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Flying With a CPAP, Insulin, or a Wheelchair: The Med-Device Rules Airports Hide

Nobody at the check-in desk volunteers that your CPAP doesn't count as carry-on. I learned the med-device rules the slow, stressful way so you don't have to.

The first time I flew with a CPAP machine I nearly paid for an extra bag I didn’t need, because nobody at the desk told me the rule. So let’s get the flying with a CPAP machine medical device rules sorted properly, the stuff airports very much do not advertise.

I’ve now flown with a CPAP across about a dozen countries, sat next to my mum and her insulin, and pushed more than one borrowed airport wheelchair. Here’s what actually works.

Here’s the big one, and it’s true on basically every major airline I’ve ever checked. Approved medical devices do not count toward your carry-on allowance. Your CPAP, your nebulizer, your portable oxygen concentrator — they ride as an extra item, on top of your normal cabin bag and personal item. Free.

But — and this is the catch — nobody offers you this. You have to say it. At the gate, at the desk, wherever, the magic phrase is: “This is a medical device, it doesn’t count toward my carry-on.” Nine times out of ten they nod and wave you through. The one time they don’t, ask politely for a supervisor, because the policy is almost certainly on their own website.

Pack the CPAP in its own bag, ideally a clear-ish one or its proper case. At security, take it out and put it in its own tray, same as a laptop. They may swab it for residue. That’s normal, takes thirty seconds, don’t panic.

Medications go in your hand luggage. Always. Full stop. Hold bags get lost, frozen, or delayed, and you cannot afford for your insulin to be on a carousel in a different city.

For liquids — insulin, liquid meds — you’re exempt from the silly 100ml limit when it’s medically necessary. You can bring more than 100ml. But declare it at security, have it accessible, and don’t bury it under your shoes.

The doctor’s note. Get one. It doesn’t need to be fancy — a letter on the practice’s letterhead stating you have a medical condition requiring [device/medication], listing what you’re carrying, signed and dated. This is what smooths over the rare suspicious security officer who eyes your needles, your syringes, your liquid vials. I’ve been asked for it exactly twice in years of travel, but both times it turned a tense moment into a non-event. Worth the five-minute ask at your next appointment.

For anything with needles — insulin pens, syringes, EpiPens — carry them in original, labelled pharmacy packaging if you can. The label matching the note is what makes it obviously legit.

This is the one that trips people up and the answer is so much simpler than people think. Forget ice packs — they melt, they leak, and security gives them the side-eye.

Get an evaporative cooling pouch (the Frio brand is the one everyone uses, around $25–35 depending on size). You soak it in cold water for a few minutes, the crystals inside activate, and it keeps insulin cool for days through evaporation alone. No fridge, no ice, no power. I cannot oversell how much stress this removes. You re-soak it every couple of days and it just keeps going.

On the plane, do not put insulin in the checked hold — the cargo area can freeze, and frozen insulin is ruined insulin. Cabin only, in the pouch, in your bag at your feet.

Crossing time zones with a dosing schedule is its own thing and genuinely a doctor conversation, not a blog one — but the cold-chain part is fully solved by that little pouch.

Mobility aids fly free too, and they don’t count against any allowance. A few things I’ve learned helping family and friends:

Pre-book the assistance. Call the airline (or tick the box online) at least 48 hours ahead and request wheelchair assistance or note that you’re travelling with your own chair. This puts it in the system so someone’s actually expecting you, rather than you flagging a stranger at a desk.

Your own wheelchair is gate-checked, not hold-checked, where possible. You ride it right to the aircraft door, then it’s taken below and brought back to the door on arrival — so you’re not stranded waiting at baggage claim. Insist on gate delivery; ask for it specifically.

Tag it and photograph it. Wheelchairs do get damaged in transit, sadly. Photograph yours before handover, remove or secure detachable bits (cushions, joysticks, footplates) and carry the fragile ones on, and write your contact details on a luggage tag attached to the frame.

Powered chairs need battery paperwork. Lithium-battery wheelchairs have specific rules and the airline will want details ahead of time. Sort this on that same pre-booking call, not at the gate.

• Doctor’s note printed and on my phone.
• Meds and insulin in the carry-on, in labelled packaging, cooling pouch soaked.
• CPAP in its case with a copy of the airline medical-device policy saved.
• Assistance pre-booked if it’s needed, confirmation number written down.
• A spare day’s worth of everything, in case of a delay or a missed connection. Always pack for the trip going sideways.

None of this is hard once you know it. The whole problem is that airports lean on you not knowing — the free allowances, the liquid exemptions, the gate delivery, you have to claim them out loud.

Say the words “medical device,” carry what you can’t replace, soak the cooling pouch, and pre-book the help. Your gear has more rights at that airport than the desk will ever volunteer — use them.

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