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The Importance of CPAP Humidification

Tracy R. Nasca

So what’s the big deal about using a CPAP humidifier? Why would you want to add another piece of equipment beyond the CPAP machine and mask? It’s just something else you have to buy, fill each night with water, clean, or add to your CPAP bag when you travel….why bother?

Here is a list of common complaints from CPAP users, do any of these sound familiar?

CPAP makes me sneeze
CPAP makes my mouth dry
CPAP makes my nasal passage burn and it disrupts my sleep
CPAP makes my nose runny
CPAP makes my nose stuffy so I can’t breathe I wake up with mucous in my mouth and throat Water drips into my mask at night
My humidifier water chamber is empty long before it’s time to wake up
The water chamber collects a residue that looks like mold and it’s hard to clean
My humidifier makes gurgling noises and spits water at me

Did you know?

  • Patients over 60 are 5 TIMES more likely to require heated humidification
  • CPAP users taking 2 or more medications are 6 TIMES more likely to require heated humidification
  • CPAP users with chronic mucosal disease or have had UPPP surgery are 4 TIMES more likely to require heated humidification
  • Patients who prefer to sleep in a cold room are most likely to experience condensation (This information was provided by Fisher & Paykel Healthcare, a leader in CPAP humidifier technology)

The list of common complaints can all be resolved with proper use of a heated CPAP humidifier! Here is what you need to know:

For simplicity sake, think of your CPAP as a fan in a box. When you turn it on, it pulls in the air from your sleeping environment. The fan ramps up that air, and delivers it back to you via the tubing attached to your mask, forcing a highly pressurized blast (your CPAP pressure setting) directly into the nostrils, and mouth if you wear a full face mask. Remember that the temperature of your bedroom is the same temperature of that delivered air. Most of us prefer sleeping in a cool bedroom and sleep experts all say we should. As an example, in the winter, I set my household thermostat on 60 which means the hurricane force wind striking my nasal passages is really cold and dry! Most of us know that when we turn on our furnace during the winter it causes a drying affect. Room humidifiers help, but really have little impact on our CPAP use. In summer months, my bedroom is kept cool with air conditioning and use of a ceiling fan, so my nostrils are still blasted with cold air. No matter what the season, for CPAP comfort, I require the addition of heated humidification every night.

CPAP does not work well if we cannot breathe through our nose, or mouth if you use a full face mask. The nasal passage is highly vascular and lined with turbinates. When you have a cold or an allergy, the turbinates swell and this is what causes nasal congestion…the dreaded stuffy nose. When the nasal lining is dry, it may trigger a sneeze which is the body’s way of returning moisture. Dry mouth or airway can trigger the natural production of secretions, such as mucous. This explains why some of us awaken with mucous in the mouth and throat. It also explains why some of us experience a runny nose from CPAP use despite not having a common cold or allergy issue. When we keep the nose and mouth adequately humidified, everything works nicely together to accomplish comfort in CPAP success.

CPAP humidifiers vary brand to brand so make sure you know how yours works. Be proactive if you have doubts or questions; call or visit your CPAP provider to learn the specifics of your unit. Remember that it’s warm moisture we really need, not necessarily high heat. My best suggestion to find your optimal heat setting is to start at the lowest temperature level and turn it up only as needed to accommodate for your bedroom temperature on any given night. Your heat setting will change from season to season.

The higher our CPAP pressure and the higher our humidifier temperature is set, the more water is used. This explains why some of us run out of water before morning wake up time. If you require high CPAP pressures and run out of water too early, consider lowering the heat setting. Ask your CPAP supplier about availability of chambers which offer a larger water capacity. When we turn the heat setting too high, it can cause excess condensation in the tubing that can drip back in to our masks. It can also cause “rain out” which explains the wet mist on our face around the mask area. If this is happening to you, turn down the heat a notch or two. Use a CPAP tubing cover to help insulate the hose and reduce excess condensation. Be careful not to overfill the water chamber, it will cause a gurgling noise and spit water; think of it like a pot boiling over on the stove.

Why is distilled water is suggested by all manufacturers? It has to do with water quality. It’s ok to use tap water occasionally; it won’t harm you or your equipment. But for longevity of your water chamber, use distilled water. It is also recommended that we empty any leftover water in the chamber each morning. This helps assure that no bacteria is left to grow which might appear as a white or pink residue. Empty and rinse the chamber each morning and leave to air dry. Clean the chamber with a sudsy mix of water with a mild soap such as Ivory dishwashing liquid. At least once each week, clean chamber with a vinegar water solution soak, then rinse with clear water and air dry. This routine will remove any residue and disinfect the water chamber. Never use bleach, antibacterial soaps or other harsh chemicals in the water chamber. Please do not risk ingesting anything harmful in to your lungs.

More humidity means more comfort. Nightly heated humidification is one of the most effective tools to complete your therapy and make the CPAP experience successful.