CPAP and COVID-19

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Does Sleep Apnea Increase Your Risk for COVID-19?

Research has found that people with obstructive sleep apnea have an increased risk of contracting COVID-19 Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . People with OSA may be more likely to be hospitalized Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source if they get COVID-19. Some research also suggests that, once hospitalized, people with OSA are more likely to be admitted to an intensive care unit (ICU) Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Fortunately, using CPAP therapy as directed by a doctor is associated with lower rates of COVID-19 in people with OSA. Adherence to CPAP therapy generally requires using the device for at least four hours per night Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source no less than five nights per week, though even those who only use their CPAP device for a few hours per night may have a lower risk of infection than those who do not use CPAP therapy at all.

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Can CPAP Be Used to Treat COVID-19?

CPAP therapy has emerged as a treatment option Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source for improving oxygen levels in some people with COVID-19, regardless of whether they have obstructive sleep apnea or not.

COVID-19 can affect lung function. Many people who are admitted to the hospital with the disease have low levels of oxygen in their blood, a condition called respiratory failure. When this occurs, doctors have several options for trying to improve blood oxygen levels.

CPAP Machines vs. Ventilators

Using a mechanical ventilator Trusted Source Merck Manual|MSD Manuals View Source involves intubating a person by inserting a plastic tube into their windpipe and having a machine move air into and out of their lungs. This is an invasive treatment, and the risks of complications means that it is not the best option for everyone who needs supplemental oxygen.

In addition, mechanical ventilation requires specific equipment, which was a concern at the beginning of the pandemic when ICU beds were limited. As a result, doctors have explored the use of CPAP therapy and other non-invasive treatments to address low oxygen levels caused by COVID-19.

Benefits of CPAP for COVID

After early reports of success, doctors began using CPAP therapy as an initial treatment for respiratory failure in some people with COVID-19. One small study found that CPAP was successful at raising oxygen levels among people who were hospitalized with COVID-19. Additional studies have found similar benefits to CPAP as a non-invasive treatment for respiratory failure. For some patients, initial use of CPAP therapy may prevent the need Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source for intubation.

Given the rapidly developing knowledge about COVID-19 and its treatment, researchers are still seeking out ways to make CPAP therapy more effective and identify people who are most likely to benefit from using it. For example, one study found that lying face down Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source while awake when using a CPAP reduced the effort required to breathe and improved oxygen levels among people with respiratory problems from COVID-19.

Limitations of CPAP for COVID

Further investigation is needed to fully understand the benefits and downsides of CPAP therapy as a treatment for complications of COVID-19. Some research found that CPAP provided no added benefit Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source in people who were not eligible for intubation.

Additionally, treatments like oxygen therapy Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , which delivers oxygen through a face mask or small tubes placed in the nostrils, may offer similar benefits to CPAP therapy. It’s difficult to draw conclusions from existing research Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source about how CPAP use compares to oxygen therapy and other non-invasive treatments.

Not everyone with COVID-19 is a good candidate for CPAP therapy. Some studies found CPAP therapy to have lower effectiveness in older adults and people with more significant respiratory failure. Around half of people may ultimately require intubation despite CPAP therapy. For these people, delaying intubation may actually worsen their lung injury and increase the risk of death from COVID-19. Additionally, some people have issues continuing CPAP therapy because of feelings of claustrophobia, anxiety, or discomfort when wearing a CPAP mask.

Should You Still Use CPAP if You Have COVID-19?

In most cases, it’s safe for people with sleep apnea to keep using their CPAP device even if they have COVID-19. Using a CPAP as directed by a doctor can enable steadier breathing and improve sleep quality Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source in people with OSA. In addition, suddenly stopping CPAP therapy for a period of weeks may raise blood pressure and heart rate.

That said, if you have symptoms or have tested positive for COVID-19, you should talk with your health care provider about whether you should continue to use your CPAP machine. You should also follow this guidance from the CDC:

• Get tested as soon as possible: You can use an at-home COVID test or get tested at a local pharmacy or testing site near you.
• Call your doctor: People with OSA may be at greater risk of severe COVID-19, so talk to your primary care provider as soon as you test positive. They can discuss treatment and next steps, including any symptoms to watch for.
• Isolate yourself: Once you notice symptoms, isolate yourself from others, including people and pets in your household. Sleep in a separate bedroom and use a separate bathroom if possible.
• Tell anyone that may have been exposed: Tell anyone you have been in close contact with over the past 48 hours that they may have been exposed to COVID-19 so they can get tested.
• Wash your hands frequently: Wash your hands with soap and water regularly, including before you put your CPAP mask on at night.
• Improve ventilation at home: Keep the door to your bedroom shut but open windows throughout your home to improve air flow.
• Focus on good sleep: Getting good sleep is important when you are sick, including if you become infected with COVID-19, as it can help the immune system function properly.

Whether or not to continue using a CPAP is a decision you can make with your doctor based on the severity of your OSA and other factors related to your overall health.

Can a CPAP Spread COVID-19 to Others?

There is little evidence that using a CPAP can spread COVID-19 any more than breathing, speaking, or coughing Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Some people may be worried about a CPAP machine spreading viral particles. CPAP machines are designed to let the person exhale carbon dioxide, so they may release aerosols into the air that could contain viral particles.

Doctors and CPAP users have expressed concern that using a CPAP could increase exposure to the SARS-CoV-2 virus that causes COVID-19. Fortunately, evidence suggests that CPAP use does not cause significant spread of the virus Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source in the air or on surfaces.

Nevertheless, CPAP users who have COVID-19 should consider sleeping in a separate bedroom to reduce exposure of household members to viral particles that could be generated by the CPAP or by their normal breathing or coughing.

In a hospital setting, a helmet CPAP Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source may be used. This device involves placing a helmet over the patient’s head to reduce the potential risks of aerosols created by a traditional CPAP.

Cleaning Your CPAP Machine and Equipment

You should clean your CPAP machine and mask according to the instructions Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source for your specific device. While directions may vary, the guidance is generally as follows:

• Daily: Clean the tube, mask, and humidifier reservoir. Use warm, mild soapy water and then rinse and air dry.
• Weekly: Disinfect the tube, mask, and humidifier reservoir. Follow manufacturer instructions to properly disinfect these without damaging the equipment.

When you’re sick, whether with COVID-19 or another illness, you may want to clean and disinfect your CPAP on a daily basis. The Centers for Disease Control and Prevention (CDC) recommends that people with COVID-19 regularly disinfect surfaces Trusted Source Centers for Disease Control and Prevention (CDC) As the nation’s health protection agency, CDC saves lives and protects people from health threats. View Source they touch frequently in their home as well as any surfaces that could have bodily fluids on them, such as a CPAP mask.

When to Talk to a Doctor

Talk to your doctor if you have any questions about your CPAP therapy when you are sick with COVID-19. If you start to notice any severe symptoms, such as difficulty breathing, chest pain, confusion, trouble staying awake, or changes in skin tone, call 911 or go to an emergency medical care facility immediately.

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