CPAP Humidifiers and Winter
POSTED 11 Jun 2018

Now that winter is around the corner, CPAP users will soon be contending with colds/flu, sore throats, sinus infections, dry air, and other winter gifts. CPAP humidifiers can help alleviate these medical side effects of winter .

A CPAP Device blows pressurized room temperature air through a tube into a facial mask. The air then enters the airway where it mechanically splints open the passage to prevent airway collapse due to obstructive sleep apnea.

How Dry I Am

One of the functions of the nasal cavity is to warm the air that enters the nose, preparing it for entering the lungs. Winter brings drier air. Breathing cold dry air forced into the nasal cavity by CPAP is uncomfortable. Dry air can cause the nose to work harder to warm that dry, cold air. This can lead to mouth breathing and dry mouth.

About 40% of people who use CPAP suffer from dry mouth. Dry mouth can cause congestion, bad breath, coughing, sneezing, swelling, headaches, dizziness, allergies, sinus infections, illness, nose bleeds, and inflammation, along with a host of other medical problems.


CPAP machines, as well as BiPAPs and APAP machines, are designed to provide humidification during PAP use. CPAP air dries out the nasal passages, and humidification reduces irritation to the nasal passages by adding moisture to the CPAP airflow.

Types of Humidifiers

There are different configurations of humidifiers. Humidifiers can (1) be integrated to a specific CPAP machine, (2) built into the CPAP machine, or (3) stand alone.

An integrated humidifier is built for a specific CPAP machine and connects directly to the CPAP machine.cpap with humidifier.jpg

The built-in humidifier is part of the CPAP machine and cannot be removed. The water chamber can be removed for cleaning and filling/emptying.

A stand-alone humidifier attaches to almost any CPAP machine via a hose. Toi use a stand-alone humidifier, the CPAP device should not have a built-in humidifier, and it should not use an integrated humidifier simultaneously with the stand-alone humidifier.

If you already have a PAP machine and wish to purchase a humidifier, your choices will be somewhat determined by the PAP machine that you own. The durable medical equipment company (DME) that supplied your machine will be able to help you choose the best and available humidifier for your needs.

Cold or Warm?

In addition to the type of humidifier configuration you have/need, there are choices regarding whether you want passover air or warm heated air.

Passover Humidifiers

Passover humidifiers use room temperature water to add moisture to the airflow to reduce the irritation in the nasal passages. The water temperature will drop as the air temperature drops. The nose will again need to work harder to warm the air before it gets to the lungs.

The dropped air temperature in cold climates will result in cold CPAP water temperature, causing the amount of moisture in the water to drop. Unless you like breathing cold air, heated humidification is a better option for PAP users.

Heated Humidifiers

A heated humidifier uses heat to warm the water to add moisture to the PAP air. The heat temperature can be adjusted for more or less moisture. The higher the heat, the more moisture you will receive. The temperature can also be adjusted for higher or lower temperatures, beginning at 80 degrees.

Heated humidifiers are the preferred type of humidification among PAP users. Heated humidification not only makes the pressurized air more comfortable to breathe, it can also reduce the amount of pressure needed for some patients.

Trouble in Paradise

Now you have the humidifier which is reducing or eliminating the unpleasant irritations from the dry air you were breathing. No more troubles, right?  Hold on…

rainout condensation.jpgRemember in high school science class (I realize this may be straining some memories—including mine!) how storms are formed—the clash of warm air and cold air which results in rain.

Well, if conditions are just right in your CPAP and humidifier, you can experience a storm in your hose and at your nose!


When the air inside your humidifier is much warmer than the air in your tubing, or if humidified air cools in the tubing as a result of cold ambient room air, it may cause some moisture to condense inside the tubing and reach your mask as water, wetting the inside of your mask and face. This condensed moisture is called rainout.

Rain, Rain, Go Awayhose cozy.jpg

There are several things you can do to eliminate rainout. Remember rainout is caused by the air in your tubing being cooler than the air in your humidifier. A simple solution is to warm up your tubing. This can be done by placing your tubing under your bed covers. This is not always a solution for some people whose hose is close to them when they sleep or who move a lot in their sleep.

If your tubing needs more warmth, you can wrap the hose with an old tee shirt or other cloth. If you really want to be fancy about it, you can purchase a tubing/hose cover. These covers are made from fleece, come in a variety of colors and insulate the tubing from the colder outside air.

Location, location, location. Placing your CPAP below the top of your bed will cause any condensation to run down the tubing back into the humidifier water reservoir. If you have your CPAP machine on a bed stand, you can drape your tubing above your bed level, so that condensation again rolls down into the water chamber.CPAP setup.jpg

CPAP suppliers have created an insulated, wired tubing that heats the air as it travels through the tubing from the humidifier to the mask. Not every PAP machine offers insulated hoses, but your DME company can provide them to you for those machine that have accompanying insulated hoses.

The photo opposite shows aResMed insulated, wired tube for the Resmed S9 machine, and a setup that causes the condensation to roll back into the water chamber.

Some PAP equipment companies have developed rainout reduction features that reduce or eliminate rainout. Sensors monitor temperature, track the room temperature and adjust heat to provide the most optimal tubing air temperature to avoid condensation.

Cleaning and Maintenance

CPAP humidifiers can be used year round, helping deal with dry air, supplying additional moisture when you have a cold, and dealing with unwanted dry mouth, nose bleeds, sinus infections, inflammation, etc.

It is a good idea to adjust your humidifier when seasons change to receive the most benefit from your humidifier. In most cases, your humidification levels should be highest in the winter, lowest in the summer, and in between during spring and fall.

CPAP manufacturers recommend using distilled water in your humidifier to prevent mineral deposits from forming. If distilled water is not available, use bottled water. Do not let water stand in your humidifier between uses. Some CPAP machines have a feature that preheats the water in the humidifier chamber. 

It is recommended that you clean your humidifier and mask every day, with warm soapy water.  Let them air dry. A very easy way to clean your tubing (follow manufacturer’s instructions for wired tubing) is to take it in the shower with you, run water through it and let it drip dry.

Once a month, place your hose, mask and humidifier water chamber in water and vinegar (3 parts water to 1 part vinegar), and let them soak for 20-30 minutes. Rinse thoroughly with clean warm water and let them air dry. It is important to keep equipment clean to avoid bacterial growth from forming. Remember that PAP equipment lives in a dark, warm environment where bacteria love to grow.


Wintertime brings dry, cold air which can make wearing CPAP uncomfortable. Heated humidification provides supplemental humidity which creates an optimal sleeping environment. An adverse effect such as rainout can be prevented with simple measures and will assist you in your continuing use of CPAP to help you live a healthy and thriving life.

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