What do CPAP machines, Neti Pots, and Contact Lenses have in Common?

I’m conflicted about writing this piece. Mostly because I wear contact lenses, have friends and family who rely on their CPAP devices for a good night’s sleep and because I am an avid promoter of the Neti Pot. (If you’re not familiar with a Neti pot, it’s a small device for nasal rinsing that looks like an Aladin’s lamp.)

My conflict stems from concern that anything which might cause people to avoid using one of these is not my goal. Also, extremely rare events can be misleading and can feel a bit fearmongering. Further yet, it annoys me that natural remedies and techniques often get the most ridicule. Are they just not lucrative enough?

Despite my reservations, I want to explain a very rare problem that connects CPAP, Neti and contacts. The good point BTW, is that there is a solution.

The Commonality

What do the Neti pot, CPAP and contacts have in common? Water. So, what’s the problem? Water. More specifically, certain tap water.

Let me say in advance, there are a lot of caveats around the reference study I am exploring. However, the recommended prescription wouldn’t be a health-wise hinderance for anyone, other than taking more time from your schedule.

The Condition

Earlier this year, the Center for Disease Control and Prevention dispatched a study that followed 10 cases of a life-threatening infection, Acanthamoeba non-keratitis. (For those who want to know, let’s break down the name. Non-keratitis meaning lacking keratin protein. The Acanthamoeba part refers to a rare tiny single-cell organism that can cause disease of the eye, brain or spinal cord, or infection traveling throughout the body.)

It was reported in the news that these infections (tracked in the study) occurred sometime after each of the subjects had used a Neti pot to rinse their sinuses.

Three of the patients used a squeeze bottle, 2 an actual Neti pot (usually ceramic) and 1 an electric nasal irrigator; the others didn’t state their method. There seemed to be no distinction regarding materials, or if plastics played a role.

Frequency and duration of the nasal rinse application varied greatly, as did the onset of problems. Some used the nasal wash maybe once per week, and 1 used it up to 5 times a day. The symptoms of one patient reportedly began 2 weeks following the nasal wash, while others had been using the technique (with relief) for years before onset.

Complications

Mind you, despite the sensational coverage from some sources, these infections occurred over a period of more than 25 years (although most in the last decade). Indeed, they were serious conditions, 3 people died. But it should also be pointed out that ALL of the patients were immune-compromised (including 5 with cancer and 2 with HIV – meeting the level of AIDS).

Among study subjects there was a high rate of sinusitis (or rhinosinusitis) which refers to either infection or inflammation of the nasal passages or sinus cavities. Seven of the patients had a chronic, long-standing condition (probably their reason for using the nasal wash at the outset). Accompanying this were high percentages of skin manifestations of several varieties, two which progressed to central nervous system symptoms. I explain all this to emphasis that these were not healthy folks.

On the bright side, 7 of the 10 patients survived the Acanthamoeba infection. The study reported this as unexpectedly good considering the typical high rate of fatalities.

What Part does Water Play?

First, remember I said, ‘tap water.’ That’s the issue in this rare connection. Not all of us choose to even drink tap water, although that is for long-term planning, not generally short-term safety. If you don’t live in a place like Flint Michigan, your tap water is most likely safe to drink, despite its possible long-term deleterious effects. STILL, the tap water is not sterile. Nor is all filtered water.

Bacteria, germs and other biofilm microorganisms (groups of cells that clump to one another or on pipe surfaces) live in our pipes and/or distribution systems that carry our water. In the case study above, the link between these 10 people was the Acanthamoeba pathogen. Amazingly, many of these organisms (even this one in question) may be safe ‘enough’ to ingest. Yet, they can be less safe (and possibly dangerous) when they come in contact with your sinuses, eyes or lungs.

The unsterile nature of most of our tap water is the major hitch here.

Solutions

You may feel this is so rare you need not worry about it. You could be right. But I’m not certain, and it gives me pause.

Contact lenses are the easiest to protect from, and a little care goes a long way. The first solution for them is always use solution. Further, when you need to wash your case, it is fine to use the tap water, however let it air dry after that. Do not put contact lenses in a case wet from tap water. Hopefully, it goes without saying not to rinse the lens in tap water. Yes, I said it nevertheless.

CPAP and Neti take some extra work. The FDA (as well as the CDC) recommend either using distilled or sterile water for nasal rinsing. This advice suits the CPAP as well.

Without buying sterile water, you can boil tap water 3-5 minutes and let it cool for later use. If you keep it in an airtight container, it’ll last longer and won’t be as much work.  You still have to reheat the water for your Neti if following traditional directions (and helping the added salt dissolve quickly). Without a doubt it’s more time-consuming. Still, it will ease any jangled nerves about the prospects of a bad organism. [If you use the Neti pot only during times of a cold, sinusitis or other seasonal conditions, it’s not such a burden.)

Common Advice on CPAP Cleaning
May Need a Review

You may not do it, but the recommendation for CPAP users is to clean it (all) once a week. I bet a lot of owners don’t take this time. It means sanitizing the mask, hose and unit’s humidifier tank. The question is wash them in WHAT? Tap water?

Many directions will start out advising use of cleaners like distilled white vinegar or diluted detergent. But then say rinse it in tap water. I can’t say for sure but suspect that if you can let parts air dry (as with contact lens cases) it might be preferable.

I’m sharing a video (below) explaining HOW to clean your CPAP, but it doesn’t (and maybe should) suggest sterile water. Not to ridicule the doc on this video as almost ALL directions are similar. Yet, I wish at some point he had advised to rinse with ‘sterile’ water (and/or air dry where possible).

Final Thought

I started out declaring that I was conflicted about writing this post. I still am. I like a positive approach and don’t like sowing seeds of fear over rare situations. However, the couple tips here may not feel that onerous to you and could be lifesaving. Only downside is more things to do in your already over-crowded life.

All that said, I think a Neti pot, which has been used for countless centuries, in all kinds of conditions and nations around the world, is a godsend during bad allergy season or for sinus conditions. I know others feel that their CPAP machine has either saved their sleep or saved their relationship. The contact lens tip doesn’t even take extra time, just extra thought.

Life has lots of risks and rewards. If you are risk-adverse, these tips allow you to ditch the risks and keep enjoying the rewards.

Reference:

Haston JC, Serra C, Imada E, Martin E, Ali IM, Cope JR. Acanthamoeba Infection and Nasal Rinsing, United States, 1994–2022. Emerg Infect Dis. 2024;30(4):783-785. https://doi.org/10.3201/eid3004.231076

Science Friday, NPR program. Reported by Rachel Fellman, March 15, 2024

Title photo credit: freepik.com

https://youtu.be/IxavmHh3RMA

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2 thoughts on “What do CPAP machines, Neti Pots, and Contact Lenses have in Common?”

  1. Was there any commonality in water’s source? Or are these bacteria found in most municipal tests ?

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