CPAP And Sinus Infections

One of the more common complaints from CPAP users is that they are prone to sinus infections. Typically, they deal with it using saline irrigation, decongestants, and sometimes even go to their doctor for antibiotics. As a result, people suspect contamination or infection from their equipment, especially the mask, tubing or even the machine itself. Other suspects include molds, allergies or even sensitivity to their masks.

I had an experience today with a patient that makes me rethink how CPAP may aggravate nasal or sinus infections. This patient was unable to use CPAP after 4-5 days because his nose and sinuses would burn. He interpreted this as an infection. His numbers and other compliance parameters were perfect. While performing nasal endoscopy (placing a thin flexible camera in his nose) he commented that the sensation was identical to the feeling that he experienced when he used CPAP.

That got me thinking about how most cases of sinus headaches and pain have been shown to be a variation of a migraine. This is a neurologic reaction to any sort of irritation or stimulation. If you were to undergo a CAT scan during an episode, you’ll see that in most cases, it’ll be completely normal. Unfortunately, too many people end up being given oral antibiotics.

What can you do about this if you’re susceptible to these problems? Unfortunately, it’s a catch-22. In theory, the best way of handling this is to treat the underlying obstructive sleep apnea, but in this case, the treatment itself can cause nasal inflammation that can worsen sleep apnea. Many people benefit significantly by using CPAP, but there will always be a few people who absolutely can’t tolerate CPAP, no matter how hard they try to use it (different machines, settings, masks, medications, or other gadgets.)

Do you get recurrent sinus “infections” when you use your CPAP?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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120 thoughts on “CPAP And Sinus Infections

  1. I too have been struggling with chronic sinus and ear infections, constant drainage, cough, earaches and bronchitis thru out the years. Every occurrence is treated with antibiotics, inhalers among other remedies. Problems clear but come back again.
    I had always had a thought that the cpap was getting me sick but passed on that since I keep everything clean.
    My cpad is issued by the VA and get all my cpap gear from them also.
    Just by chance I decided to look into side effects and came upon this site.
    I always keep my cpap hose, mask and filters clean. I also do not use the humidifier part of the cpap.
    Today I decided to disinfect the whole machine and will see how I feel tomorrow morning. I also have an appointment with my VA provider and will mention my thoughts on the cpap causing my health problems. Will keep you posted. Thanks

  2. Yes I get sinus infections that end up causing congestion in my lungs. Two times its lead to congestive heart failure. So I stopped using my clap for about six months and haven’t been able to sleep at night. I’ve been back using the clap for almost two months and have just got a sinus infection and during the time I wasn’t using the clap I had no problems with sinuses. I don’t know what to do.

  3. I am a CPAP user for a period of 5 months, about a week ago I started with a cold, few days later my sinus got involved (infection) lots of discharge ( thick, brown, bloody, lots of coughing ) I went to see my Sleep Apnea doctor, He prescribed antibiotics along with other medicines (nose sprays). Please advise kindly if the air pressure (6 points) going into my nostrils has anything to do with it? and this could be the cause of my sinus infection.

  4. Yes, someone needs to tell all doctors at clinics, sleep ap U get eye & Sinus Infections, been on machine for 10-12 years when they started sleep ap. my NEW doctor looks at me like no way (both my old doctors retired, they listened understood 1 was on sleep ap ) and doesnt beleave me. then need amoxicillin 750 megers. i tryed flonase sense spring i can have flowers by me any more bought roses for wifies earthday and forgot. boy it killed me. peanut butter too up to 2 shots EpiPen. another story. now almost monthly sinus eye infection. i stopped going to doctor she does listen, thinks no way. any how typen this with 1 eye closed. the dentist says teeth hurt cause sinus infection. so i start all over again need new doctor that knows! sorry just isnt rt is it. forgive spelling. help, guess need doc thats on sleep ap and has same problems as me?

  5. Within the last year i have developed sinus problems using the CPAP machine.
    I use it everyday and it has made a huge difference in my sleep. I have had 6 cold/allergy/nasal infections since the beginning of the year. I use it no matter what, i find I rest better, but with a sinus episode it causes nasal drip, so I shut it down.
    I have made in appointment with a ENT specialist.
    I hope to get some sort of answer and solution to my problem.
    I clean my nasal pillows everyday and tubing every third day. I recently went to using 2 filters and a foam piece on my repironics device. I set my humidity to 4.

  6. I have been using S8 CPAP for a number of years (8+), just in the last year I have started getting sinus and ear infections, constant drainage, cough, earaches and bronchitis, I have replaced Mask, Tubing & and don’t use Humidifier, but infections just get worse, have been advised to buy new machine, but would have thought there must be a way of cleaning the machine itself, they cost a lot of money.

  7. I’ve been using a C-pap for almost a year. Normally, I get about 1 or 2 sinus infections per year. I am on my 4th infection and antibiotic treatment since last November when I started using the machine. I will continue to try to figure out how to keep my sinus issues in check. But I cannot go without a good night’s sleep!!

  8. Dr. Park, I have been using a CPAP for about two years. It greatly improved my physical and mental health. Last year I had three severe ear infections in my left ear as a result of colds or allergies. I thought that I might have a benign tumor in my ear, because it never seemed to completely drain. All three times I lost my hearing, and the last time my eardrum ruptured.

    I haven’t had a cold or allergy attack this year. But I can still feel irritation in my left ear. When I wake up in the morning after a night of using the CPAP, I can feel the pressure in my inner ear. My nose is not obstructed and there’s no pain, but I can definitely feel pressure in the left side of my face. My right ear is never affected.

    I’ve been to two ENTs. One wanted to put tubes in my ears. Wouldn’t that defeat the purpose of the CPAP? Neither of these doctors seemed to believe that my problem was connected with the CPAP.

    The doctor at the sleep center just told me to lose 25 lbs and I could lose the CPAP. I would like to do that, but what should can I do in the meantime?

    I’ve just found your site and everything you’re saying makes so much sense. I’ve been told by several dentists that I have a “small mouth”. So do my sons. We also had ear infections when we were small children and have all been diagnosed with ADHD. I also have IBS. I’ve always believed that my health problems were connected, and you have confirmed that. Thank you for your information.

  9. I am a ICU nurse with 45+ years of experience recently diagnosed with sleep apnea and have been using a humidified Resperonics auto with nasal pillows for 21 months. Within the last 5 months I have been experienced increasing problems of nasal congestion, productive cough, eye and nose skin excoriation, watery eyes. I have been diagnosed with allergies, symptoms I have never experienced prior to CPAP therapy. The therapy is effective and my AHI numbers have been below 5 until recently. I clean my system with a vinegar solution or hot water and soap daily. I have replaced the pillows, tubing , and filters. CPAP treatment has alleviated the usual sleep apnea symptoms but I believe has caused other problems. Unfortunately my medical team does not believe the new symptoms are related to CPAP use. I am beginning to believe they are wrong, Recently I pick up smells of dirty feet! I believe I have now have a fungal infection but no one believes me, I do not know what else I can do to improve my situation if the medical community is not cooperative.

  10. Sounds like you’re cleaning is more than enough. I can’t go a month w/o a sinus infection. My CPAP and my sinuses have a love/hate relationship. Tomorrow I will do a two day, home sleep study and will possibly go with the Micr02 to see if I’m a candidate.

  11. I’ve started getting severe morning headaches that waken me too early. If I roll to the other side to sleep, the headache changes, like a stuffed nose would change sides in a similar situation, so I tried sinus irrigation. Nothing suspicious came out, no infection, but I did feel somewhat better. I’ve also started taking a morning 24 hr. Sudafed, which works for about 19-20 hours. Then I’m up with the painful head again.

  12. This is a follow-up to my earlier 2016 post on May 26 (copied below) on the results of my new Auto CPAP machine which I started using in late May. My new machine is a ResMed AirSence 10 Auto and has been fantastic. This machine has different mask settings depending on what you use and has a quiet, smooth air delivery. After trying many different masks and head gear, the one that provided me the most comfortable fit was a Respironics Wisp nasal mask head gear. This head gear accommodates nasal cushion masks from X-small to X-large (XL best for me). The beauty about this machine is that you have 3 settings choices depending on the mask type. The settings range from “full face” , “pillow” and “nasal”. I found that the “nasal” setting works best for me. With the “nasal” setting, you barely hear anything until you inhale, and then the needed air flow is delivered. With my previous machine, it was like a hurricane blowing through my nostrils regardless of the ramp or pressure setting. I believe that this constant pressure was the culprit of my on-going sinus infections. As stated in my earlier post (below), I was constantly tired, getting one sinus infection after another, going to the ENT Dr. and using nasal sprays, Claritin and antibiotics for approximately 18 months.

    Since switching from the ResMed S9 CPAP to the ResMed AirSense 10 (auto) machine and Wisp mask combination in late May, I have not had a single sinus infection. In June, we took a 3 week trip to Europe and the new machine came with me. We walked 10-15 miles each day and never felt better. I literally have my life back and started going to the gym again and feeling great.

    I hope that each of you can find a solution that works, as nobody will fix this but you. I was NEVER susceptible to sinus infections and was in excellent health expect for an 18mo. period which I was constantly fighting sinus infections and taking antibiotics.
    Good Luck…..Eddy

    Eddy (Post from May 26, 2016 for reference)
    I have been a CPAP user since 2007 and it has helped both my wife and I tremendously. I no longer snore, which was not good for her and I feel rested and active during the day.

    In late 2014, I had another sleep study to qualify for a new machine to replace my aging Respironics REMstar AutoPAP. The new machine issued, was a ResMed S9 CPAP, which I have been using since 11/2014. Since that time, I have had numerous sinus infections and chest colds. I might note, that before switching machines, I rarely got sick and certainly was never prone to sinus infections.

    As others have stated in these posts, I would go to the Dr., get antibiotics, and symptoms would clear. However, within 1-2 months I would have another sinus/chest cold relapse that would last 2 weeks or longer. These episodes continued until 2 months ago. I was terribly frustrated and decided to determine what was different or had change. Was it that I was getting old (57) and more susceptible to infections or some other cause? As a researcher, I conduct experiments and test hypotheses every day, so I decided to get back on my 8 year old Respironics REMstar AutoPAP which I had stored and still worked.

    The results: within one month of being on the old machine, my sinuses had totally cleared and I no longer have chest congestions or nasal problems. I can certainly notice a significant difference in the flow and delivery of air between the two machines, even though they are set to the same ramp settings (4-13 cm). The older machine is much smoother and “softer” in air delivery than the new. The other major difference is that the older machine was an autoPAP and the new one was not. I have since requested another autoPAP which I will pick-up next week to determine if Auto vs. Std. is the culprit or if the inherent style and air delivery systems between machines are truly different to cause me so many problems.

    I will follow-up in a few weeks after using a new AutoPAP to see if I remain clear of infections or if they return.

    Hope this helps as I have been miserable for the past 1.5 years and thought age was finally catching up, but in the last couple of months, I feel like myself again and have my life back.


  13. I have hypertension. I am a kidney transplant recipient (HLA Identical Match) of 21 years. I am immune suppressed. Ten years ago I had a quadruple cardiac bypass The bypasses collapsed after a month because the meds I’m on for the transplant affected my veins like over-cooked macaroni. So, I was giving four stents. Just had a minor heart attack. I have had sleep apnea for years. Probably had a Respironics Bipap machine with nasal pillows for 10 years. When I can wear it am so rested. I don’t wake up at night all is well. HOWEVER, I get terrible sinitus from the machine. I sneeze continuously for days, the nose runs and my eyes water. It’s horrible, without the mask I am tired all the time. I fall asleep in the middle of the day. I have been to an ENT (nothing was found out of the ordinary in my sinuses from the tests) Then, I went to Allergist (I was not allergic to anything they test for). I was told to take Flonase and something else nasally and Benadryl at night. All went well for about ten days and then the sinitus came back . I should add that I clean my mask, tubing and hydration container at least once a week. I use distilled water to hydrate in the container. I even go a Flo-Ease machine that supposedly cleans 99.9 % of all germs and bacteria. oh yeah, I even tried a new machine and I could only use it for four hours!!! Help!!

  14. Every yr 3 times a yr I get sinus issues from Bipap. I love my machine, helps me breathe. But I simply never use it during a sinus infection. I can’t breathe worth shut and it passes me off when I try to use it and all it does is make my sinus issues worse. So why even bother with the damn thing?

  15. Yes, I get infections every 4 to 6 weeks. I do not get relief until I take antibiotics. I cannot use rinses because any fluid put in my nose causes severe burning. I use nasal pillows.

  16. I use a ResMed Air Sense 10, an auto titrating machine with a heated air supply. When I first started using the machine, the heated air supply was enabled and I started getting sinus colds. When I turned off the heating, the sinus colds stopped as well. As the heating does not make the cpap any more or less comfortable, and because it seems to promote sinus colds, I’ve kept the heating off.

  17. Yes! In fact, once for two weeks I woke with bad headaches. Even when I don’t have sinusitis, when I lay down my nose gets stuffy. It’s hard to tolerate a cpap with this! Also, I snore sitting upright, even as a kid! I recently diagnosed with UARS

  18. Yes I am presently taking an antibiotic for a sinus infection. Phlegm runs down into my throat, causing pain. This causes a head cold, phlegm in my throat. And the apnea machine helps me sleep.
    Can you help. Please? Thank you. I have been plagued with this!

  19. I have been using a CPAP machine for about 5 years. For the last two to three years I have had a chronic sinus infection. I use a saline sinus rinse twice daily, and recently also a cortisone nasal spray. Still I continue with the sinus infection. I had sinus polyps removed twice, as my ENT recommended that as a way to solve the infection problem. In the last 2 years I have been on antibiotics at least 10 times.