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Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
#11
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
(08-13-2018, 12:40 AM)refurbished Wrote: "Every breath you take ..."
Last, but not least we should consider the time of exposure to the air pushed to our lungs every night.
Dose is the important thing.
Immune system can cope with a certain amount of pathogens. If overwhelmed, fails.

The point about dosage is correct but the implication that the environmental organisms inhaled in CPAP air are pathogens is not. A few are what is known as opportunistic pathogens that are a threat only to individuals with significantly compromised immune systems or with serious predisposing diseases. It is a misconception that conventional CPAP "pushes" significantly more air into our lungs than is normally inhaled. At the pressures we run the density of the air is increased only by 1-2% so the concentration of any airborne organisms picked up from outside the machine is only  increased by that amount if at all. Since airborne bacteria are carried on much larger dust particles or in aerosols, much of which are removed by the inlet filter of the machine, the concentration is probably lower than the in the air we inhale throughout the day when not using CPAP.

If CPAP equipment is kept reasonably clean, the presence of bacteria, the vast majority of which are harmless, will be low. The numbers of some bacteria may be significantly higher in the humidifier, since some environment organisms grow well in water with minimal nutrients, but  because there is very little aerosolization, very few will be inhaled. We have greater exposure to potentially pathogenic organisms in our daily activities when not using CPAP. That doesn't mean it is impossible to become infected with an opportunistic pathogen via CPAP, but the risks are greater in or everyday activities. The time of that exposure is much longer than that associated with CPAP use and involves a lot more breaths.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#12
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
(08-12-2018, 06:13 PM)Melman Wrote: As a microbiologist, I would not state that it is impossible to acquire an infection from CPAP but the probability is much lower than from other potential sources to which we are routinely exposed.  As has been mentioned, Mycobacterium avium-intracellulare organisms are widespread in fresh water, soil, house dust and even food products (Have you ever seen a soil free potato?). The disease can be acquired by inhalation or ingestion. Sleeprider is correct in saying we are much more likely to inhale the organisms from the shower than CPAP. Although I believe he is incorrect in stating that no aerosol is generated from our humidifiers, it is much less than we are likely to inhale in almost any other activity involving water such as simply running water in a sink, filling a glass for a drink, washing our hands, etc.  It’s virtually impossible to disturb the surface of water without generating an aerosol. We also routinely inhale airborne dust which is known to carry the organisms. So those who are not using CPAP are as likely to have significant exposure to these organisms those who are. Unfortunately, short of living in a sterile isolator with filtered air and sterilized food and water, it is probably impossible for susceptible individuals to avoid exposure.

It is true that steam distilled water should be sterile but only if everything it contacts downstream of the point of distillation is sterile. In the case of inexpensive distilled water purchased at supermarkets and other vendors, it is unlikely that the condensers,  piping, storage tanks, bottling equipment, or the plastic bottles into which the water is dispensed are sterilized or that the operation is conducted in a sterile environment. The cost would be too great to allow a price of $1 or less per gallon. Such distilled water, therefore, will contain a variety of environmental organisms. As I have pointed out in the past, the only commercially available sterile water is sterile water for injection or irrigation which costs $20-25 per liter.

Even if one were to go to the expense of using such water, how would sterility of the humidifier chamber be assured? Simply washing and rinsing it with tap water is likely to result in the presence of environmental organism that may be a threat to immunocompromised individuals.
The only advantage to using distilled water is to avoid mineral deposits. Even if it were to eliminate exposure to potential pathogens it would be ineffectual given the exposure from so many other environmental sources.

If the only reason I am buying distilled water is to prevent mineral build up on my water reservoir, I am wasting my money.  

Distilled water is $0.99 cdn at Walmart.  A new reservoir is $38.xx Cdn on Amazon.  That translates to 16 months of distilled water equals the cost of a new reservoir.  

I am on city water, lots of chlorine in it, particularly in the summer.  I wonder if the chlorine would be a problem.
Sleep-well
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#13
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
Cpapian, municipal water is safe and you should have minimal deposits if you exchange water daily. Chlorine residual is required in most public water supplies and the amount varies. If the odor is objectionable, then using any of the drinking water filters that remove chlorine will give you excellent water. I use a Zero Water pitcher, but Brita and others also remove chlorine and provide better tasting water for drinking and I recommend their use for a CPAP humidifier as an economical source of clean water with no odor. Chlorine residual in public drinking water is at low levels and is not hazardous to you, but may be objectionable to some individuals. Your tolerance is the real key.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
(08-12-2018, 11:36 AM)Stom Wrote: But that doesn't mean we can't get infected fromCPAP. Here's an extreme case of Legionella pneumophila possibly transmitted via a very dirty CPAP (with pictures to remind you that, yes, you really do need to clean your mask elbow), an outlier, to remind us that while it is uncommon CPAP may be able to harbor and  transmit infectious disease:


Quote:Environmental health officers visited the case’s house and found the CPAP machine in a poorly maintained state (Figures 1 and 2). The device was retrieved and swabs of the internal chamber, filter, and mouth piece were positive for LP1.

http://www.health.gov.au/internet/main/p...i3902c.htm


So, I can't say the OP is wrong, but I would say that regular cleaning may be more important than using distilled water.


Wow - those photos are disturbing; either a very lazy user or someone who's not capable of being aware of the situation or doing anything about it.  But SOMEBODY should have paid attention.

I'm only 3 weeks into using my Resmed 10, but it's staying clean with daily use of the Soclean 2 machine.  I do go through most of a humidifier tray of distilled water each night though, so I'm keeping an eye on the visible parts of the system looking for changes.  Ended up buying a small water distiller for my well water to keep a sufficient supply for all sorts of uses and keep the cost down - even the reverse-osmosis system is producing 100ppm water.
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#15
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
Quote:I am on city water, lots of chlorine in it, particularly in the summer. I wonder if the chlorine would be a problem.

If you can drink it without tasting or smelling the chlorine, it should be fine. I have a spring water source which is low mineral but still leaves white spots. Since it has no chlorine, when I travel, I often use cheap bottled water just so I don't smell it all night. I notice it more because I am not used to it.

I have used tap water at home for many years now. I just replace the tub whenever the vinegar can no longer remove the deposits. To me, it is worth it. No jugs to deal with, no forgetting to purchase. But then again, I'm a lazy snot.
PaulaO

Take a deep breath and count to zen.




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#16
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
I wash my mask almost every day (some days are busier than others) so it really isn't an issue to wash my humidifier at the same time. I always empty it and let it dry, haven't had any real issues, going on more than twelve years so far...
When is this “old enough to know better” supposed to kick in?
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#17
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
(08-13-2018, 02:47 PM)JimInPT Wrote: I'm only 3 weeks into using my Resmed 10, but it's staying clean with daily use of the Soclean 2 machine.  I do go through most of a humidifier tray of distilled water each night though, so I'm keeping an eye on the visible parts of the system looking for changes.  Ended up buying a small water distiller for my well water to keep a sufficient supply for all sorts of uses and keep the cost down - even the reverse-osmosis system is producing 100ppm water.

I hope you’re aware that So-clean does not clean. Ozone is an effective sanitizer for clean surfaces but will not clean or sanitize soiled surfaces. If you dig down in their FAQ you will find “Your CPAP equipment is completely sanitized every time you use the SoClean. However, the SoClean will not remove facial oils or dust or other foreign materials. You should hand wash your CPAP equipment with the pre-wash solutions every 5-6 weeks.” And “The SoClean will inhibit facial oil build-up, but it will not remove the oils. Although the SoClean will sanitize and kill any germs, bacteria or other pathogens on your mask, some inert residue can be left behind. You may need to wipe off your mask from time to time, or even use the pre-wash provided.”  

If surfaces of your mask have any visible residues or detectable skin oils they will not be sanitized. Ozone will not remove such residues and will not effectively penetrate them. The So-Clean wording suggests that unclean surfaces will be sanitized but based on years of experience with a variety of sanitizers I can assure you that is not the case. Cleaning is required for effective sanitization. Hand washing every 5-6 weeks may be sufficient but you may want to consider more frequent hand washing with a mild detergent to remove visible residues.
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#18
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
Ozone is highly reactive with organic material.  People are often reminded that ozone buildup from sparks and ignitors in basements (furnaces, for example, or removing plugs from sockets) is bad for the insulation on wiring.  I don't know for certain that it isn't good for our mask pillows, but my bet would be strongly against its being good for them.

Inexpensive and highly effective sanitizers include potassium permanganate and sodium/potassium metabisulphite.  Both are used to sterilize surfaces and produce/fruit for those purchasing and eating their own local market stuffs abroad.  Do-it-yourself brew shops sell metabisulphite powders.  A couple of dollars will buy you enough to last a couple of years of sanitizing at approx. 1 tsp/liter of solution since the solution can be reused several times.

https://www.epa.gov/indoor-air-quality-i...r-cleaners

http://www.brewersconnection.com/popup/S...ulfite.htm
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#19
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
Yes, I'm aware that the Soclean's ozone does nothing to clean oils and residue from surfaces, but I received it two days after my ResMed machine, so started with clean surfaces.  My setup is the Philips nasal pillows and I've both detached the nosepiece for cleaning as well as having CPAP sanitizing wipes onhand.  I really don't like the idea of regularly flushing the hose/mask assembly with my softened well water (700ppm with organic tannins - it looks like weak tea) and soap, then hoping it dries thoroughly with no residue - leaving the insides left damp creeps me out.  Especially in wintertime, getting that hose dry between uses will be almost impossible if I run water through it.

The Resmed machine pushes air through the system gently for some time after use, as you may know, and the SoClean pushes ozone through the entire system a couple of hours after that.  Washing the hose does noting to clean the innards of the machine - so I figure my current arrangement is sufficient if I wipe residues off the nosepiece (I have yet to detect any, but wipe occasionally anyway).

I've checked inside the mask top elbow and the hose with a fingertip - they are both bone-dry at the end of the cleaning cycle; I like that.

As for ozone reacting with other elements in the room - the SoClean stays closed for two hours after ozone generation stops, and there's a carbon filter inside that supposedly reacts to convert the gas back to O2.  I can barely detect an ozone aroma after opening it and removing the mask/hose and there's just a faint aroma inside the mask for a minute or two when I use it again at night; I actually like that.

So far, it's only been 3 weeks, but my hose/mask assembly seems to be as clean as it can be - thanks a lot for the feedback and detailed info, guys!
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#20
RE: Mycobacterium avium-intracellulare ,cpap and distilled water for humidifier
FWIW on drying your hose, JimInPT. I've read others that hook up the hose to their CPAP and run it a minute or so to blow out the water. I've never done this myself, as I have the time to let my hose dry for multiple hours before use. Coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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