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Health A to Z  —  8 minutes

Sleep apnea in the age of COVID-19

April 27th, 2020
Dr Pierre Mayer
Dr Pierre Mayer
Respirologist - Medical Director - Sleep Care

Many of you have questions about whether your continuous positive airway pressure (CPAP) treatment increases the risk of spreading COVID-19 and whether it is safe for you to continue your treatment.

Dr. Pierre Mayer, respirologist and Medical Director for Sleep at Biron, answers the most common questions, drawing on resources of the American Academy of Sleep Medicine and information from the sleep clinic at the CHUM. We hope that these frequently asked questions will reassure you and enlighten you on the best practices for using CPAP devices during this pandemic period. As the situation is evolving very quickly, please note that the recommendations are dated April 28, 2020. In no way do they replace your doctor’s advice.

Answers to frequently asked questions

Why are there specific recommendations for people with sleep apnea?

COVID-19 is mainly spread via droplets. When they are expelled through breathing or coughing, these droplets can travel a distance of up to two metres, hence the physical distancing requirements.

Positive pressure treatments carry the risk of aerosolization and the formation of microdroplets containing the virus. In other words, the virus can be dispersed into the air through the mask’s exhalation valve, which must not be blocked because it is needed for removing the carbon dioxide we exhale. These microdroplets, which may contain viruses, are likely to spread further into the room and remain suspended in the air for longer periods of time.

If you have COVID-19 and use a CPAP decive, the risk of transmitting it directly to those around you and contaminating nearby surfaces could therefore be higher. On the other hand, stopping or avoiding these treatments entails risks associated with drowsiness (such as the risk of incidents). This may also worsen the condition of patients with severe obstructive sleep apnea or nocturnal hypoventilation syndrome.

How to protect your loved ones

  • Before handling the mask, follow the handwashing instructions carefully, as well as the mask manufacturer’s hygiene instructions.
  • Clean the surfaces of all furniture and other objects in the room more frequently.
  • If you have symptoms or have tested positive for COVID-19, use a separate bedroom and bathroom.

Can I catch COVID-19 through my CPAP device?

No, unless someone who has contracted COVID-19 has been near your device, has handled it, or has handled your mask. If you have no symptoms and have not been in contact with someone who has COVID-19, we recommend that you continue your treatment. If you have any concerns, please contact your doctor.

Am I at a greater risk of getting COVID-19 because I have sleep apnea?

There is no evidence to suggest that sleep apnea increases the risk of contracting COVID-19. Among those at risk of secondary complications from COVID-19 are:

  • The elderly
  • People with serious health problems such as: heart disease, diabetes, lung disease and kidney disease
  • People who have a health problem or are taking medication that weakens the immune system.

I do not have COVID-19. Do I still need to be extra vigilant about hygiene when using my CPAP device?

It is very important to wash your hands with soap and water for at least 20 seconds before handling the mask. You should also continue following the hygiene instructions provided by your device’s manufacturer.

I was about to start a CPAP treatment. Is it better to postpone it?

You can begin your treatment in total safety thanks to the distancing measures put in place by service providers such as Biron, including teleconsultation and contactless home delivery. However, we recommend that you ask your doctor if it is urgent to begin your treatment now or if it is safe to postpone it.

I have symptoms of or have tested positive for COVID-19. What precautions should I take when using my CPAP device?

Continue using the device, but only if you sleep in a separate bedroom for the duration of the illness, which is at least 14 days, including 48 hours without symptoms.

Each day, clean the surfaces of all furniture and other objects in the room, such as nightstands, desks, lamps, etc. It is very important to wash your hands with soap and water for at least 20 seconds before handling the mask. You should also continue following the hygiene instructions provided by your device’s manufacturer.

Ideally, use a different bathroom from the rest of your household and clean it thoroughly every day.

If these precautionary measures are not possible, we advise asking your doctor if other treatments are available or if it is safe to temporarily discontinue your treatment.

If I have COVID-19, will my CPAP device help me breathe or does it risk making my symptoms worse?

It is unlikely that CPAP treatment would make the symptoms of COVID-19 worse. However, your CPAP device may cause infectious droplets to travel farther than if you were breathing without the device, putting your loved ones at a higher risk of contracting the disease. If you cannot sleep alone in your room, talk to your doctor about alternative treatments for sleep apnea.

If I get COVID-19, how do I clean and disinfect my CPAP mask and tubing?

You should clean and disinfect your medical device according to the manufacturer’s instructions. See in particular the instructions from ResMed and Philips. On the AMI platform, Biron clients can find instructional videos about how to care for their device.

In general, you should regularly clean CPAP masks and tubing with soap and water. It has been clearly established that additional cleaning is not required due to COVID-19. Soap destroys the envelope of the virus that causes COVID-19, thereby neutralizing the virus.

We also recommend cleaning and disinfecting surfaces in your home that you frequently touch, such as switches, doorknobs and furniture near your CPAP device.

I can no longer find distilled water in my area. What can I use to fill my humidifier tank?

We recommend that you use distilled water to optimize the operation of your humidifier and avoid the formation of whitish scale deposits. As this water is practically free of minerals, it prevents the build-up of minerals in the humidifier tank. Nevertheless, you can still use tap or bottled water. This will not damage your device in the short term and poses no risk to your health. Be sure to clean the humidifier more thoroughly to prevent minerals from building up in the tank. However, be aware that regular use of non-demineralized or undistilled water may prematurely wear out the humidifier chamber.

An active support community

Are you undergoing a treatment with Biron? Take advantage of the AMI online platform to share your experience, express your concerns or find answers to your questions. AMI is a discussion forum where patients can exchange ideas and our respiratory therapists, trained in sleep care, are available to help you!

Remote consultation

Just because Quebec is “on pause” due to the pandemic does not mean that sleep apnea problems are also on pause! We must continue to support every one of our patients despite the lockdown. Our teleconsultation services and online boutique give you access our wealth of expertise in the comfort of your home and in complete safety.

For professional support, we are here.

We offer services that can assist your doctor in diagnosing sleep disorders and determining the appropriate treatment.

If you have any questions or would like more information, feel free to contact customer service for Biron Health Group at 1 833 590-2713.

Dr Pierre Mayer
Dr Pierre Mayer
Respirologist - Medical Director - Sleep Care