CPAP During Illness
By Lisa W. RRT-NPS
Many people wonder if they should continue to use CPAP when they are sick. If you are ill with nausea and vomiting, the answer may be no. The airflow from the machine may upset your stomach further. If you have a respiratory infection, though, it is best to continue to wear your CPAP mask during sleep. Since nasal congestion and airway swelling go hand and hand with many respiratory infections, sleep apnea symptoms worsen when ill. Skipping CPAP during sleep impairs your ability to get proper rest at a time when you need it most.
Here are a few tips to help make your CPAP use more comfortable during an upper respiratory illness:
Best practices when ill
- Use heated humidity. Your nose, mouth, and lungs are already irritated during illness. Dry, cool air irritates the tissues further. The warm, moist air from heated humidification will calm the airway tissues down and reduce swelling.
- Use saline nasal spray. Saline nose drops are readily available over the counter. Saline is merely sterile water with a small amount of salt in it. The saline solution draws some of the congestion out of the tissues to reduce swelling and irritation.
- Consider a full face mask. When ill with a lot of nasal congestion, we tend to breathe mostly through our mouths. If the nose is too obstructed, CPAP is not as effective with nasal masks and nasal pillows. Switching to a full face mask until the congestion subsides ensures you get a better night’s rest, and hopefully, that translates into a speedier recovery.
- Try new positions. Side sleeping and stomach sleeping reduce obstructions. If you do not already sleep in those positions, consider trying them while you are so stuffy. For many people, propping the head up higher on more pillows invites gravity to ameliorate symptoms and reduce obstructions.
- Monitor your AHI value. AHI is the apnea-hypopnea index. It is a measure of how effectively your CPAP machine is resolving your obstructive sleep events. Many devices report your overnight AHI value to you as well as a long term trend value. If you see a rise in your usual AHI, you should ask your physician whether you need to increase the CPAP setting during illness.
If you use an AutoPAP machine, you may notice that your average required pressure is increasing. A need for higher pressures to overcome obstructions during sleep is to be expected while you are stuffy. If you notice that the AHI value is rising as well, though, the machine has likely maxed on the current prescribed pressure range. You should ask your physician if the pressure range limits should be increased during your illness.
- Clean, clean, clean. Clean your equipment every day with soap and water. Cleaning is always critical, but it is especially important when you are sick so that you avoid reinfection and opportunistic bacterial growth. Always wash your equipment in a clean space and let it thoroughly air dry before using it. Be sure to wash your hands afterward to protect yourself, friends, and family.
- Nap in CPAP: When we are sick, we tend to nap more. Try to wear your CPAP during your daytime naps. It may be helpful to keep a second mask around so that while your nighttime equipment is being cleaned and dried, you have a nap mask available to wear.
Considerations during more severe illness
Respiratory infections may impact the lungs. Serious lung infections can impair the ability of the lungs to pick up oxygen. People with underlying conditions such as COPD are much more likely to have lung complications from any respiratory infection. These people may need to use supplemental oxygen while they are sick, and while they are recovering. Some people who use CPAP for sleep apnea may need to wear oxygen at night for other health issues.
A stationary oxygen concentrator like the Philips Respironics EverFlo is a staple of supplementary home oxygen therapy. Oxygen concentrators are sometimes called oxygen generators or oxygen machines. Oxygen concentrators entrain air from the room, filter it to remove other gases, and collect the residual oxygen. The air around us is 21% oxygen, 78% nitrogen, and 1% a mix of argon and carbon dioxide (and some other trace gases). By eliminating the nitrogen, the concentrator continually collects oxygen.
Oxygen is a drug and requires a prescription. If you need it, though, be assured it will not get in the way of your nighttime CPAP therapy. Supplemental oxygen can be added to your CPAP or BIPAP equipment with little difficulty by inserting a small plastic CPAP Oxygen Enrichment adaptor into the CPAP circuit. The oxygen tubing from the oxygen concentrator (or oxygen tank) hooks to this adaptor and “bleeds in” oxygen.
If you use supplemental oxygen, you should monitor whether there is an appropriate amount of oxygen in the blood. Fatigue, confusion, dizziness, and shortness of breath are other symptoms that may indicate the patient is not getting enough oxygen. Monitoring symptoms and using a pulse oximeter is crucial during different types of activity. Oxygen levels often drop during sleep. Consequently, patients may need increased delivery rates. Your physician can tell you what oxygen level is best for you when using the pulse oximeter.
CPAP during hospitalizations and medical procedures
If you wear CPAP or BIPAP, and are having a surgical procedure, ask about bringing your equipment to the surgical center or hospital. Anesthesia can aggravate obstructive sleep apnea after your procedure is over. The hospital or clinic will likely want you to wear CPAP while you are drowsy, and you will be most comfortable in your favorite mask if your hospital permits personal product use.
After a procedure or while you are ill, you may receive pain medication. Some pain medications can also worsen obstructive sleep apnea. Plan to doze and nap with CPAP in place.
Be sure to tell the various clinicians that you meet during your stay that you usually wear CPAP at home. That information helps them evaluate you appropriately during your stay. It is also a good idea to know what your CPAP machine settings are on your home equipment. Clinicians can use that data to determine whether you are more obstructed than normal
Take good care of yourself while you are sick or recovering. Continuing to wear your CPAPmachine during these times will help you sleep better and heal more quickly!