CPAP Cough

Key Takeaways

• Sometimes CPAP users develop a cough due to dry CPAP air, water in CPAP tubing, an ill-fitting mask, dirty CPAP equipment, allergies, or an underlying infection.
• Most research suggests that well-maintained CPAP equipment doesn't cause sinus or upper respiratory infections in CPAP users.
• Keeping CPAP equipment clean and well-maintained and using a mask that fits properly may reduce or eliminate CPAP side effects, including a cough.
• In some people, a chronic cough is linked not to CPAP use, but to obstructive sleep apnea itself, either for unknown reasons or due to another disorder like GERD or cough-variant asthma.

Don’t Just Test Your Sleep. Understand It.

Measure key sleep metrics and review your results with a licensed sleep-care provider. Discuss sleep issues and options to make restless nights a thing of the past.

Results and data from the comfort of your own bed

Virtual consultation with a licensed sleep-care provider

Diagnosis, prescription, and personalized care plan

4.8

35,000+ tests sold

Get Started

Reasons Why CPAP Can Make You Cough

There are multiple potential reasons a person could develop a "CPAP cough," such as dry CPAP air, unclean equipment, and poor mask fit. A person may think they have a cough from CPAP when it actually stems from a different cause, like allergies or an infection.

Dry Air or High-Pressure Air

When CPAP therapy delivers dry air, it may cause a dry nose, mouth, or throat, as well as a stuffy nose, in some sleepers. The CPAP machine’s air pressure rate, changes in air pressure during the night, or a lack of humidification may also lead to feelings of dryness after CPAP therapy.

For some people, CPAP-related dryness may be more than a minor irritation and result in discomfort, a sore throat, or a cough. Using a CPAP machine with heated humidification may reduce dryness, along with any related symptoms.

Excess Water or "Rainout"

While dryness appears to be a more common side effect of CPAP usage, some sleepers experience the opposite problem, called "rainout." Rainout is condensation that occurs when excess water from humidification gathers in the CPAP mask or tubing. Anecdotally, some sleepers have reported that this excess water enters the airway, prompting a cough.

Adjusting the humidification settings could reduce rainout, as well as any problems it may be causing. Other potential solutions include a tube jacket, which keeps tubing warm so humidified air won't cool off and become water, or heated tubing.

Poor Mask Fit

CPAP mask air leakage not only compromises the quality of CPAP therapy, but can also worsen dryness and lead to a cough. According to one CPAP manufacturer's study, 45% of people who quit using their CPAP machine do so because of a mask leak.

To correct a poor mask fit, you can try adjusting the straps of your mask and headgear at home, so it's neither too tight nor too loose. If that doesn't help, talk with your doctor. They can identify if you might benefit from a different mask size or another type of mask altogether.

Dirty CPAP Equipment

Dirty CPAP equipment can allow bacteria or mold to grow on your mask, in your water tank, or elsewhere in your CPAP machine. If you inhale bacteria or mold due to a dirty CPAP machine or water that isn't being changed frequently enough, you may develop an illness that could produce a cough.

Cleaning and replacing your CPAP accessories according to the CPAP manufacturer’s schedule should prevent a cough and other symptoms caused by dirty equipment. Research has found that people receiving CPAP therapy do not experience a higher rate of sinus or respiratory infections than those who don’t use CPAP.

People worried about catching a cough from their CPAP machine may be tempted to use harsh cleansers, but manufacturers don’t recommend this. Cleansers containing alcohol, bleach, essential oils, scents, or antibacterial agents may leave a residue that's harmful when breathed in. CPAP cleaning machines, like ozone or UV light cleaners, may also cause harm. Instead, clean with a mixture of water and either mild soap or distilled vinegar.

Allergies or Sensitivities

Allergies and sensitivities are more common among people with obstructive sleep apnea, and can cause symptoms including a cough. Allergies can worsen at night for multiple reasons, such as mucus moving in the nasal passages after lying down, natural nighttime fluctuations in histamine levels, and increased exposure to dust mites or pet dander in the bedroom. CPAP users may incorrectly attribute an increase in nighttime allergy symptoms to CPAP therapy.

In rare cases, a person may be allergic to components of their CPAP mask, such as silicone. An allergy or sensitivity to CPAP mask components would most likely cause skin irritation, but it's possible that in some cases, it could cause other allergy symptoms like coughing. The solution to this problem would be trying out masks that contain different materials and ultimately choosing one that doesn't cause an allergic reaction.

Underlying Respiratory Condition

Sometimes, a person's cough stems from an underlying respiratory infection or condition, like bronchitis, pneumonia, or chronic obstructive pulmonary disorder (COPD). While these issues are unlikely to be caused by CPAP therapy, they may be exacerbated by it, especially if CPAP equipment is dirty, the air isn't properly heated or humidified, or a CPAP mask doesn't fit appropriately.

A doctor can use testing to help identify the underlying cause of a cough. Coughing is an important function that the body uses to get rid of infections, so health experts advise against heavy use of cough suppressants – especially before the cause is known. Identifying the underlying infection or disorder causing the cough will determine the best treatment.

How to Stop CPAP Cough

How to stop a CPAP cough depends on the cough's underlying cause. If you use a CPAP machine and are unsure why you’re coughing, consider trying these approaches:

• Add a heated humidifier to your CPAP therapy to counteract dry air.
• Adjust heated humidification settings, or ask a doctor to do so, if excessive water or "rainout" in CPAP tubing or a mask seems to cause coughing.
• Adjust your CPAP mask, or ask your doctor about trying different masks if yours is ill-fitting or an air leak is present.
• Clean your CPAP accessories using water with gentle soap or distilled vinegar based on your equipment’s manufacturer schedule.
• Replace your CPAP accessories, including the mask, tubing, filter, and water chamber, according to the manufacturer’s schedule.
• Dump old water out of the water chamber before refilling it with clean water.
• Only use distilled water in your water chamber, not tap water or bottled water.
• Talk to your doctor to determine if allergies or an underlying respiratory infection or disorder may be the cause of your cough, rather than CPAP therapy.

When to See a Doctor

According to the American Lung Association, an occasional cough is a completely normal and healthy way for the body to get rid of germs and irritants. However, there are times when you want to see a doctor for a cough. See your doctor if your cough happens alongside any of these symptoms:

• Shortness of breath
• Bloody phlegm
• Excessive mucus
• Yellow-green phlegm or mucus
• Fever
• Headache
• Tiredness

See your doctor if your cough lasts more than three weeks, or if the cough makes a loud wheezing or barking type of sound.

It's also a good idea to see your sleep specialist or doctor if you're having trouble with your CPAP therapy. If you are experiencing CPAP side effects, whether coughing or something else, your healthcare professional can work with you to troubleshoot the problem and ensure you’ll be able to continue your CPAP therapy.

Frequently Asked Questions