Should You Use CPAP With a Cold or Stuffy Nose?

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If you catch a cold during the winter, you might question: Should I use CPAP with a cold? Continuous positive airway pressure (CPAP) is an effective treatment for sleep apnea, but if you become congested with a stuffy nose or have a sore throat or a cough, you may wonder if you should take a break from using it. Discover the potential benefits of using CPAP during a cold, treatments that may improve nasal congestion and cough, and how to clean up your equipment after you have recovered.

Cold Symptoms May Interfere With CPAP Use

Upper respiratory infections such as the common cold or influenza may make it more difficult to use CPAP. Similar to what occurs with allergies, the nose may become congested, stuffed up, and runny. A stuffy nose may make it hard to breathe with the machine if you use a nasal mask. The discharge of snot or mucus may dirty the CPAP mask, especially if you use nasal pillows that sit within the nostrils.

The flow of air may also cause irritation if you have a sore throat. It may provoke coughing spells. Each time you cough, opening the mouth may make the pressure uncomfortable. What should you do?

Can You Take a Break From CPAP Use During a Cold?

It is fine to take a break from using CPAP if you have a cold or stuffy nose. There will be no major side effects of abruptly stopping therapy (make certain that you do not drive if you are too drowsy). You may find that you have a residual benefit from the treatment, even several days into the break. This is because the inflammation and swelling of the tissues in the upper airway will take time to become affected again.

What symptoms might require a break from using CPAP? Consider going without it if you experience bothersome:

  • Ear pressure or fullness
  • Ear pain
  • Persistent nasal congestion
  • A runny nose (rhinorrhea)
  • Nosebleeds (epistaxis)
  • A sore throat
  • Coughing
  • Shortness of breath
  • Vomiting
  • Headaches

If these symptoms are minor, and not disruptive, try to continue to use CPAP. For example, minor nasal congestion may actually be relieved by CPAP. The pressure will clear out the mucus and open the nasal passages. Where does this mucus go? Like all post-nasal drip that is not spit out (expectorated), it is swallowed.

What if you are prone to ear problems? People often worry that frequent ear infections or a history of tubes in the ears may be affected by CPAP use. The tube that connects the inner ear (behind the tympanic membrane or eardrum) is connected to the throat via the eustachian tube. Air pressure from CPAP does not travel from the throat to the inner ear via this tube. There may be minor pressure changes transduced via other tissues, but these are negligible. Mucus will not be forced along this tube and would not be expected to cause an ear infection.

If you decide that your symptoms require a break from CPAP use, this is okay. Try to get back to treatment as soon as you can as you recover enough from the cold.

How to Continue CPAP Use With Nasal Congestion

If you decide to continue using your CPAP during your cold, or when your nose is congested, you may find it helpful to use interventions or treatments to make it more tolerable. 

Some people actually like to use CPAP during a cold, especially if there is not a lot of nasal discharge. The heated and humidified air may add comfort and relief. This pressurized air may also move mucus along the nasal passage and decrease congestion. If you can use it for a few minutes, you will notice that it becomes easier to breathe very quickly as the nose opens up.

Consider these options:

Nasal Decongestants​

An over-the-counter saline spray is inexpensive and effective. It can be used as often as you need it and will moisten the lining of the nose. Afrin spray may also provide relief, but it should not be used long-term or too frequently due to the risk for rebound congestion of the nose. Other prescription medications may relieve chronic congestion related to allergies, including topical nasal steroid sprays such as Flonase, Nasacort, Rhinocort, Nasonex, Patanase, and Astelin. It may also be helpful to rinse the nasal sinuses during a cold with a neti pot.

Cold and Flu Medications

Consider the use of medications that target cold and flu symptoms. In particular, antihistamines (such as diphenhydramine) may provide some relief and improve sleep. In addition, guaifenesin (Mucinex) may thin the mucus and help to clear it out. If the problem is due to a cough, cough suppressants like cough syrup or throat lozenges may be an effective adjunctive treatment.

Heated Humidifier and Heated Tubing

It is recommended that the CPAP's humidifier is used, especially when a cold or nasal congestion is present. This reduces irritation and inflammation along the airway. Research suggests that it reduces the risk and duration of infections. To minimize the chance that condensation will form in the tubing, also use a heated tube.

Full-Face Mask

In some cases, it is simply impossible to use a nasal mask due to a cold or nasal congestion. This may be more likely if you have a deviated nasal septum blocking one side of your nose. In this scenario, consider the use of a full-face mask. This will allow breathing to occur via either the nose or mouth. In some cases, the full-face mask can be used temporarily. As nasal breathing improves, it is possible to switch back to a nasal or nasal pillow mask.

Positional Therapy

In order to improve breathing during sleep, consider sleeping on the side or stomach. It may also be helpful to raise the head at night. This can be accomplished with the use of a sleeping wedge pillow or by stacking several pillows up. Getting the head up may provide relief, even without the continued use of CPAP.

Pressure Changes or Auto-CPAP

When the nose is more obstructed, additional CPAP pressure may be required. This airflow may open things up. Consider reaching out to your physician to have the pressure adjusted, if needed. Auto-CPAP therapy, in which a range of pressures can be delivered, may also be a helpful option. Unfortunately, CPAP devices are typically only replaced every 5 years by insurance, so you may have to wait to get one.

How to Clean CPAP After a Cold

During and after your cold, it is important to be diligent about cleaning the CPAP mask, tubing, and humidifier tank. How can this best be accomplished? Consider these steps:

  1. Give everything a thorough cleaning with dish soap and hot water.
  2. Let the mask, tubing, and humidifier sit in a sink of soapy water for 20 to 30 minutes.
  3. Rinse the equipment with water until the soap is thoroughly removed.
  4. Let it hang to air dry.
  5. Replace the filter on the machine.​

You don't have to worry about getting sick from your own germs; your body has already made a truce and fought these off, so the chance of reinfection is unlikely. It is unnecessary to use a CPAP sanitizer (such as the SoClean device that retails for $299). 

A Word From Verywell

Although you may want to take a break from CPAP when you have a cold, you don’t have to. If you find that you can tolerate the treatment during illness, it will help you to sleep better and wake feeling more rested.

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