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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183 thoughts on “CPAP And Sinus Infections

  1. That’s exactly what I did…I have a so clean machine…and a new cpap machine…I feel better already…I hope this is the answer and all my infecton will go away. thank you for your comment…you would think the insurance would help to pay for one, instead of paying all the doctor bills because of all the infections you get with a cpap.

  2. I also buy disposable small spherical in line micro filters that help filter out the dust (I live in the southwest). I change the filter about every 2-3 weeks, they are clear so you can see when the filter is getting dirty. It’s very easy to do and fits between the hose and the SoClean adapter on the machine. It will filter spores too if you have allergies. It’s about $30 for 10 filters and I buy them at a CPAP store on line. And of course I wash my foam intake filter on the back of the machine. I’m glad the SoClean is working for you!

  3. Yes, after using cpap for 19 years and being very compliant, I have over the last few years noted many more sinus and allergy issues that are stubborn and loathe to go away. Migraine\sinus headaches are very numerous, and I am unable to use my machine or sleep flat due to profuse mucus and drainage. I believe, no matter how clean I keep my cpap which is new, it is making me sick, and keeping me sick. My guess is, cpap, allergies and sinus are all making each other worse together. I have to quit cpap to stop and shorten my infections. Still a problem with OSA, will probably need a dental apnea oral appliance.

  4. Try a SoClean system. Since I started using one my sinus infections have all but disappeared. I do get dried out from time to time even with using my humidifier. I was about to dump my CPAP until I tried a SoClean. It really does work. It was worth every penny I paid for it. I even got a travel version that I leave in my travel trailer.

  5. I have pressure and mild dizziness in my head that behaves exactly like a sinus infection: head and face pain that moves around, constant tinnitus, unsteadiness etc. but very little drainage. This has been going on for over 6 months nonstop and hit with 4 ABs that have accomplished nothing and an MRI that has suggested nothing to treat. I believe the APAP machine has been aggravating the problem by forcing air into my nose. I only had mild apnea anyway. I am switching to breath right strips and nasal sprays and sleeping with temazepam and other aids to see if I can make a dent in it.

  6. I just read this entire website and I was sure it was me that wrote every single comment. I thought I must have had a camera on me. I have never had sinus problems in my life. I have had my CPAP for 4 years. Starting December 2017 I got what I though was the flu or cold. It is now May, 2018 and I have had three doses of antibiotics. They work well for about 5 days and then all my symptoms return. Headache, sore cheeks, sore dry eyes, clogged head. I went to an ENT and they put a camera down my throat. Nothing deadly was found thank goodness. I just have REALLY REALLY DRY nose and air passage. I clean my CPAP periodically but not going to lie. I don’t sanitize it. After reading all the comments, I am going to take a break from the CPAP and see what transpires.

  7. I started using Airsense 10 with humidifier cpap in May of 2015 (With nasal pillows). Starting in June of 2015 I started getting allergy/sinus type symptoms. I have had about 5 episodes of this and am currently experiencing another episode. I bought a so clean machine About one year ago and that doesn’t seem to help. It’s gotten so bad that now my sleeping has gotten terrible and the bags under my eyes look horrible. I’ve tried reducing humidity on cpap in summer and that hasn’t helped either. Going to GP again tomorrow and will also make apt with ENT specialist. Thinking about switching to dental appliance which my husband uses and likes. All this money spent and I felt better with sleep apnea…ugh!

  8. My suggestion is get a HEPA filter from your supplier, one like one used on the outflow of a ventilator. HEPA will filter down to micron viral size. See if this removal of everything via this filter helps. Many machines come with ultra filters available.. don’t know if you are using these ‘pollen filters’ or not, but the HEPA, is the HEPA. It is unusual to use with CPAP but can be done.

  9. Hello Polly. Sorry to hear about your problems but I would avoid giving up on your cpap even for a short period. I got over my sinus problems and Im now convinced it was caused by tree pollen. Have you a humidifier attached to your pump? This will cure the dryness in your throat and nose. Trust me, it makes such a difference.

    My problems have moved on to having a very slow resting heart rate in the low 40s. It would be interesting to hear if others have experienced the same thing with their sleep apnea.

  10. I have been on cpap for 8 years. I am a retired RN with a masters in critical care. I have had to educate myself because the medical community did not give me enough information on treatment. Such a shame that the medical profession puts the least educated as first contact. This is what I have learned over the course of my therapy.
    1. Sleep apnea is a dynamic condition that responds to many external stimuli.
    and treatment modalities should be adjusted accordingly.
    2. I have lived in 4 states and realize that the quality of air has an impact on my sinuses and ears with Kentucky being the worst. I used a micron filter but still endured sinus and ear infections. Since that time I have moved to the gulf coast with minimal problems. I think the salt air has helped.
    3. My heart rate is usually 42 without any symptoms. I exercise and have no problems or symptoms until it drops below 40. Still haven’t been able to find much research on sleep apnea bradycardia. Israel has a nice volume of research related to sleeping disorders and I continue to search.
    4. I have found a sleep hygiene program that works well for me. I perform a few tongue and neck exercises, blow up a balloon 5 or six times for lung exercises and practice relaxation for 5 minutes. My AHI numbers do vary depending on allergy season and range from 1 to 26 on a variable pressure that I do adjust seasonally. I use nasal pillows, a wisp, and occasionally a full mask depending on how the respiratory allergies are affecting me.
    5. I believe sleep apnea, like all chronic conditions, is in a state of flux depending on external stimuli. It is that stimuli that we as patients can alter and change to improve our ability to live a quality life with a chronic condition. I hope this rather lengthy missive helps.

  11. Read your reply with great interest Anita. I had terrible sinus problems which were checked with a camera. Nothing found. However as the trees (im in uk) began to get into full leaf the irritation and blood stopped.

    What caught my attention in your reply was your resting heart rate. I too have started dropping down to 40 but none of my medical practitioners are worried as my pulse is always up and steady when I see them. Its racing in the 60s 🙄!

    Im reasonably fit but i am diabetic and they have been struggling to control my high bp with medication. Ive read that if you have a resting heart rate as low as ours that we are regarded as athletes. Believe me im no athlete!

    Ive had a low resting heart rate for a couple of years now which I first noticed at 49bpm. Now its 40! So im getting fitter a year away from 60?? My apnea specialist said it was nothing to worry about but how low does it have to go before it is a worry?

    Thanks for your reply.

  12. This is a follow up to my post of 7/31 at 11:02. Reading all these posts has really enlightened me and given me different options. I went to my GP yesterday and told her that I’ve had 7 sinus episodes since using CPAP. After looking at the dates of those episodes it appears they mostly occur between April and October (with exception of one in Februar). She suggested that I start taking Allegra right before the Spring and continue through October (along with (Fluticasone nasal spray) since she feels my allergies along with CPAP are possibly causing my problems. I’m hoping this will help as now I’m on an antibiotic. I’ll update at a later date with everything I try and see if they help me.

  13. Good for you, observing and questioning what is happening to you is the best way to find out what the heck is going on
    A slow resting rate is a problem if your body cannot meet it’s metabolic needs and causes symptoms of dizziness, shortness of breath, cold hands and feet, and extra heart beats, ect That is probably why your doctor is not too concerned.
    . My take on bradycardia:
    The body’s response to a change in a feedback loop. I believe my Blood pressure is up in response to the slow rate to compensate for the delay in the cardiac output. I believe our entire biological system is a feedback loop to some biological changes happening as a result of internal or external stimuli . The question is what has changed to cause the slower rates?
    I believe the whole is greater than the sum of its parts with external stimuli contributing to body responses. Unfortunately, medicine is a reductionist science and attempts to isolate and compartmentalize the scientific response. That is changing slowly.
    As for an athletic heart, the heart is a muscle and enlarges in a athlete because of consistent life long exercising that demands fuel for muscle contraction resulting in increased ventricular wall thickness of the good type. More functioning muscle more power.
    That is not the case in our bradycardia. Heart rates are dependent upon multiple feedback (there is that word again) loops to beat and respond. Sorry about being verbose but I can get on a roll when the medical community does not provide a good knowledge base for their patients. That being said, remember, this missive represents my opinions based on my knowledge base. Good luck with your sleep apnea treatments
    respectfully Anita

  14. I have been on a CPAP for 2 years and using the nasal pillows… switched to the dreamware mask a year ago. I too have been dealing with a sinus headache for the last year! Been on antibiotics several times that don’t do much to help. All year I have been contemplating the balloon sinuplasty to open up my frontal sinus canals (had complete sinus surgery 10 years ago) however my ENT says there is no guarantee it will help completely. This week my cardiologist suggested my headache and fatigue may be due to the cpap. I too have been concerned about low heart rates at night that dip into the 30’s and low 40’s! (Doctors don’t seem too bothered by this.). My plan is to contact my sleep doctor this week…. have been experimenting with changing humidity settings etc, but think I need some other opinions!

  15. I too purchased a SoClean machine several months ago and my sinus headaches did not go away. In my opinion, It’s the absolute best accessory you can get to clean a CPAP Machine. However, that didn’t solve the migraine headaches in the early morning for me. Nothing has.
    The CPAP/SOClean combined system is so stupid simple to use! Place your mask (with strap) into the SoClean chamber, close the lid and press the start button. Depending on your programmed settings (7 minutes manual; 1 hour auto hours later) your entire machine will be sanitized and ready for use!
    Just doesn’t solve sinus/migraine headaches like people wish/hope/say it does!

  16. VGPEte,

    Great to hear that SoClean is easy to use. As I mentioned in my article, most of the sinus “infections” and other symptoms from using CPAP are not due to bacteria or fungi, but due to sinus migraines, where our nose and sinuses are over-reacting to air-flow and positive pressure that CPAP provides.

  17. Turn up the humidifier heat – also have your card read or get the download from your machine – pay attention to ‘leak’ if your mask is not sealing correctly you have excess flow trying to make up for the leak that can cause some flow dryness to your mucous tissue of your airway – can make for a headache – turn that humidifier up high. This may cause some rain out in the tube if that occurs – drain it – or use a heated tube. Should stop that headache

  18. This is an Opinion
    I have had sleep apnea for over 20 years.
    No one should be on BLOOD PRESSURE MEDCATIONS.

    First BLOOD PRESSURE MEDCATIONS are called BLOOD THINNERS. They are not blood thinners at all. It’s a deception. How could any one have thinned blood circulating? They don’t make your blood thin at all. What they do is either remove needed substances and/or restrike the brain’s control of the Renin System from maintaining the correct pulse for a Homeostasis state of balance.

    In Canada the brain washing to take blood pressure pills began in 1975. The Canadian Federal government had commercials run on television saying next time you go to the Doctor ask to have your blood pressure checked. Almost all countries on the flat earth did the same thing, but today only about 5 countries still push these BP pills.

    Bloods Pressure’s grandfather was BLOOD LETTING. Do you know George Washington had a Sore Throat and his physicians were using Blood Letting to get rid of his sore throat? Every time they checked on George his sore throat was still there. His physicians did bloodletting several times throughout the day and George Washington died due to the loss of too much blood. When Doctors began to being available to help people, they would not do the blood letting because they were the wealthy and using their hands to work was below them. So, who did the blood letting in the beginning? Barbers were used by the doctors to do the bloodletting. The Barber Pole with the red, white and blue colors were a sign that this particular barber shop did bloodletting.

    There are some BP pills that remove Salt and Water from the body. The body needs Salt to in order to keep the body Hydrated. If you do not have the right amount of salt in your body it can lead to problems.

    Low Sodium leads Severe Hyponatremia (see

    There are some BP pills that are designed to alter your Pulse Rate by lowering it. No one dies from high blood pressure, people die from low blood pressure. There are studies showing people with high blood pressure live longer than people with low blood pressure.
    These BP pills lowering BP are affecting the Renin System controlled by the brain. The Renin System creates your pulse and blood pressure. BP pills alter the Renin System by lower the pulse rate on your Arteries. If do not have the correct blood pressure it leads to not enough oxygen in the blood stream and leads to a slower heart and leads to mortality.
    The brain controls everything in your body to keep it in a Homeostasis state of balance.
    People with a resting heart rate of low 40’s and under are athletes who have exercised and eaten property over a number of years. These athletes develop “Athletic Heart Syndrome” which is a good thing, but an older or elderly person with a low heart rate in the 40’ s would be a grave concern to a Doctor and patient because the patient’s mortality rate is very high.

    There is a protocol doctors are supposed to follow for checking BP. Basically this is it: The patient has to be checked 4 days a week for two weeks, appointments the same time, the same examination room, ten minutes to give the patient time to relax. Unfortunately, Doctors claim they don’t have the time to follow the BP Protocol. Having your doctor check your BP indiscriminately here and there is dangerous to your health because they are going to prescribe BP Pills for your based on flimsy evidence.

    Did you know Surgeons will tell their patients to stop taking BP Pills and Cholesterol pills? Cholesterol pills bring you harm. Why? Because your brain controls the making Cholesterol.

    The Liver makes Cholesterol everyday all the time and in fact the liver stores approximately 5,0000units.

    Did you know or has any one ever told you what Cholesterol is and what it does to help keep your body’s Homeostasis state of balance?

    Cholesterol is a Natural Healing Substance of the body!

    Why would any doctor say you need to lower your Cholesterol?

    How can too much of a Natural Healing Substance be bad for you.

    Both your BP and Cholesterol have a part in maintaining your body to function normal.
    Lowering your Cholesterol leads to problems in healing your body inside and outside.
    Do your own research on the Net into BP and Cholesterol. Search studies from at Medical Universities and actual studies done by individuals’ scientist. For instance, try to find the study done on BP in Chile where they found people who live at the equator have much lower blood pressure than people who live in the north and south of Chile.

    I apologize for any grammatical miscalculations.

    Thank you for reading my opinion.

    Respectfully – Thank you

  19. Yes, the cpap has significantly prove the quality of my sleep, but since i started using it, 3-4 month, I’ve experience on and off sinus infections. Not sure what to do. Doctor said to try Zyrtec, doesn’t seem to help.

  20. Been on cpap for 18 years and my sinuses are in horrible shape, spit up thick phlem every morning, nose constantly stuffed up . ENT said get off Afrin, did for 2 months and my condition is a lot worse.

  21. I agree with a lot of this. First no one has mentioned how do you clean the heated tube? Six months before your insurance will cover it. Three months for plastic tubing,etc. I can smell the the odor in all tubes. Ones snot odor infiltrates the water, heated hose, etc. I clean and soak with vinegar and soap ( pillows, hoses,etc. ) as my apnea dr., suggested. Oh, what about any odors in the machine itself. And to be honest which I have told my doctor as well out of 4years now I think I got only one night good sleep. I’m always aware of that strap and machine. Well I wish everyone the best with this apnea business including myself.

  22. I actually notice a marked, almost immediate opening of my nasal passages with putting on the face mask. I breathe much less from my mouth with the apparatus on and really prefer to wear it whenever recumbent.

  23. Is there some medication that I can put in the humidifier (water tray) to eliviate my sinus problems. I wake up with stuffed sinuses and slightly dizzy. At the same time, my mouth is extremely dry.

  24. Yes…usually within a few hours of starting to sleep with the nasal pillows..gel or silicone, I feel that terrible, fiery, burning sensation up one or both nostrils. Profuse rhinitis, heavy nasal accumulation, sneezing, and runny eyes are the result by morning! Problem is I have had leakage, bruises, etc, with all other masks, and tend to sleep best with the nasal pillows.
    After trying about 20 masks, I have determined that the ‘cloudy silicone’ is the culprit. When I use Amara view, which has the clear plastic/silicone under the nostrils, I don’t get infections! But I sleep poorly and have more PVCs! 😥 It’s been two years of hell.



  26. I have totally given up on the CPAP for good and now leaning towards a $1,800 oral appliance. The last time I used it I disinfected all my CPAP gear with bleach water I had the sinus infection the next morning. I went from the nasal pillow, to mask covering just the nose and then the full mask. I can’t say I haven’t tried.

  27. Is there ‘more’ or ‘less’ nasal infection with PAP masks and systems. I would say it’s the same as with the general public. We deal with ‘hundreds if not thousands’ of PAP users. I’m one of them myself – have been for years; no special procedures for cleaning. No infections from this source, zero. Are there some users that may be more susceptible – I won’t say ‘no’ perhaps some – I’d suggest they have had this since before PAP. It really is a personal choice -want to clean often and with extensive resource and manner – it’s your PAP device. Ozone damaging the device or masks – I’d suggest YES – changes the material. Ozone is ‘Ozone’ – read on that topic. Best Regards

  28. My husband has to wear his cpap because of severe sleep apnea, but the constant “virus” he gets on the right side of his face (eye/nose) is getting to be too much. We use the So Clean and he’s diligent about cleaning it. He wakes up sneezing constantly and his eye waters. He has a constant tickle in his nose and then starts to get body aches. It takes several days to clear up and then he gets it again, so the cycle is vicious.

    Could he be allergic to the materials? There must be other options.

  29. OMG, that is me! I just bought a SoClean and talked to my Pulmonary Doctor today and they thought perhaps the same thing an allergy. Nose waters, eye waters and feels like a pin above my nostril on the outside of my nose sticking in. My one eye and nostril drain for days and I sneeze uncontrollably. This is crazy.

  30. I’m a two fur – a Respiratory Therapist that is a “CPAP User”
    The dry – pain in the sinus – is just that – my impression is that patients don’t use sufficient humidification with the PAP device – the nasal pillows *as example – may have a slight leak – that causes air flow in and sometime around the edge of the nare – drying the tissue of the inner nose with this flow – drys the tissue and causes pain – discomfort. Turn up the humidifier – start at 4 and more *I believe this will be seasonal * It is here in my desert Arizona home – relative humidity in winter is 7% or less at times – great potato chip weather – but 60% in the rainy season – so it will vary during the year.
    Will using tap water make a difference – I like the purified water from a simple water purifier device vs the chlorine laden city water which will in time scale the chamber. I used to be a no humidifier user – and still do this with travel – short term – but using an humidifier at 5 makes my nose comfortable – try it see if this does not solve your sore nasal tissue.

  31. I can’t use cpap without getting constant sinus infections. This means headaches, body aches, sweating and overall feeling exhausted. I clean the machine properly- it doesnt matter. I’m prone to sinus infections and the cpap only makes it worse. I’m very frustrated.