# CPAP and energy use



## freshsail (Apr 8, 2010)

A lot of us have been diagnosed with sleep apnea which basically means you need to use a CPAP machine when sleeping every night. To skip this little detail puts you at a much higher risk of heart issues and stroke, not something I wanted increase the risk of while living aboard our sailboat Northern Star. Unfortunately the most common machines in the market are 120v and require you to be plugged in at the dock or running an inverter all night to feed the beast. Typically these machines draw 2-10 amps/hr which means they could use close to 100 amp hrs per night with an inverter. If your living on anchor with a 12v system this is a tall order and in our case both my wife and I have sleep apnea and need a CPAP. When I figured out the total power needs of our CPAPS along with everything else connected to our system, I thought it was going to blow apart our dreams of cruising away from the dock.

Fortunately I discovered that at least one of the major CPAP suppliers also makes a DC converter that basically allows you to use a handful of direct 12v amps and avoid the 120v completely. There may be other direct 12v options for other suppliers also. Once again, in our case, it meant going from up to 200 amps hrs/ night from our batteries with an inverter to 20 amp hrs without, a number I can deal with in our power management system.
I bring this up because I've seen references here and elsewhere that indicated not using CPAPs on board because of the power problems they pose. The message is, don't leave them home, your health is more important than a handful of amp hrs, and a decently designed power system can keep you cruising happily.


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## Capt Len (Oct 9, 2011)

My BiPap runs on 12v or makes 12 with the supplied power 110 cord. Consumption (of amps) has never been a problem. Pushing the boundrys by not using it regularly starts you on the road to delirium. fibrillation and heart failure. Disconcerting to say the least .Much more serious than toe fungus.


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## TakeFive (Oct 22, 2009)

Sorry for the long winded comments. But I think these can help you guys:

I am not sure how old your equipment is, but my sleep tech told me that virtually all the new CPAP models currently available run exclusively off 12vDC, with a 120vAC power brick supplied for in-home use. You can buy a 12vDC adapter from the manufacturer ($70-100), but any generic one will work as well ($2-10). Do NOT use an inverter because it wastes a lot of power. The power bricks that come with these are generally way oversized so that they can power a heated humidifier. You should ditch the humidifier on the boat because it drains way too much power.

My current unit (Respironics REMstar Plus C-flex) is a couple years old and runs exclusively 12v as I described above. My previous unit (Respironics REMstar Plus LX) had 120vAC direct to the device, but had a little 12v socket in its side for mobile use. This is still functional but gradually dying, so it's my backup unit.

My newer unit is much more energy efficient. At my 13" H2O pressure setting it runs 9 watts inhale, 7 watts exhale. For comparison, my older unit runs 15.0/12.5 watts. So in both cases I'm well under 10Ah per night. 200Ah per night is just insane!

I have two group 24s in parallel, which is plenty of power for this. And if I were to run them totally dead for some reason, I just pull the string on the outboard, so there's less risk than you guys who have inboards.

FYI, I initially encountered some idiosyncrasies trying to run either of my two CPAPs off of 12v. When I plug into the 12v socket, the unit struggles to start up. It seems like revving up the fan from a dead stop takes more current than the socket can supply. I believe that it is because the wire run to my 12v socket is too long, and the voltage drop through the wires prevents it from getting enough juice to start up. (This same problem happens both on my own Catalina 250 and my friend's Mason 44, which has much larger batteries.) When this first happened to me I overcame the problem by starting up the motor, which spiked the voltage to 14v. Once the CPAP was up and running I shut off the motor and the CPAP continued running at 12.8 volts. Since then, I just bring a portable jump starter on the boat with me and plug the CPAP into that. I get about 3 nights off the jump starter and if I need more I recharge it off the outboard's alternator and house batteries. But plugging into the jump starter eliminates the wire run, so its voltage and amperage are good enough to start the CPAP. For you guys with inboards, it also ensures you won't run your house/starter batteries dead.


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## freshsail (Apr 8, 2010)

We have two ResMed Elites, one set at an IPAP of of 7 the other set at 10 and neither have heating or humidity options hooked up (we've got no problem getting plenty of humidity on the boat). They both draw between 1 and 2 amp/hr with the converter. We also ran a dedicated circuit to our panel just for CPAPs.


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## outbound (Dec 3, 2012)

Board certified in sleep medicine and ran a sleep clinic before retirement. Prevalence of sleep disorders including sleep disordered breathing is so high in neurological disease felt compelled to do so. Not using your C, Bi, Auto PAP or assisted servo ventilation is a huge no no for sailors.
On passage your sleep is likely to be interrupted. Watches, difficult environment, change in circadian setting all contribute. Beyond the risks of cardio or cerebro vascular events your cognition deteriorates just at the times you need your maximal alertness and mental acuity. Even for coastal sailors comsumption of ethanol suppresses stage R and enhances slow wave sleep for the first 4h of sleep while making OSA much worse.
It warms the cockles of my heart to see so many strive for full compliance.


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## capt jgwinks (Sep 24, 2013)

ND Great info for is commercial guys. You can get or keep your license with sleep apnea of you get a waiver, but you would be required to use the machine on board. No problem on a freighter,but the six pack operators would have a problem if they slept aboard.


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## RobGallagher (Aug 22, 2001)

outbound said:


> Board certified in sleep medicine and ran a sleep clinic before retirement. Prevalence of sleep disorders including sleep disordered breathing is so high in neurological disease felt compelled to do so. Not using your C, Bi, Auto PAP or assisted servo ventilation is a huge no no for sailors.
> On passage your sleep is likely to be interrupted. Watches, difficult environment, change in circadian setting all contribute. Beyond the risks of cardio or cerebro vascular events your cognition deteriorates just at the times you need your maximal alertness and mental acuity. Even for coastal sailors comsumption of ethanol suppresses stage R and enhances slow wave sleep for the first 4h of sleep while making OSA much worse.
> It warms the cockles of my heart to see so many strive for full compliance.


I have had sleep apnea forever.... I keep putting off the sleep clinic because I really don't like sleeping in hospitals.

I guess I'll have to suck it up and get it done. You are very convincing. Thanks.


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## TakeFive (Oct 22, 2009)

RobGallagher said:


> I have had sleep apnea forever.... I keep putting off the sleep clinic because I really don't like sleeping in hospitals.
> 
> I guess I'll have to suck it up and get it done. You are very convincing. Thanks.


Best thing I ever did (~18 years ago). You need to do it. Sleep clinics are usually far away from communicable diseases and you typically enter through a separate lobby after hours.


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## Capt Len (Oct 9, 2011)

Don't put it off. My appointment was March a couple of years ago so in Dec went back to Thailand.to wait it out. Got suddenly worse and collapsed in a train station of complete heart failure .The delirium was entertaining but the dying not so much .Thai med system so good.Revived, bought a 4 thousand dollar breather and made it back to Canada.Got to the hospital here in Nanaimo and flatlined again. Heart efficiency (blood in compared to blood out ) was 17% and full of clotted and fibrillating. Worse case would have been a chunk breaks off and lodges somewhere important.not much wrong with fatal but crippled a bummer. Now ,between the BiPap and rat poison I'm really pumped but bleed a lot when I slice myself or have a motorcycle accident. Price you pay for continuing to play. Worth it.


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## MarkSF (Feb 21, 2011)

RobGallagher said:


> I have had sleep apnea forever.... I keep putting off the sleep clinic because I really don't like sleeping in hospitals.
> 
> I guess I'll have to suck it up and get it done. You are very convincing. Thanks.


These days, an awful lot of health care systems are doing home studies. You go home with a phone-sized device that measures your sleep at home. I'm with Kaiser and that's what they did. It's hard to believe that an insurer would refuse a home study, as it's less expensive.

I measured my Respironics System One 60 series at 7 Ah overnight for 7.5 hours. That's without the humidifier, at about 12-13 inches water.

A lot of new machines have a feature (Respironics call it A Flex) where the pressure is reduced during exhale. This is more comfortable, AND uses less power. For me, it made the difference between the old machine, without it, sitting in a cupboard. The new machine with it is used 100% of the time.


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## TakeFive (Oct 22, 2009)

Above I mentioned that I run my CPAP from a portable jump starter because it struggles to start up when plugged into a 12v outlet. (Hypothesis is that long wire run to the 12v outlet limits its ability to deliver needed amperage to start up the fan.) The device linked below sells at PepBoys for $50, but typically goes on sale for around $20 on Black Friday. Although I had another jump starter already, I decided to pick this one up last Black Friday because I couldn't pass up a good deal (and the other one is >10 years old). It is much lighter than my older jump starter, but still seems to have enough capacity to run for a couple of nights between charges. You might want to keep an eye out for when this goes on sale:

http://www.pepboys.com/product/details/9912232/00020

​


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## jimrafford (Jan 7, 2011)

If you haven't explored it there are oral dental appliances that can help. I was involved in the development of some appliances. Ask you dentist.
Jim


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## Capt Len (Oct 9, 2011)

Two kinds of apnea. Ive got the central nasty where you just stop breathing Can even happen when awake.Bipap keeps me on a schedule and give an alarm if i don't respond. Probably caused by neve damage in one of my many impact incidences. As with most equipment you have to change the filter and sterilize the humidifier and breather bits occasionally to avoid the dreaded Legionairs or its many cousins.


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## outbound (Dec 3, 2012)

Len. Actually more complicated then that. You are fortunate you respond to BiPap. Many require assisted servoventilation.
It unfortunate that some opt out of benign pap therapies and choose surgery. Success rate for surgery is quite poor in general even when it "cures" snoring. It may also make subsequent pap therapy more difficult.
Also unfortunate some don't seek appropriate follow up. May be big difference between follow up with board certified sleep physician and less qualified provider. As your health, age and weight change it is common for your therapy to need to change.
Len makes me think of this. Home sleep testing is usually an inadequate assessment of central sleep apnea. One form of CSA, periodic breathing, can be a marker of congestive heart failure. Better to treat the cause than symptom if possible. Plain CSA may reflect opiate use. Better to restrict dose or employ other pain control techniques. Usually there is a threshold below which CSA is not significant.
Home sleep testing is inadequate to assess parasomias such as REM behavioral disorder and the like.
Although home sleep testing is adequate if done correctly for simple obstructive sleep apnea it is inadequate for myriad types of sleep disorders. Therefore strongly suggest, if done, it should be done in accordance to American academy of sleep medicine guidelines and only ordered under the guidance of a boarded sleep physician.


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## MarkSF (Feb 21, 2011)

"As your health, age and weight change it is common for your therapy to need to change." Automatically done by the CPAP machine.

"One form of CSA, periodic breathing, can be a marker of congestive heart failure." Automatically measured by the CPAP machine.

My one local Kaiser hospital is testing hundreds of people a week, and about 20% of patients have CPAP machines. A sleep clinic would have to be the size of a hotel to incorporate that many patients.


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## outbound (Dec 3, 2012)

As regards dental appliances there is a wide variance in effectiveness. In clinical practice find the inexpensive Boil and Bite devices may be insufficient and can lead to tooth movement or other dental difficulties down the the road. Some dentists specialize in helping with sleep disordered breathing. They will construct a well fitting device and have it made to create the right amount of jaw advancement or other movement to be effective. Generally speaking oral devices can be very effective for mild to moderate OSA. Just make sure if a device is made you have a good sleep test done afterward to see if it actually solved the problem
One of the big problems with home sleep testing is the reader may have difficulty knowing when you are awake or asleep. If wake is scored as sleep the events per hour will be decreased. Also there is no sleep staging. Unfortunately, many insurances will only pay for home testing unless the physician can successfully argue with them that a true polysomnogram is required.


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## outbound (Dec 3, 2012)

Auto titrating machines have been around for quite awhile. The original population studies showing efficacy of pap in lowering cardiac and cerebral events did not employ them. Different manufacturers use different programs to achieve the auto pap function. To my knowledge ( retired two years ago) it remains unknown as to which software package is more effective. Some authorities have not been sanguine about APAP. Impact on autonomic system is known to be a major benefit of PAP. In normals in the hours before wake there is a dip in sympathetic output. This results in fall in the "work" the heart does and may even impact hypertension. We know simple CPAP does this. 
Also APAP is reactive. It attempts to score the presence or absence of events and "learn" then react accordingly. There are many reasons when in less than ideal settings there may be difficulties. Ideally there should be less then 5 events per hour. Ideally there should be no leak. Ideally the person should have no central events as APAP can have difficulty with CSA /periodic breathing and can even worsen it. 
I employed APAP in practice. It's use was driven by economics. My personal ecomonics were not a concern rather it seems to be due to the wishes of the insurance companies. At the close of practice I remained uncertain as whether APAP was better, worse or equivalent to CPAP and clinical follow up. It is known CPAP works. Large, truly randomized, well controlled population studies following people for years, even decades are quite expensive. To my knowledge such trials comparing nomograms,software, C versus A pap have not been published.


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## outbound (Dec 3, 2012)

Perhaps a "hypothetetical" ( lawyers) clinical scenario will elucidate .
A vet comes to clinic on Prozac ( SSRI) for war induced PTSD and depression. night time time released opiate for chronic pain 'and antihypertensives. He had HST ( home sleep test) through a regional service and was placed on APAP. He is referred due to lack of perceived benefit having had a single car accident due sleepy driving. He is undergoing a divorce.
You find out he has hit his wife during sleep. His psych thinks this is due to PTSD induced nightmares. You find out he has wine with dinner and a nightcap of bourbon.
You spend time on the phone and finally get an in lab test. It shows obstructive apnea in the first half of the night, central apnea later and REM behavioral disorder in his last Stage R period just before wake.
You ask him to limit alcohol to two glasses of wine with no intake for 4hours before sleep.
You have psych stop SSRI and substitute dopergic agent.
He gets reassessment by neuro surgery/pain clinic and with spinal cord stim, aggressive PT stops the long acting opiate and is able to reduce to low dose short acting during the day.
You ask PCP to discontinue one of his HTN drugs and use prazocin
Repeat polysomnogram shows minimal OSA ( then treated with oral appliance), no Central apnea, no rem behavioral disorder. He reports no nightmares at home and divorce is deferred as he is getting along with wife, stopped hitting her, feels rested, and centered.
In short one size does not fit all. Absence of sleep physician input can lead to less then ideal outcomes.


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## MarkSF (Feb 21, 2011)

Hardly a typical scenario, though, is it?

My APAP is currently set to minimum pressure of 12, max 20. The old CPAP was set to 12. Therefore, how could the APAP be less effective? The pressure is never less than the old machine, but it is able to use higher pressures in response to a change of conditions. If I have a cold, consume some alcohol, or even have a large, salty meal, it reacts. You can see it in the 90% pressure measurement. Interestingly, salty food actually has more effect than alcohol.

A CPAP would have to be set to the highest pressure ever needed, which is likely to reduce the possibility of compliance. My personal experience is that the APAP is providing far better therapy than the CPAP ever did, with greater comfort, which has resulted in 100% compliance now, as opposed to 50% or less with the old CPAP. What has also helped is the Flex feature, which lowers pressure on exhale, the effect of which is to make it feel like it's using much lower pressure than it is.

I can see the point of a sleep clinic if APAP therapy is not providing the expected improvement. But to do one initially, by default, is wasteful. It would be tantamount to doing a CT scan for every headache - no, let's try Ibuprofen first. 

This is precisely the problem with medicine in the US. A few patients getting money-no-object treatment, while many get nothing.


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## outbound (Dec 3, 2012)

Unfortunately, all to often in medicine what seems true by case report, in the lab or in small uncontrolled study is shown to be false in well designed studies or epidemiological follow up. For instance , over therapy is not without hazard. There is a phenomenon often referred to as emergent centrals. 
Basically, early in therapy central respiratory drive is decreased as therapy decreases CO2. The brain has established a set point for CO2 below which breathing does not occur. Early in therapy there may be an increase in central events. This usually clears if person is fully compliant. In people who are intermittent compliant this may reoccur. I am unaware of firm statistics as to the repetitive occurance of central events in people of APAP or people over treated with CPAP. However, I believe I have seen people, more than once, have improved compliance and improved parameters when converted from APAP to CPAP. I would note I've also seen the reverse. Not uncommonly in suspected binge drinkers and those who crash diet.
In summary I think it's great to have multiple forms of therapy and have endorsed and encouraged their use in appropriate settings. My concern remains the one size fits all approach. People are different. You need to be aware of those differences and respect them with your prescribed therapy treating the whole person. I was delighted when we could offer home testing. I have no issue with auto pap use in appropriate settings. When I left my lab was and continues to increase its serviced population resulting in good lab and personal economics. For me it's an issue of insurance companies dictating care. I continue to believe the patients pathology, psychology, and physiology should dictate care. I continue to believe our knowledge base needs to increase to understand the nuances of appropriate usage of all these therapies.


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## outbound (Dec 3, 2012)

Better example of counterintuitive thinking. There is some evidence to suggest beyond a certain age patients fully compliant to PAP therapy may have INCREASED mortality with a myocardial infarction.
After this surprising report some came to think the repetitive ischemia of apnea produced increased collaterals in the heart explaining the decreased MI mortality when OSA is not treated.
I'm sorry can't recall the citation. Would note risk/benefit clearly supports full effective use in middle age and younger.
Going day sailing. See ya later.


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## outbound (Dec 3, 2012)

Mark
Agree my clinical experience may not be representative. I was blessed to have as my partner a clinician boarded in internal medicine, intensive care and pulmonary medicine,as well as sleep. I'm boarded in sleep, neurology stroke and epidemiology. Between us we covered the general gamut of illnesses seen in association with sleep disorders.
The case presented would be considered fairly mundane on a clinic day.


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## P424 (Feb 13, 2005)

Do it it will change your life in suttle ways but i never sleep without mine now. You wont wake up with enormous energy and it wont help you win the lotto but you will be you not sleepy you and i can drive all day without nodding out and sleep all night without getting up to pee 4 times. Doesnt make you superman unless you are already.


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## RobGallagher (Aug 22, 2001)

I just got my follow up appointment after my in-home sleep study.
In case anyone follows this thread in the future, the results of my sleep study really opened my eyes. I always ass-u-med that I had a few bad bouts of non-breathing per night, and then I slept soundly. Just enough to maybe make me feel tired in the AM but not enough to kill me. Boy was I off the mark, not that it would kill me dead, but it was going on all night, a full eight hours of disrupted sleep.

They had sent me home with an iPhone sized device that measured my heart rate, breathing, and O2 levels. The thing strapped to my chest with simple plastic tubes to my nose and a clip on my finger. Not a big deal.

The results are surprising, I stop breathing for about 25 minutes per 8 hrs of sleep. A few seconds every other minute or so. Although my heart rate stayed pretty stable (I do some running/cardio - maybe that helped), my oxygen levels plummeted and, of course I am not getting 'good' sleep.

We started to discuss types of machines and my main concern was power, as I sleep on my sailboat 3 nights a week in season. Naturally enough, the DR's first question was what kind of boat I had. It seems the good Dr. races on a C&C 33. We talked ended up talking more about sailing than sleep apnea and that was pretty cool. Then he finds out my boat is named Hanuman, he looks at me funny, so I start to explain, he stops me and tells me he's Hindu. 

Someone will call me to discuss what kind of options I have for what contraption they will hook me up to .

Any suggestions? More concerned about 12 volt connectivity than anything else. I did go back and re-read this thread, just wondering if anyone has anything new to add?


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## TakeFive (Oct 22, 2009)

I already said it on this thread, but my sleep tech told me that all of the modern CPAPs run off of 12v. Most run off power bricks, so when you're on the boat just replace that with a 12v adapter and you're home free. Don't bother with an inverter - that's just inefficient.

I've also had problems on three different boats getting the CPAP to start up on 12v, presumably due to voltage loss over long wire runs to the 12v outlet. So having a portable battery dedicated to the CPAP (with a short wire) is a good thing. Since you're a day before Black Friday, I'd recommend heading to Pep Boys or similar for a doorbuster deal on a 12v jump starter. Here's my previous post on the topic:



TakeFive said:


> Above I mentioned that I run my CPAP from a portable jump starter because it struggles to start up when plugged into a 12v outlet. (Hypothesis is that long wire run to the 12v outlet limits its ability to deliver needed amperage to start up the fan.) The device linked below sells at PepBoys for $50, but typically goes on sale for around $20 on Black Friday. Although I had another jump starter already, I decided to pick this one up last Black Friday because I couldn't pass up a good deal (and the other one is >10 years old). It is much lighter than my older jump starter, but still seems to have enough capacity to run for a couple of nights between charges. You might want to keep an eye out for when this goes on sale:
> 
> http://www.pepboys.com/product/details/9912232/00020
> 
> ​


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## Outlaw7 (Nov 21, 2015)

WOW, what great timing! I just purchased a Newport 28 and one of the first things on my list was to set up power for my BIPAP Machine, forgot all about its brick. I suffer from Central Sleep Apnea at the top end of severe. I am 62 and was only recently diagnosed within the last three months. I have used my machine every night and it has made tremendous improvement in my life!


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## Capt Len (Oct 9, 2011)

So I started off with severe central which caused complete heart failure a couple of years ago. Got a Bipap and after a couple of flat lines,doing pretty good. (I'm 73) Now my last sleep test sans machine in hospital last week has me at only 42 events an hour. An event is 10 sec no breath or a 3% drop in blood oxygen .I think the pump is great and runs well on 12 without/or with the humidifier. Size of mask is important for comfort. Avoid the jelly pads and keep the filters clean.So lately the industry is full of panic because of a study showing higher death rates with Bipap than Cpap so doctors are recalling everyone for another look and advice ,probably to avoid a class action against the manufacturers.So call me cynical. But I don't leave home without it.


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## freshsail (Apr 8, 2010)

Glad to see some good discussion and insights to my original post, my wife and I are still using our CPAPs on 12 volt while anchored out and living on on our Saga 43 and only using a handful of amps per day, really no reason not use one on board if you've been diagnosed with sleep apnea....


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## TakeFive (Oct 22, 2009)

I heard a radio commercial about this today. I don't know anything about it, but here's the website for those who might be interested:

https://minicpap.com/


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## Capt Len (Oct 9, 2011)

According to Air Canada you need to notify 48 hrs in advance if you intend to bring aboard as carry on a breathing device whether you intend to use it or not. Not allowed to plug it in to ships power but not so particular about battery Wet cell or lithium ok. I think that just a matter of time before the same batteries that power that fancy burning hover board are in the news .


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## TakeFive (Oct 22, 2009)

Capt Len said:


> According to Air Canada you need to notify 48 hrs in advance if you intend to bring aboard as carry on a breathing device whether you intend to use it or not.


Are you sure that restriction isn't just for oxygen?


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## Capt Len (Oct 9, 2011)

It's on their info web page. I've done several trans Pacific flights and it gets less pleasant each year. They even changed the on board manual to exclude powering med devices sometime while I wasn't looking. But when I mentioned a lithium pack I got a happy nod and the OK .Just a warning to carry wet cells upright.


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