Older man with CPAP 2085 × 1438
Source: iStock photos

More than 22 million people in the United States suffer from sleep apnea. We know that the most common form of this condition—obstructive sleep apnea (OSA)—is more than just a nuisance; multiple studies show that disrupted sleep is connected to greater risks of dangerous diseases and conditions, including:

  • Heart disease
  • High blood pressure
  • Stroke
  • Type 2 diabetes

There are many other diseases that OSA is associated with, and it plays an outsize role in seemingly unrelated issues, too. For example, those with OSA are five times more likely to have an auto accident than people who don’t have OSA. And it’s not just the patient who endures interrupted sleep; often their partners are sleep deprived, as well, and then end up suffering from some of the same complications of sleep deprivation.
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Why cleaning the CPAP is important

In my Sleep Medicine practice, almost all of my patients with OSA are prescribed a CPAP to treat their condition. It’s one of the most reliable and effective sleep apnea treatments available, and patients can see a vast improvement—if they comply with the protocol and use it regularly. So, that’s the first hurdle; effectively getting the message across as to how vital it is that the CPAP is used every night. They see the best results when they use it for the entire night, but, in my observation, even using it just four to five hours a night on a regular basis makes a marked difference in improving their health and the adverse effects of untreated OSA.

The second hurdle—after getting them to consistently follow their CPAP protocol—is to help them understand the importance of cleaning their machine regularly. I recommend daily cleaning of the mask and hose since using a machine that has not been effectively sanitized puts patients at greater risk of infection and disease. The reasons for regular cleaning are simple:

  • Oil, sweat and dead skin cells can accumulate in the CPAP mask every time it’s used.
  • The water in the machine and the moisture in the mask and hose are potential breeding grounds for bacteria and germs.

A study from Brigham and Women’s Hospital and Harvard Medical School found 2,000+ bacteria counts evident after just 48 hours on 48 percent of samples from CPAP masks they collected. Another study showed that patients who use CPAP are 32 percent more likely to get pneumonia, in part due to poor CPAP maintenance.

In my practice, I see patients who will complain of respiratory infections many times per year—and when I dig down into what could be a contributing factor, more often than not I find that they are in the group that doesn’t clean their CPAP regularly. Once I convince them of the importance of that step, and then they comply, their incidence of respiratory infections goes down markedly.

I have had patients in my practice admit to me that not only do they neglect to clean their machine regularly, but they are also using the same water for several days without changing it. When I talk to those patients who are not cleaning their machines regularly, there are a few common themes:

  • It’s too much trouble.
  • It’s too hard to keep it clean.
  • It takes too much time.

Today, with so many CPAP cleaning options available, patients should have no excuse for putting off this important step in their OSA treatment.

CPAP cleaning options

Some of the cleaning methods they can choose from include the following:

Soap and Water

The old method of disassembling the mask and hose and cleaning it with soap and water can, in fact, be time consuming and inconvenient. If it’s not performed with extreme attention to detail, it can also be ineffective, since hard-to-reach surfaces in the humidifiers, masks, and hoses may be potential breeding grounds for bacteria. Another consideration that makes this method suboptimal is that the very means of cleaning—tap water—can be a potential source of germs.

Wipes

Though cleaning CPAP equipment with specially designed wipes may seem, at first glance, more convenient for users, it actually may be more dangerous than beneficial. However, wipes cannot clean inside the hose, and when researchers looked at this method just a few years ago, they found that rather than eliminate pathogens, the wipes—though formulated expressly for the purpose of cleaning CPAP equipment—tended to just transfer bacteria from one surface to another.

Vinegar and water

Similar to the soap-and-water method, this way of cleaning requires users to, first, disassemble their CPAP. Then the equipment must be soaked for at least 20 minutes, rinsed thoroughly and, finally, allowed to dry completely. So, for CPAP patients who choose this method—which in itself is a time-consuming process—there is the chance of introducing bacteria to the equipment at multiple points.                 

UV light

Because it doesn’t introduce moisture into the equipment, this method is an improvement over soap and water. But some studies have shown that the light may not reach shadowed parts of the mask and hose, and thus it potentially leaves bacteria and germs intact in those areas where the light may not get to. Also, UV light will not kill bacteria in the hose, the inside of the machine or the water in the reservoir.

Activated oxygen

Used in cleaners like SoClean, activated oxygen (ozone) has been shown to have multiple benefits over other ways of cleaning the CPAP. A naturally occurring gas, ozone is extremely safe when it is used properly. It has been used to purify water since the 1800s. Today, it’s the method that hospitals, food handlers and the hotel industry use for sanitizing, as it’s been proven to kill virtually all known forms of bacteria in air and water. As a CPAP cleaner, SoClean kills 99.9 percent of germs, without introducing moisture that could then become a breeding ground for more germs. SoClean is designed to safely use ozone, rather than sending it directly out into the room.

So, when I am working to ensure that my OSA patients comply with their treatment protocol by consistently using their CPAP machines, I also emphasize the importance of cleaning the equipment regularly. I lay out the pros and cons of each cleaning method, and an ozone device with proven efficacy rates and multiple safety features is the one that I usually recommend because it is superior on many counts.


Editor’s note: Although this story promotes a commercial product, we were not paid to publish it.

Robert S. Rosenberg, DO, FCCP
Robert S. Rosenberg, DO, FCCP has over 30 years of experience in the field of sleep medicine. Board certified in Sleep Medicine, Pulmonary Medicine, and Internal Medicine. Dr. Rosenberg serves as the Medical Director of the Sleep Disorders Center of Prescott Valley, Arizona. Often lecturing at medical conventions on sleep topics, Dr. Rosenberg is an affiliated professor of sleep medicine at Midwestern College of Osteopathic Medicine and on the board of directors for the American Sleep Association. Dr. Rosenberg is a newspaper columnist addressing Sleep Questions. His advice has appeared in O, The Oprah Magazine, Prevention, Women’s Health, Woman’s World, Parenting, and Ladies’ Home Journal, among others. Dr. Rosenberg publishes a monthly newsletter for healthcare professionals condensing the latest research in sleep medicine. He also publishes a monthly newsletter on a variety of sleep topics for the public. Dr. Rosenberg is the bestselling author of Sleep Soundly Every Night, Feel Fantastic Every Day. His most recent book is The Doctor's Guide to Sleep Solutions for Stress & Anxiety. Dr. Rosenberg frequently appears on television & radio and is rated as an A+ guest. Learn more about Dr. Rosenberg by visiting AnswersForSleep

8 COMMENTS

  1. Has anyone heard of Solidcleaner CPAP cleaner? I am going to buy one, this seems less expensive and has a longer warranty time. Do you have any recommendations with a limited budget? Thank you.

    • Bought SolidCleaner on Amazon but it’s been removed for whatever reason.
      Go to the company’s website for the product.

      Cleaned my Airsense 10 Autoset as it does ‘smell’ cleaner and helps breathing easier when the CPAP is cleaner. It takes a few minutes to assemble to clean and then to disassemble as it’s kept in the original packaging and box and simple to use.
      30 minute cycle which includes supposedly includes ~5 minute air out time.
      Make sure you use the cleaner in a relatively well aired out room as you will smell the Ozone when the cleaner is on. Then wipe down the machine and hoses after use and let it air out for at least ~1-2 hours before using.
      Cost was reasonable but Not covered by health insurance but you can use your HSA/FSA funds to pay for it.
      Had it for ~1 year but use every few weeks (2-3 weeks) for cleaning. Keep it clean and it should last a few years.
      Contact the company for spare parts like adapters or hoses, if needed.
      Buy an extra sets of extras just in case anything happens.
      Good luck!

  2. WARNING: FDA statement on use of ozone based CPAP cleaners available at https://www.fda.gov/news-events/press-announcements/fda-reminds-patients-devices-claiming-clean-disinfect-or-sanitize-cpap-machines-using-ozone-gas-or
    As per the statement, often the problem is the patient’s inexperience with using ozone gas or how dangerous it can be. For instance if you were to swallow a shaker full of salt, it would kill you. But, we are not afraid of salt. This is just something to be aware of if purchasing an ozone generating product. Learn as much about ozone before spending money on machines that use this currently non FDA approved method. It is your personal decision whether you are comfortable with its use. The FDA does take a lot longer to approve medical products and it is a government agency, which does come with politics. So, like everything, just do your due diligence, learn what you can, and use your reasoning along with your personal doctor’s advice. Doctors are often reluctant to recommend most products, let alone non FDA approved products for legal purposes. I myself, former LPN with 20 years experience, am trying to decide whether or not to purchase one. Too bad you couldn’t just put it in the dishwasher right? It would be nice if ResMed or other manufacturers would just come up with a self cleaning model that only required mask cleaning, but you run into insurance not wanting to pay for the cost of cleaning. That is my guess for them not pursuing this rather obvious improvement.

  3. Content appearing on this Site is opinion only and no information appearing herein should be construed as medical advice.
    RespMed says using Ozone (O3) nullifies their warranty.
    Need reference for study showing increased pneumonia in CPAP users.

  4. I bought the So Clean2 and am now reading that because of the ozone used by the So Clean2 to clean my C-pap machine, it is not FDA approved and may actually endanger my lungs. Now I am scared because I was thinking it is even more important to keep your C-pap machine clean now that we have the Coronavirus attacking us. Please advise!

  5. Beware of Cleanzone now cpap cleaner. I ordered one back on December 26th and still haven’t received it! Called clean zone and they can’t even tell me when it will ship or when I will receive it!?

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