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Should you keep using your CPAP when you are ill? A practical, clinically grounded guide for UK CPAP users when to continue, when to pause, how to adjust your setup, and how to clean your equipment thoroughly after recovery.
Should You Keep Using CPAP When You Are Ill?
The short answer, for most CPAP users with a common cold or mild to moderate influenza, is yes continue using your therapy if at all possible. This is the consistent advice of UK sleep clinicians and respiratory specialists, and the reasoning is straightforward.
Sleep apnoea does not take a break because you are unwell. In fact, illness often makes OSA temporarily worse nasal congestion increases upper airway resistance, inflammation in the throat narrows the airway further, and the poor sleep quality that accompanies illness reduces upper airway muscle tone. All of these factors compound the underlying condition. Stopping CPAP therapy during illness means losing the one mechanism that is actively keeping your airway open, at precisely the time when your airway is most at risk.
There is also the matter of oxygen saturation. During a respiratory illness, particularly influenza or a chest infection, blood oxygen levels can drop more readily during sleep. Your CPAP device helps maintain the respiratory mechanics that support adequate oxygenation. Abandoning therapy removes this protection.
That said, there are specific circumstances where a brief pause may be appropriate, and there are meaningful adjustments you can make to your setup that will make using CPAP during illness considerably more manageable.
▶ Continue CPAP if…
- You have a common cold with nasal congestion
- You have mild to moderate flu symptoms
- You can breathe adequately through nose or mouth
- You have a nasal mask and can switch to full face
- Your humidifier is functioning and set higher
- Symptoms are upper respiratory only (no chest)
- You feel well enough to attempt sleep with mask
- Your sleep clinic has advised continuing during illness
▶ Consider pausing and seek advice if…
- You have a severe chest infection or pneumonia
- You are completely unable to breathe through nose or mouth with mask
- You are vomiting (aspiration risk with mask on)
- You have a very high fever with confusion or delirium
- Your GP or respiratory team has specifically advised stopping
- You cannot clean the device and are at high infection risk
- Wearing the mask is causing significant distress or worsening symptoms
Why Illness Makes CPAP Harder and What Changes
Understanding what is happening physiologically during a cold or flu helps explain why CPAP feels different when you are unwell, and points toward the practical solutions that help.
Nasal Congestion and Increased Resistance
The most common CPAP challenge during a cold is nasal congestion. When the nasal passages are swollen and filled with mucus, airflow resistance increases significantly. For users of nasal masks or nasal pillow masks, this means breathing feels harder than usual, and the temptation to remove the mask is strong. In Auto CPAP users, the device may also increase its delivered pressure in response to the higher resistance and increased partial obstructions, which can itself feel uncomfortable.
Mouth Breathing and Mask Leaks
Nasal congestion frequently forces mouth breathing during illness. This creates a significant problem for nasal mask users: pressurised air delivered through the nose escapes immediately through the open mouth, rendering therapy largely ineffective and causing a disruptive, noisy air leak. For the duration of the illness, switching to a full face mask which covers both nose and mouth is often the most practical solution.
Sore Throat and Mask Discomfort
Flu and some cold viruses cause significant throat inflammation. Breathing pressurised air through an already sore and inflamed throat can amplify discomfort. Increasing your humidifier setting to maximum, using a heated tube if available, and ensuring your machine has not defaulted to a lower humidifier setting are all practical steps that reduce this effect.
Disrupted Sleep and Altered Breathing Patterns
Illness disrupts normal sleep architecture. Fever, coughing, and body aches all fragment sleep, and the resulting changes in breathing pattern mean your device data during illness will almost always look different from your healthy baseline higher AHI, more leaks, more pressure variability. This is normal and expected. Do not be alarmed by a few poor nights in your MyAir data; monitor the trend over the week rather than each individual night.
Adjusting Your CPAP Setup During Illness
Several practical adjustments can make a significant difference to comfort and therapy effectiveness when you are unwell. None of these require changes to your prescribed CPAP pressure they are changes to the delivery method and ancillary settings.
If you normally use a nasal mask or nasal pillows, switch to a full face mask for the duration of the illness. Mouth breathing will otherwise defeat your therapy entirely.
Turn your humidifier to its highest comfortable setting. Warm, moist air soothes inflamed airways, loosens mucus, and reduces the throat irritation that makes CPAP feel uncomfortable when ill.
A saline nasal rinse or spray immediately before putting on your mask can temporarily clear congestion, making it easier to breathe through the nose and improving mask seal and comfort.
Humidifier Settings During Illness
Your CPAP humidifier is one of your most valuable allies during a respiratory illness. Warm, humidified air helps in several ways: it reduces dryness and irritation in the already inflamed nasal passages and throat, helps loosen and thin mucus making it easier to clear, and makes the experience of wearing the mask and breathing pressurised air far more comfortable when your airways are inflamed.
During illness, increase your humidifier setting to a level that provides clear comfort benefit without causing condensation in your tubing (rainout). If you experience rainout water collecting and gurgling in the tube reduce the setting by one step or switch to a heated tube if available. A heated tube (such as the ResMed ClimateLineAir) allows you to run higher humidity without condensation and is particularly valuable during winter respiratory illnesses.
Using Decongestants and Nasal Sprays
Over-the-counter nasal decongestants both oral medications such as pseudoephedrine and topical sprays such as xylometazoline (Otrivine) can be a useful short-term tool for CPAP users with significant congestion. By temporarily reducing nasal swelling, they can restore nasal airflow and allow continued use of a nasal mask.
However, topical decongestant sprays should not be used for more than five to seven consecutive days, as rebound congestion (rhinitis medicamentosa) can develop and worsen the problem. Steroid nasal sprays such as beclomethasone (Beconase) or fluticasone (Flixonase), available over the counter in the UK are a safer option for managing congestion over a longer period and are suitable for regular use. Discuss ongoing nasal congestion management with your GP if it is a persistent issue.
Sleeping Position During Illness
Sleeping with your head slightly elevated using an additional pillow or raising the head of your bed can help reduce nasal congestion by using gravity to encourage drainage from the nasal passages. This simple adjustment often makes nasal breathing and mask use easier, and also reduces postnasal drip that can aggravate a sore throat overnight.
Managing Your CPAP Data During Illness
If you monitor your therapy via the ResMed MyAir app or review your device data, you should expect to see changes in your numbers during a period of illness. Understanding what is normal variation versus what requires action helps prevent unnecessary anxiety or inappropriate self-adjustment.
CPAP Mask and Equipment Hygiene During Illness
Your CPAP mask, tubing, and humidifier chamber come into very close contact with your airways during every therapy session. During a respiratory illness, these components become contaminated with the viruses and bacteria responsible for your infection. Thorough and prompt hygiene is essential both during the illness to prevent reinfection, and particularly after recovery to ensure you are not re-exposing yourself to pathogens trapped in the equipment.
During a cold or flu, wash your mask cushion, frame, and nasal pillows daily with warm water and mild unscented soap. This removes the viral and bacterial load that accumulates with every night’s use. Allow to air dry completely before the next session.
During illness, mucus and respiratory secretions can be carried back into the humidifier water by the reverse airflow that occurs when you remove your mask. Empty, rinse, and refill the chamber with fresh distilled water every single morning without exception.
The outside of the delivery tubing should be wiped with a damp cloth daily. While the interior of heated tubing is difficult to clean during regular use, ensure it is thoroughly washed with warm soapy water and rinsed after recovery.
CPAP equipment is intensely personal. Never allow another person to use your mask, tubing, or humidifier chamber, and particularly not during or immediately after a respiratory illness. Cross-contamination with respiratory pathogens via CPAP equipment is a real risk.
The air inlet filter on your CPAP device captures particles and pathogens from room air. After a significant respiratory illness, replacing the filter (if your device uses a replaceable type) is a sensible precaution. Check your device manual for the filter location and replacement guidance.
The Deep Clean: After Your Illness Clears
Once you have fully recovered, carrying out a thorough deep clean of all your CPAP equipment is essential before returning to your regular maintenance routine. This ensures that no viral or bacterial material remains in the system that could cause a re-infection or contaminate the equipment going forward.
- Mask cushion, frame, and headgear: Wash thoroughly in warm water with mild unscented soap, rinse completely, and allow to air dry in a clean environment away from direct sunlight. If the cushion shows any discolouration or feels tacky, consider replacing it illness is a common prompt for early cushion replacement.
- Delivery tubing: Flush warm soapy water through the full length of the tube, rinse thoroughly by running clean water through several times, and hang vertically to dry completely. Do not use the tubing again until it is fully dry internally to prevent mould growth.
- Humidifier water chamber: Wash with warm soapy water, paying attention to any scale deposits. Rinse thoroughly, allow to air dry completely, and refill with fresh distilled water before the first post-illness therapy session. If the chamber has any residual discolouration or odour, replace it.
- Device exterior: Wipe the full exterior of the CPAP machine with a slightly damp cloth, paying attention to the air inlet area. Do not allow any moisture to enter the device’s internal components.
Common Symptoms and Practical Solutions
| Symptom | What Is Happening | Practical Solution |
|---|---|---|
| Cannot breathe through nose | Nasal congestion blocking nasal passage | Switch to full face mask; use saline nasal rinse before bed; short-term decongestant spray |
| Mask leaking badly | Mouth breathing breaking nasal mask seal | Switch to full face mask for duration of illness |
| Sore, dry throat in the morning | Dry air worsening inflamed throat | Increase humidifier to maximum; add heated tube if available |
| AHI much higher than normal | Congestion increasing airway resistance | Continue therapy; treat congestion; Auto CPAP will adjust automatically. Review if persists post-recovery |
| Coughing with mask on | Postnasal drip or throat irritation | Elevate head with extra pillow; increase humidification; saline gargle before bed |
| Condensation in tubing (rainout) | High humidity + cool tubing | Reduce humidifier by one step, or switch to heated tube |
| Very low MyAir score during illness | Disrupted data from illness effects | Expected and normal monitor trend over full recovery week, not individual nights |
| Nausea or vomiting with mask on | Flu-related gastrointestinal symptoms | Remove mask immediately; pause therapy until vomiting has fully resolved; restart when stable |
When to Seek Medical Advice
While most CPAP users manage a common cold or flu at home without complications, there are warning signs that warrant prompt medical attention particularly for those with underlying respiratory conditions such as COPD, asthma, heart failure, or obesity hypoventilation syndrome, for whom respiratory infections carry a higher risk.
- Severe breathlessness at rest — difficulty breathing while sitting still, not just on exertion, requires same-day medical assessment
- Chest pain — any new chest pain during a respiratory illness should be assessed promptly to exclude cardiac causes
- SpO₂ consistently below 90% — if you have a pulse oximeter and your readings are persistently below 90% during waking hours, contact your GP or call 111
- Confusion or marked drowsiness during the day — in patients with CO₂ retention risk (COPD, OHS), this may indicate hypercapnia and requires urgent assessment
- Symptoms lasting more than ten to fourteen days without improvement — may indicate a secondary bacterial infection requiring antibiotic treatment
- High fever not responding to paracetamol or ibuprofen — persistent high fever in a patient with underlying respiratory disease warrants clinical review
