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Ok, so here it goes...

I'm a 32 year old male who is has a fairly high body mass index. I workout and have a body structure that it basically like a bodybuilder/powerlifter. At 6 feet tall even, I weigh roughly around 315-320lbs most of the time, fluctuating at times depending on the time of year. Over the past few years as I've gotten heavier I've noticed that I don't sleep as well. I wake up at times while falling asleep, feeling like I can't get my breath. I feel tired and fatigued at times through the day. I've had a couple of surgeries over the past couple of years and when I've been in recovery they've noted my low O2 count (I told them I'm most likely have undiagnosed sleep apnea prior to these). Simply said, I don't want to live like this anymore. My insurance doesn't cover sleep studies and I don't have the money to go through the process of multiple studies, other appointments, and purchasing equipment. I do have enough money though to buy a cpap and equipment without a Rx. I came across this site and it has emboldened me to do so, so I'm looking for help to take that next step. I'd like to know what model(s) I should look at, etc. I've noted the sleep monitoring software as well and would be using that as feedback as well. Any input/help would be greatly appreciated in the first step of this journey.
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Hi meandeanmachine,

Welcome to the Apnea Board.

For purchasing CPAP machines and equipment without a prescription, you're likely going to be searching on places like Amazon or Cragislist, and areas like those examples. We have a list of Best choice CPAP models that are data capable, which means you not only can see data on the machine's display, but it stores data on an SD card too. You can then insert the SD card into the reader slot on your PC, and in conjunction with, for example, Sleepyhead and Imgur, you create your own machine reports to track what your CPAP therapy looks like. Sleepyhead is highly regarded here as being accurate and easy to use. The same is said of Imgur, with this being used to host your report images for viewing here on Apnea Board.

Now back to machine choices. You could start by reading this:CLICK HERE. A quick sketch is most choose between ResMed and Philips Respironics machines. Both are regarded as the top choices. As is, ResMed seems to work a bit faster if there are automatic pressure adjustments, and Respironics typically needs to be tuned individually a bit more. Either will need some adjustments for you as the individual user. And BTW when that time comes, that's where posting your reports are helpful. Others will give input on helping you get the most from whichever machine and therapy needs you have. Finally, it seems most benefit from starting with an APAP type of machine. The main benefit is that it can be set to help you find your optimal pressure needs.

One last, but very important item, will be your mask choice. Because it touches your face, it must be comfortable. It needs to be able to be adjusted to be as leak-free as possible as well, so getting the proper size also matters. My suggestion is read up on masks from varying companies and searching here on the Apnea Board. One further aspect is that there are 3 configurations called nasal pillow, nasal mask, and full face mask. These are in order of least to most in regards to how much of your face is covered. That least to most facial coverage is important as the larger the area covered, the more area there is to seal and/or leak. OK hope this helps you get started. Ask questions to learn more; that's why we're here.

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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You would want a Auto CPAP with full Data reporting to check yourself with Sleepyhead software. If you could borrow one that would be best. If not I'd looking into either buying a cheap used one or renting one for a week. The problem with buying a new one at this point is you might end up with the wrong machine for your condition. You won't know until you've had some feed back from being on a machine. Here's a link that talks about what to look for in a machine. http://www.apneaboard.com/wiki/index.php...ne_choices
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.

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Be aware that there is a risk of not getting the right machine. The Auto CPAP mentioned above will give us a good idea of which machine would be right for you and is the best machine for about 85% of users. The Sleep Study you are skipping would give good indication of the correct machine.

We would guide you thru self titration using the Auto CPAP and Sleepyhead Software instead of a sleep study. Keep in mind that our recommendation may be to take a sleep study depending on what we see.

Read the links in my signature. a lot of good info there.

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MeanDean, one avenue for you is to discuss your symptoms and concerns with your primary doctor and request a prescription. There is no requirement for a sleep study, and your body build and symptoms are sufficient to recommend auto CPAP therapy. It's easy to circumvent the prescription, but it's a good idea to work with your doctor.

As far as purchasing, I think the best results are usually provided by the Resmed Airsense 10 Autoset (auto-CPAP models 37207, 37208 with heated hose, and 37209 For Her).  It has a faster auto response to breathing obstruction cues like flow limitation and snores, and is best at getting to a therapy pressure before a lot of apnea events occur...can't say that about the Philips Dreamstation.  It is a machine that offers complete data so you can rapidly optimize the therapy pressures and get feedback on the effectiveness of the therapy.  The machine will include a built-in humidifier and will come with tubing and a filter and a nice travel case. You can upgrade to a heated "Climateline" tube for about $40. Do not confuse this with the Resmed Airsense 10 CPAP (37203) which is a fixed pressure machine with no data.

I sometimes see this machine advertised by a distributor on Craigslist for $495.  I know a number of people have purchased machines and masks without problems from this supplier with the phone number 206-965-9995, but you should use a secure payment method like Paypal if you go that route. Any of the online suppliers in the Apneaboard supplier list is a reliable source and offer full services and warranty. Amazon prices are up recently and hard to find, but you can still find machines from the reseller named Sistemma if you search.

Getting a mask is a little harder. I would suggest getting the Resmed Airfit P10 nasal pillow mask. It comes with 3-sizes of nasal pillow and is the simplest and lightest interface on the market. It is reasonably inexpensive. If it later turns out you need a full face mask, then you can move on to a larger and generally more expensive mask. I think it's best to start with the minimal solution first. With machine and mask you are pretty much all set. Re-supply as needed. Once you are setup, the forum can help you get to the best pressure range and become comfortable and adapted. Good luck!
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I guess I would second SleepRider's idea about co-opting your PCP, and for a whole 'nother reason. It's hard to get a mask without a prescription, and you might need to try several before you come up with the right thing. Supplier #1 has a really good setup where there is free return insurance on some masks and an option to buy return insurance on others. This is a great way to get mask needs sorted out. They require a prescription.

The prescription for a mask does not have to be fancy or model-specific.
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If it were me and had no ins. I would start with a secondhand auto with a SD card, or a months trial. This will self adjust to what is going on and what type of apnea you have. More than likely an apap will do all you need to, some cases require another type of machine. For example CA or your weight may be causing a bit of OHS, that may need more than apap. I would be working with a doctor.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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Hi meandeanmachine,
WELCOME! to the forum.!
Good luck as you start your sleep apnea journey.
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Thank you so much for all the initial info and welcome to the board. Sorry for the late response but a stomach bug had me down this week and all I wanted to do was lay down and die. Hopefully today's upswing will continue.

I'll be reading gthrough all the recommendations and options before I make a selection, thank you all for your input and suggestions.

Also, as a note, here are some things I notice when I fall asleep...

I can feel myself stop breathing within the first 30 or so seconds of falling asleep. It also happens in any position I'm in. Directly on my back, left, right, head down/on my stomach. I've read where this is possibly central sleep apnea? Does this effect what machine/therapy I'd seek? Also I can literally feel the muscles in the back of my throat/my tongue relax and cause the blockage at times. When I fall asleep, I tend to just relax and think about opening my airway even wider and this keeps my breathing normal. Obviously I'd say that changes once I fall asleep, but I'm not sure. I just wanted to share these tidbits with you all if it helps gain a view of the bigger picture. I know that obviously nothing is a substitute for actually getting data from using one, but just getting it all out there for any further additional information. Thanks again, everyone.
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Without trying CPAP first, I do n't think you should worry about those sleep transition apnea. They may be obstructive or central, but as the breathing gets handed off to the autonomic system, a few apnea often occur and may cause an arousal since you are still in light sleep. If I nap without air I get startled awake by apnea just as I drift off, and I know those are obstructive. I think you will feel a lot of relief once you add some pressure. Anyway we're not going to concern ourselves with anything but obstructive apnea and hypopnea without evidence that centrals are actually present. The odds are you have simple obstructive apnea and as your throat relaxes you have a transitional apena, so auto CPAP remains a good choice.

You might want to get a quote from Sistemma by phone. This is an Amazon seller, but has direct contact info, and has been a reliable source of very low priced new units.
16631 28th Drive SE
Bothell, Wa
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