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This is from a correspondence I've been having with Susan McCord, who gave me permission to share it with all you on the forum. Italicized emphasis is my own... Will be interested to hear what you guys think she should do:

"I've been sicker than a dog with this CPAP/sinus stuff since the day after Christmas. Nobody, including my sleep doc will really discuss it with me or else they just dismiss it. This has been going on, off and on, since shortly after I started CPAP in July.

Today I was at my cardiologist for a checkup, and was telling him about all this ongoing. Usually it goes away spontaneously in 2-3 days--this time it's hung on for 10 days so far. Can't stand it.

Anyway, cardiologist, who's also an internist prior, told me it's not uncommon at ALL for pts. on CPAP to have this and that I have an infection. I asked him why the MDs don't tell us about it--he and I have a VERY open relationship and he knows I can't stand having smoke blown up my ass--he told me it's because the sleep docs are so worried about compliance that they don't tell pts. about the possibility of sinus complications AND that it's not uncommon for them to avoid talking about it even if pts. bring it up. They tend to assign the sinus problems to something else.

I was mildly horrified and, frankly, I think he is too. He told me to talk to my PCP and get started on an antibiotic and whatever else PCP recs. He also said people usually stay off CPAP for a week or so till the infection clears. THAT scares me to death. I don't think I'm gonna do it. Internet says to d/c too, but I don't think I can......what do you think I should do???"

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I live in the high desert, and my sinus infections started when I got my CPAP. I went to my PCP many times, and I don't want to live on antibiotics forever....and I began to believe that the humidity well addition to my CPAP might have been part of the reason that I kept getting infections...so I took the water well off my machine, and started using a sinus irrigation daily. This works VERY well, is really easy, and I have not gotten an infection since.
I am just getting over a sinus infection. In my case, it is my sinuses telling me the pressure is too high in combination with the mask. I need to have the air diffused a bit, hence I cannot use nasal pillows. A nasal mask is OK. I had to go from the softgel back to the Active LT, as there is more interior space to diffuse the pressure of the air. I also lowered the pressure one whole point from 14 to 13. When things improve, I will try going up again.

When I started CPAP I was using the Swift mask and had 3 infections in 4 months. I have 'sensitive' sinuses!!
I haven't used the humidifier on my CPAP in maybe three or four years. I don't want to say how often I clean my CPAP -- okay, never -- but because the only moisture in the facemask is from my lungs, and most of that is vented, and I live in a dry climate, I've never had a problem. However, I'm sure what also helps is that, for chronic allergic rhinitis, I take daily Claritin D (used to take Allegra D before my insurance stopped covering it; one 12-hour pill at night is enough for me) along with Nasocort and Astelin sprays to keep my sinuses clear. Keeping breathing passages free is the key. When I have a cold, I use a lavage system to help clear the sinuses, and sometimes plain saline spray helps a lot to loosen dried mucus there. I don't use Afrin anymore; I don't want to risk the bounceback effect, but neither do I need it, not only because because of the Claritin D's decongestant, but also -- here's the irony -- if your sinuses (or even just one side) is at least partially open, the CPAP (which, remember, I always use without a humidifier) keeps the sinuses open while you sleep! For this reason (in addition to the usual vital ones), I always use CPAP during a cold. The downside is that all that stuff gets blown back, but you wake up unstuffed, and a morning shower helps loosen the blownback stuff quicker than the two hours or so it takes normally to drain. Also, the dryness of the air can harden post-nasal drip mucus into small plugs that you try to cough up, but Mucinex (Guafenisin) loosens this up and should be taken throughout a cold, as well. The only consequence of this methodology that I've observed is a cough that occasionally needs antibiotics to get rid of, but I'm not sure it's because of what I personally do because most (non-CPAP) folks around me with the same cold will frequently have the same persistent cough that needs antibiotics. In sum, I have found that keeping everything dry instead of moist -- including the CPAP (i.e. no humidifier) -- seems more likely to inhibit infection, especially in the sinuses.
I don't want to contradict what everyone's saying about CPAP and sinus infections, but if you were to undergo a CT of your sinus every time you get an infection, over 90% of the time, the sinuses will be completely clear. It's been shown that in most cases, what may feel like a sinus infection (pain, pressure, nasal congestion, headaches, eye pain, and even colored mucous) is actually a variation of a migraine that's happening in your sinuses. The nerve endings in your sinuses are extra sensitive to any kind of stimulation. This is why it can be aggravated by allergies, weather changes, chemicals, irritants, and even CPAP pressure. It's also the reason why decongestants and allergy medications can help sometimes, but not fully. Later on, when swelling and sinus blockage continues, the bacteria that normally inhabit your nose can begin to multiply. This situation doesn't happen too often. Unfortunately, it's impractical to get x-rays every time you feel sinus pain, and you have to give antibiotics empirically.

Interestingly, certain antibiotics (called macrolides) have an anti-inflammatory property that's been well described. It's been used successfully in the past to treat chronic sinusitis. One way these medications work is by stimulating your stomach to empty it faster. So with less stomach juices lingering, less can come up into your throat every time you stop breathing, causing less inflammation and swelling in your throat and nose. A Z-Pak is a common antibiotic in this family that's commonly given out by doctors. This is why many patients that take Z-Pak feel better within 1-2 days, rather than the typical 3-5 days that it takes for most antibiotics.
Since going on CPAP, I find I have a lot fewer colds, etc. Before CPAP, I breathed thru my mouth more and that would trigger a sore throat which would develop into a cold and encourage more mouth breathing. Frankly, I did not believe colds only lasted 7 days back then.

These days, things are much approved. I am a bit lax at cleaning my tubes and stuff though I do empty my humidifier and hang up my hoses to dry every day. I also use our well water (and occasionally tap water when traveling) instead of distilled water, yet I continue to rarely get colds. When I first went on CPAP in '97, I had a lot of adjustments (the masks were not like today's!), but I don't remember having more colds than usual during that time. I do continue using CPAP when I'm stuffed up, simply doing what I can to reduce the congestion before I go to bed. The machine normally keeps it open during the night. I do sometimes take lotradine to help that, especially in the spring.

When I have had colds, I have found that the CPAP can blow stuff down further than it normally would be and I can cough a lot in the morning. I don't like this and worry if my immune system were not so effective, it could cause me problems. Thankfully, the CPAP prevents colds enough that I only have this problem rarely, not even once a year.

I did once have a cold or something that hung on and hung on -- until I soaked everything every day so that I could recover. I don't know what it was about the bug I had but at first, I just figured it was one of my rare colds that would go away shortly. However, when I put the CPAP on in the evening, there was a smell in the tube that I associate with sickness (not throwing up, but a smell that sometimes occurs in a room where there is someone that is sick). Breathing air thru the tube all night apparently bolstered the infection in my body. I began cleaning the tubes more frequently and eventually realized that the smell was there unless I actually cleaned the tubes every day. When I did that, I was then able to shake the illness.

The doctors say you can't get an illness that way and you're not supposed to be able to re-infect yourself, but that's what happened to me. Once I cleaned the tubes daily, the smell went away and I finally healed.

My takeaway is, normally, you're not going to have problems with getting an infection from CPAP but it's not impossible.
There are many good tips and discussions on this thread for anyone dealing with sinus issues, so if this is a problem for you, I encourage you to review it all.

Another aspect that I have been dealing with lately is therapy and monitoring of my vitamin D levels. This requires a blood test which can be done along with a regular physical at a doctor's office, but there are also now some at home tests you can do and mail it to the lab yourself. (current prices I found on this range from $50-135 on various websites) I am bringing this up because there is a lot of recent research and a lot of buzz about vitamin D right now and the effects of it on many health conditions and diseases, including immunity. My doctor initiated this test and therapy for me, and I asked my mother's doctor about testing her, which he agreed to. Both of us were in the "insufficient" range and are prescribed therapeutic doses to improve our levels over time. I encourage anyone reading this to do your own research on Vitamin D and talk to your doctor about getting tested. If you don't have insurance right now, do the research anyway and the home test if you can afford it. This affects many disease processes including heart disease, many types of cancer (treatment and prevention), diabetes, bone health, and others. It is one thing that may help your overall and long term health. Anything you can do to prevent sinus infections will make your CPAP therapy easier.

I also have the condition described by Dr. Park, just now. That is Migraine, causing sinus inflammation and pain. I thought I had chronic sinusitis for years, until my doctor figured out it was probably a migraine condition. This has affected my CPAP use, making it difficult to breath at times, with or without the CPAP. I am learning to manage this with medications and lifestyle. I use a corticosteroid nasal spray every night, and sometimes antihistamines; also nasal rinses, migraine medication - Maxalt (a "triptan" Rx medication), vitamin & mineral supplements and medicinal herbs. If your sinus problems don't go away, it may be worth considering if you also have a migraine condition.

I imagine most people have multiple health conditions affecting their overall health and CPAP use. Understanding each of them and managing them well is the challenge we all face.
Much has been posted here, but in the OP the only thing that I considered significant was one doctor's statement, "Anyway, cardiologist, who's also an internist prior, told me it's not uncommon at ALL for pts. on CPAP to have this and that I have an infection."

So I guess this is his way of saying it is common for CPAP patients to have sinus infections and they are caused by CPAP.

From personal experience using CPAP and talking to hundreds of fellow CPAPers, I see no evidence for his statement.

In my own case, the number of colds and the severity of allergies declined with the start of CPAP therapy. Also, I have had no sinus infections in the five years I have been using CPAP.

How often do I clean my equipment? It has been two years since I cleaned the hose; mask gets cleaned about every two weeks; and when I use the humidifier, I just top the water off every night for weeks at a time.

When I am fighting a cold, I would not dare discontinue CPAP. With a cold, the CPAP is needed more than ever to keep the body in "fighting shape".
i use nasal washes every night using a syringe and salt solution. no infections yet after several years of this.
loren wolsh said:
i use nasal washes every night using a syringe and salt solution. no infections yet after several years of this.
I have been using my cpap machine for 5 years at least. In the beginning, I had a lot of problems with sinus. I know that
humidity is supposed to help as they have these things with water in the air when you are congested. After thinking about
it, I changed my machine from low moisture to high moisture it seems to have conquered the problem. I breath very well and are never congested. My sleep apnea is serious, my setting was on 17 but he saw a good difference in me and lowered it
to 15 now. With it set on high moisture, you use a lot more water.
Sinus infection/inflammation is a real pain and I suppose infection could be linked to inadequate cleaning of cpap equipment. Lots of people around here are have sinus problems, and exposure to pollen outdoors in the daytime seems to be the main source of inflamed sinuses. We have had unusually heavy pollen this year -- as has much of the country I believe.

I am not inclined to think my cpap (with humidifier) is contributing to my sinus problems, as I regularly clean it very thoroughly with hot water and soap. I find the humidifier on a warm setting to be soothing when I am having sinus trouble, but this might not be true for everyone. Also, I had sinus trouble long before I had a cpap device.

I am convinced the cpap is vital to my well-being (and my brain's) and would not consider skipping it for any reason.

In my experience, sleep clinics vary greatly in their quality. I would try to visit a good one and talk to an experienced technician if I had serious questions about the possibility of infections, etc. A German technician at the first clinic I visited (Community Hospital in Syracuse) told me more than I ever wanted to know about sleep apnea, but I am very grateful for her help.

I agree with the use of nasal washes, especially if pollen is the problem. Thanks for the reminder. I have the NeilMed Sinus Rinse Kit and will start using it regularly during the pollen season. The wash (like the cpap) takes a little getting used to, but I have found it very beneficial and soothing,
I've had a low-grade sinus infection for several months. A couple of weeks ago I started drying out my gear by hooking it up to the machine after I clean it in the morning and turning it on for an hour or so, with no water in the humidifier chamber and no heat. So far it seems to be helping. I don't know if it's a cure, but I do feel better. In our damp climate, water will sit in the tubing all day long, and my theory is that drying it out eliminates habitat for bacteria. Any thoughts or experiences from anyone else?

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