If you are treated by positive pressure and you have symptoms such as a new coughing, fever, a new shortness of breath, extreme fatigue or a sudden loss of smell, call 1 877 644 4545 to find out if you have contacted COVID-19. https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/19-210-30FA_Guide-autosoins_francais.pdf?1584985897

All respiratory infections, including COVID-19, call for hand and respiratory hygiene to avoid transmission.

If you suspect having contracted COVID-19, you must isolate yourself from other persons living under the same roof. Retire to your bedroom and keep the door close. Now is maybe the time to have your partner ….sleep on the couch. If you have COVID-19, the people near you are already at risk of catching the infection though, the transmission is far from being for certain. As mentioned previously, living in the same household as an individual known to have COVID-19 is associated with 1 in 9 (11%) chance of being infected (Qifang Bi Lancet infectious Disease Q Bi 2020 ). What is not known is how those numbers are changed if a COVID-19 positive household member sleeps with a CPAP. The risk is likely increased for those sharing the bed, the bedroom, the common in-house spaces, and finally the shared spaces in the building, in decreasing order. However, the magnitude of the increase is not known and quite frankly, nobody is looking into it. The impact on others will depend on whether efforts are made to limit spread (washing hands, surfaces, respiratory etiquette), the viral load (how concentrated the virus in the airway), the volume and force of the coughing-speaking but also on the vulnerability of other individuals.

In a study most quoted (ERJ 2019 Hui) using smoke to look at dispersion of particles at the highest levels of CPAP pressure while using different masks, leaks could account for air borne particles travelling 30 cm with nasal masks compared to negligible displacement of particles while using a facial mask. So, no leak with proper fitting facial mask seemed safe whereas nasal mask allowed dispersion at a distance often present when sharing a bed. Lower levels of pressure will cause lesser dispersion. With bi-level devices (commonly known by the brand name BiPAP © rather than by its bi-level generic name); — depending on the simulation model — particles will travel for about 1 meter depending on the size of the room, humidity, temperature and ventilation.

Using a mask with a good seal is therefore of paramount importance.

Nasal and nostrils masks are more comfortable and less cumbersome, yet leakage is greater than with facial mask. The situation is worse for mouth breathers as this is problematic in a COVID -19 context.

Facial masks would be a favorable choice for its sealing quality but we still have very little data and it is unknown if this smoke model is representative of the reality.

Having a mask with a good seal is important.

Given a choice, choose a properly fitting facial mask over others. Eur Resp Rev Ferioli 2020

If your mask leaks from all over, it is time to get another one or change brand. Check online on how to adequately adjust your mask, and if the problem persists, get in touch with your caregiver, Côté Santé, for a remote session. We could go over the mask attachment or you could order a replacement.

Transmission is not only by air but mostly by touching objects. It is unclear whether being treated by positive pressure increases the risk for people already living with you. The situation is different for health care workers who would take care of you in the event of hospitalization.

As added precautions, especially in presence of vulnerable individuals, it is advisable to increase home social distancing when using positive pressure (APAP, CPAP, BiPAP, bi-level, ventilator, servo-ventilator, etc.), by keeping the bedroom door closed 24 h / 24, except for bathroom needs and passing plates.

Once you are trough with the device, close the pressure first, THEN remove the mask so that your germs do not get airborne.

If you cough in the mask, wipe the mucus with a cleaning wipe that you will then discard in the garbage.

Before opening the door of the bedroom, weather permitting, ventilate your room from an outside window for 10 minutes and close the bedroom door while outside your room in an effort to limit the spread of the virus.

In an ideal context, you should be the lone user of your own bathroom.
Imperatively, you do not share hand towels, face clothe or bath towels with others. All shared common spaces should be cleaned once you have left the area.

If you must share the same sleeping spaces, you will have to weigh the benefits with regards to your treatment by bearing in mind your health status prior to the onset of your treatment, other conditions, and the severity of abnormal oxygen as observed in your test as well as the possible risks and vulnerability of people living with you. A consultation with a doctor should be a must, yet there will be no clear or universal answer.

Identify your mask, tube, humidifier and compressor with your name and phone number. Keep a copy of pressure data in your CPAP bag (a copy of the prescription or the latest download would be fine). If you hold a copy of your sleep test, insert it along with the prescription in your device’s bag. It is possible for the pressures to be modified in the event of a hospital admission. This is normal. You will eventually return to your former pressures. This will require a prescription to remodify the pressures. It is also possible for exhaust port to be modified to add filters while in hospital.

CPAP or its bi-level cousin has been used successfully to treat the first COVID-19 infected Chinese admitted in intensive care unit, even if obstructive sleep apnea was not an issue (JAMA Huang, Feb 7, 2020). It helps day and nighttime breathing and oxygenation in a properly supervised setting.

Given that some may be advocating for temporarily suspending the treatment during an active infection from COVID-19 (something we have never suggested with influenza or any respiratory infections), we must bear in mind the risks involved in interrupting the therapy in a patient’s particular case and consider measures to minimize the extent of such an interruption (refer to section concerning mitigation measures). An interruption could be considered in cases where several persons or vulnerable individuals share the same restrictive quarters without the possibility of having access to isolation to one room in an individual with the mildest sleep apnea abnormalities and the mildest manifestations. It is imperative to get a medical advice. Balancing the risks and benefits is difficult.

Stay zen. Sleeping is part of the treatment. Rest!

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