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
232 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
Theres 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
522 Will I be more likely to have severe complications if I get the virus
Well thats 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 Im 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
632 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 whats going on its 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 thats 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
828 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 youre going to wear a mask of some kind Thats why its 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
Its very important to realize this because whoever asks this question theres a lot of terminology we use that people are confusing what they are referring to So when we say the word CPAP thats continuous positive airway pressure that describes how we deliver the breath Its not the mask its how we deliver the breath If you have a bilevel machine it means theres a way we deliver the inspiratory breath and a pressure that we deliver the expiratory breath Thats called a bilevel machine
If we are now talking about an invasive ventilator that means Im 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 Im in the medical ICU when patients come in with respiratory failure or theyre hypoxic which means low oxygen Or theyre hypercapnic which means high levels of CO2 or theyre going to be in respiratory distress
If youre using a CPAP machine because youre in respiratory distress because you have a COVID 19 infection that scares me because thats 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
1509 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 dont 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 youre not using your CPAP because you have obstructive sleep apnea youre going to further weaken your immune system And if you do have coronavirus or youre worried about getting coronavirus or any virus youre definitely going to be more susceptible
1650 Would bilevel PAP be even more effective than CPAP
We dont treat coronavirus with bilevel and CPAP when we talk about patients at home When youre in the hospital thats a whole different story When we talk about inpatient medicine right now its a tough time because when we talk about patients that come in with COVID 19 and theyre in a medical ICU setting a negative pressure room that if theyre in respiratory distress if youre 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 Thats where its very scary whether youre in the hospital or the same thing goes for my patients at home If Im 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 youre using these things because youre short of breath please inform your doctor because you may need to go to the hospital
1934 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 youre 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 youre not short of breath and youre 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 thats not going to be using a CPAP device
2145 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 youre in a hospital we call them hospital associated If youre 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 Im sure you may have heard about that Its called acute or adult respiratory distress syndrome and its very very serious This is what Im doing as a pulmonologist right now in treating many of my patients who unfortunately developed ARDS or many of my patients develop youre 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 its that combined with the ARDS combined with secondary pneumonias that are very serious Let me say Im 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 dont 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 youre 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
2410 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 lets talk about it at home Thirty million plus people have obstructive sleep apnea and Im sure a lot of those are using CPAP continuous positive airway pressure So how do you infect others Its because its a noninvasive positive pressure ventilation Because its noninvasive you have to wear an interface That could be nasal pillows a nasal mask a face mask and theres always going to be leak Because theres going to be leak thats why the virus can spread and it can definitely affect others
In the outpatient setting if theres 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 its 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
2709 I have the coronavirus should I stop using CPAP so that I dont 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
2939 If I have the coronavirus how do I clean and disinfect my CPAP machine mask and accessories
Its going to be recommended by your DME company which stands for durable medical equipment Theyre going to tell you how you need to clean your machine When we talk about how the answers going to be soap and water When we talk about how often you need to do that usually its 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 Theres no downside to doing that but dont focus on only cleaning the machine but its going to be hygiene in general Its going to be disinfecting your hands washing your hands I think a big thing right now is cell phones Im 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 dont 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
3113 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
3241 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 cant say enough about the filter is that you want to do it to the most recommended of your DME company You dont need to change your filters more than necessary You dont need to request more masks or more tubing Do your hygiene using the soap and water but do it as its recommended
3526 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 Im sure there are people out there that are maybe doing their own thing During a time like this when theres not a lot of evidence based medicine in what to do people will try different things so its 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 youre going in the lungs
Please just stick to whats recommended Dont add anything else I only see horrible things happening
3717 What do I use in my CPAP humidifier if we have dont have distilled water
You could just use filtered water you could use boiled water you could use tap water Its 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 Weve been using that with our patients
3820 Is humidified air better than dry air for preventing the spread of the coronavirus
There is some data out there for viruses that they dont do good when its very hot outside when its very humid outside they dont live as long So I will agree with that statement but let me take a step back and say I dont think having less humid air or being a little colder is going to prevent any viruses I dont think the answer is humidity I think its 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 dont do as well in humid air and hot weather But this is not the answer to stop the spread or to cure coronavirus
4000 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 wouldnt shy away from the ibuprofen
If you have any medication nowadays and youre curious about is it safe is it not safe what should I be doing you know what Im going to sayplease call your primary case physician health care providers to try to get the right answers
4520 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
Theres no data right now to say they are at a higher risk Youve got to be careful Whether its for your own loved ones or even when I make any statements because things do change and this is a very tricky aggressive virus thats 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
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All four of the Alaska Sleep Clinic locations are accredited by the American Academy of Sleep Medicine AASM AASM is a professional society of physicians researchers and other health care professionals who specialize in the study diagnosis and treatment of sleep disorders The organization accredits sleep medicine centers in the United States
About Accredited Sleep Centers
Each sleep center accredited with the AASM has demonstrated a commitment to the highest quality of care in the diagnosis and treatment of sleep disorders Accredited facilities have a board certified sleep medicine physician who leads a sleep team of trained health care professionals To become accredited by the American Academy of Sleep Medicine sleep centers must comply with the AASM Standards for Accreditation the gold standard for patient care in the sleep field These requirements incorporate the latest diagnostic and treatment advances and the standards ensure that sleep centers provide high quality patient centered care
