How often do you change water

Well, darn, you beat me, I was about to post a reference to the same study.

I see these posts about "what makes sense" all the time and I find it concerning. What makes sense and what is true are often at odds. What makes sense is often anecdotal, meaning personal or untested experience.

It is TRUE that water vapor is smaller than bacteria and therefore should not be able to transfer bacteria or virus from the water into the breathing mask. But, that logical conclusion is not supported by actual scientific testing. (one of many studies referenced above.)

The study does not give definitive answer to how often you should sterilize your water tank, however the practice of "topping" off your water daily would be the worst case approach, since the remaining water each morning would/could be a breading ground of ever increasing amounts of bacteria.

The amount of bacteria that can infect your water tank would play a big role in how often to sterilize it, but a best practice would be at least to NOT top off. Emptying the tank each morning (or night) would toss out the potentially contaminated water leaving only trace amounts on the inside walls of the tank. Refilling with clean sterile water would then dilute any remaining colony. You water supply (that you wash the tank in) and your home environment is different than everyone else, so how often you need to clean the tank is different than everyone else. In my case, I live in the country on a farm with chickens and duck right out side my bedroom window, the chance of airborne bacteria in my room is very high, so I would need to be more concerned with this that someone in a home that is almost hermetically sealed and that runs air cleaners (HEPA). My house water is from a well and hence is more likely to contain bacteria and viruses than most (not all) city water, so I also need to pay more attention when cleaning the tanks than someone with known cleaner water.

My point is it is very dangerous to place your lungs at risk by "what makes sense". A lot of money and effort has been spent trying to determine what is safe for you at home (which is completely different than in a hospital, as was pointed out in that study) and it is well worth paying attention to their recommendations which is to take steps to prevent bacteria infections by properly cleaning the water tank, hit hose and mask. And possibly in some cases to include an inline hydrophobic filter in the air hose between you and the water tank.

HoseCrusher wrote:There are actually two sides to this discussion...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556912/

snip
The treatment of choice for obstructive sleep apnea (OSA) is nasal continuous positive airway pressure (nCPAP) during sleep, but dryness of the upper airway compromises compliance. Heated humidifiers may mitigate such noncompliance; however, recent observations suggest that their use, particularly if not cleaned, increases the risk of respiratory infections. Humidifier water may be contaminated, but the long-held view that passive humidifiers cannot aerosolize water may obscure the perception of risk of infection.

snip
Bacteria were recovered in 9 of 11 tests from the breathing tubes of CPAP devices fitted with heated humidifiers with water contaminated with Brevundimonas diminuta or Serratia marcescens.

This means that under controlled experiments the information provided by F&P is incorrect. xPAP machines can form aerosols.

The bigger question is how do you introduce contamination to the water in the first place, and how often does your machine run at higher flow rates where it is capable of producing aerosols?

You keep dragging out that OLD (rigged) study that was done and funded by a company that makes and sells water filters.

Disclosure Statement

This study was funded by Pall Corporation. All authors are, or were at the time of the study, employees of the Pall Corporation.

https://en.wikipedia.org/wiki/Pall_Corporation

http://www.pall.com/main/home.page

If you look at the picture and where the filters were placed in those machines, it's not even like the way newer HH tanks and hoses are connected. It was done in 2007 and the machines were ResMed S7 Series which had already been replaced by the S8 Series.

Photograph of apparatus used to condition filters with humidification. Nine ResMed S7™ nasal continuous positive airway pressure machines were fitted with Pall BB50T breathing filters at the outlet of the ResMed HumidAire™ 2i humidifiers. The filters were arbitrarily but consistently positioned with the long axis of the filter perpendicular to the lab bench. The breathing hoses were attached to the filters on one side, and the other side was suspended 1 to 1.25 m above the outlet to ensure that condensate would flow backward into the downstream side of the filter.


And, they actually introduced bacteria into the water. It doesn't state what type of water they used, but it was deliberately laced with bacteria.

Methods:

Heated humidifier water contaminated with bacteria was studied under conditions simulating week-long use of nCPAP for OSA.

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Myth.........BUSTED!!!


Den

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The "bottom line" with any of this is.........Do what YOU feel comfortable with.

And, don't preach to everybody how DANGEROUS this therapy could be.


Den

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The study was paid for by them, but referenced many other studies and also replicated the other studies at the beginning of it's own work.

The point of injecting bacteria into the water was simply to have a controlled known amount of bacteria, which is normal procedure for such a study.

The results of the study showed two things, it disproved the conclusion that water vapor of pass over heater humidifiers could not transport bacteria into and up the airway hose in normal home use conditions of CPAP machines. The second result, which was built on the first was the introduction of a filter into the airway to determine if the filter could reduce the migration of the bacteria up the airway - it did, but I believe to be irrelevant to most home users since we don't put a filter in the air tube.

The point of the study was not to determine HOW the bacteria migrated up the air way, just that it in fact did originate in the water and migrated up the airway. That was proven. Contaminated water can result in bacterial infections in CPAP users. It did NOT prove that Bacterial infections HAVE occurred and been caused by using heater humidifiers on CPAP machines.

By emphasizing that one should do what one feels comfortable with is promoting an unsafe behavior and potentially dangerous one. One should do what is best know to be safe and in the case of unknown should follow best practices to minimize risk.

Teaching your son safe driving is PREACHING to him how dangerous driving a car can be - just because someone has driven a certain way all their life and gotten away with it does not make it safe, it makes them lucky.

FrankNichols wrote:The study was paid for by them, but referenced many other studies and also replicated the other studies at the beginning of it's own work.

The point of injecting bacteria into the water was simply to have a controlled known amount of bacteria, which is normal procedure for such a study.

The results of the study showed two things, it disproved the conclusion that water vapor of pass over heater humidifiers could not transport bacteria into and up the airway hose in normal home use conditions of CPAP machines. The second result, which was built on the first was the introduction of a filter into the airway to determine if the filter could reduce the migration of the bacteria up the airway - it did, but I believe to be irrelevant to most home users since we don't put a filter in the air tube.

The point of the study was not to determine HOW the bacteria migrated up the air way, just that it in fact did originate in the water and migrated up the airway. That was proven. Contaminated water can result in bacterial infections in CPAP users. It did NOT prove that Bacterial infections HAVE occurred and been caused by using heater humidifiers on CPAP machines.

By emphasizing that one should do what one feels comfortable with is promoting an unsafe behavior and potentially dangerous one. One should do what is best know to be safe and in the case of unknown should follow best practices to minimize risk.

Teaching your son safe driving is PREACHING to him how dangerous driving a car can be - just because someone has driven a certain way all their life and gotten away with it does not make it safe, it makes them lucky.

B - S!!!

I got news for you.......this world if FULL of "bacteria". Some of it is good and some not so good. Some lives inside you!

That test was bogus and rigged in many ways that normal users wouldn't encounter.....then or now.


Den

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Besides the obvious issue of junk science as a marketing tool,
we need to be cautious of the dangers inherent with avoiding ALL microbes.
In order to have a healthy immune system, the involved systems need PRACTICE.
If you think like a sick person--you will become one.
Of course, if your immune system is weak, it may be too late to fix it by acting normal.
Then go right ahead, be obsessive, it may be right--FOR YOU.

chunkyfrog wrote:Besides the obvious issue of junk science as a marketing tool,
we need to be cautious of the dangers inherent with avoiding ALL microbes.
In order to have a healthy immune system, the involved systems need PRACTICE.
If you think like a sick person--you will become one.
Of course, if your immune system is weak, it may be too late to fix it by acting normal.
Then go right ahead, be obsessive, it may be right--FOR YOU.

Chunky frog, I completely agree with you. I have all my life avoided antibiotics unless absolutely required, I avoid flu shots and prefer to get sick occasionally. I believe that the biome of bacteria surrounding us is a vital part of us. Most people don't realize that there are more bacteria around and inside of us than we have cells in our body - they seriously out number that which has traditionally has been called "us". And science is finding more and more ways that those bacteria affect our bodies. One unexpected interaction that is showing up in more and more experiments is the particular flora in your gut can affect if you are over weight or not. Transferring that gut bacteria from a skinny individual to an overweight individual can result in the overweight individual losing weight.

So, I am all for 'living in our environments". However, I stand by my advice above, for people that do not have the time to do the research, I would much rather advise better safe than sorry, especially with we are talking pennies vs dollars, and seconds vs hours. Even in hospitals respiratory infections on ventilators is not uncommon. I understand that hospitals are full of sick people with "bad bacteria" being spread around. But they are for the most part full of highly trained people trying to prevent them from spreading around.

So, consider grandma goes to see her grandkids who just got home from school where they pick up a bacterial infection. After visiting Grandma goes home and prepares for bed. Her normal routine is to top off the tank instead of cleaning it, so she opens it and the bacteria is transferred into the tank. Not much today, but tomorrow she does again, and the next day, and while she normally would clean the tank ever few days, sometimes it is hard to remember when the last time she did it is, so now on the forth day, the tank has a very active and growing colony of the bacteria she brought home... simply rinsing the tank instead of topping it would have stopped the potential infection.

Better safe than sorry is all I am saying, especially when is is so cheap and easy.

Den, sorry, you're not getting off that easy...

This actually involves two parts.

The first part involves xPAP machines producing aerosols. F&P and the others say no, but testing shows something different.

If you will remember I got into this discussion when I suggested adding a little salt to the humidifier water to aid in eliminating congestion. You insisted that because the theory states that evaporated water can't hold anything and since the manufacturers hold on to this theory that my idea was not valid.

I went on to produce test results that showed something different.

I found this article that showed S7 machines produce aerosols, I tested my S8 and found that it produces aerosols, and later I tested an S9 and it also produced aerosols.

Other brands of machines may behave differently. I don't test beyond my immediate needs. However looking at their designs I don't see many differences in the basic design so I would speculate that when you blow air over a body of water at a rate equal to the mask exhaust vent rate there is a good possibility that some aerosols are formed...

xPAP machines are capable of around 150 - 200 liters per minute of air flow. It would be very interesting to see the test results from a manufacturer. Say fill the humidifier chamber to the full mark and set the machine to something in the 60 - 100 liters per minute range. Unfortunately you will never see this type of test. It has already been done and the results show that aerosols are formed. So much for theory...

So, is it possible for an xPAP machine to form an aerosol? Yes.

Moving on to part 2.

Is the water in your humidifier contaminated?

This question has more variables associated with it.

In my case I ran a liter of distilled water with my salt added through my humidifier. I simply added and did not wash or rinse in between fillings. At the end I put the water into a container and took it to the water analyses laboratory and had it tested for pathogens. None found.

This means it doesn't matter if the xPAP machine forms aerosols or not. If the water isn't contaminated there is no chance of harming your lungs from the humidifier water.

Is the water in your humidifier contaminated? I don't know. Have it tested and find out.

My comfort level is to wash my humidifier and hose once a month. This is based upon real world test results and the conditions surrounding my use. When traveling or when the grandchildren come over with sniffles and are sneezing and coughing, I clean more often.

You can choose to ignore real results and cling on to theory but I tend to walk in the real world.

By the way, I have been using salt in my humidifier for many years now and my machine is still working fine and I have had no issues with congestion. I will add that I have not poured salt water into my machine but it doesn't seem to care that salt water is in the humidifier.

Wulfman... wrote:The "bottom line" with any of this is.........Do what YOU feel comfortable with.

And, don't preach to everybody how DANGEROUS this therapy could be.


Den

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What part of that do you NOT understand?
You've produced no evidence that ANYTHING growing in distilled water (for any period of time) could be even remotely "dangerous" to one's health. Germs? Bacteria? Pathogens? What, specifically, are they and how are they dangerous?
Any "germs" (or whatever) would have to originate from somewhere in the person's dwelling and that would present a bigger problem (you're breathing unfiltered air the other hours of the day when not hooked to the CPAP)........and, the "germs" would have to get through the filters in the machine........then fall in the distilled water........and stay there.

I suspect that your "aerosols" (water droplets) were actually water vapor that converted back into liquid when they hit some cool surfaces.

Soooooo.........Fisher and Paykel are liars?

This is so absurd! It's like "OMG!!! There are GERMS and BACTERIA.........run for your lives!!! They're going to get us!"

And, NOBODY has ever said "DON'T CLEAN YOUR EQUIPMENT".
Even F&P tells you to clean your equipment in that website.


Den

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PHOBIA vs life-saving therapy:
We cannot fix your problem
Please stop trying to infect others.

Bacterial infection can be transferred over the internet. I hate to go out to eat with the members here, I'd starve to death while you guys were arguing over who had the menu upside down.

It's a moot point to a dumb question, if you can't figure out the answer for yourself your problems in life are far worse than HH water tanks. I've used water I pumped from the Saigon River, that I had to shut my pump off and wait while dead water bloated buffaloes, floated by. No-one got sick from my water, I used calcium hypochlorite, (bleach), killed all them critters. Jim

Goofproof wrote: . . . water I pumped from the Saigon River, that I had to shut my pump off and wait while dead water bloated buffaloes, floated by. . . . Jim

What a lovely picture; now where did I leave my straw?

chunkyfrog wrote:

Goofproof wrote: . . . water I pumped from the Saigon River, that I had to shut my pump off and wait while dead water bloated buffaloes, floated by. . . . Jim

What a lovely picture; now where did I leave my straw?

Way too big to get thru my straw, but my 1 1/2 inch hose might have got plugged up. I built my 2 1/2 ton truck up to haul shower and fire water, made it safe to use, for a field hospital, at DiAn 1st Inf basecamp. No-one ever got sick from my water, if they couldn't read, they came out of the showers with red skin, too early my water hit 30 ppm chlorine, after it set a hour it settled down to 10 ppm. I also built the gasoline water system to heat the water. Full service Mechanic!

I suppose I could have installed a Water Buffalo filter, but they were on back order.

Most folks wouldn't drink out of a dug well if they knew what was living and dead inside one. My uncle at one 30 foot from the Barn and 40 foot from the house, with the bucket and pully rope. It had the best tasting water, critters and all, always cold. Humans adapt to how they have to live, it's change that kills us. Jim

HoseCrusher wrote:Den, sorry, you're not getting off that easy...

This actually involves two parts.

The first part involves xPAP machines producing aerosols. F&P and the others say no, but testing shows something different.

If you will remember I got into this discussion when I suggested adding a little salt to the humidifier water to aid in eliminating congestion. You insisted that because the theory states that evaporated water can't hold anything and since the manufacturers hold on to this theory that my idea was not valid.

I went on to produce test results that showed something different.
....

I'm assuming that you are referring to your experiments of a couple of years ago in which you put salt in your humidifier tank. If I recall correctly, your experiments had no control with the result that there was no way to prove that the salt that you concluded had been aerosolized had not, in fact, just been the result in incomplete cleaning of equipment.

All experiments need a control group and potential sources of experimental error need to be thoroughly investigated. Otherwise, it's not complete science and the results will always be suspect.

Another point of difference here is that salt in a humidifier is dissolved in the water. Bacteria in the humidifier are in suspension in the water. It would take some experimentation to prove that this difference is, or is not, material to the question of transference of salt/bacteria from humidifier tank to the patient.