CPAPtalk.com

archangle wrote:

Mike6977 wrote:

Vader wrote:Boiled or not, I would never use tap water for a neti pot. Home distilled only for me.

Hi Vader.

I think that's an excellent suggestion, especially for a CPAP board.

After all, what does a CPAP humidier do except aerosolize the water you put in it . . . then blow that misted water into your sinuses for six to eight hours straight?

No, it's not aerosolized or misted. It's evaporated. There's an enormous difference in terms of spreading bacteria.

Of course, I'd prefer there to be no bugs growing in my humidifier water. It's easy enough for me to use distilled. I've only used tap water occasionally while traveling and I didn't bring any and didn't have a chance to buy some.

In terms of the risks of Naegleria, there has been one diagnosed USA case of Nagleria infection from neti in recorded history. There have been a few more in other parts of the world, including India, where neti is more common, and (probably) the water used is less well treated.

I do Sinus Rinse with tap water because it's easier to get the right temperature. I don't do Sinus Rinse that often. If there's anything that bad in the tap water, I probably breathe it in aerosolized form when I shower anyway.

I’d just like to mention that I fully understand that my (Vader’s) comments were only used to provide context for the comments made by Mike6977.
And of course, FOR THE RECORD those comments made by Vader, were only to comment on what “Vader does”, and in no way suggest anyone should do anything so careless, as to follow the advice of someone who is NOT a scientist.

I remember the last time a similar debate was discussed here, this forums “Professional Scientists” were quick to dismiss Vader’s views on distilled water.
So trust me, professional friends, I have NO FURTHER DEBATE in this matter.

archangle wrote: There are worse things to worry about than an alligator in the bathtub. If you find one, run, but I don't think most of us need to worry about finding one there.

That was good! Thanks for the evening

archangle wrote: No, it's not aerosolized or misted. It's evaporated. There's an enormous difference in terms of spreading bacteria.

I actually ran a test on this and at a pressure of 8 cm H2O it seems that there is a small amount of aerosol action taking place.

I put some salt into the humidifier water and collected condensate from my mask. The condensate had salt ions in it. The only way to get salt ions into the condensate is if there is some aerosol action. Mind you it wasn't much, but there is a little more going on than simple evaporation.

Try it for yourself and let us know what results you get.

Hi, archangle.

I agree with 90% of your post, and disagree with one part of it. But it's a critical part, imho.

Let's start with what I agree with:

archangle wrote:there has been one diagnosed USA case of Nagleria infection from neti in recorded history.

Googling, I come up with 120 deaths*, but it's still a small risk: 120 <312,092,343 (USA population as of August 29th, 4:07am EST), about 3 deaths per year, says the CDC.

*http://abcnews.go.com/Health/Wellness/w ... d=14328749

archangle wrote:If there's anything that bad in the tap water, I probably breathe it in aerosolized form when I shower anyway.

Agree there too, but with one proviso. Unless you're really into showering, I'd imagine you shower once, perhaps twice a day, each shower session lasting about 5 to 10 minutes.

Infections from pathogens, viruses and chemicals are dose-dependent. If there is something aerosolized in the water, I'd much prefer a 5 minute shower exposure than an 8 hour xPAP one.

Additionally, I'm guessing that most people using tap water to drink—or fill their xPAP tanks—use water from the cold pipe alone.

If you shower with heated water, you're mixing very hot and cold water.

In my building, the hot water from the hot pipe is steaming hot, so I'd venture that in the boiler room, the water is boiling.

Most pathogens have a thing about boiling water, so again, that 5 minute a day exposure is reduced even further.

________________________________________________________________________________________________________

Here's where we congenially disagree:

archangle wrote:No, it's not aerosolized or misted. It's evaporated.

I want to make sure that we're both agreeing on the definition of aerosol.

Wipedia wrote:With studies of dispersions in air, the term aerosol evolved and now embraces both liquid droplets, solid particles, and combinations of these

http://en.wikipedia.org/wiki/Aerosol

Thus, if I spray my hand with a bottle of Winex, I get aerosolized with different sized droplets, not just microscopic sized ones.

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Reading your post, I tried this experiment: I filled my cleanable water tank for my ResMed S9 with cold water, up to the max line limit.

I put the tank in the S9, unhooked the hose from the unit, and turned out the lights, turned on a tiny LED penlight.

I started up the S9, no ramping, default pressure at 10.4 cmH2O. Put my hand in front of the S9's exhaust port, used the penlight to back-light the results for maximum contrast.

The water in the tank was cold. No time for evaporation. But I could see a spray coming from the port. In a minute my hand was dripping wet.

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I redid the experiment, filling the water to the 3/4 mark.

This time, I dried all the parts of the tank (the cleanable tank can be disassembled) with a paper towel, eliminating the possibility that the water was from spillage inside the air chamber of the tank when I filled it.

Same result. Cold spray, clearly visible.

I shined the penlight into the S9 as it was running.

Of course, at first, I thought what I was viewing was (ps)2 + (.5 * r * V^2)2 = (ps)1 + (.5 * r * V^2)1 = a constant = pt (Bernoulli's Principle), that the increased air velocity in the tank's air chamber produced decreased pressure, and thus drew out water from the water tank in that manner.

But on closer inspection, I could see that the airflow speed and volume was causing the water in the water tank to roil vigorously, and so I suspect that was the cause of what I perceived to be clear aerosolization from the exhaust port.

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There are a number of potential pathogens in tap water:

http://www.iwaponline.com/jwh/005/0427/0050427.pdf

Add this to the number of chemicals commonly found in tap water, and I can see why ResMed's pamphlet unequivocally states: "Use only distilled water" in your tank.

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OH NO YOU DIDN'T!


The concise version:

hosecrusher wrote:I actually ran a test on this and at a pressure of 8 cm H2O it seems that there is a small amount of aerosol action taking place.

I put some salt into the humidifier water and collected condensate from my mask. The condensate had salt ions in it. The only way to get salt ions into the condensate is if there is some aerosol action. Mind you it wasn't much, but there is a little more going on than simple evaporation.

Try it for yourself and let us know what results you get.

Posted while I was typing.

Mike6977 wrote:Hi, archangle.

I agree with 90% of your post, and disagree with one part of it. But it's a critical part, imho.

Let's start with what I agree with:

archangle wrote:there has been one diagnosed USA case of Nagleria infection from neti in recorded history.

Googling, I come up with 120 deaths*, but it's still a small risk: 120 vs 312,091,573 (USA population as of August 29th), about 3 deaths per year, says the CDC.

Only 1 USA case involved neti.

There were 120 deaths from Naegleria since 1960 in the US. Most involved swimming or other watersports in lakes or streams.

Mike6977 wrote:If you shower with heated water, you're mixing very hot and cold water.

In my building, the hot water from the hot pipe is steaming hot, so I'd venture that in the boiler room, the water is boiling.

Most pathogens have a thing about boiling water, so again, that 5 minute a day exposure is reduced even further.

________________________________________________________________________________________________________

Here's where we congenially disagree:

archangle wrote:No, it's not aerosolized or misted. It's evaporated.

I want to make sure that we're both agreeing on the definition of aerosol.

Wipedia wrote:With studies of dispersions in air, the term aerosol evolved and now embraces both liquid droplets, solid particles, and combinations of these

http://en.wikipedia.org/wiki/Aerosol

Thus, if I spray my hand with a bottle of Winex, I get aerosolized with different sized droplets, not just microscopic sized ones.

________________________________________________________________________________________________________


Reading your post, I tried this experiment: I filled my cleanable water tank for my ResMed S9 with cold water, up to the max line limit.

I put the tank in the S9, unhooked the hose from the unit, and turned out the lights, turned on a tiny LED penlight.

I started up the S9, no ramping, default pressure at 10.4 cmH2O. Put my hand in front of the S9's exhaust port, used the penlight to back-light the results for maximum contrast.

The water in the tank was cold. No time for evaporation. But I could see a spray coming from the port. In a minute my hand was dripping wet.

________________________________________________________________________________________________________


I redid the experiment, filling the water to the 3/4 mark.

This time, I dried all the parts of the tank (the cleanable tank can be disassembled) with a paper towel, eliminating the possibility that the water was from spillage inside the air chamber of the tank when I filled it.

Same result. Cold spray, clearly visible.

I shined the penlight into the S9 as it was running.

At first, I thought what I was viewing was Bernoulli's Principle, that the increased air velocity in the tank's air chamber produced decreased pressure, and thus drew out water from the water tank in that manner.

But on closer inspection I could see that the airflow speed and volume was causing the water in the water tank to roil vigorously, and so I suspect that was the cause of what I perceived to be clear aerosolization from the exhaust port.

Water heater temperature is usually kept to 140F or less for safety reasons. 140F is still considered somewhat dangerous due to the risk of skin burns. 120F is considered more normal. Naegleria grows best at 42C/108F, so I doubt 120F or even 140F is enough to kill it reliably. Plus the cold water isn't processed through the water heater.

Will you be happy with the definition "aerosol = liquid water droplets in the air?"

Try your experiment again with the mask on doing actual CPAP. I will agree that you may get aerosol droplets if you don't have a mask connected and let the machine blow a flow rate several times the therapeutic rate. On my machine I get about 28 l/m airflow when using it. With a disconnected mask, it's 177 l/m or so, six times higher.

My PRS1 doesn't seem to throw any water droplets even without a hose attached. Nothing visible, nothing collects on my hand, or on a mirror held at the humidifier output or at the mask end of the hose. No droplets in the hose. Maybe the S9 is "mistier" than the PRS1.

HoseCrusher wrote:

archangle wrote: No, it's not aerosolized or misted. It's evaporated. There's an enormous difference in terms of spreading bacteria.

I actually ran a test on this and at a pressure of 8 cm H2O it seems that there is a small amount of aerosol action taking place.

I put some salt into the humidifier water and collected condensate from my mask. The condensate had salt ions in it. The only way to get salt ions into the condensate is if there is some aerosol action. Mind you it wasn't much, but there is a little more going on than simple evaporation.

Try it for yourself and let us know what results you get.

Were you wearing the mask, or letting the air blow unrestricted?

How did you measure salt ions?

Did you perform the same test with no salt?

Since distillation is a process that involves heating water to the point where steam occurs, better sanitization would occur. I can see where water droplets would occur in a CPAP humidifier if the air flow is such that rippling occurs, somewhat like wind causing waves and salt spray on the beach.

Well water is more likely than city or county water to have minerals, contaminants, or actual live organisms, even in a deep well where the temps are lower. Cryptosporidium or Giardia are common bacteria found in wells that aren't chlorine bleach treated.

The reality of it all is that most people don't have serious reactions to CPAP humidifier output, but there's always the 1% that do. I have used distilled water at times, but it gets to be a hassle transporting and storing another gallon jug on a regular basis.

Edits for clarity and improved saftey

archangle wrote:Try your experiment again with the mask on doing actual CPAP.

My PRS1 doesn't seem to throw any water droplets even without a hose attached. Nothing visible, nothing collects on my hand, or on a mirror held at the humidifier output or at the mask end of the hose. No droplets in the hose. Maybe the S9 is "mistier" than the PRS1.

Hi archangle. I'm on a 10 minute awake-break, so I have to be brief.

While I will conduct your test, I wouldn't expect visible water droplets to make through to the mask. But invisible micro-droplets could be another story, so I'm not sure a mirror test will be definitive.

So, if you're willing to put in an extended effort to achieve definitive results, may I suggest an experiment for you to try? It involves QPCR, which is much safer than using a petri dish, and you don't have to wait weeks for the results. NOTE: anyone attempting this should exercise genuine caution, in addition to using an old xPAP unit if you have one.

Clearly, the definitive test would be to take a popular, water-borne pathogen, say, Aspergillus fumigatus, A. flavus, or A. terreus, (available via mail-order) and place a sample in your xPAP water tank.

Turn your xPAP unit on, and collect what exits on the mask end, filtering it carefully through a polycarbonate filter—a 0.2mm pore £ 45mm diameter filter seems reasonable off the top of my head. Then, quickly fold the filter, and pop that now dirty filter into a 2.0 ml conical bottom, screw-cap tube. Again both the filter and the tube should be easily available via a mail order lab supplier.

Surgical gloves, and a particulate mask would be a very good idea, as you want to be on the safe side.

Freeze the tube to -20 degrees centigrade—dry ice and a proper thermometer should do the trick. Pack the tube in securely in bubble wrap, with some sort of insulation layer, and hand it off to a local lab to be extracted and analyzed via QPCR.

Then, repeat the experiment again, using distilled water as the control arm.

Come to think of it, best to perform the control arm first, then the pathogen arm, dropping off both tubes at the lab together, saving time and money.

Naturally, you'll want to sterilize your unit, tube and mask when you're finished with the pathogen arm of this experiment. I know ResMed has a hospital sterilization routine in it's pamphlets


Mike

archangle wrote: Were you wearing the mask, or letting the air blow unrestricted?

How did you measure salt ions?

Did you perform the same test with no salt?

I blocked the mask and collected condensate from the vent by pass.

I used the Pure Water Tester from Hanna to check the water. Part of the test involved cleaning everything (hose, humidifier, and mask) and doing a test using distilled water. This test revealed that when distilled water is used, the condensate ends up without contamination.

I ran this test because I had the idea that adding some salt to the humidifier water would help with nasal stuffiness and congestion. When I read that the operation of the humidifier was supposed to be by evaporation, the added salt would be of no value. Testing revealed otherwise and I routinely add a small amount of salt to the distilled water I use in my humidifier. I am using 0.2 grams of sea salt per liter of water. It is not known if the very small amount of salt ions can be therapeutic, but after more than a year of using this I remain congestion free and have suffered no ill effects.

Long Live the Placebo Effect...

On the other hand, a trace amount of salt may help.

On still another hand, knowing that it is possible for "stuff" to migrate from the humidifier to my lungs gives me incentive to keep my humidifier, hose and mask clean.

Mike6977 wrote: I'm on a 10 minute

In other words, you have no info on what happens under realistic conditions.

DaveLP wrote:Since distillation is a process that involves heating water to the point where steam occurs, better sanitization would occur. I can see where water droplets would occur in a CPAP humidifier if the air flow is such that rippling occurs, somewhat like wind causing waves and salt spray on the beach.

Well water is more likely than city or county water to have minerals, contaminants, or actual live organisms, even in a deep well where the temps are lower. Cryptosporidium or Giardia are common bacteria found in wells that aren't chlorine bleach treated.

Exactly.

DaveLP wrote:The reality of it all is that most people don't have serious reactions to CPAP humidifier output, but there's always the 1% that do.

When we include chemical contaminates, with a low level exposure extending many years, I can't guesstimate what percent of the xPAP-using population will suffer some ill effects. I'd imagine those who are immunosuppressive are at the greatest risk, but I'd rather be safe than sorry.

archangle wrote:

Mike6977 wrote: I'm on a 10 minute

In other words, you have no info on what happens under realistic conditions.

But isn't that the whole point of conducting controlled experiments? To gather data using the most realistic conditions possible?

(Btw, I'm editing my previous post to make the experiment safer, and removing the flippant tone.)

...

HoseCrusher wrote:When I read that the operation of the humidifier was supposed to be by evaporation, the added salt would be of no value.

Testing revealed otherwise

Sorry, Hosecrusher, somehow I missed those two key sentences in your post.

With both of us now confirming a seeming aerosol effect, I think it's best to hand over the next step to Archangle.

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archangle wrote:. . . you have no info on what happens under realistic conditions.

Archangle, respectfully, couldn't I say the same about you?

That's why I suggested you run the most realist test I could devise. It even has a control arm.

I'd do the experiment myself, but I can anticipate you're being unhappy with my findings.

I really don't want to run the experiment a bunch of times, with you critiquing some aspect of it each time I posted my results.

So, I felt the best course was for you to set up the experiment to your satisfaction, do the tests, post, and we would all have some hard data to discuss.

I'm more than willing to shoulder some of the burden. If money is an issue for you, PM me and I'll cover all the costs involved.

If Vader wants to help make this a group project, he can pay for or supply the laboratory-grade distilled water used in the control phase.

Mike

...

archangle is correct about water in a humidifier can not pass on any type of micro-organism according to one of the manufactures site I went to today. Apnea machine manufacturer had FAQ on humidifiers and said that neither a virus nor a small cell critter can hitch a ride over on the water from the humidifier.

For the Neti Pot, I am sticking to washing the heck out of the pot. Using distilled water, which I keep room temp in the house. Using the prepared salt packages, because it is too much aggravation to mix up the same stuff, (and ordinary table salt is not the right stuff anyway).

I am guessing a cock roach could crawl through the tube and up my nose and tickle me.

Pleasant dreams all.

The manufacturers would like you to believe that humidification is accomplished by evaporation only. Obviously, they didn't bother to actually test their products to see if any aerosols are produced.

Run a test for yourself. The PWT meter is inexpensive and salt is also inexpensive. To collect the condensate simply set up a glass in a bowel of ice and let the air blow in the glass. You only need a small amount of condensate to be able to use the meter for measurements. Different machines may work differently, but mine is capable of a slight aerosol.