xPAP-induced sinus infections! Positional alternatives?

Hello, everyone. I'm new here.

I was diagnosed with OSA about 10 years ago. My first machine was big beige boat-anchor which while operating sounded much like someone using a vacuum cleaner a few doors down. Since then it's been this machine, that machine, a UPPP that only worked for a year or so, nasal masks, crappy Respironics full-face masks and finally a Res Med Quatro full-face mask which does work but needs constant, frustrating adjustment due to leakage 'round my nose, but that's the nature of the beast I guess.

Anyway, ever since I began using a BiPap, I've had a virtually unbroken succession of low-grade sinus infections. Every time I turn around, it's another 'scrip for antibiotics. There seems to be no escaping them. Humidifiers, scrupulous disinfection of the water tank, washing the mask every night with baby shampoo as recommended, while good hygenic practices, have no effect. The infections just keep right on coming. I understand they're a fairly common side effect of xPAP therapy.

My sleep doc said after my last study that my apnea appears to be positional (i.e. "stay off yer back!") so I've been experimenting with homemade appliances to substitute for the purpose-made belts, t-shirts and so on which my "insurance" will not cover. (Specifically, a large fanny pack filled with sheets of scrap styrofoam, worn at chest level with the pack on my back). The jury is still out. I've been feeling tired upon waking lately but that could be because I've gotten to bed really late a lot of the time (I'm a single guy and I get lonesome so I often go online till the wee hours, not a good idea, I know), or it could be the time-release melatonin in addition to my nightly medication. I feel mentally alert when I wake but physically blah (bloodshot eyes, physically weakish, etc.). If I do caffeine (which I don't do often at all) I think I pay for it the following day. I'm not sure if my problems are the fault of my sleep habits, the failure of my home-brew appliances or if I'm a prisoner of the bi-pap whether I like it or not (and I don't).

Is there any hope for me? Should I just bite the proverbial bullet and go back to the bi-pap, and invest in industrial quantities of Zithromax?

morpheusjr wrote:... My sleep doc said after my last study that my apnea appears to be positional (i.e. "stay off yer back!") so I've been experimenting with homemade appliances to substitute for the purpose-made belts, t-shirts and so on which my "insurance" will not cover. ...

Don't forget pinning a tennis ball to the T-Shirt trick. Lots of different ways to train yourself to stay off your back. Some work better than others, but nothing is perfect.

morpheusjr wrote:... I'm not sure if my problems are the fault of my sleep habits, the failure of my home-brew appliances or if I'm a prisoner of the bi-pap whether I like it or not (and I don't). ...

Hmmm... Then I'ld say I am a WILLING prisoner of my xPAP therapy. I doubt I would be alive without it. I had SEVERE sleep apnea. And even ignoring moderate sleep apnea can have fatal consequences.

morpheusjr wrote:... Is there any hope for me? Should I just bite the proverbial bullet and go back to the bi-pap, and invest in industrial quantities of Zithromax? ...

You might want to try using saline nasal spray to help keep your sinuses open. Sometimes stuffy sinuses are a reaction to the pressure. Using saline nasal spray seems to help me open my sinuses, without the addictive antihistamines or expensive prescribed nasal sprays. It also seems to help reduce the sinus infections and colds that I had almost my entire life.

I don't know if that will help you. But It might and it's a LOT cheaper and safer.

Try everything.

Try these: https://www.cpap.com/productpage/In-lin ... bipap.html

I think there's some risk they'll confuse a BiPap machine, so watch it at first.

Obviously, keep your filters clean and use the ultrafine filter if applicable.

Forget that baby shampoo BS. Get medieval on those germs.

Get a spare mask, hose and humidifier tank as your insurance permits. It's a good idea to have a spare anyway. Accumulate a few sets. Your insurance may allow you to buy cushions more often than whole masks.

Once you get a spare set, you can now risk damaging one set by trying "experimental" cleaning procedures.

Look at the "ResMed disinfection and sterilization guide for hospitals"

It allows, as part of the hospital style cleaning, water immersion at one of

158F (70C)-100 min
167F (75C)-30 min
176F (80C)-10 min
194F (90C)-1 min

This is the process for using the same mask on multiple patients. It says its validated for up to 20 cycles. It's not recommended for home use, and requires some other items and equipment. The point I'm making is that hot water at this temperature and time is not supposed to damage the mask.

Heat up some water at home. Disassemble your spare mask. Immerse it in the hot water according to the schedule above. I have done this myself by boiling a large pot of water on the stove, turning off the heat, then dropping the disassembled parts into the water, and swirling it around to be sure every part gets wet. I left the parts in the water for several minutes.

Nothing I had was damaged by this process, but it was all stuff I could have done without if it had been damaged. I've only done this once on some used stuff I got. You might consider doing it at least once on your equipment or do it after each sinus infection.

I've done masks and hoses this way. I would not do this to headgear. I don't think I've ever done it to a humidifier tank.

One user on this board reported melting the "short hose" on her mask, but she put the parts in boiling water with the heat still on and left it for 10 minutes or so. Proceed at your own risk.

Yes, this and other severe cleaning processes might shorten the life of your mask or other parts. Try it on a part you have a spare of and see what the result is. Parts are cheap compared to sinus infections.

I regularly clean my masks and tank in the dishwasher. Disassemble, then wash on the hottest, longest cycle your dishwasher will do. Mine has a "sanitize" cycle. No dishes at the same time. I use regular dishwashing powder and an extra rinse cycle. No heated dry cycle. Once I clean a set of parts, I let them dry thoroughly and set them in a clean, dry place and use the other set for a week or so. I figure dry surfaces are less likely to grow germs. I don't wash the headgear this way.

I've done this for 7 years and get a year or so out of mask cushions. Nothing else seems to wear out.

I wash the hose by putting it over the kitchen faucet and running the hottest water I can get through the hose. I then hook it to my older CPAP machine to dry out the inside. I put it away with the clean mask and use my spare hose.

Get several extra mask cushions as your insurance will pay for them. (Or check ebay. I've found genuine cushions real cheap there for my ComfortGel mask.) Clean a batch of them, and switch them every day. Let the one you just took off sit somewhere dry for the next day or two. You can put one of the dry but not clean cushions back on the mask once you use up your supply of clean ones.

I've occasionally used Everclear (95% pure drinking alcohol) to clean things other than my CPAP equipment. Once you rinse it off, you know it's not going to be toxic to the body in trace quantities. I'm a little scared of residue of some of the commercial cleaning products. Of course, there's some risk it will damage some of the material in some of your CPAP parts, so realize you're doing an experiment. Everclear is very flammable, so be careful.

In your case, I'd probably replace or boil the old hose. They're cheap.

I presume you use distilled water. Try emptying the tank every night.

I wonder if you could find a backpack you could stand to wear at night and stuff with something.

I use to suffer from chronic sinus infections. I started using neti pot twice a day, I take claritin for allergies, flonase nose spray and Sudafed on occasion when needed. This had kept me off antibiotics now for about 5 yrs.

When I am feeling well, I use my Neti pot before bed...then flonase and off to bed. I wake up clear in the morning.

Try getting your vitamin D levels checked...the robustness of your immune system is dependant on your D levels. I have to take 15,000 IU/day to keep my levels in the 70s (above the level associated with disease). If you do take a supplement, ensure it's the D3 form which is the form used by our body and not the D2 form ehich is the plant form that has 2 drawbacks: it must be converted to D3 and as we age we lose efficiency in doing that and it can be toxic as it's not bio-identical.

Oh, get your thyroid function checked because chronic sinus infections/sinusitis is associated with hypothyroidism.

First, thank all of you for your responses. I appreciate them to the max. It's great to have finally found an active community of fellow OSA patients.

archangle wrote:Try everything.

Try these: https://www.cpap.com/productpage/In-lin ... bipap.html

I think there's some risk they'll confuse a BiPap machine, so watch it at first.

I have a recent-model Philips/Respironics auto-titration unit (see below). Maybe I'll ask my equipment dispenser if it'll work (would contacting Respironics directly be useful?)

archangle wrote:Forget that baby shampoo BS. Get medieval on those germs.

I actually rinsed out the humidifier tank every night at first in vinegar but then switched to a mild solution of Clorox. Sometimes I run that solution through the hose, being careful to dry it out well. Perhaps I should dunk the mask in that solution too? There'll be no risk of heat damage, and all bacterial and fungal nasties get zapped by Clorox. I don't have a dishwasher either, so I'm thinking this might be the way to go. Chief drawback, it's highly toxic and smells yucky.

Spare parts are always a good idea. Very good advice, no matter what.

archangle wrote:I wash the hose by putting it over the kitchen faucet and running the hottest water I can get through the hose. I then hook it to my older CPAP machine to dry out the inside. I put it away with the clean mask and use my spare hose.

I knew there was a use for my old boat-anchors!

Maybe I can do the same thing using isopropyl alcohol. Or the Clorox solution mentioned earlier. No one around here sells Everclear. Isopropyl is nasty, but I'm afraid that cheap vodka would contain other things which I don't need in my equipment.

archangle wrote:I presume you use distilled water. Try emptying the tank every night.

I don't use it now. Not because of its expense, but it's a royal pain in the ass to buy ("Sorry, we're out of stock. We'll have more next Thursday!"), a pain in the ass to travel with, impossible to find within easy driving distance of any given motel or hotel and on an airplane, well forget it! But even when I did, I recall having the same problems. (I was somewhat lax about sanitation then, so we may be talking about apples and oranges here).

Could I resort to those water-purifying tablets they sell in camping supply shops, even if only in a pinch?

archangle wrote:I wonder if you could find a backpack you could stand to wear at night and stuff with something.

I tried finding an inexpensive book bag a few months ago, but no one had them. Now that the back-to-school stuff is in stock, I'll have to see about finding one I can use. Wonder what I can stuff it with? Styrofoam packing "peanuts" perhaps?

Muse-Inc wrote:Try getting your vitamin D levels checked...

I did get my vit. D levels checked and they came up low. I now take several thousand units of D3 a day.

Muse-Inc wrote:Oh, get your thyroid function checked because chronic sinus infections/sinusitis is associated with hypothyroidism.

I do suspect low thyroid activity. I took a thyroid test a while ago and of course it came up "normal". Those thyroid tests are bullshit. They don't turn up anything unless you're practically dying. I'm taking kelp supplements, and that seems to help somewhat (rhyme not intended!). Not sure what else I can do. Any ideas?

I had to get sinus problems under control before CPAP therapy could work. And, CPAP did make the sinus problems worse, no doubt about that. But, I'm convinced it was not microbes in the hoses. I washed the hoses, mask and humidifier with soap, soaked in vinegar and other microbe-killers, to no avail. Antibiotics worked only momentarily--the infections always came back. What worked was lots of sinus rinses, using neilmed salt+soda packets. As the ENT doctor explained it, you are always going to have bacteria and fungi getting in to the sinuses; but, the the sinuses normally drain, so they do no harm. If anything causes the sinus openings to become enflamed and swell shut, the microbes multiply in there, causing an infection. CPAP therapy can irritate nasal tissues. But, regular sinus rinses washes out things and helps to keep the sinuses open and draining. These days, I have no sinus problems and I hardly even wash hoses anymore. But, I do keep up a maintenance regime of sinus rinses.

Well, that's my experience. Your mileage may vary. But, if I were you, I would give sinus rinses a try.