Using your CPAP machine with a cold or flu

Using Your CPAP in Winter with Colds and Flu

December 5th 2023

Since most people catch a cold two to four times a year, if you’re on CPAP therapy for sleep apnoea you’ll probably have to use your CPAP machine with a cold (or even flu) at some stage. Symptoms of the common cold, such as a stuffy nose, sore throat and cough, can affect both your sleep and CPAP therapy routine. What’s more, in the winter months, when cold and flu bugs tend to be at their peak, the lack of humidity in the dry, cold air can cause the nasal passages to become dry, which can make CPAP therapy more challenging.

The good news is that if you have a dry or runny nose with CPAP, or the air you breath in through your mask feels too cold and your sleep is disrupted, there are a few things you can do to help overcome these problems, including:

Using a full face mask
Using heated humidification
Using home remedies

We’ll explore these issues in this article, along with other simple suggestions to help make using a CPAP machine with a cold or flu easier. Before we get to the potential solutions for you, let’s take a closer look at the relationship between sleep apnoea, CPAP and colds and flu.

Can a cold worsen sleep apnoea?

It’s never easy to sleep when you have a cold or flu, but for people who also have sleep apnoea – whether treated or untreated – it can be even harder. That’s because the pauses in breathing associated with sleep apnoea are caused by the narrowing of the airways as you sleep. So if these airways are further blocked or irritated by a cold or other upper respiratory tract infection, your sleep apnoea may get worse too. If you are on CPAP therapy for your sleep apnoea and have a cold, it can be more difficult than usual to tolerate the treatment, too.

Why using CPAP with a head cold can cause problems

One of the main functions of your nose is to warm and moisten the air you breathe. Therefore, if the air you breathe in is cold, the tiny blood vessels inside the nostrils dilate (get bigger) to increase the blood flow and help warm up the air. This extra blood flow then causes the airway to narrow, leading the body to produce additional mucus to protect its sensitive tissues and add more moisture to the inhaled air. Unfortunately, side effects of this may be nasal congestion and a runny nose – and if you have cold or flu symptoms such as a blocked nose or sore throat at the same time, this can add to the problem.

So should I still use my CPAP when I have a cold?

Despite the issues mentioned above, the answer is yes! Stopping CPAP treatment is not advised, because if you do stop CPAP use when you have a cold or flu, your sleep apnoea symptoms such as tiredness you felt before using therapy could return. However, an exception is if you have an acute upper respiratory tract infection, in which case you may need to temporarily stop treatment – your doctor should be able to advise you.

Ways that you can use your CPAP with a cold

1 - Using a full face mask rather than a nasal mask

Some CPAP masks are nasal masks that only cover your nose, but when nasal congestion develops, they can become more difficult to use. This is because nasal congestion or resistance as experienced during a cold can lead you to breathe through your mouth rather than your nose.

As a consequence, air from your CPAP machine may escape through your mouth (mouth leak) during treatment, which can be a significant problem that will compromise the effectiveness of your CPAP therapy. If you do have mouth leak, it means your airways may not be as open as they should be during treatment, as some of the pressurised air is escaping, which can cause discomfort and a dry mouth.

For these reasons, it can be a good idea to switch from a nasal mask to a full face mask when you have a cold or flu. A full face mask delivers air through both your mouth and nose. Using this type of CPAP mask with a cold will ensure that if you do start breathing through your mouth, you will still receive your treatment and it will continue to be effective.

2 - Using heated humidification

Use of heated humidification with CPAP equipment is recognised as an effective method of helping to prevent or reverse the symptoms resulting from breathing in cold, dry air during winter.¹ This is because the air is warmed and moistened before it reaches the nose, so it may help with nasal congestion and ease inflamed nasal passages. In essence, the humidifier is designed to make using CPAP with a cold or flu more comfortable. If you are using a ResMed device, your care provider may be able to supply you with a humidifier to fit your CPAP machine, or your machine may already have a humidifier built in.

It’s important to note that some people using heated humidification can experience a problem known as ‘rainout’ during cold weather. This is when the warmed, moistened air coming from the humidifier is cooled by room temperature air as it moves down the CPAP tube towards the mask, and the moisture in the cooler air returns to a liquid. This process can lead to droplets of water or condensation gathering in the tube and mask as a result.

So if you do try a humidifier while using CPAP with a cold or flu, the following tips may help:
Always have the CPAP machine and humidifier positioned lower than the bed.
If you are getting a dry nose or mouth, try turning up the humidity. If you are getting any moisture in your mask or feel you are suffering from ‘rainout’, turn down the humidity.
Insulate the hose by covering it with a tubing wrap. Custom made tubing wraps can be purchased from ResMed.
If you continue to get a dry nose or mouth, or moisture in your mask, consider using heated tubing designed to deliver air to your mask at a consistent, comfortable temperature and humidity. Some CPAP devices also feature algorithms that automatically adjust the air temperature depending on the surrounding conditions, which can also help to reduce the risk of water droplets forming in your CPAP tubing.

3 - Using home remedies

There are also a few things that CPAP users can try at home to help make treatment more comfortable:
Use of a saline nasal spray to add moisture to the sinus passages can relieve swelling and help you breathe easier.
Decongestants medications may help, although these can take a while to work and should be used early enough so that they take effect by bedtime.
An over-the-counter nasal spray can be used to decrease inflammation in the nasal passages and help reduce swelling inside the nose.

If you try the suggestions above and still feel too uncomfortable while using CPAP with a cold or flu, or you experience ear pressure or ear pain, or have any other concerns, contact your GP or medical provider.