Sleep Apnea and COVID-19: What We’ve Learned

Sleep difficulties have been widespread during the COVID-19 pandemic, affecting as many as 40% of adults and spurring new terminology like “coronasomnia.” While there is no evidence that COVID-19 can cause or increase the risk of sleep apnea, these two conditions may complicate one another in various ways.

Obstructive sleep apnea (OSA) is a disorder involving disrupted breathing during sleep that affects as many as 30 million adults in America. COVID-19 can also cause breathing problems when the disease affects the lungs. Doctors, researchers, and people with sleep apnea have sought answers about whether the two conditions could be linked.

While research is ongoing, you may find it helpful to learn about what is currently known about sleep apnea and COVID, including how to protect your health if you have sleep apnea and become infected with COVID-19. 

There is no dependable evidence to suggest that having obstructive sleep apnea directly increases your risk of getting COVID-19. 

Early in the pandemic, some initial studies found a correlation between having obstructive sleep apnea and being infected with COVID-19. However, these studies did not demonstrate a direct causal link, and follow-up research has not found an association between OSA and coronavirus infections.

While it is not believed that having obstructive sleep apnea can increase the risk of COVID infection, obstructive sleep apnea may negatively affect the immune system. 

For example, untreated obstructive sleep apnea involves frequent sleep disruptions and degraded sleep quality. Good sleep is known to enable a healthier immune system, so poor sleep linked to OSA may heighten the risk of contracting certain infectious diseases. 

Although the evidence to date is not conclusive, a number of studies have found that when people with obstructive sleep apnea get COVID-19, they have a higher likelihood of developing severe symptoms. 

Disruptions in sleep and breathing caused by obstructive sleep apnea can lead to inflammation in the body that may contribute to more problematic immune responses after an infection. 

In addition, obstructive sleep apnea can reduce blood oxygen levels, which in turn helps the virus reproduce in the body. Low blood oxygen can also make breathing difficulties worse during an infection and increase the risk of cardiovascular complications and kidney damage.

Untreated obstructive sleep apnea is linked to health conditions that are risk factors for severe cases of COVID-19. These conditions include: 

• Diabetes
• Higher body mass index (BMI) and obesity
• Heart failure and cardiovascular disease

Having obstructive sleep apnea may also play a role in the long-term complications associated with COVID-19, frequently referred to as “long COVID.” After an initial infection, sleep loss caused by obstructive sleep apnea or another condition may contribute to persistent issues with fatigue or daytime sleepiness.

It is important to note that not all published studies have found a strong association between having obstructive sleep apnea and an elevated risk of severe COVID-19. However, as a precaution, many doctors will consider whether a person has obstructive sleep apnea when providing medical care for COVID-19.

Continuous positive airway pressure (CPAP) is a common treatment for obstructive sleep apnea. CPAP machines work by sending pressurized air into the airway to keep it open during sleep. 

If you use a CPAP machine for sleep apnea, you may wonder whether it is safe to keep using it if you have symptoms or have tested positive for COVID-19. While general information is available about COVID-19 and CPAP devices, your doctor is in the best position to offer advice for how and when to use a CPAP in your specific situation. 

Can Using a CPAP Spread COVID-19? 

In theory, a person infected with COVID-19 who uses a CPAP could spread COVID-19. This is because the device generates aerosols that could contain the virus. However, some research has found that a CPAP machine does not emit more aerosols than breathing or coughing.

In general, a person who has COVID-19 should follow the current Centers for Disease Control and Prevention (CDC) guidelines for isolation and quarantine from other household members. During this time, they can use their CPAP machine while isolating in a separate bedroom. 

Can Using a CPAP Make COVID-19 Worse? 

Research to date does not demonstrate that using a CPAP is likely to make COVID-19 worse. In fact, some evidence shows that treatment for obstructive sleep apnea may help improve outcomes for people with a COVID infection.

Can CPAP Machines Treat COVID-19? 

In a hospital, doctors may use a CPAP machine to help people with severe COVID-19 get the oxygen that they need. But in this situation, they are using CPAP to treat COVID-related breathing problems, not sleep apnea.

There is no evidence that COVID-19 causes obstructive sleep apnea. 

However, like obstructive sleep apnea, COVID-19 can affect breathing and the body’s oxygen levels. COVID-19 can disrupt respiration through symptoms like coughing and shortness of breath. 

In more severe cases, COVID-19 can harm the lungs by causing pneumonia and acute respiratory distress syndrome, a condition that prevents the lungs from properly filling with air. 

Even after an initial infection, COVID-related breathing problems can last for months. Additionally, people with long COVID often have sleep difficulties. But there is no established link between having COVID-19 and developing obstructive sleep apnea. 

Is There a Connection Between COVID-19 and Central Sleep Apnea?

To date, there is very little research about COVID-19 and central sleep apnea. 

Central sleep apnea is much less common than obstructive sleep apnea and is estimated to affect less than 1% of adults. This condition occurs when breathing becomes abnormal because of disrupted coordination between the brain and the muscles that control breathing. 

Reports from individuals suggest that COVID-19 could affect the risk of central sleep apnea. But much larger and more robust research studies would be required to prove an association between the conditions. 

It is natural to have questions about what to do when you have COVID-19. If you also have sleep apnea, you may be worried about how the conditions affect one another. A number of important steps—including talking with your doctor, reducing exposure to others, and striving for solid sleep—can help protect your own health and the health of those around you. 

Consult With a Doctor

If you test positive for COVID-19, you should notify your primary care physician. Your doctor can provide tailored guidance based on your current symptoms and health history, including a diagnosis of obstructive sleep apnea. 

If you have any severe symptoms, such as pain in the chest or trouble breathing, you should call 9-1-1 or go to an emergency care center. 

Closely Monitor Your Symptoms

Symptoms of COVID-19 can change over time. While most cases of COVID-19 are mild, symptoms can worsen and become severe. Potential warning signs of severe COVID-19 include: 

• Difficulty breathing
• Chest pain or pressure
• Lips, skin, or nail beds that are discolored or pale
• Disorientation
• Extreme sleepiness

If you notice that your symptoms are getting worse, that you are developing new symptoms, or that you have indications of severe COVID-19, you should seek out immediate medical care.

Avoid Spreading the Virus

If you have tested positive for COVID-19, you may be capable of spreading the disease to other people. To reduce the risk of getting other people sick, try to reduce the chances of exposing them to the virus. 

Examples of steps that you can take to decrease viral spread include: 

• Following the CDC’s current quarantine guidelines
• Isolating yourself in one bedroom and reducing contact with household members
• Wearing a mask when around other people or pets
• Washing hands frequently
• Disinfecting surfaces that you come in contact with
• Promoting airflow and ventilation in living spaces

It can also be beneficial to inform anyone that you have recently been in close contact with about your positive test result. This can help them avoid spreading the virus to others. 

Clean Your CPAP Machine

If you use a CPAP or other type of positive airway pressure device, make sure that you are following recommended steps for keeping it clean. These include cleaning the hose, mask, filters, humidifier, and other components. 

Your device’s user manual should include instructions for cleaning the device and its accessories. The manual should also state how frequently each part should be washed. Some components, such as a mask, tube, or air filter, may need to be replaced periodically. 

If you are exposed to COVID-19 or sick with an infection, you may want to clean some parts of your CPAP more frequently. You can check with your doctor or the manufacturer for specific recommendations. 

Prioritize Sleep Hygiene 

If you have COVID-19, you’ll want to make sure that you get quality rest. However, being sick and worrying about infecting others may interfere with your normal sleep. To try to sleep as well as possible, take steps to practice good sleep hygiene. 

• Have a consistent bedtime: Even though being sick can throw off your routine, it’s best to try to stick with the same bedtime schedule every night.
• Reduce excess noise and light: You’re more likely to sleep soundly if you eliminate potential distractions or disturbances, such as from too much light and sound. An eye mask or ear plugs may help. It’s also a good idea to keep electronic devices out of the bedroom. 
• Avoid caffeine and alcohol: Caffeine is a stimulant that stays in your system for hours and can make it harder to sleep well. Alcohol may make you sleepy at first, but it actually reduces sleep quality over the course of the night. It’s best to stay away from caffeine after lunch and avoid alcohol in the evening.
• Find a way to wind down: Try to ease your way into sleep by doing something relaxing, like taking a bath or reading a book, in the lead-up to bedtime. 

You should consult with your doctor if you have symptoms of COVID-19, have tested positive for COVID-19, or if you have sleep apnea and want guidance about how to manage the condition during the pandemic. 

COVID-19 can cause a wide variety of symptoms, including: 

• Cough
• Chills
• Fever
• Difficulty breathing
• Fatigue
• Aches and pains, including headaches
• Stuffy or runny nose
• Loss of smell or taste
• Scratchy throat
• Digestive problems like nausea or diarrhea

If you have one or more of these symptoms, you may want to get tested for COVID-19. Various types of tests are available, and you can ask your doctor or pharmacist about testing options. 

If you have already tested positive for COVID-19, you can inform your primary doctor. They can ask about your risk factors for severe COVID-19 and discuss whether any specific treatment is appropriate. You should seek emergency medical attention if you have signs of potentially severe COVID-19, such as: 

• A hard time breathing
• Pressure or pain in your chest
• Pale or bluish skin or lips
• Sudden confusion
• An inability to remain awake

It is also important to let your doctor know if you notice changes to your sleep patterns or your breathing during sleep. If you have not previously been diagnosed with sleep apnea, your doctor may recommend testing to check for a sleep disorder. Some of the most common symptoms of obstructive sleep apnea include: 

• Very loud and recurrent snoring
• Making snorting, gasping, or choking sounds while sleeping
• Frequently having morning headaches
• Experiencing significant sleepiness during the day