Not Yet Started - Any Advice?

Apparently I have very severe sleep apnea (score over 100) that is mediated with CPAP use at average presure of 11. I travel a lot. This is brand new to me. I am not concerned with budget - any recommendations/warnings on equipment selection, use, mental and physical adjustment. Are alternatives really viable == like the oral appliances? Is a nose pillow less obtrusive than a face mask -- any downside? Thanks for any feedback.
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Welcome to the forum.

Here is some good information to start with. You want a FULL data machine and not just data that amounts to how many hours you use the machine.
Data capable machines.http://maskarrayed.wordpress.com/
What to know before meeting with DME..http://maskarrayed.wordpress.com/what-y ... me-part-i/

Unless you have some sort of major physical problem preventing you from breathing through your nose easily, I would suggest starting mask be a nasal pillow mask (link for the one I use is in my profile) because it simply has less surface to have to worry about sealing. Easier to control the leaks. Less on your face and more comfortable.

Mask choice and preference is highly personal. What I might hate, you might love or the other way around.
There are pros and cons to all masks.

If you absolutely cannot breathe through your nose (even during daytime) then you might as well start with a Full face mask. Full face mask being one that covers the nose and mouth at the same time.

Some people do have some success with oral appliances but not a huge number do and of those that do their OSA might have been much more mild in their OSA scores. With over a 100....that would be a huge hurdle to overcome.

There is some adjustment both physical and mental. Some take to all this real easy and some it is a huge bump in the road. Attitude plays a part in adjustment.

Traveling is easy with the machines. They aren't large (about the size of a large novel) and it really is a non issue anymore. If you are in a position to get a back up machine you can do like I do...have it always in its case for travel and then I don't have to mess with taking things apart on the machine I use nightly.
Though it really isn't that big of a deal.

Read, read and read some more. It takes a while to absorb all this new information.

What Pugsy said.

First I want to second/third the need to read Janknit's blog entries:

• What you need to know before you meet your DME
  Data capable machines.

You might also find my blog entries useful:

• Advice for the newly diagnosed
  Understanding the data in your sleep test

Finally, as pugsy points out: Masks are like a pair of shoes. What fits and works for me might never work for you and vice versa. Also like finding a pair of really great fitting shoes, finding the right mask can require trying on a large number of masks. Unlike shoe shopping, you'll want to be able to try each mask out at home in your own bed all night long while you're sleeping. Funny things happen to some of our faces when we're asleep: the muscles relax and a mask that fit really well when we first laid down can then spring all sorts of annoying leaks.

Welcome to the board.

CPAP is the "gold standard." Oral appliances rarely work that well, and are often expensive. Surgery often works poorly, if at all, and you often still need CPAP later even if it does work. Be really careful about surgery. There are lots of chop happy surgeons ready to butcher you. Surgery often has bad side effects.

Read the links listed above.

1) Your DME (CPAP salesman) will probably try to screw you by giving you a less capable machine. With insurance, a good machine will probably cost no more than a less capable one. The DME makes less money on the good machine.

If it's midnight and a DME tells you it's dark outside, go and check for yourself.

2) Find out who the authorized "in network" DMEs are for your insurance. Shop around for one that will give you a good machine. Use this as leverage to get the DME to behave.

3) Don't let them give you a full face mask until you tried one that doesn't cover your mouth. You may need a full face mask if you mouth breathe, but a "nasal" mask is much easier to live with if you can avoid mouth breathing. (Mouth breathing is when you let air leak out of your mouth.) You should be able to exchange at least one mask for a different type in the first 30 days.

4) Most DMEs and "sleep" doctors are incompetent on CPAP therapy. They're working in the world of ten years ago when you got a sleep test, slapped on a CPAP, and didn't check the user's progress for a few years unless he had big problems. Modern CPAP machines record an enormous amount of useful information every night that can really help treatment.

If you have apnea, this is still a lot better than not treating it. Life and death better than not treating it in many cases. Unfortunately, you will probably have to do a lot of the legwork yourself to really do it right and get the full benefit of your therapy.

Come on archangel...don't hold back...tell us how you really feel!

FYI: I have it on good authority that Archangle does not eat puppy burritos.

archangle wrote:Welcome to the board.

3) Don't let them give you a full face mask until you tried one that doesn't cover your mouth. You may need a full face mask if you mouth breathe, but a "nasal" mask is much easier to live with if you can avoid mouth breathing. (Mouth breathing is when you let air leak out of your mouth.) You should be able to exchange at least one mask for a different type in the first 30 days.

And welcome from me too. I second this very important point. If you can use a nasal mask (after reading what others are using) it seems to be the easiest to fit and keep clean; in my opinion.

I'll add...
5. Get a humidifier with the machine (most come with them attached) because it makes a big difference for most people and while you are at it get a hose cosy to cover the hose.

I'll leave others to answer to questions you asked. I see they have done a good job. My advice is to problem solve, if needed , on the forum so that you can use the machine all night, every night, and naps from day one. Only then will you see benefits. Take it with you traveling. Since price is no consideration you might want to buy a second smaller, less expensive machine (assuming you want a cadillac for home) to take traveling. An extra mask and hose for home use is a good idea. Some of us take to the machine like a duck to water, I did, while others have some problems. I will say that I'm a mouth breather and love my Fit Life Total Face Mask. I also liked the FFM, but they caused breakdown on the bridge of my nose. Whatever works for you- will probably take some experimentation. Keep us posted. Good luck.