Sleep apnea and the CPAP machines that treat it

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Cleaning your equipment is essential to its effectiveness


What is sleep apnea?

More than four percent of men and three percent of women in the United States suffer from obstructive sleep apnea (OSA). Obstructive sleep apnea occurs when a person’s airway becomes completely or partly blocked by the collapse soft tissues of the nose, throat and or chest during sleep.

This collapse of the airway causes a decrease in oxygen to vital organs as well as increases stress on vital organs, especially the heart and lungs, and disrupts sleep continuity. This leads to many health problems as well as daytime fatigue and a worsening of daytime performance at work, school and play.

What is CPAP?

CPAP (continuous positive airway pressure) is considered the gold standard of treatment with measurable night-to-night efficacy of the treatment. The CPAP machine delivers pressurized air through an interface commonly called a mask which can be an insert into the nose as a nasal pillow, cover the entire nose, or cover both the nose and mouth in delivering the pressurized air into the nose and/or mouth.

The interface is connected to the CPAP machine by a long, flexible hose to allow you to be more comfortable in bed as well as have near-normal movements while asleep without dislodging the mask.

Why does the CPAP machine need cleaning?

As you breathe in and out, your breath and any bacteria or viruses in your breath are transported from the mask into the CPAP hose and reservoir or water chamber. Although there is a filter that decreases some of the transmission of germs into the CPAP system, there is still potential for accumulation of bacteria on the various parts of the CPAP.

Germs from the skin can be a contaminant as well as the usual environmental dust, dirt and allergens. These accumulating in the machine can not only potentially cause you to get sick, but also can cause problems with the machine’s ability to function.

Therefore, it is important to clean your machine regularly to minimize germs, dust and allergens that may get into the CPAP equipment. This can protect you from illnesses such as sinusitis, allergy flare-ups, asthma, pneumonia, localized acne and conjunctivitis as well as keeping the machine working at its best.

How should I clean my CPAP machine?

When you buy a CPAP machine, it comes with instructions from the manufacturer on how to best clean it. There are several different types of CPAP machines and each is slightly different, so it is important to follow the manufacturer’s guidelines.

One should on a daily basis wipe the cushion and inside of the mask as well as draining any water in the humidifier reservoir. A baby wipe or similar gentle, non-alcohol-based wipe can be used.

To avoid waste of water, adjust the amount of distilled water you are using in the humidifier so that there is very little present in the morning as well as little to no condensation of water in the tubing. If this is an issue for you, discuss it with your DME or CPAP supplier to help with adjustment of the humidification level of your machine. 

At least weekly, the mask used, detachable hoses and connectors, and the humidifier chamber if present can all be soaked in soapy water and then allowed to air dry. My general recommendation is using a gentle soap such as Ivory liquid soap or baby shampoo with enough water to cover the devices and let it all soak for 10 to 30 minutes before manually wiping all parts, rinsing with clean water and then allowing to air dry.

For the hose, I recommend putting a small dish towel in one end and gradually shaking the tubing it until it comes out the other end to more thoroughly clean the inside of the hose. The hose can then be hung to dry over a towel rack or the shower curtain rod.

Vinegar can be added to the wash or rinse mixture as needed or desired. In general, I recommend adding the vinegar (one part vinegar to five parts distilled water) for enhanced cleaning, especially if you or someone in your bedroom are with symptoms of a respiratory illness.

If you are on a well and septic or non-chlorinated water supply, it is important to first boil the water and then let it cool, or use distilled water to clean your CPAP equipment to minimize introducing other germs into the machine. Remember to not put any parts of the actual CPAP machine in water, but instead wipe down with a baby wipe or sterilizing wipe at least weekly.

Most CPAP machines have a filter that needs to be cleaned and or replaced monthly. Follow the manufacturer’s guidelines as provided in the owner’s manual.

What machines can be used to clean CPAP?

It is important to note that while there are many machines that claim to clean CPAP machines, to date none of them have obtained FDA clearance or approval to clean this equipment. What this means is that while the agent used for killing bacteria or viruses may have been proven to be effective and FDA-cleared or approved in other circumstances, it has not been specifically tested for cleaning CPAP equipment. The FDA as yet has not made a judgment regarding the safety or effectiveness of any CPAP cleaning machine.

There are two main types of machines used to clean CPAP machines, those using ozone gas and others using ultraviolet light. Ozone gas can be dangerous and/or toxic above certain levels. The FDA has reports of people who, after cleaning the device with an ozone-based cleaner, have experienced unexpected asthma attacks, headaches, and breathlessness.

The FDA also has not yet received data or evidence for manufacturers that say UV light can clean the inside surface of CPAP hoses or information to confirm that the UV light does not damage CPAP machines. The FDA also does not have evidence that machines using UV light protect you from unsafe levels of UV radiation exposure.

Despite not having FDA clearance or approval, devices used to clean CPAP equipment are gaining in popularity in part because of accepted use of ozone in the food industry, hotels for sterilization, and for water purification. Ultraviolet light is also often used in operating rooms for sterilization.

These machines also generally do not use water, which many find to be environmentally friendly, and generally they clean with just a push of a button. Currently on the market, the machine using UV light for cleaning is call the Lumin. Popular machines using the ozone are Silenflow, So Clean, Prime Clean, Sleep 8, VirtuClean and Zoey.

What should I look for if I decide to purchase a CPAP cleaning machine?

While I will not endorse one brand or another, some key questions to ask when purchasing a unit are:

1.  What is my budget? In general, for devices made in the United States or Canada there does not appear to be a significant difference between the ozone cleaning devices and ultraviolet devices in the level of reported germicidal effectiveness.

2.  What is the length of warranty and my ability to return the device if I am not happy with it or change my mind? For example, a patient may be bothered by the ozone smell or have a new onset of respiratory symptoms such as cough or increased asthma flare ups and may need to stop using the cleaning device for symptom resolution.

3.  Do I have to detach the hose or CPAP equipment for the cleaning process?

4.  Is an adapter needed for my hose, and if so, is that at an additional cost?

5.  Do I want a machine that is portable?

6.  How often do I have to change or purchase filters or other consumables and what are their costs?

Have more questions?

Please consult your owner’s manual or the manufacturer’s website regarding the specific CPAP machine you have, as well as their recommendations for cleaning. Your DME provider (the person who supplied you with your CPAP machine) and your sleep physician are also sources of information.

Dr. Rosario is a board-certified ENT and sleep physician practicing at Andros ENT & Sleep Center in Inver Grove Heights, Minnesota. She has many times been recognized as a Top Doctor and Best Doctor in various Minnesota magazines and can be reached at drrosario@androsent-sleep.com or 651-888-7800.