Can You Use CPAP With a Cold or Stuffy Nose?

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If you get a cold during the winter, you might wonder if it is still safe to use your CPAP machine. Continuous positive airway pressure (CPAP) is an effective treatment for sleep apnea, but, if you become congested or have a sore throat or a cough, might it make this worse rather than better?

CPAP and Colds

The short and simple answer is that the CPAP cannot work effectively if you have a self-limiting respiratory illness that impedes breathing. The machine is meant to provide you with a pressurized stream of air to prevent airway obstruction in otherwise normally functioning lungs.

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 mucus can also contaminate the CPAP mask, especially if you use nasal pillows. Studies suggest that there is a risk of secondary infection if microorganisms are allowed to breed and multiply on a contaminated mask.

The flow of air may also cause irritation if you have a sore throat and provoke coughing spells. Each time you cough, opening the mouth may make the incoming pressure all the more uncomfortable.

Considerations

As a general rule, 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.

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.

Among some of the other reasons why you may consider giving CPAP a break:

  • Ear pressure
  • Ear pain
  • Persistent nasal congestion
  • Rhinorrhea (runny nose)
  • Nosebleeds
  • A sore throat
  • Coughing
  • Shortness of breath
  • Nausea and vomiting

If the respiratory symptoms are minor, try to continue to your CPAP. Minor nasal congestion can actually be relieved by CPAP as the pressure help clears the mucus and open nasal passages. Any residue would then be swallowed as you sleep.

Ear Infections

People often worry that frequent ear infections may be affected by CPAP use. Try not to worry; air pressure from CPAP does not travel from the throat to the inner ear via the Eustachian tube. There may be minor pressure changes, but these are usually negligible. Mucus will not be forced along these tubes and worsen the symptoms of 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.

Treatment Options

If you decide to continue using your CPAP 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 as the nasal opens up.

There are also medications that can ease symptoms while using CPAP, including decongestants and cold & flu remedies.

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 (oxymetazoline) spray may also provide relief but should not be used too frequently for too long a period due to the risk of rebound congestion.

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 like Benedryl (diphenhydramine) may provide relief and improve sleep.

In addition, Mucinex (guaifenesin) 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 Tubing

It is recommended that the CPAP's humidifier be used, especially when a cold or nasal congestion is present. This reduces irritation and inflammation along the airway.

Research suggests that a heated humidifier also reduces the risk and duration of infections. To minimize the risk of condensation and bacterial colonization in CPAP tubing, use heated tubing.

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 such cases, consider the use of a full-face mask.

A full-face mask allows 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.

Raising your head may also 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

During and after your cold, it is important to be diligent about cleaning the CPAP mask, tubing, and humidifier tank. 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 reinfecting yourself with a cold or flu virus when using CPAP; the chance of reinfection is unlikely. In most cases, it unnecessary to use a CPAP sanitizer (such as the SoClean device which retails for $299). 

With that said, unsanitized CPAP equipment can cause secondary infections unrelated to a cold or flu. This is especially true with respect to bacterial infections like acute bacterial rhinosinusitis (ABRS) or bacterial pneumonia, particularly in people with compromised immune systems.

A Word From Verywell

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

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