The Continuous Positive Airway Pressure (CPAP) machine is the standard treatment for Obstructive Sleep Apnea (OSA), delivering pressurized air through a mask to keep the throat open. When the COVID-19 pandemic began, CPAP users faced a significant question: how to safely continue therapy while infected with a respiratory virus. While CPAP therapy does not worsen the viral illness, its mechanism presents a unique concern regarding the potential for spreading the virus to others in a shared household.
The Primary Concern: Aerosolization Risk
The central concern with CPAP use during a respiratory infection is the risk of aerosolization, which is the process of converting respiratory droplets into fine, airborne particles. A CPAP machine generates a continuous stream of pressurized air, which increases the spread of droplets from the user’s nose and mouth. This air pressure forces virus-containing respiratory secretions into the surrounding air through the mask’s exhalation ports or any unintentional mask leaks.
These smaller viral particles, or aerosols, can remain suspended in the air for an hour or more and travel farther than larger respiratory droplets. In a closed environment, such as a bedroom, this mechanism significantly increases the potential for transmission to household members, especially a bed partner. The risk is pronounced if the mask fit is poor, as air escaping under pressure from the seal can propel the virus into the room.
Although some studies suggest the risk of spread may not be greater than normal breathing or coughing, precautions remain necessary. The CPAP machine constantly introduces air pressure that actively projects exhaled breath into the room. Viral particles can also contaminate the machine’s external surfaces and accessories, contributing to transmission risk through direct contact.
Safe Usage Protocols for Home CPAP
The primary protocol for safe CPAP use with COVID-19 is stringent isolation from others in the home. The infected person should use the CPAP machine only while sleeping alone in a separate bedroom, preferably with the door closed. If a separate room is unavailable, contact a healthcare provider immediately to discuss temporarily stopping CPAP use or exploring alternative treatments for OSA.
Improve ventilation in the isolation room to help clear any generated aerosols. Opening a window or using a portable air purifier with a HEPA filter can reduce the concentration of viral particles in the air. This environmental control minimizes the exposure risk to anyone who may need to enter the room.
Disinfection of the CPAP equipment must be performed daily when the user is ill with a respiratory infection. The mask, tubing, and water chamber should be disassembled and cleaned with mild soap and warm water after every use. After cleaning, components must be rinsed thoroughly and allowed to air dry completely before the next use.
The exterior of the CPAP machine should be wiped down regularly with a common household disinfectant, as the virus can survive on plastic surfaces. Avoid spraying liquid directly onto the machine’s housing or allowing water to enter the device, which could cause internal damage. After the isolation period ends, all disposable accessories, such as the filters, should be replaced to prevent recontamination.
Recognizing Severe Symptoms and When to Stop
Home CPAP therapy treats obstructive sleep apnea and is not a substitute for hospital-grade mechanical ventilation used for severe respiratory failure. Users must be vigilant for signs that their illness is progressing beyond mild or moderate symptoms and requires immediate medical attention. A primary indicator to stop home CPAP and seek emergency care is the development of shortness of breath while resting or performing minimal activity.
Other severe symptoms include persistent chest pain or pressure, new confusion, or an inability to wake up or stay awake. Users should monitor their oxygen saturation levels, if possible, and seek care if the reading drops significantly below their normal baseline or falls below 92%. Continuing CPAP use with a severe respiratory illness may mask the condition’s severity and delay necessary hospital treatment.
If the user finds the mask intolerable due to severe congestion, coughing, or nausea, they should stop using the machine. While temporary discontinuation of CPAP may lead to a brief return of OSA symptoms, it is safer than struggling with the mask while acutely ill. Any decision to stop CPAP for more than a few days should be made only after consulting with a healthcare provider.