CPAP Machines on Shabbos/Yom Tov

Medical research into sleep apnea and what it can be responsible for is established and continuing to develop. Sleep apnea can cause:

• Heart arrhythmias
• Heart failure
• High blood pressure
• Stroke
• Depression
• Hyperactivity

The use of CPAP (or these days APAP machines) is now widespread and the relief that the devices provide is real, including:

• Restoration of normal sleep patterns.
• Greater alertness and less daytime sleepiness.
• Less anxiety and depression and better mood.
• Improvements in work productivity.
• Better concentration and memory.
• Patients’ bed partners also report improvement in their own sleep when their mates use CPAP, even though objective sleep tests showed no real difference in the partners’ sleep quality.

Current machines are turned on by pressing a button and then “wait” for you to start breathing. Once you breathe, air is pumped into you (at a pre-set measured level depending on whether you are moderately or severely impaired) and this keeps a flap open so that the air you breathe during the night is unobstructed. The obstruction is also one cause of snoring. The machines are relatively quiet.  Some machines build up to the required pressure gradually. There is an LCD or LED style readout on the machine that is activated once it is turned on. There is no “visible” fire/filament. Some patients also use a humidifier which is attached to the machine. This warms and wets the pumped air in patients who are unable to breathe through their nose, and whose mouths become dry and irritated as a result.

Can these machines be used on Shabbos/Yom Tov? Let’s note first that the accepted opinion is that of R’ Shlomo Zalman Auerbach ז’ל that Electricity is forbidden מדרבנן unless there is flame involved (or filament, as opposed to incandescence). The Chazon Ish isn’t disregarded, but his opinion that all electricity is forbidden דאורייתא is not followed when it comes to medical issues.

What about the status of the patient? Is he (most patients are men 40+) a חולה at the time he is using the machine? What type of חולה is he? Is he a חולה שיש בו סכנה or שאין בו סכנה?   Is he considered “sick all over”, that is חולה של כל הגוף? Perhaps he is a ספק סכנה? The answer to these questions will probably depend on the severity of the apnea. For example, it might be questionable if the patient was only “mild” as opposed to moderate or severe. On such matters, one needs to consult with experts, that is, Doctors. Preferably, one should see a Sleep Physician.

Using a shabbos clock doesn’t really help. It can’t turn on the machine. Furthermore, many machines turn off automatically anyway if left on.

I am pretty sure that if you asked a Brisker Posek, they would tell you that there was no שאלה and to go ahead and use it. There is a tradition from R’ Chaim Volozhiner through to R’ Chaim Brisker, the Griz and the Rav, that the Brisker way is to be מחמיר when it comes to looking after health and avoiding illness. There are many stories told in this regard. One that comes to mind was R’ Chaim making his eldest son R’ Moshe Soloveitchik (the father of the Rav) absolutely swear that he would never ever be מחמיר on issues of סכנת נפשות or ספק סכנת נפשות. Only after R’ Moshe did that, was he given permission from his father to take up his first Rabbonus.

There have been a few articles written on this topic. R’ Moshe Heineman (who was close to R’ Moshe Feinstein) from the Star K, is lenient, see here. See the opinion of R’ Halperin and R’ Prof. Abraham over here and here who are also lenient.

One is required to turn on the machine with a שינוי (change) to minimise any infraction. [I also think one could consider getting two people to turn it on together].

I rang R’ Hershel Schachter to ask his opinion. He stated that if there is no choice but to use such a machine, then what can one do. He quoted the שולחן ערוך of the Baal HaTanya  who is lenient in Dinim of a חולה and said that this opinion is defended by the אגלי טל from Sochatchow (the Kotzker Rebbe’s son-in-law). He also suggested turning it on with a Shinui.

Some might argue that “what is one night” although this year we know it can be three nights as it is this evening. It seems that the Poskim are wary about interrupting medical treatment and consider such interruptions as contributing cumulatively to the danger (סכנה).

I haven’t considered the issue of the humidifier and whether it boils the water to יד סולדת and if there are ramifications thereby.

Does anyone out there know of other Psakim?

Disclaimer: The above is not L’Halacha and not L’Maaseh. Ask your own Rabbi for advice if you have an issue.

Author: pitputim

I've enjoyed being a computer science professor in Melbourne, Australia, as well as band leader/singer for the Schnapps Band over many years. My high schooling was in Chabad and I continued at Yeshivat Kerem B'Yavneh in Israel and later in life at Machon L'Hora'ah, Yeshivas Halichos Olam. View all posts by pitputim