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[CPAP] Use Of Distilled Water In Humidifier
(09-28-2015, 10:54 AM)philipquillen Wrote: I recently upgraded from a Resmed S8 to a Resmed Airsense S10 Autoset machine. Embossed on the top of the humidifier chamber is the phrase "Distilled Water Only".

Is there some specific reason for this advisory? I am assuming that the humidifier chamber is the last element in the airflow chain .. just before the air is fed to the hose.

Is the use of distilled water really required? Is this a medical issue or simply a machine maintenance issue?
Okay ... distilled water vs tap water is hot topic around here, you only have to mention water and we all jump Smile
My 2 cents ... if S8 water chamber can use tap water, so the A10 water chamber, same thing, no difference
I've used tap water in my S9 water chamber and now tap water in A10 water chamber too. The idea of using of distilled water is to prolong the life of the water chamber (not mine) and reduce mineral deposits build-ups. Also protect manufacturers from lawsuits, in case someone injured or died from using contaminated water from rivers, lakes, dodgy source, or infested with crocodiles

Don't take my words for it, here what the experts are saying ...

If you have a standard humidifier tub, it is recommended that you use distilled or deionized water.
If you have a cleanable tub, tap water is fine for everyday use

Fisher and Paykel (post # 19)
Do I need to use distilled water in the chamber?
It is strongly recommended that you use distilled water in the chamber as it is free of minerals and will prolong the life of the chamber. Using distilled water will also prevent mineral build-up on the inside of the chamber which can make it appear dirty. Distilled water is pure and therefore the most suitable to use. However, the use of normal tap water will not harm you but may cause the chamber to deterioate at a rate faster than expected

Can germs pass from the humidifier to me?
Answer: No, using a heated humidifier in line with your CPAP device will not cause you to become sick or give you germs. Fisher & Paykel Healthcare’s heated humidifiers are pass-over humidifiers that do not produce aerosols (the fine water droplets that are visible to the eye such as steam from a kettle). Pass-over humidifiers add moisture in the form of water vapor. Water vapor particles are smaller than bacteria or viruses so it is impossible for them to be transported up to the mask (and then to you). Even if pathogens (germs) were able to exist in the chamber, they would not be able to be transported to you. Refer to the diagram below which demonstrates the size of water vapor, bacteria and virus particles.
[Image: germs]

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Nevertheless, Zonk, we found colonisations beyond the tank, and rapidly, which is one reason we now have someone doing a more intensive study. Water vapour is not the only way bacteria or fungus can get carried into your nose or mouth, just one way. The steady stream of air doesn't help, either. More invidious however, is the slow long term colonisation of the system via slow growth and natural spreadage - it may not be vapour born, and it would mean you probably haven't washed your hose in six months, but it can, once contaminated, work its way up the hose - you would probably notice a bad smell or taste long before it came near your face, though.

The main danger, though, if you empty and dry your tank daily, along with drying the hose, of using tap water is not pathogens, but tank and joint degradation by build up of kalk and other substances. Even with regular cleaning, we found, kalk build up was inevitable quickly on tap water, as were certain colonisations, no matter how thoroughly you cleaned the tank. We were using PRS machines, which have notoriously difficult tanks to clean, all nooks and crannies (really, who the heck designed that?) and found you never get it quite clean in certain hard to reach places. And we found colonisation in those areas in all but pure distilled water cases. I hope they overhauled the tank design in the DreamMachine sufficiently to address that issue.
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Thanks to DocWils for the first water thread worth reading.
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*kalk=limestone or lime.

Are some of the colonizations actually from the user's exhalations?

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There are several studies that correlate upper-respiratory infections with cpap use. There is not consensus on cause, but meanwhile I believe I will continue using distilled water and cleaning my equipment. Anecdotally, I know I feel better and sleep better when I do, and I am not the only one to experience that!
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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As far as respiratory infections; I seldom get a respiratory tract infection since I started PAPing.
I do not credit this to any filtering or distilled H2O use; but to less irritation from snoring, snorting and all the other things we do that irritate our airways as we struggle to breathe with OSA.

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JustMongo passed away in August 2017
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~ Rest in Peace ~
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Use distilled water if it's convenient. It's cheap and easy enough for me to be a no brainer.

ResMed makes "cleanable/dishwashable" tanks and "standard" tanks.

In the early days of the S9 water tanks. the "standard" tanks didn't open easily so you could clean them really well. You just had to run water through the holes to try to clean them out. They also made a more expensive tank that could be opened for cleaning.

Shame on you, ResMed for not making all of them "cleanable."

The "standard" tanks were stamped "distilled water only." The "cleanable" tanks were not stamped.

They tended to ship "standard" tanks with machines in the USA, but shipped cleanable tanks outside the USA.

In the USA, it's fairly easy to get distilled water for most of us. I can buy a gallon (4 liters) of distilled water for $1 or so in my local Walmart or grocery story, carry it out to my car, and take it home. Apparently, in many parts of the world, distilled water is a lot harder to find, or is more expensive. Also, if you don't travel by private automobile, lugging around a gallon of water is a lot harder.

My understanding is that in most parts of the world, CPAP'ers don't usually use distilled water and aren't told to.

BTW, ResMed changed the standard tanks during the lifetime of the S9 machines and now all S9 tanks are openable, but there are still "standard" "distilled water only" tanks. All A10 tanks are openable, although they still make a cleanable and standard tank. The A10 standard tanks say "distilled water only" and the cleanable ones don't.
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(09-28-2015, 02:32 PM)PaytonA Wrote: I do use distilled water but there are a few things in this presentation that are questionable to me. First, water from any moderate to large size community water service will very likely have as little bacterial infestation as distilled water. Secondly, if you are depending on distillation to remove or kill bacteria then why would not the heated humidifier do the same.

There's an important difference between distilled water and tap water. The tap water has some "germ food" in it, even if it doesn't have live germs.

Airborne germs are falling into the water in the humidifier, so even if the tap water was sterile when you added it, it's a possible location for germ growth.

If you had 100% pure water and dropped germs into it, they wouldn't be able to reproduce. In order for a germ to make another copy of itself, it needs to get energy and chemicals to create another germ. Pure water doesn't have the chemicals that the germ needs to reproduce.

Even if all the germs are dead, tap water has some of the "chemicals of life" in it and germs may be able to feed off of those chemicals and reproduce.

While it's harder for germs to grow in distilled water, it's not an absolute thing. Distilled water isn't 100% pure. Some contaminants may seep in during the bottling process. It can also absorb various chemicals from the air. Also, dust in the air may end up in the humidifier water, and the dust may be germ food. I think distilled water slows germ growth, but doesn't completely stop it.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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It has been my understanding that all the ResMed tanks are hand washable but the nonstandard tank can be put in the dishwasher. When you all refer to washable vs standard is this what you mean or am I misinformed?
if you can't decide then you don't have enough data.
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There are a few things I'd really like to see studied. I know they probably won't all fit in one study, but here are some ideas.

1) Measure how the germs make it to the patient, not just the hoses. i.e. if there are germs in the tank or the tank, do they make it to the patient? Are some germs more mobile? In particular, what about the more dangerous germ species?
2) Germs to the CPAP patient vs. germs to the non-CPAPer from room air.
2) Figure out what species of germs grow in the water. Dangerous vs. benign.
3) The effect of daily dumping water vs. distilled.
4) Use of Control III or similar.
5) Use of SoClean or similar.
6) Use of reverse osmosis water
7) Use of bottled but not distilled water
8) Effect of new vs. old filters.
9) Effect of different filters.
10) Effect of different kinds of tap water. i.e. lake water vs. well water. Do the dissolved minerals and other chemical affect germ growth?
11) Effect of various cleaners. I've always been a bit suspicious that, for instance, very dilute household soap residue might actually provide germ food.
12) Effectiveness of home dishwashing machines.
13) Vinegar or other home remedies.
14) Immersion in boiling water.
15) Use of antibacterial filters, such as Respironics, especially if used multiple nights.
16) Do humidifiers aerosolize the water in the humidifier?
17) Can Naegleria foweleri grow in the water tank?
18) Can N. fowlleri in the tank infect a patient? Conventional belief seems to be that it only infects from liquid water up the nose.
19) The usefulness of drying out hoses, masks, tanks, etc. I switch tanks, hoses and everything once a week and let the set I've just cleaned out dry out for a week. Does that actually help?
20) Boiled tap water.
21) Are there any useful additives to humidifier water?
22) I presume viruses can't grow in the water tank and aren't a problem. Correct?
23) I presume the room air makes a big difference. How do you make sure you're getting a good sample of airborne contaminants. If there's a killer mold that really loves CPAP tanks, but it's only in the air in hot, humid climates, how do you check that?
24) Heck, throw it in. What about BPA or other leachants from the plastic in humidifier tanks, etc.?
25) Can germ growth be a problem in the air filter, inside the blower, etc.? We usually assume not due to it being dry and dark.
26) Are there any plastics that provide a particularly good place for germs to grow? Maybe even provide food for the germs?

Well, I can see I got carried away with the list, but perhaps there's a pony buried in there somewhere.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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