Can a CPAP Machine Cause Pneumonia?

CPAP is the gold standard treatment for obstructive sleep apnea (OSA). By delivering pressurized air through a mask worn while you sleep, the treatment prevents the upper airways from collapsing. 

This prevents the pauses in breathing that trigger the frequent interruptions to sleep associated with obstructive sleep apnea. However, does treating sleep apnea this way place you at increased risk of pneumonia?

What Causes Pneumonia?

Pneumonia is a lung infection which can be caused by fungi, bacteria or a virus. It results in inflammation in the lungs and is potentially life threatening. Someone with this condition will experience breathing difficulties as the air sacs within the lungs begin to fill with fluid.

When you have obstructive sleep apnea, you are already at a greater risk of developing infections as your immune system is compromised by the disorder. 

The breathing difficulties resulting from the disorder also mean you are more likely to inhale contents and fluid into the lungs. This can introduce germs into the lungs that could cause an infection.

How CPAP May Increase the Risk of Infection

When you first receive your Continuous positive airway pressure (CPAP), it will be brand new and completely sterile. 

However, once you start to use it you expose the CPAP to germs. As you should be the sole user of the device, any germs already reside within you – so you should be at low risk. 

The issue will arise if you share your device or mask, introducing new germs unfamiliar to your body – which increases the risk of infection.

Fungi and Mold

Breathing in dry air can be unpleasant and also result in waking up in the morning with a dry mouth or a sore throat.

To make the treatment more tolerable, most devices use a humidifier to moisten the air you inhale, while some people also use heated tubing. 

However, introducing moisture increases the risk of providing breeding grounds for fungi and mold. 

When you inhale the pressurized air, you could then be breathing in one of these contaminants. The pressurized air increases the chance such contaminants are blown straight into the lungs. 

Once in the lungs, they can lead to an infection like pneumonia. Inhaling pressurized air can also make it harder to cough up the mucus which may be building within the lungs.

How High Is the Risk?

This is the good news, because while the risk of developing pneumonia increases when using CPAP, it remains relatively low providing you clean your equipment on a regular basis. One study in Taiwan over an 11-year period looked at this issue, involving around 6,800 participants with sleep apnea.

In the study, 9% of the sleep apnea participants developed pneumonia. This compared to a little under 8% of the larger control group of people without the sleep disorder. Inhaling the pressurized air increased the risk as the air may blow any pathogens directly into the lungs. 

However, most of those who developed the infection were older participants who had additional health issues like heart disease and diabetes. Those with more severe sleep apnea also seemed more at risk of developing an infection in the lungs.

How To Prevent Pneumonia When Using CPAP

The germs which can cause an infection will be picked up as the pressurized air is delivered through your mask while you sleep. The key to reducing your risk of infection is to keep your equipment clean and to replace parts as recommended by the manufacturer.

The following are tips on how to prevent infections.

  • Clean your equipment regularly with soap and water. This means all parts, including the mask, tubing and humidifier chamber. 

It is best to follow the guidelines supplied by your manufacturer, but you should clean the equipment at least once a week -- daily if you have a cold or other such illness.

Make sure all parts are dried thoroughly before reusing. Cleaning does not take long, but is key to preventing a build-up of potentially harmful germs.

  • Parts such as masks, mask cushions, humidifier chamber, tubing  and filters need regular replacement. Again, check the manufacturer’s guidelines for recommended life span for each part. Filters are designed to catch contaminants and purify the air you inhale -- and should not be overlooked when replacing supplies.
  • Make sure you pour out any excess water after every use. You certainly don’t want to leave water in the device for any length of time as this can provide ideal conditions for mold. 

The heated humidifiers and heated tubing of modern machines may reduce condensation, but they can still leave some moisture which needs to be dried out.

  • Ideally, use distilled water in the humidifier chamber rather than tap water. This is particularly relevant if you live in an area -- or are visiting an area -- where you are not entirely confident of the quality and purity of the local water supply. Tap water can also contain minerals which may accumulate in the humidifier chamber.
  • Although it may sound obvious, it is still worth reiterating that you should never share your CPAP equipment with anybody else. Letting another person use your equipment can introduce germs your body is not used to -- and increase the chance of developing a cold or an infection in the lungs.

Adherence to CPAP is important in preventing the return of your sleep apnea symptoms. While there is an increased risk of developing pneumonia while using CPAP, it remains fairly low. 

The key is to maintain a consistent cleaning routine. By ensuring your CPAP equipment is clean, you deny the breeding grounds for the germs, fungi or mold that can cause such an infection.