Obstructive sleep apnea is a common chronic illness, for which positive airway pressure remains the best treatment. Optimizing patient adherence to this treatment is often challenging. Controversies remain regarding the optimal strategy for initiating treatment, and whether the choice of specific positive airway pressure modality is important. Increasingly, treatment may be started using an auto-titrating machine without in-laboratory titration. Recent advances in technology permit monitoring of patient compliance and efficacy, but have not proven to necessarily improve outcomes.