ApneaNews Wrote:NOTE: The author of this article is Apnea Board member truckerdad57 (Bob Stanton).
Traveling with CPAP—Yes, You Can
A long-haul truck driver shares his 14 years of experience successfully taking CPAP wherever life takes him, including to altitudes higher than 10,000 feet, campgrounds without electricity, and of course along the open road.
By Bob Stanton
I am a long-haul over-the-road truck driver, and I have been traveling with a CPAP for 14 years now at more than 300 days per year. So when I hear a person with sleep-disordered breathing say they are planning a trip and “can’t” take a CPAP along, I will set them straight. The truth is YES you can take CPAP with you; it just takes a little preplanning and knowledge. Even one night without CPAP can be detrimental to a person’s health. The Washington Post asked the question earlier this year, “Did sleep apnea contribute to Justice Scalia’s death? His unplugged breathing machine raises that question.”1 So my response to people who say they are planning to travel without their device is…Are you planning to be like Justice Scalia? Here are solutions for different travel scenarios that may arise.
Portable CPAP Options
There are two CPAP devices currently on the market that are specifically designed as “portable” devices. They have the advantages of being small and designed for travel, and feature a variety of battery and other charging options (such as solar panels). The portable devices—Transcend by Somnetics and the Z1 by Human Design Medical (HDM)—are available in both set pressure and autotitrating (APAP) models. They have the additional advantage of both having options for heat moisture exchange systems to preserve exhaled moisture. Disadvantages are a lack of battery-powered heated humidification and that a second CPAP (that is, one for home use and a portable CPAP for travel only) will not be covered by insurance. For patients who need bilevel or servo-ventilation (also known as adaptive servo-ventilation or ASV) therapy, there are not any specifically portable-sized machines on the market yet, so those users will need to bring their standard-sized device with them.
Battery Power Options
Going camping, traveling by RV, or flying can mean running the CPAP on battery. Honestly, being prepared with backup power even when at home is a good idea in case of an unexpected power outage. Battery power systems can be set up for bilevel and ASV devices, in addition to the more common CPAP and APAP devices.
When run on modified sine wave power or low voltage, some devices can scramble compliance data, have their internal electronics damaged, or just not work right at all. Working with a vendor familiar with CPAP will avoid issues about pure versus modified sine wave power in 12V-110V inverters.
Steve Mell, lead sales representative with Battery Power Solutions, says, “A problem with any battery power system for CPAP is that having enough power for heated humidification means some big heavy batteries.” Devices vary though in the amount of power consumption, so it is advisable to check with the specific manufacturer in regard to power consumption while using a battery to power a CPAP with heated humidification. My CPAP devices will not run heated humidification on battery power, so I have a few work-arounds. One, I can still get some humidification by filling the humidification chamber and turning the heat off; two, adding nasal irrigation, with prepackaged products like NeilMed NasaMist, helps. Personally I irrigate before and after I get up due to the dryness of truck sleeper berths, and it is quick and easy. (Pressured airplane cabins can also cause issues with nasal irritation caused by dryness.)
Running CPAP from a Vehicle’s Battery
For road trips in a personal vehicle, powering CPAP via battery power from an in-vehicle 12-V outlet is an option. The two portable CPAP devices mentioned above come ready to run off 12-V in-vehicle outlets, and several other CPAP manufacturers have 12-V power adapters available. Again, check with the specific CPAP manufacturer for exact specifications for an inverter and to determine needed watt capacity. Also, find out from the manufacturer if the device needs pure sine wave power or not. Most inverters sold create modified sine wave power.
If you plan to sleep while the engine is running, you can use heated humidification with few problems. If the engine will not be running, then you need to have a low voltage cutoff on your inverter. (Most inverters have them built in to protect the inverter.) Many inverters running a CPAP overnight will drain the car’s battery well below the level needed when the vehicle can be started in the morning. So I recommend bringing a pair of jumper cables in case of this scenario or, better yet, using a separate CPAP battery system you charge while driving.
Also, there are solar charging panels available for both the battery packs for portable CPAP and separate CPAP battery packs. In my experience, solar panels typically take about 4 to 5 hours to recharge a CPAP battery.
Solutions for Cold Weather and High Altitude
Going camping with a CPAP may involve the mountains and/or cold weather. A ski trip can mean sleeping in a ski lodge that is located more than 10,000 feet above sea level. Many CPAP devices will automatically adjust for altitude up to 7,500 feet (which is the normal adjusted pressurization of an airliner); some will manually adjust up to 9,000 feet.
At 11,991 feet above sea level, Loveland Pass in Colorado is the highest point in the United States where a truck driver can take a semi-truck. I have taken several CPAPs there during testing, and all have shown 0.2-0.4 centimeters of water pressure loss at the summit. To compensate for the loss—only the clinician can decide if it will be clinically significant for the patient—the clinician may consider setting a patient’s device to a narrow range of APAP pressure around their normal therapeutic pressure. On a related note, I find the article “Traveling to High Altitude When You Have Sleep Apnea”2 to be a must-read for anyone traveling to high altitudes, even if they do not have OSA; it discusses the symptoms of acute mountain sickness.
Another potential issue to consider when camping is CPAP-induced hypothermia. When a person sleeps in temperatures below about 45oF, the air circulated through the CPAP can overwhelm the body’s ability to warm it, resulting in a lowering of core body temperature. I have woken up in an unheated truck sleeper in stage 2 hypothermia, so I have a healthy respect for this little studied issue.3 The portable CPAP provides a simple solution—I find that bringing the CPAP into a sleeping bag to breathe preheated air works great.
Flying with CPAP
Since a CPAP is a medical device, it is exempt from carry-on baggage restrictions on most airlines. It will go through special screening at the TSA checkpoint4 prior to being allowed on board. Most travelers with CPAP prefer to take the device as a carry-on item, rather than risk losing it in checked baggage. Whether to bring distilled water through the security checkpoint is a debated point among frequent travelers (more on distilled water in the next section). TSA Special Procedures outlines the exemptions for medically required liquids.5
Using the CPAP in flight will require additional research on the particular airline. Some airlines, like American Airlines, require 48 hours advance notice. An Alaska Sleep Clinic blog post has convenient links to major airlines’ CPAP-related guidelines.6 If you do not have either a portable CPAP with battery or a battery setup, you will need to discuss power options available and seating requirements of the airplane. A copy of your doctor’s prescription and a copy of the FAA approval letter for in-flight use of your make and model CPAP may be needed. These letters are available through CPAP manufacturers’ websites.
Carefully read the device’s user instructions. It may have a “flight mode.” What this does will vary. For example, for the Fisher & Paykel Icon+, the mode allows the device to operate on reduced power by disabling power to the heated humidifier and heated tubing.7 For the ResMed AirSense 10, the mode turns off the internal modem for communicating CPAP compliance data.8 (Just like cell phones, CPAP modems cannot be used during takeoff or landings. If you are using an external modem for CPAP compliance data, disconnect it for the flight.)
Locating Distilled Water
Most CPAP manufacturers recommend using only distilled water in the humidification chamber, but I have found this can be challenging on the road as it’s often hard to plan or research in advance if distilled water will be available. I do use distilled water whenever I can. The truck stop chain Travel Centers of America often carries gallon bottles. Major cruise ship lines are familiar with CPAP, but whether distilled water is available from cabin stewards for free or can be purchased on board varies from cruise line to cruise line.
The patient and clinician should have a conversation regarding what to do if distilled water is not available when traveling (such as whether using bottled water that is not distilled is acceptable). I avoid local tap water at all costs. Also, it is important to dump the humidification water after every CPAP use. This allows the humidification chamber to dry and avoids lots of general hygiene issues when traveling.
General Cleaning While Traveling
The author’s traveling CPAP set up in the semi-truck sleeper berth.
Note the SoClean2 sanitation system, Fisher & Paykel Icon+,
NeilMed Nasarinse (yellow can behind the CPAP), and hose looped
through the carabiner to avoid water slosh while the truck is moving.
Just like at home, a CPAP mask and hose will need to be cleaned. In my experience, taking the mask and hose into the shower works well. A small bottle of proper fragrance-free dish soap in my shaving kit makes keeping things fresh simple. If you want, portable sanitizing systems like the SoClean 2 Go are available.
Extension Cords and Surge Protectors
Having a surge protector to protect a CPAP is a common sense precaution. Small travel-friendly surge protectors are available. When traveling to other countries, I recommend researching in advance the configuration of the wall outlets at your destination.9 You may need a wall outlet adapter; I suggest packing a 3-prong to 2-prong adapter, just in case. (Most US motels and hotels have updated 3-prong outlets, but when traveling abroad you never know.) Traveling abroad may also require an international power strip to convert local voltage to 110V. One of the advantages of the two portable CPAP devices mentioned in the first section is they often include these strips in their power supplies. Most modern CPAPs will also convert voltages for you. Consult the owner’s manual of the device to find out.
Also, you must always pack an extension cord. Murphy’s Law applies when traveling. (If it can go wrong, it will go wrong.) If you have an extension cord, there will be plenty of outlets for your cell phone, CPAP, etc where you want them. When you forget the extension cord, the only outlet will be on the wrong side of the bed!
One final note about power: Don’t worry about knocking out the power when plugging in the CPAP. If the hotel’s power can’t handle the 185-200 watts a CPAP draws (not much more than a big light bulb), I would be worried about staying there in the first place.
Check and Recheck Before Departure
To ensure problem-free travel, I recommend setting up whatever system you plan to use well in advance. Try sleeping with it several nights before the trip to adjust and to make sure you have no problems. For example, if you buy a portable CPAP for travel only, then knowing in advance that its exhalation pressure relief may feel different than what you are used to will make your trip more enjoyable. Packing an extra mask, like the cloth masks by Circadiance, takes up little space.
If you do forget something, you may be up the proverbial creek without a paddle. If abroad, finding CPAP supplies may be an issue and getting a replacement shipped to you creates problems with customs (in my experience). I have been involved with emergency CPAP replacements for US drivers while they were delivering in Canada, and we couldn’t get the replacements through customs. Also, finding a replacement CPAP battery for my brother on a weekend camping trip involved calling a vendor at home (not an option for most CPAP users) and requesting they FedEx a replacement. I personally always like to have a backup system with me. Being a seasoned road warrior, I run a main CPAP and power system in the semi-truck. I also have a portable CPAP with battery as a self-contained backup system.
CPAP Alternatives for Travel
In some cases, it may be appropriate to use an alternative therapy when traveling only. Two of the most common solutions are oral appliances and Provent, neither of which requires electricity to work and so completely avoids any power compatibility issues.
Tom Cavitt, director of professional education for oral appliance manufacturer SomnoMed, says, “Many patients use continuous open airway therapy (COAT) instead of CPAP to treat their obstructive sleep apnea, especially when traveling. We have many commercial airline pilots [who] are doing this to treat their OSA.”
In summary, don’t let concerns about traveling with a CPAP deter patients (or yourself) from good effective therapy when away from home. You name the problem, and there probably is a solution. It just takes a little advance planning and research. Don’t be afraid to check message boards for travelers or CPAP users for advice.
Bob Stanton is a working long-haul over-the-road truck driver on CPAP since 2002. He is the co-coordinator of Truckers for a Cause, a patient support group for truck drivers with sleep apnea. He also is an advisor to Dedicated Sleep, a managed care sleep apnea testing and treatment firm specializing in transportation. He also regularly speaks at medical conferences on topics like practical considerations in OSA treatment for CMV operators and dealing with CPAP during disaster situations.
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