Practical Advice on Obstructive Sleep Apnoea and Travel

Preparing for your trip – what might you need?

The amount of preparation you need to make for your trip and any additional equipment you might require will vary depending on whether you are:

• Travelling in the UK or abroad
• Staying with friends or in a hotel
• Camping/caravanning
• Travelling by car, train, by air or by ship (or on foot)
• Able to access a dependable power source

Initial questions to ask include:

• Is suitable power available to run my CPAP machine in the place where I am going?
• Is there any additional equipment I might need?
• Can I keep my machine with me when I travel?
• Will there be any problems with Customs or Security?
• Will there be any problems at check in?
• Can I use my machine whilst in transit (e.g. on an aeroplane)?
• Do I need special insurance cover for myself and for my CPAP equipment?
• Are there any health problems that I may encounter?

Getting there

• By car. This should be no problem as you can carry all you need quite easily.
• By train or bus. Your machine and any additional equipment will add to the weight and bulk of your luggage but apart from that there should be no problems (You probably won’t be able to use your machine whilst you are actually travelling).
• By sea. You should contact the shipping company to ask about use of CPAP on the ship especially if you are going on a cruise. (Is a suitable power source available? What type of plug is needed?).
• By air (see attached chart):
  • Take the machine with you on the aircraft because hold baggage can go missing!
  • Get a letter from your clinic to cover you with the check-in staff, security and customs.
  • The CPAP machine and any additional equipment will add to the weight and volume of your hand baggage.
  • Many airlines restrict the number of items of hand baggage that you can take on board. You can avoid this by putting your machine in your normal hand-baggage (beware of weight considerations). But if you need to take it separately, you may need to contact the airline to make special arrangements.
  • In theory you can use a CPAP machine on an aircraft. However, the willingness of airlines to allow this seems to vary widely. Contact the airline you are flying with well in advance to see if you can arrange this. Don’t take no for an answer as the first instinctive reaction of the airline may be to refuse your request. Try contacting the technical department of the airline if the “front of house” people are not much help – at least you may get some ammunition to help you in your fight! Some airlines have already ‘passed’ certain machines for use, for example ResMed machines on Quantas. They require a simple medical form to be completed in advance – so leave plenty of time.
  • Some people with OSA can use a dental device (also known as an oral appliance, or mandibular advancement device) for short periods instead of CPAP. Such an appliance can be useful on aircraft. Your sleep clinic, or failing that a good dentist, can advise. You would need to get this organized and have a trial run as long before your trip as possible as some people find it difficult to use these devices.

Some things that you may find useful anywhere

• Extension lead. There may be no plug socket within reach of the bed
• Surge protector. Electrical surges can occur anywhere and can damage your machine. (The routine use of a surge protector is recommended even at home).
• Mat for the machine. Bedside furniture is not always well made and can amplify the noise of the machine if it is not padded. (NB. Some machines get warm in use – check to ensure that any mat you use is not going to be affected by heat).
• Travel adapter(s) for the country(s) you are going to so that you can plug into the mains.
• Padded bag for the machine. (You may end up travelling over rough roads – which can reduce a CPAP machine to a box full of spare parts if it is not protected).
• Spare fuses (and a screwdriver so that you can open a plug to change a fuse!).
• Insulating (electrical) tape. (Great for dealing with holes in air hoses – which can (and do) occur at the least opportune moments).

Where are you staying?

With friends/family or in a hotel or boarding house

These locations are considered together as the problems can be surprisingly similar (in the UK at least!). Consider the items in the list above – especially the first two! If in doubt check that power supplies are no problem before you travel.

Camping/Caravanning

Camp sites may have mains power outlets available – check before you go. If you are using a tent and there is no nearby power source you may need a battery. Caravans often have a source of 12 volt power (see below) – either via the car battery or through a separate battery (and motor caravans have ready access to the car battery). If you are using the battery of your car to power external equipment, take care not to run the battery down so far that you cannot start the engine!

Motor boats and sailing yachts

Marinas usually have sources of mains power available but check before you go. Motor boats and yachts usually have reasonable power supplies available to run items of electrical equipment. If you are going sailing on a friend’s boat check availability of power before you go. If buying a boat you should check this out as part of the pre-purchase examination of the craft.

Cruise ships

Cruises are usually planned well in advance. As part of your planning, contact the cruise line to ensure that you can access a power source suitable for your machine in the cabin on the ship.

Power supplies

(If in doubt, always seek advice from the manufacturer of your machine, or from the technical staff at your clinic before you go).

The main thing to check before you travel with your CPAP is the type of power supply available to you where you are going and in particular the voltage (in some parts of the world the power is 110 volts not 220 – 240 – e.g. parts of the USA). Then check what voltage(s) your machine will run off. Some will only take 220 – 240 volts, others can work off other voltages (e.g. 110 volts or 12 volts). (NB They may need to be reset before they can work off other voltages – usually by a simple switch.

Make sure your machine is set correctly before you try to run it in a new location). If you have a 220-240 volt only machine and you are going somewhere where the voltage is different then you may need to borrow a machine which will work off whatever power source is available (some clinics have loan machines) or else ensure that you can supply your machine with the voltage it needs.

You can get small transformers that will allow you to run (for example) a 220 – 240 volt machine off 110 volts but check that the transformer will take the power demand you are making.

Mains power

The power supply in the more populated areas of developed countries should be reliable. In less-developed parts of the world (and in more remote areas of the developed world), power sources may be unreliable or even non-existent. There are a few things that it is worth doing before you go:

• Try and get information about the reliability of the power supply in the country or area where you are going.
• In many parts of the world the advertised mains voltage is more nominal than real and you may need to look into an alternative power source such as a battery.
• Hotels may advertise that they have their own generator – but does it run all night? What if it breaks down?

Off the beaten track

You may wish really to get away from it all and find yourself away from a source of mains electricity. Equally you may find that the power supply in some countries is unreliable. This does not mean that you have to do without your CPAP machine and there are several ways of producing the power that you need. The suitability of each will depend on how you plan to get where you are going. Heavy equipment and a walking holiday are probably not compatible!

For short periods a dental device (oral appliance or mandibular advancement device) may be suitable for short periods instead of CPAP (see above).

Generators

Even the quietest makes some noise and may not be suitable for use where others can be disturbed (e.g. on a camp site). Small generators also have small fuel tanks – not enough for a night’s run.

Airport Security and Customs

Most airport and customs officials are helpful and a covering letter from your clinic will help you overcome any problems that you may encounter from officialdom. You may occasionally get stopped and asked to show your machine to airport security but as more and more people are travelling with these machines, the more the security people recognize them when they see them on X-ray. [Tip for the regular traveller: Most clinic letters come on A4 paper. Take a copy reduced to A5 (half size – more convenient) and get it laminated to protect it from wear and tear. Keep it in the bag with your machine].

Health and Hygiene

If you have any particular health problems (e.g. heart disease, breathing difficulties) or are worried about the health implications of travelling with OSA, you should always check with your GP or your clinic as to any special precautions you need to take in the areas where you are going.

Keep your mask, hose etc. clean – your clinic should have advised you how to do this. In hot climates, especially in hot humid climates, bacteria and fungi grow well. This should not be a problem provided you maintain good hygiene standards for all your equipment but you need to take particular care if you are using a humidifier. Soap and water are fine for regular cleaning, but do dry things carefully after washing to ensure that your equipment does not deteriorate and to prevent the growth of fungi in (for example) hoses (also the water in most parts of the world is far from pure).

Disinfectant wipes are useful for cleaning the equipment when you are travelling. Some disinfectants also have a detergent action, so are good for cleaning as well as disinfection, but regular use can damage plastic items such as masks and hoses. Chlorine-based disinfectants (e.g. Milton) are very effective but can also damage plastics (and are corrosive so take care how you use them). Always follow the instructions on bottles of disinfectants to ensure safe and effective use.

Keep any head straps etc. scrupulously clean. Micro-organisms can grow quickly on sweat-soaked straps and can cause skin problems.

If you need any gel or other item to prevent pressure sores take plenty with you – especially if travelling in hot climates. Humidifiers If you use a humidifier your clinic should have advised you as to how to keep it clean.

Insurance

Do inform the company providing your travel insurance of the fact that you have OSA otherwise you may find that your policy is not valid. Be prepared to deal with the questions that may arise as the condition is still not well known amongst the staff of insurance companies. Once again, plan well in advance as this may take time to sort out.