Can You Use CPAP With a Stuffy Nose?

Continuous positive airway pressure (CPAP) machines are an effective treatment for sleep apnea, but the therapy may not be as effective if you have a cold, flu, or respiratory infection.

In some cases, using a CPAP with a stuffy nose may make it even more difficult to breathe. The CPAP mask can also become contaminated with bacteria, increasing the risk of a secondary infection.

Taking a break from CPAP therapy when you have a cold is generally safe. But if you choose to keep using your CPAP while sick, there are a few things you can do to improve your experience.

This article provides tips for using a CPAP when sick with a cold. It also explains how to clean your CPAP, and how to breathe easier by using over-the-counter (OTC) medication, humidifiers, and more.

CPAP and Nasal Congestion

CPAP machines are meant to provide you with a pressurized stream of air to prevent airway obstruction in your lungs. However, the CPAP cannot work effectively if you have a respiratory illness that impedes your breathing.

Upper respiratory infections such as the common cold or influenza may make it more difficult to use CPAP. Similar to what occurs with allergies, the nose may become congested, stuffed up, and runny. A stuffy nose may make it hard to breathe with the machine if you use a nasal mask.

The discharge of mucus can also contaminate the CPAP mask, especially if you use nasal pillows. Studies suggest that there is a risk of secondary infection if microorganisms are allowed to breed and multiply on a contaminated mask.

The flow of air may also cause irritation if you have a sore throat and provoke coughing spells. Each time you cough, opening the mouth may make the incoming pressure all the more uncomfortable.

Reasons to Take a Break From CPAP

As a general rule, it is fine to take a break from using CPAP if you have a cold or stuffy nose. There will be no major side effects of abruptly stopping therapy.

You may find that you have a residual benefit from the treatment, even several days into the break. This is because the inflammation and swelling of the tissues in the upper airway will take time to become affected again.

These are some of the other reasons why you may consider giving CPAP a break:

• Ear pressure
• Ear pain
• Persistent nasal congestion
• Rhinorrhea (runny nose)
• Nosebleeds
• Sore throat
• Coughing
• Shortness of breath
• Nausea and vomiting

Ear Infections

People often worry that frequent ear infections may be worsened by CPAP use. However, air pressure from CPAP does not travel from the throat to the inner ear via the Eustachian tube.

There may be some pressure changes, but these are usually so minor that you may barely notice. Mucus will not be forced along these tubes and worsen the symptoms of ear infection.

If you decide that your symptoms require a break from CPAP use, this is OK. Try to get back to treatment soon as you recover from the cold.

How to Use CPAP With a Stuffy Nose

If you decide to continue using your CPAP when your nose is congested, you may find it helpful to use interventions or treatments to make it more tolerable. 

Some people actually like to use CPAP during a cold, especially if there is not a lot of nasal discharge. The heated and humidified air may add comfort and relief.

This pressurized air may also move mucus along the nasal passage and decrease congestion. If you can use it for a few minutes, you will notice that it becomes easier to breathe as the nasal area opens up.

There are also medications that can ease symptoms while using CPAP, including decongestants and cold and flu remedies.

Saline Spray or Rinse

An over-the-counter saline spray is inexpensive and effective. It can be used as often as you need it and will moisten the lining of the nose. It may also be helpful to rinse the nasal sinuses during a cold with a neti pot.

Nasal Decongestants​

Afrin (oxymetazoline) spray may provide relief, but it should not be used too frequently for too long a period due to the risk of rebound congestion. Other prescription medications may relieve chronic congestion related to allergies, including nasal steroid sprays such as Flonase, Nasacort, Rhinocort, Nasonex, Patanase, and Astelin.

Cold and Flu Medications

Consider the use of medications that target cold and flu symptoms. In particular, antihistamines like Benadryl (diphenhydramine) may provide relief and improve sleep.

In addition, Mucinex (guaifenesin) may thin the mucus and help to clear it out. If the problem is due to a cough, cough suppressants like cough syrup or throat lozenges may be an effective treatment on the side.

Heated Humidifier and Tubing

It is best to use the CPAP's humidifier, especially when you have a cold or nasal congestion. This reduces irritation and inflammation along the airway.

Research suggests that a heated humidifier also reduces the risk and duration of infections. To minimize the risk of condensation and bacterial build-up in CPAP tubing, use heated tubing.

Full-Face Mask

In some cases, it is simply impossible to use a nasal mask due to a cold or nasal congestion. This may be more likely if you have a deviated nasal septum blocking one side of your nose. In such cases, consider the use of a full-face mask.

A full-face mask allows breathing to occur via either the nose or mouth. In some cases, the full-face mask can be used temporarily. As nasal breathing improves, it is possible to switch back to a nasal or nasal pillow mask.

Positional Therapy

In order to improve breathing during sleep, consider sleeping on your side or stomach. It may also be helpful to raise your head at night. This can be accomplished with the use of a sleeping wedge pillow or by stacking several pillows up. Raising your head may also provide relief even without the continued use of CPAP.

Pressure Changes or Auto-CPAP

When the nose is more obstructed, additional CPAP pressure may be required. This airflow may open things up. Consider reaching out to your healthcare provider to have the pressure adjusted, if needed.

Auto-CPAP therapy, in which a range of pressures can be delivered, may also be a helpful option. Unfortunately, CPAP devices are typically only replaced every five years by insurance, so you may have to wait to get one.

How to Clean Your CPAP Machine

During and after your cold, it is important to be diligent about cleaning the CPAP mask, tubing, and humidifier tank:

1. Give everything a thorough cleaning with dish soap and hot water.
2. Let the mask, tubing, and humidifier sit in a sink of soapy water for 20 to 30 minutes.
3. Rinse the equipment with water until the soap is thoroughly removed.
4. Let it hang to air dry.
5. Replace the filter on the machine.​

You don't have to worry about reinfecting yourself with a cold or flu virus when using CPAP; the chance of reinfection is unlikely. In most cases, it's unnecessary to use a CPAP sanitizer (such as the SoClean device, which retails for $299). 

With that said, unsanitized CPAP equipment can cause infections unrelated to a cold or flu. This is especially true with respect to bacterial infections like acute bacterial rhinosinusitis or bacterial pneumonia, particularly in people with compromised immune systems.

Summary

While it is usually fine to take a break from CPAP therapy if you are sick with a cold or respiratory infection, it's still wise to check with your healthcare provider first.

Some people find that using the CPAP when sick is helpful, while others benefit from OTC medication, humidifiers, and other strategies to breathe easier. As always, make sure to clean your CPAP routinely to protect yourself from infection.