Cage Match - Sleep Apnea vs. Upper Respiratory Infections

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.

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.

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?

Well, my experience is just the opposite - used to have kind of generalized (if not seasonal) rhinitis before Apap and since starting it, have had zero trouble with my nose at all. I also don't hardly ever use the humidifier (already live in a fairly humid, if cool, area) and find that when I do, I get congested a bit, even at a low setting. So.... s'up to you I guess. I also have a radical take on everyone going sterilization/sanitation crazy these days... cleaning the hell out of everything, including our insides (and then having to replace even good bacteria with probiotics (never touch 'em), and think we've left ourselves wide open to even weak bacteria of any kind by our germophobic behaviour, which is a relatively new thing and cleaners are full of who knows what chemicals that weren't readily available e.g. 50 yrs ago. Everyone's sick all the time now, and take hordes of meds for whatever they've induced by their paranoia, but I think there's a happy medium, a less fanatic way of life. Not to say you should be 'dirty', but scrubbing every surface 10 x a day, and ourselves even more often (making Proctor & Gamble and Johnson/Johnson ecstatic) has gone over the top. I don't clean all my equipment that often at all and have had no negative results because of not doing it. I mean it's all just sitting there in room air (like us), possibly with a cover over the mask during the day, but why assume it's the source of trouble?

I think the 'source' is the good-bacteria barren state of things, not some nefarious villainous bug.

In 4 years I have had maybe 3 cold/flus, only one of which turned into the mildest pneumonia I have ever had. Using my cpap with the Humidity up full and with a full face mask during that time made it a breeze to get through compared to the past. In fact I wore it during the day while working from home because it made breathing so much easier.

I think your doctor is coping out and blaming everything on cpap.

I have chronic allergic rhinitis because I won't give up my cats, but I only get one or two colds a year. I'm lax at sterilizing my equipment, generally just rinsing out the humidifier tank and wiping down the mask, clean the hose every couple of months. No sinus infections at all. I've been using my CPAP for three years.

Are you sure you're not mouth-breathing or leaking? If your therapy is leaking out your mouth, then it can be worse than sleeping without cpap.

Are you using a fine filter in addition to the sponge filter on your machine? Dust can definitely cause respiratory aggravation. You can also try the bacteria filter if you're worried about stuff coming up from in the machine/humidier.
https://www.cpap.com/cpap-filters.php

Do you get aerophagia or reflux from the pressure? Reflux especially can be a problem, because you can breathe in the acid, which can set you up for lung infections. Reflux can be from too low a pressure. Perhaps in some it's due to too high a pressure?

As for cleaning, I tend to clean the tank and mask silicon once a week and soak stuff in vinegar whenever I remember (which is rare now - I think I haven't cleaned the hose in nearly two years).

You might also want to get your Vit D levels checked. I've hardly had a cold, and not a single bout of flu or bronchitis (which I used to get *all* the time), since starting on Vit D 2 years ago.

I'm the same as Julie- getting on cpap actually helped my lung health. I'm surprised this doc says that most of her patients have infections. Something is wrong.

jbt, I hear ya. But I too disagree. Look, about four months ago I came down with something like walking pneumonia; I never got a clear diagnosis. Very rare for me. I suspected my cpap. But looking back, I doubt it. I had a bad cold; I went on a plane to visit my mother; rented a car; that all took me into a new area of the country where my cousin's friend had a terrible flu; met the friend; took the plane back. Things slid downhill from there.

I believe that you mention traveling on business. This reminded me of my own recent illness.

So I doubt it was my cpap behind my respiratory hell. Nevertheless, I ordered a So Clean machine in the middle of it, just to cover my bases.

The vast majority of people on this and other cpap forums do not report upper respiratory infections as a problem. That said, I just finished washing my hose and mask in soapy water--just to be sure!

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.

I've searched pubmed for a link between the use of Cpap and an increase in lung infections but i couldn't find much - i didn't do a very long and involved search . I did find this which is the opposite finding


Sleep Med. 2012 Aug;13(7):859-63. doi: 10.1016/j.sleep.2012.04.004. Epub 2012 Jul 2.
Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome.
Gelardi M, Carbonara G, Maffezzoni E, Marvisi M, Quaranta N, Ferri R.
Source
Otolaryngology Unit, Department of Neuroscience and Sensory Organs, University of Bari, Bari, Italy.
Abstract
OBJECTIVES:
To analyze nasal inflammation in a group of patients with obstructive sleep apnea syndrome (OSAS) by means of nasal cytology and to describe the changes induced by continuous positive air pressure (CPAP) treatment.
SUBJECTS AND METHODS:
Thirty-two consecutive patients affected by OSAS (mean age 46.9 years) and 13 control subjects (mean age 49.1 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and, in particular, nasal cytology was performed; inflammatory cells (neutrophils, eosinophils, mast cells, lymphocytes), bacteria, and spores were counted. A subgroup of 19 OSAS patients underwent regular nasal CPAP for eight weeks while the remaining 13 were noncompliant. Nasal cytology was repeated after eight weeks in all patients and controls.
RESULTS:
All patients with OSAS were affected by some form of rhinopathy, mostly subclinical, which was not found to influence compliance to CPAP. Regular CPAP treatment induced a significant reduction of cell infiltration (neutrophils, eosinophils, lymphocytes, and muciparous cells), which was not seen in nontreated patients.
CONCLUSION:
Nasal inflammation/infection is a very frequent finding in OSAS and can be reverted by the regular use of CPAP.

Pre-CPAP I had 6-10 URI's a year and 3 or more would turn into asthmatic bronchitis each year. Since CPAP, I've had in 3 1/2 years exactly 3 URI, 2 in the first year. I never get sick anymore even when kids and husband come home sick.

I'm terrible about cleaning equipment! About every 2weeks I clean my mask and tank and change filters. I NEVER clean my hose, and I'm still using the one that came with my machine.

If you keep getting infections, have your Vitamin D levels checked (should be at least 40--up to
60 or 70) uand consider eliminating gluten grains and sugar from your diet. It might be CPAP, but there are confounding factors that should be considered.

jbt1125 wrote: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.

jbt1125 wrote:Does anyone have an opinion about the box you hook up to that is supposed to sanitize all of your equipment?

Are you talking about the SoClean device that costs around $250 or $300?
A handful of forum members here are using it and seem to be satisfied.
search.php?keywords=SoClean
You can read through some past discussions about it at this link.

Have you really looked at other areas of your life that might have changed (or not when they should have) incidental to using Cpap? Have you tried turning your humidifier down for a few days to see if it helps clear up your system?

Two things that might help us help you.

Tell us where you live. Places like the North Pole or a rain forest might have an influence.

Tell us exactly what equipment you are using and your pressure settings.

Like some others I am the opposite of a clean freak. I replace my my mask every year or two just before I decide to clean it. Same with hose. I swish some tap water in the humidifier tub every week or three.
I do have a runny stuffy nose as a chronic condition, but I have had this before CPAP. If anything it is less of a problem with the mask.
I too would look carefully at other lifestyle issues before deciding CPAP was the cause.

I didn't start this as a debate about whether or not CPAP causes chest infections...I probably should have used a different title...my attempt at humor...what I really wanted was suggestions about how to sanitizer better. The "SoClean" suggestion is what I was looking for.

My Vitamin D levels are very high, in my case, I really don't think that there is some other lifestyle explanation... too many decades without this ever happening, only thing to change in my life is CPAP. My doctor agrees.

I live in Austin, TX, I have the Resmed S9 with the humidifier. I love how I do on the machine. AHI close to zero.

For those that say they have never seen any link between CPAP and infection or that they didn't see anything with a quick search. Here is the google return, many of which are opinion, but also many scholarly articles...several pages worth -

https://www.google.com/#q=CPAP+chest+infection

Here is one - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556912/

Separately, here is a search and articles on how there could be a possible link between CPAP and meningitis risk, where the patient has a sinus infection. Makes sense to me, you are pressurizing your nasal passage and shoving whatever bacteria is in/up there, further up toward the brain.

https://www.google.com/#q=cpap+meningitis

None of this will sway me from trying to continue treatment, I just wish we had better/easier ways to clean our equipment....

You might want to try something a lot less expensive first:
https://www.cpap.com/productpage/Contro ... eaner.html
Be sure to follow directions carefully--this stuff is strong!