Soap -- Mask Cleaning

[ScottBerglin]

I sometimes notice an odor when I first turn on the machine. I can't describe it as anything other than a CPAP odor. It goes away when I wash the hose, but then comes back again. Sometimes soon, sometimes not for a long time. And sometimes it just goes away on it's own. Do you have any idea what might be causing this?

Yes, I have an idea.

Although odor is subjective, I usually can tell a mechanical odor from a biological odor...so my first question is whether your "CPAP odor" is an equipment odor. If so I wouldn't think it "goes away", but rather you become unaware of it with time (our noses seem to do that).

It is more likely a biological odor.

Intuitively, I've always suspected the humidifier to be an incubator for microbial growth...(what better environmental qualifications are there, dark, moist, temperate and oxygenated). It has all the requirements except one, "food". Distilled water doesn't carry any food value for microbes and I don't think the direction of air flow allows much contamination from the mask or the patient. Also, for the record, I think the "bio" filters on the air-inlet side of the CPAP machine are too coarse to filter out microbes, I think their purpose is to filter out "food".

The "short-science" here is simply that "food = odor". By the way, that's why we call them "spoilage microbes". It's god's way of telling us not to eat something...ie: when it goes bad, it stinks. So, the net-net is, the more food-for-microbes content, the more odor.

Incidentally, adding agar (food) to petri dishes is how bacteria are cultured in a lab, also why it takes 24-48 hours to do so. I see your humidifier as a petri dish with the agar missing.

My hypothesis is that the mild growth of microbes one might find in a humidifier, produces an equally mild odor, recognizable but not objectionable. As I say, this is a hypothesis, I haven't analysed my own humidifier content, but your post is making me more curious about this.

Of course, what to do is wash the humidifier and the hose together. If you do this, the odor shouldn't come back quickly. (However, it occurs to me that you mentioned living in a high-humidity environment...this may require for frequent cleanings). If the odor remains, or does come back quickly, it may be an equipment odor.

The second thing to do, always a good idea, is to run the CPAP for a few seconds before putting on the mask, simply to vacate the stagnant air in the system.

Also, when you run out of water in the humidifier, the odor should diminish shortly thereafter (most microbes can't reproduce in a dry heat).

[TorontoCPAPguy]

The science from your viewpoint is, indeed, interesting and I can buy into much of it myself. However, when it comes to cleaning breathing equipment my personal habit is and will continue to be:
1. Soak the mask bits and pieces excepting the cloth headgear in warm soapy water; the purpose for which is simply to free up and get rid of the 'crud' that has accumulated and dried. I generally soak my mask bits in warm, soapy water for anywhere from 15 minutes to 8 hours (you are correct, of course, about the composition of the materials, excepting some of the swivels, etc., which are not polycarbonate nor silicon rubber). It is my opinion that getting rid of this 'crud' is essential to long term health. I use a very soft bristled paintbrush to dislodge any remaining 'crud' that may have accumulated in the wee cracks and crevices. I want it gone.
2. Any gentle soap is going to do the job. The purpose of the soap is simply to get rid of the 'crud' - IMHO nothing more and nothing less. Here is a blurb from "ABOUT.COM" that says it all eloquently:

Detergents and soaps are used for cleaning because pure water can't remove oily, organic soiling. Soap cleans by acting as an emulsifier. Basically, soap allows oil and water to mix so that oily grime can be removed during rinsing. Detergents were developed in response to the shortage of the animal and vegetable fats used to make soap during World War I and World War II. Detergents are primarily surfactants, which could be produced easily from petrochemicals. Surfactants lower the surface tension of water, essentially making it 'wetter' so that it is less likely to stick to itself and more likely to interact with oil and grease.
Modern detergents contain more than surfactants. Cleaning products may also contain enzymes to degrade protein-based stains, bleaches to de-color stains and add power to cleaning agents, and blue dyes to counter yellowing. Like soaps, detergents have hydrophobic or water-hating molecular chains and hydrophilic or water-loving components. The hydrophobic hydrocarbons are repelled by water, but are attracted to oil and grease. The hydrophilic end of the same molecule means that one end of the molecule will be attracted to water, while the other side is binding to oil. Neither detergents nor soap accomplish anything except binding to the soil until some mechanical energy or agitation is added into the equation. Swishing the soapy water around allows the soap or detergent to pull the grime away from clothes or dishes and into the larger pool of rinse water. Rinsing washes the detergent and soil away. Warm or hot water melts fats and oils so that it is easier for the soap or detergent to dissolve the soil and pull it away into the rinse water. Detergents are similar to soap, but they are less likely to form films (soap scum) and are not as affected by the presence of minerals in water (hard water).

Modern detergents may be made from petrochemicals or from oleochemicals derived from plants and animals. Alkalis and oxidizing agents are also chemicals found in detergents. Here's a look at the functions these molecules serve:
•Petrochemicals/Oleochemicals
These fats and oils are hydrocarbon chains which are attracted to the oily and greasy grime.


•Oxidizers
Sulfur trioxide, ethylene oxide, and sulfuric acid are among the molecules used to produce the hydrophilic component of surfactants. Oxidizers provide an energy source for chemical reactions. These highly reactive compounds also act as bleaches.


•Alkalis
Sodium and potassium hydroxide are used in detergents even as they are used in soapmaking. They provide positively charged ions to promote chemical reactions.

I personally opt for a gentle, 'pure' and odor-free soap to accomplish this task.

3. The second task that I am absolutely anal about is getting rid of the bacteria that has been growing. While I do believe that simply washing in gentle soap is likely sufficient..... one has to wonder why Control III is such a popular germicide. I will either dump an ounce of Control III into the warm soapy water and ensure it reaches all the nooks and crannies as I wash; or I will actually rinse the masks, refill the basin with a gallon of warm water and dump the germicide into that... I generally opt for the former for the sake of speed and convenience and the belief that it will get the job done either way.

Here is a list of excellent and vouched for soaps that are odor free and do the job, by the way:

Method Go Naked Dish Soap - TARGET
Seventh Generation Free & Clear Dish Soap - TARGET
Purex
Ivory unscented
Dr. Bronners (health food store) totally unscented
Ivory Classic Pure liquid Soap - no scent
7th Generation unscented (for handwashing dishes)
Dove Baby Unscented Shampoo - LOBLAWS
Ivory Liquid Hand Soap.
I have a pump by my sink, and a small squeeze 300ml bottle for my travel cleaning always packed

Of these 'recommended' soaps, I use the first two and when I found them I bought a case of the stuff. No more searching the isles from store to store. Ditto the Control III. Find it and get a case of it. $118 worth will last me for about 4 years at the rate I use it.

Cleanliness is next to godliness. I can only attest by saying that spending almost a month on total life support and the enduring damage and issues that one need endure to remain alive and kicking makes me a strong believer.

I have FIVE Quattro full face masks now and rotate through them over the course of the month. I have replaced the cushions once in two years (recently). I do my mask change weekly to a fresh one (kept in a ziplock baggie which has a couple of holes punched for air circulation but to keep the dust and crap out) and I wipe down the mask in use every morning with an odorless wipe of some sort, a Control III wipe if I can find them. Cheap enough. Essentially just to get the surface 'crud' off and degrease the mask.

The hoses are washed the exact same way but not quite as often. The humidifier tank is always filled only with distilled pharmaceutical grade water and it is tossed in with the hoses or masks to be cleaned and disinfected about once a month because it is quick and easy to do.

All of this may sound complex but rest assured it is not. The whole process takes me about a half hour once a month. And it provides me with cheap enough peace of mind.

After you have had bacteria of unknown origin blown into your lungs and wound up on life support where your lungs were being suctioned mechanically during each day (NO. YOU CAN'T IMAGINE WHAT IT IS LIKE.) and where three years (last week) down the road you are still paying the price...... rest assured, my friends, I am being more than gentle with my words here and choosing them very carefully.

I sat having dinner with my family at 7 p.m. one night. The next morning at 8:00 am I was in an ambulance en route to the trauma centre and being worked on as I was no longer breathing, nor could they inflate my lungs, which at this point were filled to the brim with gunk. I am fortunate. The ambulance was sitting at the end of the street waiting for a call; the hospital is two blocks away; the trauma unit was empty; they had ONE single ventilator available and the specialists that I needed to save my life were not on call but were actually THERE when I arrived. Everything fell into place and I am here to tell you the tale. And you can take it from me.... if there were ANYTHING more that I could do in order to make the use of airway equipment safer, you may rest assured I would be doing it. Practically speaking I believe that what I have posted is more than ample caution.

One last piece, in parting. On my follow up with a respirologist as we were looking to determine my lung capacity post-trauma and see if it could be worked on..... the respirologist, a professor at one of the local medical schools in respirology, put up my x-ray (or CT scan?) on the screen and turned to me. And turned back to the picture and then back to me. His words? "I cannot believe that these are your pictures..... we usually only see pictures like this from cadavers".

Friends, take the high road.

[312capri]

Wow, I feel like I've started an avalanche with just a simple question on how to clean your mask! I want to personally thank each of you that have so graciously taken from your busy lives to contribute to this thread! There's a plethora of information here and I've learned a lot!

Thanks!

[archangle]

After you have had bacteria of unknown origin blown into your lungs

Was there any indication that the infection came from CPAP? Or what type of bacteria it was, etc.?

I'm not looking for an argument. I'm a nuke everything cleaning it kind of guy myself.

[TorontoCPAPguy]

Archangle: The bacterial pneumonia could not be traced to anything in specific. My personal belief is that it may have been a complicated set of circumstances. The entire family had Influenza A/H1N1... remember that one? Mild cold like symptoms and we all recovered in a week. We had all been vaccinated although I am not convinced that this had a major part in the recovery from the Influenza as the family that we were infected by had the same and were not vaccinated. In most H1N1 patients, the recovery was complete. In my case, my 'resistance' was mitigated, obviously, and whatever bacteria was sitting in my lungs took advantage of the opportunity and grew so rapidly that I had no clue what had hit me. Like I say, one night sitting having dinner and the next morning at 7 a.m. the last thing I recall is sitting in a chair in the hallway downstairs on the main level and someone screaming (it was my wife) for the kids to call 911..... and then going down the front stairs and seeing the side doors of the ambulance open and someone opening up a bagged green balloon (ventilator). That was it. Lights out for almost a month. At one point my wife had been dragged from the hospital by friends worried for HER wellbeing. They took her home to feed her and talk and as they sat down the phone rang and she was called back to the hospital. They wanted to unplug me. She refused (contrary to our living wills BTW) and demanded heroic efforts. She refused steadfastly and three days later I awoke to the sound of two doctors talking at the foot of my bed "Let's unplug this bastard and see if he can breathe on his own". They put me on straight oxygen and I sucked for all I was worth .... you never want to feel that feeling of drowning. Never. But I guess I impressed them sufficiently that they did not put the tube back down my windpipe but put me on a respirator.... a mask pushing oxygen in and sucking it out. You NEVER want to feel that either. At that point they had to sedate me as I could not take it and was taccychardia and BP as high as you could possibly imagine. Sink or swim and I had passed. A few days later they put me on straight oxygen again and I sucked in air for all I was worth again..... they took the tape off my eyes and eventually I opened my eyes. The moment I did, the physiotherapist walking by hollered at me "Mr. L... I see you are back with us.... we're going to get you out of bed today!" I could not even lift my hand, but they did get me out of bed that day. THREE big orderlies/nurses hauled me out of bed, let my foot brush the floor and tossed me back into bed... the rest was a slow and arduous struggle back to the living world. As I speak of it right now, for the first time in almost three years, I can visualize, smell the smells, feel the indignities, feel the warmth of the nursing staff that sat at the foot of my bed 24/7 and watched me and treated me. Wiped my butt. Wet my lips with foam rubber brushes. Etc. I can remember that it was around graduation time and I can remember two of the kids that were in critical care that did not survive their tangle with drugs and alcohol at their grad parties. And the incredible wailing of their mothers. And the squeeking of the wheels of the guerneys when they were wheeled out to the morgue. And all that time I felt no fear, just a sublime comfort in knowing that I was in the hands of a supreme being. Things were not in my hands any longer. It was not my time. I had dropped FIFTY+ pounds in the process. The worst was being moved from critical care and total attention... to 'storage' where I was essentially left to regain my strength. I was determined. They though a month and a half before I could go to a nursing home. I thought a week and a half. I won. Two weeks out of critical care I went home. I could barely walk with heavy assistance (think they took me into the house with a wheelchair). My beard had gone snow white..... when I heard I was going to have visitors I was determined to shave myself. It took me over three hours. I slept through the entire visits for the most part. I had to learn to swallow again. To take care of my personal needs if you get my drift. The story is much longer and more sordid than I can relate but rest assured, friends, YOU do not want to take even the most remote chance of going where I went. You want to keep up your strength and your resistance. I eat healthy these days. I supplement extensively (Magnesium, Potassium, Taurine, Q10, B complex, D, E, C time release, etc., etc.) and when I did an experiment of one and stopped for a week, I felt like heck. I avoid all (ALL!) salt, caffeine, MSG, processed foods, milk, chocolate, refined sugar, artificial sweeteners and other chemicals, etc. Completely and totally. Even to the point of not buying frozen chicken as it is generally laden with salt.

I have had my hesitation in sharing this with you all.... I am not looking for pity nor congratulations on surviving. I simply want to relate to you how easy it is for a wee bit of bacteria inhaled or blown into your lungs to sit there and wait for opportunity. Sleep apnea will give those little buggers their opportunity in your reduced 'resistance'. Your body's systems are compromised by lack of proper oxygenation; could be further compromised by apnea induced aFib too. And presto. The tiniest, most inocuous bacteria that in a normal, healthy person would be eradicated or never 'blossom'.... well, blossoms. Fast. So fast it can hardly be dealt with. And at this point we are talking about a world of hurt and a life/death struggle. I have never met more chaplains during a hospital visit (and apologized for not 'being there' for most of those visits). At one point, one of my arterial taps came loose and I filled the bed with blood, which the nurse could not see as she/he was sitting. Enough of this. I am sure that you have the picture now. I KNOW you have the message now.... the message is simply this: "If you can avoid a situation that you would rather avoid.... DO IT!!". And if you don't (smokers take note) - don't come cryin' to me.

I wouldn't wish what I went through on anyone.

Where did the bacteria come from? The germs? I don't think it really matters. The fact is that a machine taking room air and air passing through and over contaminated surfaces and blowing that air into your lungs is going to put stuff that you do not want into the deepest recesses of your lungs.... and there they will wait for their opportunity. An opportunity that will be presented by a compromised immune system the result of sleep apnea.

Been there. Done that. Got the T shirt.

I am a scientist by education (Physics.. not biology) so I am a skeptic always, as are all good scientists. Show me the evidence. I'm caught between a rock and a hard place. I have to defer to those that are better educated in the subject than I.... but then again, I have the T shirt and I think there's plenty to be said for that route to enlightenment as well.

[archangle]

Thanks for the story.

Let me throw in a PSA and point out that there's a cheap Pneumonia vaccine. Not 100% effective, but probably worth getting it. Pneumonia's a bitch.

Us CPAPers are probably more susceptible than the general population due to other health effects, even if crud from the CPAP doesn't get us.

[TorontoCPAPguy]

312capri....
Never feel that you have begun a controversy nor 'an avalanche'!!! The forum teaches and we learn by the exchange of this information, personal experiences, references, etc. The more we share and communicate, the better this forum will be and the better WE will be for having been exposed to the dialogue.

It is only when there is anger in the dialogue that I get upset. I have always been an 'open book' and shared experience and education where it might be of some value and that is really the way every single member of a forum should look it the experience. Right or wrong... present food for thought. It is how we learn.

Anyone want to ask me about apnea, aFib, supplementation? I have spent hundreds and hundreds of hours contemplating. I have managed to address my sleep apnea (AHI=0.00, SpO2>95% always, etc.). I have managed to find the path to resolution of my aFib I hope (TIKOSYN uptake December 2011/Normal Sinus Rhythm since). And I have taken the time to study what my body wants and is lacking in terms of nourishment.... biggies like hydration, intracellular Magnesium, serum Potassium levels, etc. All of the "inflammation" seen on my earliest CT scans after release from hospital is gone! I am still fighting my demons, but making progress. I am determined to get healthy as heck. If you have not had your Magnesium and Potassium levels checked lately.... it should be part of your annual physical along with all of the other prerequisite tests. Things like Creatinine levels should be checked annually (at least) because Creatinine level is a finite indication of how well your liver/kidneys are working and those of us with sleep apnea are prone to liver/kidney/spleen and other major organ issues..... they are not being properly oxygenated (which is why we all need to have a Contec CMS50EW recording pulse oximeter... so we can tell if we are SpO2>90% min. all night long). There are plenty of indicators in blood tests as well as urine and stool tests that you will never know unless YOU tell the doctor you want to know. I had to convince my family doctor as to why I wanted to know these levels and he was aghast that I would know about them! I could give you the list of what I ask for... but better you study what all of these 'standard' blood tests can and will tell you about your body so you know what you are seeing and what you are aiming for. For instance, I know that if my Serum Potassium is 3.9 I am going to have heart 'arrhythmias'... PVC's, PAC's, whatever. It needs to be up around 4.5 and it is so simple to achieve by simply drinking some low sodium V8 each day. The interchange of all of these thoughts and ideas is what this and other forums are all about.... never think for a moment that bringing up a topic and having it rabidly discussed is a bad thing. It is not. It is a GOOD thing! We get food for thought and pehaps learn just a wee bit more valuable information in the process.