in at the end of the summer, and I feel awful till the first frost.

I just bought a room air cleaner from home depot and bought the inline air filer for my machine.
I have been fine since(knock on wood). You may have something in the air that is upsetting you..

I wish you good luck!

[zoocrewphoto]

W
My dr. went out of her way to say that she is very supportive of CPAP. But she just mentioned to me, in a very matter of fact way, that her CPAP patients on average have more chest and sinus infections. She is a very well regarded dr. with decades of experience and I trust her. .

But she only remembers the ones who had problems. The ones who don't , don't see her often, in fact she might not even know/remember they are on cpap. My doctor who is quite good just has a note somewhere in her system that I use it and has never referred to it.

I have only seen one article on people getting infections and they were not a majority and most had problems with cleaning. It is NOT a common thing.

I agree. My doctor seems to forget that I am on cpap.

I started cpap April 30 of 2012. The first weekend of June, I came down with the worst cough, no idea why. I suspected the cpap machine, and did a full cleaning of everything. The cough still went 2 weeks. Then, in July, it started up again and went 6 weeks. My doctor decided it was medication that I had been on for a year. Um, no. I begged for help as the coughing spasms were causing me to take off my mask, which meant my sleep was crap.

The cough returned again in September and again in October. I finally discovered why. It was an allergic reaction to a chemical that spilled in my mom's minivan, which I used for traveling the first weekend of June, the second week of July, etc. The longer the distance, the worse the cough. We deep cleaned the minivan, including taking out the seats, and I used allergy medication on trips as a preventative measure. I haven't had a bad cough since October of 2012. Oh, after telling the doctor that October, she prescribed a new cough medication and a special asthma inhaler. If I feel that cough start, I can knock out right away.

I am still using the same hose that I started with. I haven't deep cleaned it in over a year. I have my original mask and one I got last April. I do get new cushions and use them for 4-6 months with simple cleaning with water and dawn. I rinse the humidifier tank occasionally, but usually I just top it off.

Unless I get hit with an allergen, I have no asthma problems. My migraines pretty much disappeared with cpap treatment. I do occasionally get a weather related headache.

I would expect to find myself in the more sensitive category, but I don't seem to require any special cleaning to keep healthy.

[RestedRebel]

I actually feel better and have had no sinus infections or bronchitis since starting up cpap therapy almost a year ago. In fact, I breathe better during the day, don't have all that dried up nasal mucous I used to have each and every morning before cpap therapy. I clean my humidifier tank every week in the dishwasher, clean my nasal mask regularly, change my filters, but wouldn't call myself obsessed with cleaning it. The humidified, filtered air seems to make me breathe better, and I would be at a loss if I couldn't use my cpap to sleep at night because relying on that pressurized, filtered, humidified air seems to have become a habit with me.

Unlike you, I don't travel much, and I suspect many of your woes and ailments are related to airplane travel, sharing that pressurized cabin with people carrying all kinds of germs and viruses. I dread having to travel to a destination wedding for fear up picking up something nasty, either virus or germ related.

I have lost 107 lbs. since starting cpap therapy, and my biggest fear right now is that I'll be taken off cpap therapy. I can handle having to sleep with a low pressure, but not having any pressure at all, no filtered, humidified air - that's what scares me.

I don't think cpap is causing your problems and believe it is just a coincidence that you've gotten sick since starting therapy.

[jbt1125]

thanks again, some good advice in here...

not convinced this is coincidence, sorry... but absolutely could be something sinus related, could be the air (no smokers in our house, but maybe something different), could be the machine just wasn't clean enough.

will report back after a period of soclean usage...

for what its worth, my personal theory is around the hosing.... I just don't see how it can be kept germ free... I have followed all the directions around how to clean it, etc. but I find it next to impossible to thoroughly dry after a cleaning, and the fact that it is dark, heated, with moist air in it just seems like a breeding ground for bacteria....

[hegel]

As I mentioned in passing in my post, I too bought the So-Clean machine for precisely the reasons that you mention. I'm very happy with it. I bet that you'll like how your mask/hose smell. Also, the machine cleans your humidifier and cpap too!
I dump my humidifier water every morning and towel dry the reservoir. Then I air-dry my hose and mask by running the blower through both for about 15 minutes, thinking that a dry environment is less likely to allow bacteria/germ growth. Then the So-clean does its thing at 10:00 A.M.

Here in Berkeley the air is getting DRIER now. Counter-intuitively, colder winter air requires MORE humidity in my cpap machine. Even though it rains a lot more.

[Todzo]

As I have posted a couple times prior, my early experience with my CPAP was great. I use the nasal pillows and was getting 7 hours of sleep with AHI in the 0-2 range pretty regularly. Then the infections started. Despite my best attempts at keeping the machine, hoses, mask, filter, etc. clean. I saw my Doctor last week and she prescribed antibiotics and told me not to use the CPAP again until I was full recovered. She also mentioned, that while she is hugely supportive of treating sleep apnea through CPAP, that most of her CPAP patients have sinus and chest infection problems. In other words, she was not surprised by this pattern.

Apparently some 36% of those with OSA have high respiratory control system gain[1]. This means that they have times when they breath a lot more and a lot less than another person would at the same level of metabolism. As well the times of high breathing rates tend to cause arousals which then cranks up the respiratory control system gain even a bit higher due to the stress hormones released during the arousals.

Simply this can be hard on the lungs.

Its very frustrating to me, because it took a LOT for me to go get the sleep study done, and a LOT for me to actually start using the machine. I was cleaning it regularly, traveling with it on business, purchasing distilled water at my destinations, etc. Its a lot of work, but I committed myself to it. All of this at 41 yrs old with perfect health record (except the apnea), BMI of about 27, sleep apnea in the moderate category. To go through all this and keep getting sick is frustrating. As my dr. agreed, it is sort of impossible to completely sanitize all the CPAP equipment. I mean, in the hospital they use all kinds of crazy protocols around sanitation, so what makes us believe that some Johnson's baby shampoo and a rinse is going to do the trick? All the microscopic nooks and crannies in the machine, tube, etc. I am just deflated because I want to use my CPAP but I am not willing to be sick because of it.

If you want to catch a super bug you need to go to a hospital (or similar place where they do their absolute best to “kill them all” where microbial life is concerned).

We need to learn to live WITH our microbial friends rather than prospering the super bugs by killing off the microbial life that would have kept those super bugs in check.

All of this not to even mention the peer reviewed articles out there about meningitis risk if there is any sinusitis, etc. Well, I frequently get allergies, nasal congestion, etc.and I have a deviated septum.

Before someone suggests its not the CPAP, I NEVER got sick like this to my chest prior.I am healthy. And before someone suggests that I am trying to find ways to not use the CPAP, let me tell you that I WANT to use it.

I think that there is some kind of sanitizing box out there that you hook up to, does it work?

I think that what CPAP brings into the equation that is causing the infection problems is that the pressure raises respiratory control system gain by making inhalation easier. This stresses the lungs and causes other changes that make the immune system, especially in the lungs, work less well.

Probably the most accessible “handle” to help here is to reduce stress in your life if possible. My experience is that stress can be a very very large factor in respiratory control system gain and the unstable breathing it can cause during CPAP use.

I do find exercise helpful to keep nighttime unstable breathing away. Some aerobics, some 85% of maximum heart rate interval training if you are up to it, and some resistance training.

While I have used O3 in the past to disinfect the insides of a very old CPAP I now think this is the wrong approach. I do not use anti-microbial soaps, on me, on my floor, in my house. Basic cleaning yes but we need a substrate of healthy microbial life in us, on us, and around us to do well. I am in the process of learning how to develop a healthy microbiome. I do eat a great variety of veggies and fruits much and often.

[1] http://www.atsjournals.org/doi/abs/10.1 ... pJVaUN385Z

[Julie]

Once and for all - the air going into you from the machine, hose, mask, etc., is the same air in the room around you that you've been breathing all day long. What point is there is scouring your equipment under the circumstances? You don't seem to get it. You're not having surgery overnight and your room's not an OR.

[jbt1125]

Julie, based on your posts, I am quite sure that you don't get it. I am sorry, but I find your posts are very general and naïve, in my opinion. When you breath the air in your home, it is not through a tube, that has humidified, heated air pressurized through it for 7 hours. Its the moistness of the tubes/CPAP machine/humidifier, etc. that causes the issue. If I was strictly on a CPAP with no humidifier, your statement would be closer to accurate (still not entirely accurate given hosing, nasal pillows, opportunity for getting gunk, etc.). With a humidifier, your statement is nowhere close to being accurate.

Several posts in this thread have helped me a lot, I am very appreciative. I think I am going to bow out of this one now, however, before getting into further debates about what is room air vs. pressurized air, humidified vs. not, what heat and darkness do to water, etc. It wasn't really the point of my post. thanks again for all the helpful info.