Heated hose / heated tubing
The heated hose (heated tubing) is an accessory that is an optional accessory designed to augment therapy in cases where the patient is experiencing issues with excessive dryness caused by CPAP/BiPAP therapy within either the tissue membranes of the nose or the patient's mouth where the standard humidification systems are not sufficient.
The heated hose (or with Resmed products the "Climate Line") functions to heat the air within the hose to a temperature defined by the clinician or patient. By raising the temperatures within the hose the air within remains at a constant temperature.
Thus preventing condensation from accumulating within the hose, which later presents a risk of being sent up the hose leading to patient discomfort or awakenings. This heated tubing also ensures a maximal concentration of humidified air reaching the patient.
The majority of CPAP/BiPAP systems have humidification systems in place and offer a heated hose solution on their more modern systems. Patients using Nasal Pillows or Nasal Mask based configurations tend to benefit the most from a heated tubing based solution as the nasal passages are not as capable of remoisturizing themselves over the course of the night. However, some patients do experience dry mouth over the course of the night when using a Full Face Mask.
Keeping the nasal membranes moisturized prevents inflammation from developing and keeping the mouth moisturized prevents the development of sores or the gradual chipping of teeth due to the teeth being completely dry over the night.
It is ultimately an optional accessory but one that is of potential benefit to all users as it ensures optimized delivery of humidity and reduces the risk of rainout when paired with the humidification system. Optimized delivery of humidity potentially results in a more comfortable sleeping experience.
CPAP/BiPAP machines have the settings for humidification in the patient comfort section of the machine in most cases. The tube temperature option will unlock when a heated coil of heated tubing connects to the machine, and the patient receives notification on screen that heated tubing is connected.
The heated hose/tubing systems have a chip built into them which the CPAP/BiPAP device can read and uses to regulate the settings input by the patient or clinician. The temperature range in settings varies by machine, although with warmer air, there is a decreased likelihood of condensation buildup forming in the tubing.
The humidification settings on the CPAP/BiPAP generally range from one to eight (with one being the lowest and eight being the highest) depending on the device and the tubing has a range of between 61 Fahrenheit to 86 Fahrenheit. It is important to note that when using higher humidity settings that a patient take into account their general environment.
When one is experiencing more humid weather conditions the possibility of water accumulation increases tremendously, and it is advisable to lower the humidity to a lower value if the patient uses a setting within the six to eight range to prevent water accumulation. There is an automatic setting on newer devices where the CPAP/BiPAP will control the humidity level and tube/hosing temperature. The CPAP/BiPAP in auto mode monitors the temperature and humidity of the external environment using built-in sensors.
The difference between auto and a manual setting is very much comfort based as some patients prefer higher humidity levels, which require a manual setting. Though when using a higher humidity setting water will be evaporated at a higher rate and with higher settings runs out before one has completed a seven-hour to eight-hour sleep block.
Water Considerations for Humidification
It is important to note that the humidifier built into the device operates at peak efficiency when using distilled water. It does not require distilled water, even though this is the manufacturer's recommendation. The rationale for distilled water centers primarily on the mineral content within the patient water supply. A secondary, and more theoretical concern, revolves around the possibility of pathogen contamination within the tap itself contaminating the water coming through the tap.
Pathogen from tap transfer is extremely rare and when encountered is often encountered results from filling the water tank in an environment where mold flourishes, mainly a bathroom sink, shower or tub. It is prudent when using tap water to refill the tank from a tap where the environment is not often humid; an example would be the kitchen sink.
The benefit of using tap water is threefold: convenience, less laborious, and it is very cost effective. However, when using tap water, the humidifier will begin to mineralize overtime on the base of the water tank as tap water contains a mineral content which distilled water lacks.
However, with proper maintenance, the mineralization is not an issue and can be removed very easily using readily found household ingredients (e.g., vinegar). A descaling procedure should be performed at regular intervals to prevent mineral buildup.
The mineral content in tap water will create a hard mineral scale on the bottom of the water tank as the humidifier heats and evaporates the water over time. This scale accumulates on the base of the water tank resulting in a decrease in the efficiency of thermal transfer delaying leading to increasing time for water evaporation.
Additionally, if the water tank runs out and heavy mineral scaling is present, the unit may begin emitting a burning smell if all the water has evaporated in the humidifier. There is not a danger here, but at this juncture, the water tank needs to either be replaced or have a descaling procedure performed on it to remove the mineralization.
Extremely Rare Tank Events
In unlikely circumstances, the water tank may also become contaminated with bacteria or mold from the environment that is temperature resistant or colonizes in a location within the tank that is not heated. Colonization is identifiable by a moldy smell coming from the air within the heated tube/hose or a pinkish tint inside the water tank.
Colonization can result in sinusitis or bronchitis. In the rare instance of a colonization event, it is advisable that one replace the water tank, tube and cushion to prevent recontamination.
Third Party Sterilization
There are also third-party devices which can sterilize the unit and, specifically, the mask cushion which is not covered by insurance and cost ~ USD 299.
One commercial unit uses an oxygen-based solution that requires use daily to clean the entire machine (including the hose, mask, and more). This commercial solution has a daily setup time of about 15-30 minutes, then runs for a period and uses oxygen to sterilize. It is of paramount importance that one run the machine to ensure oxygen removal from the CPAP/BiPAP or risk irritation.
The other marketed device uses UV light to sterilize just the mask as it cannot penetrate the tubing. The effectiveness in sterilization by these systems is not empirically validated. Without validation or details as to what the units sterilize, or more accurately remove.
Ultimately, one may find equal effectiveness in using over the counter disk soap and hot water to clean out the tube. The tube should never be placed in the dishwasher as it contains electronics and further, the dishwasher cannot clean within the hose.
The cost of a heated tube/hose varies by the device manufacturer and model. One can expect an out of pocket cost that ranges from 30 USD to 59.99 USD, a water chamber to complement the system costs in the range of 15 USD to 40 USD depending on the manufacturer and model of the device.
It is important to note that there is nothing gained by using a heated hose/tube without a humidification system. It is also an entirely optional accessory geared mainly towards patient comfort.