Soon after the COVID-19 global pandemic shut down virtually the entire world, it did not take long for sleep medicine clinicians to begin pondering possible ways in which CPAP may spread the coronavirus. The CPAP/COVID connection even expanded to the realm of shared equipment when some biomedical experts floated ideas about how to convert CPAP machines into makeshift ventilators. 

In mid June, the idea that CPAP may increase the chance of virus spread is still very much alive, with officials at the Cleveland Clinic posing the question on the hospital’s web site. Ranked #4 on U.S. News & World Report’s Best Hospitals Honor Roll, the Cleveland Clinic brings a measure of gravitas to all of its subspecialties, and sleep is no different. 

“PAP therapy is an open system that can generate contact, droplet, and airborne COVID-19,” says Colleen Lance, M.D., Sleep Disorders Center, Cleveland Clinic, on the blog section of the Clinic’s web site, “increasing the risk of transmission like other procedures such as tracheal intubation, noninvasive ventilation, and cardiopulmonary resuscitation.” 

For those who share a bedroom and may have been exposed to someone with COVID-19, Lance recommends using the PAP machine in another room until disease status is confirmed. As for the threat of the virus being transmitted via PAP tubing, filters, or mask, the Cleveland Clinic deems the answer “unknown” at this point. 

If patients already have COVID-19, should they stop using PAP until they are no longer contagious? It’s a tough question, and Lance advises checking with a medical provider to determine if stopping is ok in the short term. “This way, your provider can inform you of alternative methods that will help you sleep comfortably until you can use your machine again,” she says. 

What exactly are these “alternative methods”? Lance does not specify, but clinicians such as dentists and ENTs have been supplying these alternatives for years now. For obstructive sleep apnea (OSA) sufferers with compromised immunity, and/or those in situations where the threat of COVID spread is higher, some measure of creativity may be necessary until the virus threat subsides. 

Fortunately, there are alternative OSA treatments such as oral appliances and positional sleep therapy that can be used alone, or in conjunction with CPAP. “If CPAP must be avoided, a good alternative is positional sleep therapy,” says Shad Morris, D.M.D., inventor of the slumberBUMP. “Positional sleep therapy devices keep people on their sides during sleep, which is optimal for the airway.” 

Another alternative for mild to moderate OSA is an oral appliance. Also known as mandibular advancement devices, oral appliances position the jaw for better breathing. “Oral appliances can be used in conjunction with positional sleep therapy,” Morris explains. “CPAP can also be used with positional sleep therapy devices as a dual therapy.”