Individuals diagnosed with COVID-19 can generally continue using their Continuous Positive Airway Pressure (CPAP) machine to treat sleep apnea. Stopping CPAP therapy abruptly can worsen sleep apnea symptoms, negatively affecting overall health and recovery during illness. However, using the device requires immediate and rigorous safety measures to protect household members from potential viral spread. These precautions focus on containing the respiratory droplets exhaled by an infected person, which the CPAP machine can disperse widely into the surrounding air.
The Primary Risk: Aerosolization
The main concern with CPAP use during an active COVID-19 infection is the process known as aerosolization of secretions. This occurs because the pressurized air stream from the CPAP machine transforms viral particles in the user’s breath into microscopic, airborne droplets, or aerosols. These fine particles are smaller and lighter than typical respiratory droplets, allowing them to remain suspended in the air for longer periods and travel farther from the user.
The pressurized air is expelled through the mask’s exhalation ports, which are designed to vent the carbon dioxide the user breathes out. If the user is infected, these expelled aerosols contain the SARS-CoV-2 virus, potentially contaminating the air and surfaces in the immediate environment. This mechanism creates a localized increase in viral load, posing an infection risk to others who share the same space.
Safety Measures for the Household
The most direct way to protect others in the home is through strict isolation protocols during CPAP use. The infected person should use their CPAP only when sleeping alone in a completely separate bedroom, ideally with a closed door. If possible, the infected individual should also use a separate bathroom to minimize the risk of surface contamination.
Ventilation within the isolation room is another method for decreasing the concentration of airborne particles. Opening a window in the bedroom can improve airflow, and using a high-efficiency particulate air (HEPA) filter unit helps remove aerosols from the air. Household members should avoid entering the room while the CPAP is in use, and must wear a well-fitting mask if they must enter for any reason.
The location of the machine’s exhaust port, where the exhalation air is vented, should be directed away from high-traffic areas or common air circulation pathways. All high-touch surfaces within the isolation room, such as doorknobs and bedside tables, require regular disinfection. This comprehensive environmental control limits the spread of the virus outside the user’s immediate area.
Cleaning and Disinfecting the Equipment
During an active COVID-19 infection, all CPAP equipment must be cleaned and disinfected daily. This heightened frequency is necessary because the virus can survive on plastic surfaces, increasing the risk of transmission through contact. The mask, tubing, and humidifier water chamber should be washed using warm water and a mild, non-abrasive soap.
After washing, all components must be rinsed thoroughly and allowed to air dry completely before the next use. The exterior casing of the main CPAP device can be wiped down with a disinfectant solution or a wipe approved for use on electronics. Avoid getting any moisture inside the machine’s internal components, as this can cause damage.
Users must avoid using ozone or UV-based CPAP sanitizers, as their effectiveness against the SARS-CoV-2 virus is unproven and they may damage the equipment over time. Once the user has fully recovered from the illness, the disposable filters within the machine should be replaced immediately. Non-disposable filters should be cleaned or replaced according to the device manufacturer’s instructions.
When to Stop Using CPAP
Continuing CPAP therapy is generally beneficial, but specific symptoms signal the need to pause treatment and seek medical attention. If the user experiences worsening respiratory distress, such as severe shortness of breath or persistent chest pain, the CPAP should be paused. Signs like a significant drop in blood oxygen saturation levels or an inability to tolerate the mask due to coughing or anxiety are also reasons to consult a healthcare provider immediately.
CPAP machines are designed to treat sleep apnea, not to serve as a substitute for hospital-grade ventilators or high-flow oxygen delivery systems. If the user’s oxygen requirements increase significantly or if they require intubation, the CPAP machine is no longer the appropriate treatment. Delaying professional medical support by relying on home CPAP when symptoms become severe can worsen lung injury.
A physician or pulmonologist must be contacted if the user is considering stopping CPAP therapy for any reason related to their COVID-19 illness. They may suggest alternative treatments for the sleep apnea during the period of acute illness, or advise on transitioning to a higher level of respiratory support. The patient should only discontinue use under direct medical guidance.