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Tips for Traveling with Your CPAP Machine

One of the most common excuses for not wanting to use CPAP is that "I travel a lot." Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant. With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be done with relative ease. People use CPAP on planes, and even go camping with it. With the FAA's recent ruling and instructions on carrying and using CPAP on airlines, it's become even easier to travel with CPAP machine. I know there are various types of PAP devices, but for the sake of simplicity, I'll call these devices the generic name, CPAP.

Flying with Your CPAP

The Federal Aviation Administration (FAA) recently ruled that airline passengers must be allowed to use respiratory assistive devices, such as a CPAP machine (Nondiscrimination on the Basis of Disability in Air Travel – May 13, 2009). However, don't think that you'll just breeze by security checkpoints at the airport. Here are some common tips that are recommended when you fly with your CPAP machine:

1. Never check your CPAP machine.

2. Always have with you a prescription for your CPAP machine and your latest sleep study. You never know if your unit gets lost or stolen, or breaks down.

3. Attach a medical equipment tag, identifying the contents as such.

4. Let the TSA security agent know that you have a CPAP machine. Remove it from the back and have it scanned separately.

5. Request that security agents change gloves and wipe down the table before inspecting your machine. Wrap your device in a clear bag while being scanned to prevent contamination with germs and other chemicals.

6. Keep a record of the model and serial number in hand, just in case.

7. If you're going to use your CPAP machine in-flight, check beforehand if there's an outlet next to your seat, and if you have the right adaptor.

8. If the flight attendant says something about your CPAP being another carry-on, let him or her know that it's a CPAP machine and under the Americans with Disability Act, it's not counted as an added carry-on.

9. Consider having your doctor give you a letter describing the need for your CPAP machine.

10. Most CPAP units will automatically convert to the correct local voltage. Check with your instruction manual or manufacturer to confirm this. You may, however, need a plug adaptor, as well as an extension cord, in case your outlet is far away.

Tips On Water

Many people are so focused on the logistics of their machines, that sometimes they forget about distilled water. Make sure you have plenty of distilled water available if you're going to use it on the plane, or at your final destination.

If you're not going to use your CPAP device on the plane, then make sure you empty and dry the water chamber before flying. If you're planning on using your CPAP device on-board, there are two options to be able to pass large amounts of fluids past TSA security checkpoints: Have your doctor prescribe distilled water in a pharmaceutical grade bottle. A 500 mL bottle should hold about 16 oz. Another option is to purchase papFLASK, which is designed to pass through security checkpoints with ease.

For whatever reason you don't have distilled water available, using bottled or even tap water is OK, but try to find distilled water as soon as reasonably possible. Mineral deposits in tap water can build up within the PAP machine and can cause damage if it continues long-term.

Camping or Backing Up with CPAP

For travel to areas that don't have electricity, or in case you have a blackout, there are numerous battery options available. Each manufacturer will usually have a back up battery recommendations and adaptors.

For more extended periods, various people have written about using a 12 volt deep cycle marine battery with a sine wave inverter. There are numerous other battery options so do your research. Different manufacturers have different voltage needs, so also check with your manufacturer. Since a humidifier uses a lot of energy, most people recommend not using the humidifier if you're only camping for a few days. There's lots more information about batteries in CPAP support sites such as sleepguide.com, cpaptalk.com, talkaboutsleep.com, or apneasupport.com.

Have A Back Up Plan

Some patients carry around their oral appliances with them whenever they travel, either using it in place of their CPAP machines or just in case the device breaks. Some people use both the oral appliance and their CPAP machines simultaneously. If you've never tried an oral appliance and you're interested in an alternative option, it may be worth giving it a try now before you need to travel for long extended periods.

No More Excuses

With advances in technology and more acceptance by the medical community as well as the lay public, there's basically no reason (unless it's psychological) you can't travel with a CPAP machine. With knowledge and some flexibility and creativity, anyone can travel with CPAP, even in the more remote areas of the world. There have even been descriptions of solar power being used to recharge batteries used for CPAP. If you travel frequently to the same location, consider purchasing a second unit. Prices for middle of the road CPAP models are in the $300 to $700 range.

The first major challenge is in finding a way to make CPAP work for you. The second major challenge is in un-tethering your machine from your bedroom. Many people are living vibrant and normal lives, despite having to use their CPAP machines while traveling. Or is it because they are using their CPAP machines regularly while traveling? You decide.

10 Tips For CPAP Success

Learn the Insider Secrets of Highly Successful CPAP Users…

Get your FREE access to the audio replay and mp3 download of this interview with Aurelio Henriquez who has extensive experience helping patients with sleep apnea succeed in using their CPAP machine.

Since 2002, Aurelio has helped hundreds of CPAP users overcome their struggles while he was with the NY Methodist Sleep Disordered Center as a Polysomnographic technologist and then later as the technical lab director for the Columbia University Sleep Disorder Center.

Learn:

• What to expect when you first try CPAP in the lab

• How to avoid the #1 mistake every new CPAP user makes

• Where to get the best CPAP equipment for the best price

• What one thing you MUST do BEFORE using CPAP to dramatically increase your chance of success

• What makes some people fail and some to succeed on CPAP and how you can be successful

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Everything You Ever Wanted to Know About CPAP Masks

Are you having problems with your CPAP mask? Are you newly diagnosed with sleep apnea, and want to find out which options you have? If so, hear me interview Chip Smith and Brian Werther of Restoration Medical on "Everything You Ever Wanted to Know About CPAP Masks."

During this information packed hour, you'll learn:

 

• The key to getting the right fit
  
• An insider's guide to finding the right mask for you
  
• How to overcome the most common mistake people make when they're choosing a mask
  
• Most common problems people have with their CPAP mask and how to avoid them
  

 

Title: Everything You Ever Wanted to Know About CPAP Masks

Format: MP3 download

Price: $17

 

Click here to order.

5 Things You MUST Know About Sleep Apnea Surgery

Sleep apnea surgery is one of the most controversial subjects in sleep medicine. There are heated debates within the sleep community as well as in online forums and support groups. Sleep apnea surgery is definitely not for everyone, for some, it can be a life-changing experience. Here are 5 important issues that you must be aware of before considering any form of sleep apnea surgery:

1. Does sleep apnea surgery work?

Yes, but only when done properly. Just like with CPAP or dental devices, if you don't use it properly or use it at all, it won't work.

One of the most common misconceptions about sleep apnea surgery is the relatively low success rate of the uvulopalatopharyngoplasty (UPPP) procedure, which is often quoted at 40%. But performing this operation is like bypassing only one blocked heart vessel when you have 3 other vessels that are blocked. For some strange reason, ENTs are overly obsessed with the soft palate, since this is where snoring usually comes from and we have the most research and procedures for the soft palate.

We now know that if you address the entire upper airway together (nose, soft palate, tongue), then your success rates are much better, approaching 80%. Why only 80%? There's only so much you can do with the soft tissues within the small space within smaller jaws (which is the main anatomic reason for sleep apnea). The more aggressive you are, the higher the success rate, but the more chance of pain and complications.

If you go to the next level and enlarge your jaws (upper and lower), then success rates can reach 90 to 95%.

To put things into perspective, if you bypassed everything with a tracheotomy (placing a breathing tube below your voice box), then you'll have a 100% "cure", but obviously, this is not a very practical option.

One question you must ask then, is, what's the meaning of success? In surgery, one common definition is that the final AHI (apnea hypopnea index) on a formal sleep study drops greater than 50% of the original and the final number has to be less than 20. One of the main criticisms of sleep apnea surgery is that even if "successful", you may still have mild sleep apnea. Surgeons will argue that it's better than not using CPAP at all.

2. Not All Surgeries Are The Same

There are probably dozens of procedures for sleep apnea from various nasal, soft palate and tongue operations to skeletal framework procedures. These can range from minimally invasive to major surgery. The problem is that by definition, they'll all work to a certain degree. For example, procedures for a stuffy nose have been shown to "cure" sleep apnea in 10% of patients. But for the most part, none of these options by themselves have very good success rates.

The key is to examine the upper airway for each individual and figure out where the obstruction is and take care of it simultaneously. Most people have more than one area of obstruction. Surgeons at Stanford have about a 75 to 80% success rate with soft palate and tongue base procedures. This is called multi-level surgery for sleep apnea. You have to look at the airway from the tip of the nose all the way to the voice box.

3. There's No Cure for Sleep Apnea

Unless we all undergo tracheotomies, there's no way to prevent breathing pauses at night. Modern humans' upper airway anatomy is thought to be predisposed to breathing problems at night, which only gets worse as we age. I talk about why this problem has gotten much worse in recent years in my book, Sleep, Interrupted. All of us are on a continuum, where various factors (anatomy, age, weight, inflammation, etc.) contribute to forces that make our tongues and palates to collapse. The older we get, we'll either gain weight, which narrows our breathing passageways, or our throat tissues will sag and collapse easier.

Surgery will shift the line of this continuum downwards, but it won't bring it down completely. This is why it's important to incorporate a healthy diet and lifestyle and exercise regimen into any sleep apnea treatment regimen.

For most people, lowering the numbers significantly will make you feel much better. But sometimes, the numbers will go down dramatically, but you may not feel any better. This just goes to show that there may be other issues besides sleep apnea that have to be addressed. You've had sleep apnea for years or decades. Just by fixing your sleep apnea won't immediately fix problems that can arise from sleep apnea, such as hormonal problems, weight gain, or memory problems and brain fog.

4. Surgery is the Last Resort, But Don't Rule It Out

Admittedly, there are many people who rush to surgery prematurely, but there are also many others that aren't even offered surgery due to misconceptions by physicians. There are also many patients that are turned off by all the conflicting information that's available on the internet.

Before you even think about surgery, make sure you've tried or considered all the other options thoroughly. Most people who fail CPAP do so because of poor counseling, support and follow-up by the medical system. Just like everything else with life, your chances of success depends on which doctors you see. The follow-up and support offered by your CPAP equipment vendor can also play an important role in whether or not you'll benefit from CPAP. The same issues also apply with dental devices for sleep apnea.

This is why it's important to educate yourself about all the treatment options, and not to give up too easily. Too many people give up at this point, and don't consider any further treatments. Surround yourself with a group of trusted doctors and professionals that forms a team. Use their expertise and guidance to find a way to make things work. If nothing works for you, don't rule out surgery just for the sake of avoiding surgery. Learn and educate yourself about surgery before rejecting it.

5. How to Find the Right Surgeon

Finding the right surgeon for your sleep apnea condition can be challenging. Everyone claims to specialize in snoring and sleep apnea surgery. Who are you to believe?

First of all, find someone who's comfortable performing a wide range of procedures in all the three areas of the upper airway (nose, soft palate and tongue). Are they familiar with the minimally invasive procedures as well as the standard options? No everyone will be an expert at all the procedures, but it's important to know about all the other options as well as well as to make appropriate referrals when necessary.

There are a variety of "minimally invasive" procedures out there, especially for the soft palate, but these procedures have to be offered very selectively. Even if successful initially, is your surgeon prepared for relapsed that are likely years later? Is the goal of surgery only to cover up the snoring, or will it treat the underlying anatomic causes?

If your surgeon recommends palatal surgery "just to see," without addressing the entire upper airway from the nose to the tongue, go for a second opinion. If you do decide to undergo a palatal procedure (with or without tonsillectomy), be prepared for a 60% failure rate, which means that the tongue needed to be addressed as well. Sometimes, more needs to be done to the soft palate or the nose has to be addressed. Everyone is different, and the treatment recommendations have to be tailored to the individual.

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For a more detailed free report on The Truth About Sleep Apnea Surgery, click here.

CPAP Success Secrets Revealed

CPAP Success for Sleep Apnea: What You Must Know

CPAP, or continuous positive airway pressure, is one of the first-line ways of treating obstructive sleep apnea. Gentle, positive air pressure is passed through a mask into the nose to keep your throat tissues open. For many people, CPAP works very well, but there are many others that have difficulty adjusting to CPAP and end up giving up. 

 

There are a number of proven, systematic steps that can be taken to improve CPAP usage, and I’ll cover each of these steps in future posts, but theres’s one important factor that determines whether or not you’ll ultimately benefit from CPAP even before you start. This is your mindset.

 

CPAP compliance, or the number of people who are able to use and ultimately benefit from CPAP, ranges anywhere from 29 to 83%. (Compliance is only a measure of how many hours patients actually use their machines. It doesn’t actually measure how well they are benefiting from CPAP treatment. You can be 100% complaint, but not sleep any better.) In the real world, compliance is  much less than 50%. We know that with intensive education, support, and follow-up, CPAP compliance rates can be very high, but in our fragmented health care system with multiple providers for each patients, results are much less than ideal.

 

However, over the past 11 years in clinical practice, I’ve noticed a few observations: Bus drivers and airline pilots accept CPAP therapy readily and are usually very successful in adapting to and benefiting from their CPAP machines. In addition, newly diagnosed sleep apnea patients who have either friends or relatives who have good experiences with CPAP also tend to do well. On the other hand, if they hear horror stories about CPAP, they tend not do do as well.

 

What this goes to show is that your mindset and motivation ultimately affects whether or not you end up accepting or rejecting CPAP. Pilots and bus drivers have their jobs on the line. Until they are treated and cleared by a medical doctor, they can’t return to work. A close friend or family member’s experience using CPAP is also a major factor in how well you’ll be able to tolerate and benefit from CPAP. Imagine having the proper mindset, as well as undergoing intensive education, counseling, support and follow-up. CPAP success rates are sure to go up.

 

What was your motivating factor in succeeding with CPAP? If you couldn’t tolerate CPAP, what was the main reason? Please enter your comments below.

 

Sleep Apnea CPAP Compliance Craziness

One of my biggest pet peeves is how doctors use the word compliance. If a patient doesn’t comply, it usually implies it was the patient’s fault. In sleep medicine, compliance is often used to measure how well patients use their CPAP machines. But compliance is not the same thing as success.

 

Various studies report CPAP compliance rates at 29% to 83%. The problem is that the definition of compliance changes from study to study. More recently, we’ve adopted the new Medicare requirement for CPAP compliance, which requires that the patients use CPAP at least 70% of the time over a 30 day period, for at least 4 hours every night. Otherwise, the machine has to be returned.

 

If you sleep 7 hours every night, it comes to 210 total number of hours per 30 days that you’re sleeping. Seventy percent of 210 hours is 147 hours. If you sleep only 4 hours every night, then this figure drops to 88 hours, which means that you have to use your CPAP machine only 40% of the total time that you’re sleeping to be considered "compliant." This doesn’t take into consideration if you’re actually feeling better or if the machine is being used effectively. 

 

Since CPAP works only if you’re using it, if only 40% of people are still using CPAP regularly 5 years after beginning treatment, then the CPAP success rate is at best 40%. But not all people who use CPAP will benefit, so this figure is likely to be much lower. Many more people are likely to stop using CPAP as the years go by. 

 

There are many patients that are 100% compliant with CPAP, using their machines 100% of the time they are sleeping, with no leaks and a low AHI, and still feel no better. Sometimes they can even feel worse than when they don’t use CPAP.

 

From what I’ve seen with CPAP compliance studies or even with sleep apnea surgery studies, they all manipulate the numbers to make their results look great. In very tightly controlled research studies with frequent follow-up and intensive intervention, results are likely to be good. But in the real world, with fragmentation of care, poor follow-up and lack of patient education, true success (the patient feels much better AND the numbers show it) is disappointingly low, no matter which option you choose. 

 

Despite all these obstacles, there are proven ways to improve CPAP success. With a systematic and formalized education program, along  with intense counseling, follow-up, and long-term support, many more people can benefit from CPAP. Ultimately, a major part of poor CPAP compliance is due to the health care system that’s dropping the ball.

 

Am I being realistic or too pessimistic? Let me know what you think of this issue in the comments box below.

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