Help this sleep reseacher answer a CPAP patient's question

I started CPAP about 8 months ago. I do not seem to have OSA, but another type of sleep disordered breathing called UARS. I started it because I was having a great deal of respiratory distress and sometimes resulting infections, that seemed to be caused by specific incidences only at night. On a particularly bad night, I would go to bed fine and then wake up in the morning with a bad sore throat, cough, and stuffed up nose that could last for days or weeks. The symptoms could disappear just as fast as they began. It drove my doctors crazy because this did not seem to be the result of either allergies or colds. It was later determined to be acid reflex of the LPR variety. Subsequent visits to Gastroenterology did not show any stomach or diet related issues AND prescription acid fighting medications had absolutely no effect on the symptoms.

After suffering for years with these respiratory problems and basically giving up on the doctors (none of them thought I had any type of SDB), I decided on my own to try CPAP after reading Dr. Steven Park's book, Sleep Interrupted. It has worked marvelously well. I have not had any mysterious cold or flu symptoms since I started.

UMsleepresearcher wrote:Totally agree with Den, Blackspinner, and jnk.

I believe impaired immune function (and inflammation, autoimmunity) from sleep deprivation/OSA is the bigger threat, and that in the long run CPAP can alleviate these problems, a least to some extent. The intricate relationship between sleep and the immune system is just now starting to get proper recognition, and I hope others will take notice.

thanks again for the advice,
Tiffany

Just to provide a little echo, my husband has been using CPAP for nearly 20 years. Before he started, he had frequent colds with severe symptoms, and he had very troublesome nasal allergies. Immediately upon starting CPAP, his allergies became nearly nonexistent and his colds became infrequent. When he does have a cold, it is always mild and of short duration. And he is a very old dude.

The problems I had pre-CPAP were not so bad, but even these problems have improved.

But, yes, it would be good to have some science to support all our anecdotes. Good luck.

Thank you ChicagoGranny, that is exactly right...we're trying to generate some firm evidence to help support the anecdotal reports. we hope an efficient study will eliminate one potential barrier to CPAP use, and allay patient concerns surrounding repeated used of CPAP equipment.

Regards,
Tiffany

Wulfman... wrote:For those who have never had one, I would strongly recommend they get a pneumonia shot as a preventative measure.


Den

.

+1

30 day crowdfunding timeline is up. There was interest in the CPAP community, but funding goal wasn't met. I plan to look for other more traditional funding sources in the future (or different approaches to crowdfunding) to put this patient's concerns about CPAP use and infection risk to “bed” and hopefully eliminate one potential barrier to CPAP use, and allay patient concerns surrounding repeated use of CPAP equipment.

Not sure how to take this post down now (if someone knows a way, feel free to share). If we have to keep it up, I'm open to suggestions about how this project could be pitched differently, perhaps to different groups, in a way that will highlight the importance of CPAP and a need to dispel myths surrounding it.

thanks,
Tiffany

Dear Tiffany,
Public misconceptions need to be remedied, but this might involve the work of publicity experts.
I question the promises of "research", and attempts to monetize the issue.
Ignorance seems to be like cash in the pockets of those with any pull.

UMsleepresearcher wrote:I'm open to suggestions about how this project could be pitched differently

This is a generous group when it comes to giving advice to apnea patients. But, when it comes to money - tightfisted! Try elsewhere?

Thanks Chunkyfrog. It's not about cash in the pockets though.

To mine data of this magnitude (we were going analyze medical charts to examine upper respiratory infection rates pre-and post-CPAP in over 4,000 OSA patients, while accounting for other medical problems that could confound this relationship) it takes a data manager, a statistician, and effort from other sleep scientists to do this in an efficient manner over a reasonable timeline. We've found a way to do this quite efficiently, as far as research budgets go, but clinical research projects like this unfortunately don't happen without some way to support these folks' time, effort, and resources. Then, once the project is done, the data gets rigorously reviewed before any results can be published to be sure that the data is sound and presented in an unbiased way.

To be good health providers, and give patients the best and most sound advice, we rely on objective data (evidence-based medicine) to guide how we take care of our patients. Right now, even though we don't think that CPAP use causes URIs, we don't actually have good evidence to back up what we tell our patients. This study would have helped provide evidence to answer this common question. We won't be able to achieve such aims using PR people alone. However, they are helpful in letting the public know what new data emerges from scientific studies, once those studies have been properly done.

I suppose it would make sense to have some actual science to point to, proving your hypothesis, instead of all of us just continuing to explain to newbies why Cpap won't make them sick!

UMsleepresearcher wrote: . . . Not sure how to take this post down now (if someone knows a way, feel free to share). If we have to keep it up, I'm open to suggestions about how this project could be pitched differently, perhaps to different groups, in a way that will highlight the importance of CPAP and a need to dispel myths surrounding it. . . .

Post as stands may do good. This place is a one-big-bucket-catch-all of sleep-related stuff, and this thread takes up no more room than any other.

My opinion is that primary docs need to be the target for the myth-dispelling. Unfortunately, too many primary care dudes consider the PAP thing a money-grab by machine manufacturers, since they are the ones to have funded the studies and that do all the marketing. The more academic establishments get involved, the more likely the ears and eyes of the family physicians will get captured and educated.

jnk... wrote: the humidity lost from the venting from the mask,

Can you explain that?

The way I see it, the air entering the mask has higher humidity content than the ambient air because it has passed through the humidifier. The user breaths in a portion of that humidified air and another portion, that has never entered the user's body, is excess to the user's needs and is vented back out from the mask to the ambient air. Therefore, the air the user breaths has humidity higher than the ambient air.

wardmiller wrote:the humidity lost from the venting from the mask,

Oh, gosh, it was so nice to have the humidity. It was the best thing the first night I tried CPAP. I do have fewer colds with CPAP.

wardmiller wrote: . . . Can you explain that? . . .

CPAP.COM dudes wrote:"The movement of CPAP air through the air passages can dry out the airway. . . . CPAP air is an irritant - to one degree or another - to everyone. In some cases the irritation dries out the nasal passages and may cause bleeding. It may also cause swelling, excess mucous, congestion or sneezing. The irritation may create a very fertile ground for infections to begin. The irritation may be cumulative, building up over time. . . . Many PAP users experience nasal congestion and dryness of the nose and throat during treatment. This can be especially problematic for new users who are adapting to treatment."-- https://www.cpap.com/cpap-faq/Humidifiers.html

ResMed dudes wrote:"Using a PAP machine or other sleep apnea therapy device can sometimes lead to drying and congestion of the throat, nose, and mouth because the airflow generated by the machine is often greater than what your body is accustomed to humidifying on its own. Humidifiers and heated tubes can increase the amount of humidity in the 'inspired air' (the air which surrounds you before you inhale it) and may help counteract these symptoms and help make therapy more comfortable."-- http://www.resmed.com/us/en/consumer/su ... evice.html

In other words, the temperature in your nose and throat and the amount of humidity in your nose and throat are both generally higher than the temperature and humidity of the air in the room. PAP usually requires a mask that vents to prevent CO2 buildup. That constant movement of air just outside the nose and throat can change the "climate" of the air breathed in enough to change the "climate" of the air in the nose and throat--lowering temperature and humidity. This can, as you point out, easily be remedied by using a heated humidifier; however, those new to PAP therapy may not have developed the skills to dial that in according to their needs. Alternatively, the body can often adjust itself to the change in "climate" over time even without the comfort assistance of a humidifier. That's why some choose to forego the hassle of humidifiers after a while. And naturally, all of this is more a problem in dry climates than in humid climates.

Furthermore, all of the above ignores the larger issue of mouth-breathing, and especially mouth-breathing when using a nasal mask, which is of course a much more significant cause of drying of the airway than the designed venting of masks. That fact highlights the importance of leak data being provided to patients and clinicians.

But bottom line for me, according to my personal view, is that since no one starts out using PAP perfectly and since any form of venting can involve drying, then the initiation of PAP, on average, may involve some slight increase in risk for getting a cold. No biggie. But it is what it is. That mostly meaningless increase in risk need not be overstated but, in my opinion, also need not be completely ignored. Even very beneficial medical therapies can have minor risks that are far outweighed, in balance, by the life-saving benefits of the therapy.

There is little research on this. But what research there is, seems to show a slight increased risk. But is the risk from cpap or the comobidities of sleep apnea? That make us more likely to get pneumonia. For instance, diabetes type 2 makes you more likely to get pneumonia. Diabetes is also a comorbidity of sleep apnea. People with sleep apnea are also more likely to have other lung diseases than the general population. So this again makes you susceptible to pneumonia. There are several comorbidities of sleep apnea that Make you more likely to get pnemonia. Because of these, even if you do not treat your sleep apnea with cpap. You are still at a slight increased risk of getting pneumonia than the general population. All I can say is keep your equipment clean and use a sanitizer on it when cleaning. Then use distilled water in your humidifier.