Earth Day spotlight: Are you concerned about the plastics in CPAP equipment?

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Any time you are required to use medical equipment to treat an injury or illness, it seems like it should be safe to assume that the materials used in the equipment are safe and hypoallergenic (such as with plastics in CPAP).

For the most part, this is true, but sometimes things happen that patients need to be made aware of. Or, sometimes patients resist using equipment because they have concerns.

Since this is the week of Earth Day, and part of our focus here at the ASAA is improving our sleep environment and patient safety, here are three situations we can address in terms of the use of plastics in CPAP equipment.

You may have heard about one or more of these situations, or have been concerned about them. Let us clear the air and encourage you to move forward with your CPAP regardless.

If you take away only one thing from this post, let it be this: There are ways to protect yourself against potential exposures (to BPA, VOCs, or bacteria), so there’s really no good reason not to use CPAP. Learn more as we address these situations below.

Three concerns about using CPAP equipment

Should I be concerned about BPA leaching from my CPAP mask?

products that contain bpaobjects that can contain bpaSome CPAP users might be astonished to discover that there is bisphenol-A (BPA) in the composition of their CPAP mask. This includes all kinds of masks, such as nasal pillows, nasal masks, and oronasal (full-face) masks. BPA is an industrial chemical used in certain kinds of plastics and polycarbonate resins to add hardness to the plastic.

BPA, unfortunately, can leach in the presence of liquids. It is a known hormone disrupter when consumed by very young children (most widely known as the chemical previously found, but now banned, in most baby bottles).

If CPAP masks contain BPA, should this be of concern for users, since they are typically using them with humidification equipment? According to one mask manufacturer, Respironics, the answer is No. In a 2008 letter posted at, they shared their knowledge of the use of BPA-linked plastics in their products, writing that

“it is Respironics position that our products do not pose any increased risk of exposure to BPA for our users and thus our products remain safe for use.”

The Food and Drug Administration echoes that sentiment, maintaining that BPA is considered safe for adult humans and acceptable for use in the manufacture of CPAP masks. In fact, using such materials in CPAP machines is approved globally, and any level of exposure to BPA by way of CPAP mask is considered to be extremely low, posing no threat to an individual’s health.

Meanwhile, there really aren’t any alternatives. All CPAP mask manufacturers use materials that include BPA in their composition at this time; there are no “BPA-free” CPAP masks at this time.

If you are still concerned about plastics in CPAP because your mask is not BPA free, you might want to use mask liners as a barrier to prevent contact with the chemical, should it leach into your humidifier water. Many people prefer using mask liners because they protect the skin from irritation anyway, providing an inexpensive, easy solution to a common CPAP usage problem.

Whatever else you do, don’t stop using your CPAP because you fear the leaching of BPA from the mask. Your risk for damaging your health is many times greater if you quit using CPAP than if you use CPAP and expose yourself to tiny amounts of BPA.

Good news on the use of plastics in CPAP equipment for the tiniest patients… Circadiance has recently developed a BPA-free patient interface called the NeoPAP, which premature infants, newborns, and infants can wear to treat a number of respiratory concerns.

Does CPAP equipment pose a problem due to off gassing?organic compound

Off gassing is the term for the release of volatile organic compounds (VOCs) and other chemicals from the materials found in new items (think of the “new car smell” as a kind of off gassing) as the particles begin to settle.

Whether there are risks inherent in breathing air around an item that is off gassing depends on a lot of factors, such as the sensitivity of the individual, the type of chemical release, and its level of concentration.

Naturally, any item that might be off gassing in close proximity to the CPAP user is of concern: after all, these VOCs probably shouldn’t be part of the “room air” that the CPAP machine processes and pressurizes for delivery through the tubing and mask. People who are using CPAP already have enough respiratory problems to tend to.

Let’s face it, new CPAP equipment may off gas if it has been taken right out of the box, plugged in, and put to use within the same space of time.

It would be better to unpack your CPAP equipment in a well ventilated space (outside, or in a room with a window open) to help reduce the amount of VOCs one may come into contact with.

This isn’t any worse than “airing out” new memory foam pillows, pads and mattresses before sleeping on them, as they can tend to off gas, as well.

Keep in mind that any kind of brand-new, out-of-the-box device manufactured using plastics may be prone to off gassing, which can include some of the new bedside technologies for tracking sleep, CPAP sanitizing systems, or sound machines.

If you’re concerned, use an air purifier in your sleeping space to capture those particles so they are removed from “room air.” Some are FDA approved as Class II medical devices; they can provide a pure CPAP environment for those with a history of sensitivities to pollutants and may even be reimbursable by insurance if prescribed.

Meanwhile, make sure your CPAP filters (both the permanent one and the disposable one) are clean, and air out of your bedroom when weather appropriate to keep the air circulating and to reduce the concentration of VOCs.

What about the water I use in my CPAP humidifier?

distilled or bottled water is best for cpapMost of the concerns people have about using plastics revolve around the potential for chemical leaching in items that come into contact with water or which tend to overheat, which might cause chemical fumes.

In the case of the CPAP humidifier, the way that a CPAP machine is constructed should work to keep the humidification reservoir at a temperature that is safe for warming the water but which does not result in melting or overheating the plastic itself.

While CPAP machines do contain tiny amounts of BPA (see above), there aren’t enough toxins in the plastics in CPAP equipment to pose a risk to the user.

However, it’s important to use the right kind and right amount of water in your CPAP humidifier in order to get the best benefit and to protect the longevity of your equipment.

CPAP machine humidifiers generally call for distilled water, and when this isn’t available, they generally prefer that you use bottled water (versus tap water). Check your manufacturer for guidance, to be certain.

Why distilled or bottled water over tap? Tap water can contain chlorine and other chemicals that could be damaging to the airways, as well as pathogens that could make you extremely sick.

Distilled water has filtered out particulates as well as many minerals in tap water that can eventually cloud your humidification chamber with deposits. While bottled water doesn’t filter out all minerals, it’s still considered safer than tape water.

It’s important, also, to be conscientious about cleaning out the chamber each morning, making sure you wash and dry it and leave no standing water in it, if you want it to last the longest.

As for the right amount, it might seem like a good idea to scrimp on the humidifier water because you simply won’t go through all that water in any given night. However, you run the risk of damaging your CPAP machine if you add too little water to the chamber, which evaporates and overheats the plastic in the chamber. Follow manufacturer’s directions to be on the safe side.