Tap vs distilled water

[HalfAsleep]

Strong caution.

I'm reading on this forum that it's okay to use tap water or regular bottled water in a humidifier. I must say, I'm alarmed.

Distilled water is sterile. Neither bottled water nor tap water is sterile. The latter both have microbes. Although most of these are benign, some can induce fatal infections when they get into, e.g. Nasal passages. From there, they can get into the brain. That's why the US Gov't warns users of Neti pots to use distilled water.

The humidifier also has to be cleaned often since the warm water very quickly makes a happy home for nasties....

In addition, some folks are immune deficient. They can't mount an immune response to infections, and nasal passages are particularly inviting for bacteria to settle in for the long term.

So, the non-distilled humidifier water may address OSA satisfactorily,  but can seriously compromise your health.

I have a lot of personal experience with what can happen even with droplets of water from the shower. Trust me, you don't want to have that happen to you.

I believe the recommendation on water should be handled with extreme care.

[DeepBreathing]

G'day HalfAsleep.

I hear what you say, but I don't think it's a valid concern in the context of CPAP machines and humidifiers. Distilled water is not necessarily guaranteed to be sterile, and certainly isn't sterile once the bottle is opened. Tap water (here in Oz, anyway) contains a tiny chlorine residual which restrains the growth of microbes. I use distilled water only to reduce calcium build-up (our main water source is an aquifer in a high calcium area). When travelling I use tap water where it is safe to drink (eg Europe, Singapore) or bottled water where the tap water is doubtful (eg parts of Indonesia).

If your humidifier is working properly and you haven't over-filled the tank, you won't get any droplets coming through, just water vapour. As I understand it, microbes need droplets to hitch a ride and can't be transported by vapour.

I know lots of members here have been using non-distilled water for many years without a problem.

[subyroo]

I know lots of members here have been using non-distilled water for many years without a problem.

If it is safe to drink then it would have to be safe to use in our humidifier, germs - viruses etc can also enter the body via the throat and soft palate tissue.
I too use bottled water if in a suspect area, cruise ships is one area I am extremely careful with.

[Sleeprider]

I have never used distilled water and I consider it safe for most people. U.S. drinking water does not contain respirable pathogens, and is not any more dangerous to use than distilled. I spill and refill the water daily, and try to allow time for the humidifier chamber to dry between uses. The major problem with tap water is mineral buildup if the water is allowed to dry in the chamber. I have not had any problem with mineral buildup either.

The air you breath and water vapor in your shower, and out in the rain contains all the same "dangers" as water evaporated from your humidifier chamber. I won't criticize anyone who chooses to use distilled water, even though I consider the benefits negligible. I have considerable expertise in environmental risk assessment, epidemiology and toxicology, and have not found any compelling evidence that tap water increases health risks in our CPAPs vs distilled, with reasonable maintenance and hygiene practices.

I think it is worth pointing out that using a neti pot where liquid water is taken in to the nasal passages directly is a lot different from water evaporated from a container and inhaled as a diffuse vapor below the saturation point. Any organisms or pathogens present in water would be drawn into the nasal passages in the former case, but with evaporation, there is no transport mechanism.

[PaulaO2]

You ingest/inhale more water droplets (big enough to contain bacteria) during a shower than you do during CPAP use.

If you can drink it, you can use it in your CPAP.

The moment you open your gallon jug of distilled water, it is no longer sterile. The humidifier tank is not sterile. Your hose isn't sterile.

The issue is the mineral deposits, not the sterility of the water. If your tap water has a high mineral content, don't use it in your CPAP. If you don't want to do extra cleaning of your humidifier tank, don't use tap water. If you don't mind a little extra cleaning, then tap water is fine.

I've been using tap water in my humidifier for years.

[CTcentrals]

Not directly related to tap vs distilled, but I think this refers back to a couple of cleaning, disinfection, and sterility posts. I didn't post then, probably shouldn't now because I didn't save the study, but I read a research study not too long ago (I think it was pulmonology journal) about potential respiratory issues from xpap users who didn't clean or empty humidifier regularly.  The results were negligible for respiratory issues. OTOH, if you leave the tub open, then all bets are off regarding what may fall into the water or tub and take on a life of their own.  I know some folks have alluded that if it's in your house, it's in you, or at least you're probably immune to it. I personally think that's a bit naive (think baby spiders, dust mites, cat hair, etc. and off gasses).

I concur that it's a very different situation than using a neti pot.

[Mosquitobait]

Doctors in rural areas have no problems with their patients using well water. If they have shallow wells, algae bloom or water from surface water, they are told to boil it. If you get water from the tap at a rest stop, you need to boil it, since it's usually well water. Water you get from an ordinary tap is not a problem at all. According to the ER doc at my hospital, most folks who get infections from their xpap are because they never clean their equipment.

[Melman]

I am a former medical microbiologist who also worked for over 20 years in the sterile pharmaceutical industry. I have had extensive experience in hospital infection control, environmental control in sterile manufacturing facilities, and control of high purity distilled water systems used in the production of sterile injectable pharmaceuticals.

Distillation does not produce sterile water. Even the water produced by extremely expensive pharmaceutical grade system must be subsequently sterilized by membrane filtration and packaged in sterile containers under stringent aseptic conditions.

If you truly want sterile water you need to purchase sterile water for injection (or irrigation) which is costs anywhere from $10-25 per liter. Supermarket distilled water is not claimed to be sterile and at cost of only around $1/gallon, I can assure you,  is not produced and packaged under aseptic conditions in sterile containers.

As has been pointed out, there is no benefit to buying sterile water as it is rendered non-sterile once you open the cap and even more so when it is poured into the non-sterile humidifier chamber.

I use distilled water but only because my well water has a very high mineral content and I prefer not to clean the reservoir frequently. I have used well water for extended periods with no problem other than the need to clean mineral residues. As has been explained by Sleeprider and Paula, potable tap water is safe.

And like it or not, with respect to microorganisms, if they are in the air in your home, and they are in fairly high numbers, they are in you. We inhale them with every breath.

[CTcentrals]

I should have probably framed it a bit differently.  I certainly agree that whatever is in our house, bed, etc. is in us to some extent.  I'm wary of having them decompose in a contained, non-sterile environment, and then inhaling the result in concentrated form for an extended period of time.  Could be mixing apples and oranges, but I was also thinking of gasoline/petrol fumes or automobile emissions.  I'm fairly adapted to inhaling them at a certain unknown concentration, but also know that I get sick if I'm breathing them in a contained environment without adequate ventilation.  FYI, I don't wash the tub very often, usually just top it off, dump and rinse weekly, and don't have any problems using tap water except for cleaning the mineral deposits.

[Melman]

Distilled water is sterile. Neither bottled water nor tap water is sterile. The latter both have microbes. Although most of these are benign, some can induce fatal infections when they get into, e.g. Nasal passages. From there, they can get into the brain. That's why the US Gov't warns users of Neti pots to use distilled water.

HalfAsleep

You are correct that the CDC cautions against using tap water in neti pots but it's not because of bacteria or other microorganisms in general. It is because of a pathogenic amoeba, Naegleria fowleri, which is the cause of primary amoebic meningoencephalitis. It is found in freshwater in most parts of the world and has been found in some chlorinated municipal water systems. Anyone who swims in a freshwater lake, river, or pond is likely to be exposed to it. 

Infection, however, is very rare. The disease is only contracted when large volumes of amoeba containing water are injected into the nasal passages. Even under those circumstances, only a small percentage of individuals develop the disease. Even if present in your humidifier, the organism would present no risk unless most of the volume were to be suddenly and forcefully injected into your nose. 

How do I know? I worked with and studied the organism extensively for three years in graduate school and have followed the news with respect to the disease.