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.
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 t