12 February 2019

Why NOT to use a CPAP Humidifier?

“Don’t keep forever on the public road, going only where others have gone and following one after the other like a flock of sheep. Leave the beaten track occasionally and dive into the woods.”
- Alexander Graham Bell (Scottish Scientist and Inventor – 1847 - 1922)

When one sheep decides to go somewhere, the rest of the flock usually follows, even if it is not a “good” decision. If one sheep jumps over a cliff, the others are likely to follow.

Why use a Humidifier even though the sleep medical specialists and equipment suppliers keep recommending that you should use one? They have spent vast sums of money on research on how best to incorporate humidification with the CPAP sleep apnea machine. As previously advised on the blog page Why is CPAP Compliance Rate Low?, these sleep medical specialists do not truly understand how the sleep apnea machines work. They have made sleep apnea therapy for obstructive sleep apnea complex. It is SIMPLE! By learning why NOT to use a CPAP humidifier, you will simplify your sleep apnea therapy.

By truly understanding how the various machines and sleep therapy works, I believe there would be no need for many patients to use a humidifier due to the air from the machine. 

I have used average fixed pressure of 17cm H2O on a sleep apnea machine with no humidifier and I had no issues in doing so other than nasal congestion and nose bleeding. It made no difference what time of year it was or the level of humidity in the air. In a previous blog post, I outlined how to Stop CPAP Nasal Congestion and Nose Bleeding. I understand that some people will need to use the humidifier due to nose issues, however, what about the remaining majority of people who use the humidifier? 

The three main issues that require patients to use a humidifier are:
- Dry sore throat;
- Dry mouth; and
- Nasal congestion and nose bleeding. 

Is dry sore throat and dry mouth the only issues that you are having? 

Before advising from personal experience the Secrets to NOT using a humidifier, let me outline all the benefits of doing so:

- No more “rain out” issues and excess condensation 

- No need to add an extra piece of equipment like the ResMed S9 machine. You will only need one small box instead of two.   

- No need to find clean water/ distilled water especially when travelling away from home

- No more having the water chamber run out of water during the night

- No more forgetting to fill the water chamber before going to bed (Yes, I have done this! Had to disconnect the hose and get out of bed late at night)

- Taking less space on your bedside table

- No need to clean the water chamber due to residue build-up

- Saving money from using less electricity. It is estimated that using a heated humidifier uses 3 times more power when compared to not using the humidifier. The saving may not be much, maybe only $30 to $40 per year; however, this amount still buys a number of Cheeseburgers!     
- When travelling, going camping or in power blackouts, 3 times less battery capacity is required should you have no access to electricity. 

- Without a humidifier, the ResMed S9 can be used with a 30W power adapter. Originally it was half the size and half the weight of the 90W power brick. In addition, it came as a Travel Pack with 4 interchangeable plugs at the back of the power adapter making it perfect for when travelling overseas to various countries.     
- When travelling especially on short trips, as no humidifier, I put all the sleep gear including the machine in hand luggage on the plane. No need to carry an extra bag.

- No need to use XyliMelts or anything similar that you are using to keep the mouth moist

- No need to worry whether the air is too warm and there is too much or too little humidity depending on the season in the year and weather.  

- For those with air coming out of the eye tear duct issue, a major advantage was that I was able to increase the maximum pressure by more than 30% to 12cm H2O fixed pressure from 9cm H2O. More details of the air coming out of the eye tear duct and eyes are on the blog posts Air through Eye Tear Duct and Air coming out of the Eyes

- Should you be waking up during the middle of the night to urinate/ have Nocturia and your water chamber is low or empty in the morning; consider your use of the humidifier and the amount of humidity may be part of the reason. 
After seeing all the benefits of not using a humidifier, why would you want to still use a humidifier? 

The Secrets for not using a humidifier are:

1. Minimize Leaks from the Mask and Mouth Breathing. Ideally reduce Leaks to Nil so that a Zero appears on your sleep machine every morning; and

2. Breathe through your nose. Breathing through your mouth using a Full Face Mask and a Total Face Mask will lead to dry sore throat and dry mouth and possible dental health issues such as bad breath.

The nose is like a humidifier whereby it will warm, humidify and moisten the air that you are breathing in. In addition, breathing through your nose kills deadly bacteria and viruses and traps dust particles. This is one of the reasons serious consideration should be given to using nasal pillows and nasal masks where possible.  
In relation to minimizing leaks, from personal experience, I can have up to an average of 1.5 litres/ minute of leaks before I need to look at using a humidifier. Some days I can have 4 Zeros for leaks on the SleepyHead reports. I understand the average leaks for a person is 4 to 6 litres/ minute.

The question is: How do you minimize leaks and ideally reduce your leaks to Zero? 

I will look at this question in the next blog post Stop CPAP causing Mask Leaks. 

Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 12.8 cmH2O (inhale and exhale pressure). Top pressure may go above 20 cmH2O during the night. This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. I am still not using a humidifier with these very high pressures. More details are on the blog post:
Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues
Due to long COVID and bad flu in 2022, I had to increase the starting IPAP to 21.8 cmH2O and EPAP to 16.4 cmH2O. This was due to hypoxia and sleep disordered breathing reoccurring. A humidifier is still not being used and I am using a ResMed Bilevel or BiPAP auto adjusting pressure machine. More details are on the blog page: 

Should you be having side effects and issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful

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