Do I need to see a specialist?

[SabrinaFaire]

My regular doctor sent me for the sleep study and prescribed everything. Is that OK or should I go see a specialist for sleep apnea? And if so, what kind of doctor would I see?

[bwexler]

SabrinaFaire you are asking the question a bit late.
You needed to ask before you received your equipment.
Now you are probably stuck with what you have unless you develop complex Apnea or some other problem.
Finding a "good" sleep doctor is not easy. My approach is to get the data from my machine, ask questions here. Come up with a plan of action and TELL my primary doctor what i want him to do. As long as he cooperates, I consider him a good doctor. If the doc does not cooperate, he used to be my doctor.

[sir_sleeps_alot]

The sleep study that you had was reviewed by a sleep specialist and the results and recommendations were given to your doc.

Are you having a problem with your cpap that you and your primary care doctor cannot work out? Have you been on cpap for a significant amount of time without improvement?

If either answer is yes, then you might benefit from seeing a sleep specialist. Otherwise, I wouldn't worry about.

The only reason I saw a sleep specialist was because my health insurer requires it before a sleep study will be covered. I drove 30 minutes and waited around in the office to see the doc for five minutes, during which he said I ought to have a sleep study. It was a waste of time and money. I saw the nurse practitioner after the study to "get my results" -- that was another 30 minute drive and more waiting around at the office. She spent less than 5 minutes with me and pretty much just told me that I needed a cpap. Another waste of time and money!

Apparently, it is up to the respiratory therapist at the DME company to decide which machine is best for you, not the sleep specialist. Very odd.

Hope things are going well for you.

Sid

My regular doctor sent me for the sleep study and prescribed everything. Is that OK or should I go see a specialist for sleep apnea? And if so, what kind of doctor would I see?

[PaulaO2]

Pft. No, a sleep doc isn't necessary, in my opinion. The doc (of whatever variety or flavor) went by what the sleep report says. The sleep report would say "displayed signs of X" or "all signs of X were nominal", "apnea events of Y type were Z in number at pressure W and M in number at pressure Q" or whatever. Your doctor then prescribed the equipment based on the report which, duh, is what the sleep doc would have done. You then would have seen that sleep doc again in 3 months (maybe) and the in a year (maybe) and once a year after that (doubtful). Your GP has seen you for how long? And will see you again when? Your GP sees the entire picture that is you.

It is the sleep study that is the most important thing, not the doctor the acts on it.

Watch your data. Talk to your doctor about your data. Understand, with your doctor, what your data is doing. That's the best any of us can hope for.

[DocWils]

Paula, you couldn't be more wrong. You have to know what you are doing, and most GPs don't have the training to make a machine recommendation on this. Heck, I've been doing this since the dinosaurs, and I didn't know a thing about CPAP until I had to get one (and then I read up on it REAL fast). There is no way I could have written a prescription for a CPAP with correct pressure settings or anything else based on a data only report. On the other hand, if, like Sid suggests, the sleep lab sent a report and recommendations of machine type and settings, then I would have gone along with this and written out the script (here it would not have been valid - the LL only gives out machines for scripts from recognised specialists or institutions - GPs cannot write the script for the machine).

Sabrina, I suggest that if you are not sure to be happy with how things went procedure wise, ask your doc how he chose to prescribe that particular machine and setting for you. Most likely, unless he has a lot of experience in this area, he did it based on the sleep lab's recommendations, and maybe he made a few phone calls as well to specialists for their opinion.

[SabrinaFaire]

I haven't been unhappy, I was just curious if it would be better to see a specialist.

[DocWils]

How are your readings? Do you get a good AHI (5.0 or below)? Do you have a stable leak rate? Are the numbers for the various types of SA decent? And most improtantly, do you fell better rested and less sleepy in the day?

[PaulaO2]

I don't see why a sleep doc is needed. I have seen mine a grand total of 3 times in 8 yrs. The first time, yeah, maybe he was useful because I had major CPAP induced Central events. We started at 8. He then upped the pressure by two points 3 months later. Did not look at any data in between. Has never looked at any data other than an overnight oximeter data done at home done four years later. Based on that alone, he upped the pressure by another two points. Never did any followup to ensure it worked. In all that time, has never looked at any data from my machine, has never recommended another sleep study, has never recommended any kind of follow up.

How many members do we have come here that has said almost the same thing? How much do we stress "increase your pressure in short increments, half a point at a time" yet docs regularly jump 2 points or more yet never look at any data?

Any doctor worth any degree on their wall could have done what little he has done. My GP was appalled when I said I got a data capable machine. She didn't realize non-data machines existed. She was further appalled when I told her that the sleep doc has never looked at the data and most never do. "Then what good are they?"

So I stand by my original statement: unless you have a complicated case, sleep doctors are not necessary.

I admire you for your code of ethics, DocWils, but you are by far the minority.

[zonk]

My regular doctor sent me for the sleep study and prescribed everything. Is that OK or should I go see a specialist for sleep apnea? And if so, what kind of doctor would I see?

It won't hurt to see the specialist so he/she can go through sleep study reports and the SD card data

your doctor may have a list of accredited sleep doctors in your area or you can find one here
http://www.sleepeducation.com/find-a-center

Which machine are you using? Your profile shows
Machine: Phillips Respironics 460P System One
CPAP Pressure: 4 - 20

460 is fixed pressure machine and 4-20 indicate an auto-PAP (560)

[me50]

I took detailed reports from my DME and pointed out to the sleep doctor that 95% of the time, as indicated in the reports, that my pressure was at the max level. He told me "we don't know how the software calculates it and that it means that 95% of the time you are at or below the pressure settings. What he did not do was look at the graph the DME provided which shows that I am at the max pressure just about all the time. He pretty much ignored every question I had for him. Also failed to listen to me when I tried to tell him how I feel each day after waking up. This is just a few examples of what he said/did. And to think he was nominated as a top doc in the state.

I am now waiting on my records, went to the hospital and got all of my records from medical records pertaining to both of my sleep studies and will find another doctor. while I feel better with a sleep specialist, not all of them are good.

I have seen some internal med docs that knew more than some sleep specialists. My internal med doc who I chose as my primary doc because of being an internal med doc, claimed not to know how to order tests to check for gastro issues.

Excluding the fact that some sleep docs don't look at the data as they should, don't answer patient questions, etc., I still prefer a sleep doc IF there is one that does what they are supposed to do. It is a personal preference I suppose. But, that is why we have PPO insurance rather than HMO so it is easier to go for 2nd opinions.