Q: I have sleep apnea. Am I more at risk for COVID-19?
No data suggest that sleep apnea (a disorder in which breathing is briefly and repeatedly interrupted during sleep) in and of itself increases your risk. However, if you have sleep apnea and one or more known risk factors for COVID-19—obesity (which is also a risk factor for sleep apnea), diabetes, high blood pressure, heart or lung disease, or a condition that compromises your immune system; take medication that suppresses the immune system; are over age 60; or smoke—you are more vulnerable.

Q: What if I develop symptoms of sleep apnea during the pandemic?
Common symptoms of sleep apnea include excessive daytime sleepiness, trouble concentrating or remembering things, irritability, and depression as well as chronic snoring. If you’re experiencing these symptoms, contact your primary care physician for a referral to a sleep specialist, who can evaluate you more thoroughly and discuss next steps. 

Q: What can I expect from a telehealth visit for sleep disorders?
The first thing sleep specialists do is take a comprehensive sleep history. They may ask questions like:

• What time do you get up and go to sleep?
• Do you wake up with headaches, nasal congestion, or dry mouth?
• Do you take medication at night to help you fall asleep?
• Do you nap during the day?
• Do you drink caffeine?
• Have you had your tonsils out?

They may ask about your diet and if you exercise. They may want to know your current weight and whether there is a family history of sleep apnea and snoring. They’ll also ask if you have a bed partner who can confirm whether you snore, stop breathing, or gasp during sleep. During the telehealth exam, you’ll need a small flashlight or penlight that the specialist will have you shine into your mouth so he or she can examine the back of your throat, nose, and mouth. You’ll also need a tape measure to check your neck and waist circumference and a device to record your blood pressure.

Q: Is sleep apnea serious?
It can be very serious. If left untreated, sleep apnea can lead to high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke, trouble thinking and concentrating, depression, or, rarely, even sudden death.

Q: How is sleep apnea treated?
Standard treatment is a combination of lifestyle changes and a continuous positive airway pressure (CPAP) machine. Lifestyle changes include losing weight and quitting smoking. A CPAP machine—which has a pump that controls airflow, a tube that carries air from the machine to the patient, and a mask that goes over the mouth or nose or both—pushes air into the airways to keep them open. All patients are educated about good sleep hygiene, including going to bed and waking up at the same time every day, limiting alcohol and caffeine in the afternoon and evening, and removing all screens—computer, televisions, smartphones, tablets—from the bedroom.

Q: Should I clean my CPAP machine more frequently because of the pandemic?
The American Academy of Sleep Medicine (sleepeducation.org) advises you to clean your CPAP device regularly in accordance with the manufacturer’s recommendations. Please note that the US Food and Drug Administration has not approved any self-cleaning CPAP machines, especially during the pandemic.

Q: What should I do if I get infected with the coronavirus? Should I stop using my CPAP device?
If you have symptoms of coronavirus or if you test positive for COVID-19, contact your sleep specialist for guidance regarding your sleep apnea. You may continue to use your CPAP machine as long as you isolate or quarantine yourself in a different room from others in your household since there may be an increased risk of transmission to others due to potential leaks from the CPAP mask.

Q: Can a CPAP machine push the coronavirus deeper into my lungs?
No data support that. If you develop symptoms or test positive for the virus, contact your physician to determine what to do next.

Q: Are there other treatments for sleep apnea?
Patients who cannot tolerate a CPAP machine may be candidates for other procedures such as dental appliances that reposition the lower jaw and tongue; surgery to remove tissue in the upper airway; a disposable valve that covers the nostrils and applies nasal expiratory positive airway pressure; and a stimulator implanted in patients’ chests with sensors that monitor breathing patterns during sleep and stimulate the hypoglossal nerve to move the tongue to keep the airway open if breathing stops.

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COVID-19 (Coronavirus) and Neurologic Disease Resource Center