Sleep apnea while sick: using CPAP through a cold or flu

Being sick with sleep apnea usually means a blocked nose, a harder time with CPAP and more broken sleep. Most people can keep using CPAP through a cold with a few changes: more humidity, saline for the nose, sometimes a full face mask, and care with sedating cold medicines. Check with your sleep provider before you stop therapy, even for a few nights.

Why does sleep apnea feel worse when you're sick?

Sleep apnea can feel worse when you're sick because a cold narrows an airway that's already prone to collapsing. A CPAP manufacturer's patient guide explains that the pauses in breathing come from the airway narrowing during sleep, so if a cold or other upper respiratory infection further blocks or irritates the airway, sleep apnea may get worse too. It adds that CPAP can be harder than usual to tolerate with a cold.

The evidence here is thin. We couldn't find good studies measuring how much a common cold changes the apnea-hypopnea index, so most of the advice below comes from clinical guidance and patient resources rather than trials. That's worth knowing, but it doesn't change the practical picture: congestion, a sore throat, coughing and feeling unwell all make it harder to sleep with a mask on.

Our article on snoring when you're sick covers why colds make snoring louder. This one focuses on people who already have a sleep apnea diagnosis.

Should you keep using CPAP with a cold?

You should usually keep using CPAP with a cold, but ask your provider if you're unsure. The same manufacturer's guide says stopping isn't advised because the tiredness and other symptoms you had before therapy can come back. It also names one exception: during an acute upper respiratory infection, you may need to stop treatment for a short time, and your doctor should advise you.

The AASM's Sleep Education site stresses that CPAP works best when used all night, every night, and says even one night without treatment can affect your blood pressure. The National Heart, Lung, and Blood Institute (NHLBI) says to use your CPAP machine every time you sleep, including naps and while traveling. Being sick doesn't change that goal. It just means you may need some adjustments to make the mask bearable.

If CPAP is still new to you, a cold can feel like a setback. Our guide to getting used to CPAP has tips for rough patches.

How can you make CPAP easier with a stuffy nose?

You can make CPAP easier with a stuffy nose by adding moisture, clearing the nose before bed and making sure your mask can handle mouth breathing. Here is what the guidance supports:

Humidity is the first thing to try. The AASM's 2019 positive airway pressure guideline found that humidification clearly reduced several side effects of therapy, including dry mouth and throat, nasal congestion, dry nose, nosebleeds and sore throat. NHLBI lists congestion and a runny nose among CPAP side effects and says your provider can help you find ways to relieve them. If you see water droplets in your tube or mask, the manufacturer's guide suggests turning the humidity down, using a tubing wrap or using heated tubing.

Saline is the simplest nose fix. Sleep Education says a saline nasal spray can ease mild nasal congestion. If you rinse instead, the FDA says to use distilled or sterile water, or tap water that has been boiled and cooled, never water straight from the tap. Our guide on how to use a saline rinse walks through it.

Should you switch to a full face mask when sick?

Switching to a full face mask can help when a cold makes you breathe through your mouth. The manufacturer's guide explains that congestion pushes people to mouth breathe, and with a nasal mask that lets pressurized air escape through the mouth. That mouth leak can make therapy less effective and dry your mouth out. A full face mask covers both nose and mouth, so you still get treatment if your mouth falls open.

Sleep Education describes the same kind of mask as one that may help if you have air leaks with a nasal mask. Not everyone has a spare full face mask, so it's worth asking your equipment supplier now, before the next cold, whether a backup is possible. Our article on dry mouth with CPAP goes deeper on mouth leak.

Some people who use CPAP also use mouth tape with their doctor's agreement. A blocked nose is a clear reason to put it away until you can breathe comfortably through your nose again. Mouth tape is not a treatment for sleep apnea and never a replacement for CPAP. We don't recommend mouth tape for children. Our guide to mouth tape with a cold covers when to start again.

Are night-time cold medicines safe with sleep apnea?

Night-time cold medicines need extra care with sleep apnea, so ask a pharmacist or your doctor before you take one. The NHS advises people with sleep apnoea not to take sleeping pills unless a doctor recommends them, because they can make sleep apnoea worse. Many "night" cold remedies work partly by making you drowsy.

MedlinePlus says diphenhydramine, a common antihistamine in cold and allergy products, can make you drowsy, is also used to treat insomnia, and that alcohol adds to that drowsiness. The NHS notes that "all-in-1" cold remedies can combine decongestants with painkillers or antihistamines, and lists feeling sleepy as a possible side effect of some decongestant products, so it suggests looking for non-drowsy versions.

Decongestants have their own limits. The NHS says decongestant nasal sprays shouldn't be used for more than 5 days, because longer use can make stuffiness worse, and that people with high blood pressure or heart problems should get advice before taking decongestants. The NHS lists high blood pressure among the problems untreated sleep apnoea can lead to, so that check is worth doing. Our article on decongestants for a stuffy nose at night has more detail.

How should you look after your CPAP while you're ill?

Keep cleaning your CPAP as usual while you're ill, and plan to replace some parts once you've recovered. NHLBI says to clean your mask and tube every day for the treatment to keep working. Mayo Clinic's PAP cleaning guide says to wash the mask or nasal pillows daily in warm soapy water, empty and wipe the humidifier tub daily, and wash the tubing weekly.

The same Mayo Clinic guide gives a reason to refresh supplies after being sick: it says that if you're ill while using your device, you'll need to replace supplies once you're feeling better, because viruses can survive in moist, confined areas for several weeks. Your supplier can tell you which parts your insurance will replace and when. Our guide to CPAP cleaning and supplies has the full schedule.

What if you think you have sleep apnea but haven't been diagnosed?

If you think you have sleep apnea but haven't been diagnosed, it's better to judge the signs once your cold has passed, since a stuffy nose brings its own sleep problems. The NHS lists the main symptoms as breathing that stops and starts during sleep, gasping, snorting or choking noises, waking up a lot and loud snoring, along with feeling very tired during the day. If those carry on after your cold has cleared, see a GP or doctor. The NHS says someone who has seen your symptoms can help by coming with you, and that tests can often be done at home. Our guide to the home sleep apnea test explains what to expect.

When should you call a doctor?

Call a doctor if your breathing worries you, your symptoms get worse, or you can't use CPAP for more than a night or two. The NHS says to get advice for a cold if you feel short of breath or have chest pain, if your symptoms get worse, if they don't improve after 10 days, or if you have a long-term condition such as a heart or lung problem.

Tell your sleep team if a cold keeps you off CPAP, if you're waking up gasping more than usual, or if you have ear pain or pressure with the mask on. They can suggest a different mask, a humidity change or medicine for congestion. Sleep Education says to talk with your doctor about medications for congestion, a runny nose or sneezing if they affect your ability to use CPAP.

This article is general information, not medical advice. Your sleep provider is the best person to advise on CPAP use while you're sick.

Read next

• Getting used to CPAP
• How to sleep with a stuffy nose
• Is CPAP safe?

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.