Sleep doctor answers questions about COVID-19 and sleep

In this video, Dr. Raj Dasgupta answers questions about COVID-19 and sleep submitted by the public to the American Academy of Sleep Medicine. Dr. Dasgupta covers topics such as CPAP use at home, cleaning CPAP, ventilators, and medication usage.

Rajkumar (Raj) Dasgupta, MD, FACP, FCCP, FAASM, is the assistant professor of clinical medicine at Keck School of Medicine at the University of Southern California. He is also the assistant program director of the Department of Internal Medicine. He is quadruple board certified in Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine.

Video Highlights

2:32 – Does having sleep apnea make me more likely to get the coronavirus? Will I be more likely to have severe complications if I get the virus?

There’s no data that obstructive sleep apnea by itself puts you at risk. But are you going to be at a higher risk because of the comorbidities that you share because you are higher in age? The answer is, yes.

5:22 – Will I be more likely to have severe complications if I get the virus?

Well, that’s a very individualized question because people are using CPAP, continuous positive airway pressure, or treating their sleep apnea because of their different comorbidities. So, if you have bad respiratory issues or if you have bad heart disease because you are older in age, you might be more likely to develop complications of COVID-19 than other individuals.

So the bottom line point is, and I’m probably going to say this for every question coming up, is, if you have obstructive sleep apnea, or any type of sleep-disordered breathing and you want to know if YOU are at risk for COVID-19 or its complications, you have to contact your primary care physician or your sleep physician, to find out where you fit on that spectrum of the disease and how much you need to worry about it.

6:32 – During this outbreak, should I stay home if I have sleep apnea?

Yes, stay at home, regardless if you have sleep apnea or not! I am very passionate about this. When we talk about what can we do as society, as physicians, as the general public to help out with what’s going on, it’s staying home.

What we know, what the evidence shows, it that by social distancing, by staying home, by not going out if not necessary, does so much to help prevent the spread. I know that everyone hears the phrase “flattening the curve,” but that’s what we need to do, because when one person gets it, it branches out to another five people and from those five people to another 10 people. So, we do need to flatten the curve. We do need to stay home regardless whether you have insomnia, restless leg syndrome, narcolepsy, obstructive sleep apnea, if you can stay home, please stay home.

8:28 – What is a ventilator? Is my CPAP machine a ventilator?

What is a noninvasive positive pressure ventilator? It means that you are blowing the air into the patient. Instead of having something invasive, like a tube going through the vocal cords into the lungs directly, you’re going to wear a mask of some kind. That’s why it’s called noninvasive ventilation. When I think about noninvasive ventilators, there are two types. One would be hospital-based noninvasive ventilator and home-based. One is inpatient that I use in some of my patients who are in respiratory distress, where I want to do something noninvasive, and the ones at home is what many of you think, which is a CPAP machine or a bilevel machine, to really treat the upper airway obstruction.

It’s very important to realize this because whoever asks this question, there’s a lot of terminology we use that people are confusing what they are referring to. So, when we say the word CPAP, that’s continuous positive airway pressure, that describes how we deliver the breath. It’s not the mask, it’s how we deliver the breath. If you have a bilevel machine it means there’s a way we deliver the inspiratory breath and a pressure that we deliver the expiratory breath. That’s called a bilevel machine.

If we are now talking about an invasive ventilator, that means I’m taking a tube, what we call an endotracheal tube, and putting it through the vocal cords and into the lungs. I only use this terminology when I’m in the medical ICU, when patients come in with respiratory failure or they’re hypoxic, which means low oxygen. Or they’re hypercapnic, which means high levels of CO2, or they’re going to be in respiratory distress.

If you’re using a CPAP machine because you’re in respiratory distress because you have a COVID-19 infection, that scares me, because that’s not the ventilator you should be using. This is the time that you need to pick up the phone and talk to your primary care and talk to your sleep medicine doctor.

15:09 – If I do have the coronavirus, will CPAP help me treat it?

CPAP, assuming home CPAP, is only used to treat one thing, your obstructive sleep apnea. The question becomes, if you don’t use your CPAP, what could happen? We know that we want to stay healthy and the pillars of good health are going to be diet, exercise and, of course, good sleep. And one of my favorite phrases out there is that in order to get good sleep you need the right quantity of sleep and the right quality of sleep. And if you’re not using your CPAP because you have obstructive sleep apnea, you’re going to further weaken your immune system. And if you do have coronavirus or you’re worried about getting coronavirus or any virus, you’re definitely going to be more susceptible.

16:50 – Would bilevel PAP be even more effective than CPAP?

We don’t treat coronavirus with bilevel and CPAP when we talk about patients at home. When you’re in the hospital, that’s a whole different story. When we talk about inpatient medicine, right now it’s a tough time because when we talk about patients that come in with COVID-19 and they’re in a medical ICU setting, a negative pressure room, that if they’re in respiratory distress, if you’re using things like bilevel or CPAP in these patients with respiratory distress you may actually spread the virus and may infect other people in the room. That’s where it’s very scary, whether you’re in the hospital or the same thing goes for my patients at home. If I’m using a CPAP or BiPAP and I have COVID-19, I might be spreading it.

My advice to whoever asked this question is, remember these terminologies can be used in both in inpatient and outpatient setting and who would make that decision whether CPAP or bilevel for your sleep apnea by itself that would be your sleep physician. But once again, we are not treating the virus directly, and if you’re using these things because you’re short of breath, please inform your doctor because you may need to go to the hospital.

19:34 – If I do have the coronavirus, will CPAP drive the virus deeper into my lungs? 

The answer is no. Right now, there is no data to state that if you do have coronavirus that the CPAP would drive it into the lungs themselves. But the question now becomes, if you know you have it and you’re at home, by wearing that mask, you worry about spreading the virus to other individuals in the house. Maybe if you do have coronavirus and you’re not short of breath and you’re doing well and your sleep apnea is on the milder side, this may be a great time to ask your physician, “Are there other things I could do to treat the obstructive sleep apnea that’s not going to be using a CPAP device?”

21:45 – Will this cause me to get pneumonia?

No, wearing a CPAP machine does not cause your COVID infection to give you pneumonia. Any virus, including COVID-19, does a number on your immune system. It actually will make you more predisposed to other pneumonias in the community, we call them community-acquired pneumonias. If you’re in a hospital, we call them hospital-associated. If you’re on a vent we call them ventilator-associated. And we do worry about that.

Another manifestation you can get from COVID-19 in the lungs is what we call ARDS, and I’m sure you may have heard about that. It’s called acute or adult respiratory distress syndrome and it’s very, very serious. This is what I’m doing as a pulmonologist right now in treating many of my patients who unfortunately developed ARDS or many of my patients develop, you’re going to hear this in the next couple days to weeks, this “cytokine storm” that happens, all this inflammatory response that occurs in people who have this COVID-19 infection and it’s that combined with the ARDS, combined with secondary pneumonias that are very serious. Let me say, I’m talking about the worst of the worst because I am in the ICU. Many, many patients will just have upper respiratory track symptoms, some of course will be asymptomatic, and we don’t want them to go on to be in the ICU. I just want to make sure, when I saw this question and when I heard the word pneumonia, that I do address where some of the complications in the severe sense of people who have COVID infections.

To answer your question directly, if you’re talking about in the outpatient setting, no, CPAP will not drive the virus into your lungs. No, the CPAP in itself will not give you pneumonia.

24:10 – If I have the coronavirus, is there a risk that using CPAP will infect others around me and if so, why?

The answer is, yes. Now, when we talk about this, let’s talk about it at home. Thirty million plus people have obstructive sleep apnea and I’m sure a lot of those are using CPAP, continuous positive airway pressure. So, how do you infect others? It’s because it’s a noninvasive positive pressure ventilation. Because it’s noninvasive you have to wear an interface. That could be nasal pillows, a nasal mask, a face mask, and there’s always going to be leak. Because there’s going to be leak, that’s why the virus can spread, and it can definitely affect others.

In the outpatient setting if there’s other individuals around you, yes, I would be very cautious. If you think you have it, please contact your health care physician right away and find out what is the best thing to do. If it’s indicated, maybe not using a CPAP device for certain individuals might be the answer.

This is another reason why mask fitting is so important because even if you wear a full-face mask you know you do get some leak.

27:09 – I have the coronavirus, should I stop using CPAP so that I don’t infect other people?

I would contact your primary care physician before stopping it because there are so many things that will have to play a role in it. It really depends on how sick you are, and the default answer is please contact your health care provider to know what the next best thing to do is.

29:39 – If I have the coronavirus, how do I clean and disinfect my CPAP machine, mask and accessories? 

It’s going to be recommended by your DME company, which stands for durable medical equipment. They’re going to tell you how you need to clean your machine. When we talk about how, the answer’s going to be soap and water. When we talk about how often you need to do that, usually it’s going to be once a week. Is it wrong to do it every three days with soap and water, the answer is, no. Are there people out there who are doing it every day? The answer is probably, yes. There’s no downside to doing that but don’t focus on only cleaning the machine but it’s going to be hygiene in general. It’s going to be disinfecting your hands, washing your hands. I think a big thing right now is cell phones. I’m guilty. You have your cell phone, you lay it down, you touch it, you give it to someone else, you take a picture, this is another way to transmit viruses. So, don’t overly focus on your CPAP machine and ignore all the other appropriate hygiene that you need to have to prevent you from transmitting the virus.

31:13 – Will a CPAP cleaning machine disinfect my CPAP device and mask?

This is a great question regardless of a COVID-19 outbreak or not. Many of my patients have asked me about UV light and ozone. I have had tons of patients ask me, is this just as good as cleaning with soap and water, is it better? The FDA, and I got a lot of my information looking at the FDA site, there are no approved machines. There are actually people out there that are complaining of some respiratory symptoms, I believe it was asthma-like symptoms, when using things like ozone. There are also side effects when you use UV light.

No, these are not FDA-approved and especially right now, I would say, soap and water, soap and water.

32:41 – If I have the coronavirus, should I replace my CPAP accessories more frequently?

The answer is, no. When we talk about the tubing, the mask, and of course the filter, and I can’t say enough about the filter, is that you want to do it to the most recommended of your DME company. You don’t need to change your filters more than necessary. You don’t need to request more masks or more tubing. Do your hygiene, using the soap and water, but do it as it’s recommended.

35:26 – Are there any additives or chemicals that I should use to clean a CPAP machine during the coronavirus outbreak?

The answer is, NO! This question actually scares me. I’m sure there are people out there that are maybe doing their own thing. During a time like this, when there’s not a lot of evidence-based medicine in what to do people will try different things, so it’s not surprising. I would be horrified if someone put things like bleach or put other things or other chemicals in their CPAP machines because remember, you’re going in the lungs.

Please, just stick to what’s recommended. Don’t add anything else. I only see horrible things happening.

37:17 – What do I use in my CPAP humidifier if we have don’t have distilled water?

You could just use filtered water, you could use boiled water, you could use tap water. It’s not actually going to put you at a higher risk for any types of infections or anything like that. The only problem is that you may have to clean the filter out a little bit better. Those are my recommendations. We’ve been using that with our patients.

38:20 – Is humidified air better than dry air for preventing the spread of the coronavirus?

There is some data out there for viruses that they don’t do good when it’s very hot outside, when it’s very humid outside, they don’t live as long. So, I will agree with that statement, but let me take a step back and say, I don’t think having less humid air or being a little colder is going to prevent any viruses. I don’t think the answer is humidity, I think it’s going to be social distancing and all the other things we do. But this is a good statement and in broad strokes, yes, the viruses don’t do as well in humid air and hot weather. But this is not the answer to stop the spread or to cure coronavirus!

40:00 – If I develop coronavirus symptoms, should I stop taking a medication such as Ambien, trazodone, or ibuprofen?

I would be careful stopping these medications for a variety of reasons, one being some rebound insomnia, including some other things. If you are taking a medication you should talk to your primary care physician or your sleep physician before you just stop it.

There was some data that came out that made people a little scared that was saying people who take ibuprofen may worsen the symptoms. But the WHO and CDC made a statement saying that there is no concrete data or proof to support these claims. I would say this much. If you get to choose, Tylenol or Advil, meaning acetaminophen or ibuprofen, yeah, sure, I would probably err on taking the Tylenol, but if you have osteoarthritis or aches and pains, I wouldn’t shy away from the ibuprofen.

If you have any medication nowadays and you’re curious about is it safe, is it not safe, what should I be doing, you know what I’m going to say…please call your primary case physician, health care providers, to try to get the right answers.

45:20 – I have a baby with enlarged tonsils, causing sleep apnea and severe symptoms with colds. Are children with sleep apnea at a higher risk than others?

There’s no data right now to say they are at a higher risk. You’ve got to be careful. Whether it’s for your own loved ones or even when I make any statements because things do change, and this is a very tricky, aggressive virus that’s doing a number on us. But, no, to answer your question directly, it does not.

Remember, common things are common, and if you are having any type of infection or suspect any type of upper respiratory tract or are worried about a cough, please let your primary care physician or pediatrician know about this.

Please note that much of the information about COVID-19 that is needed to answer patient questions and guide clinical decision-making is still emerging.

The AASM encourages you to follow the CDC tips on how to prepare for the coronavirus. The information above is for educational use only. The AASM is unable to provide specific medical advice. You should discuss your health and medical condition with a local medical provider. You also can request a telemedicine appointment with a health care provider who is licensed in your state.

Authored by:

Kate Robards