Do I need to see a specialist?

[vcottom]

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?

My wife gets "disgusted" with me when I challenge an DOCTORS words. But when I took a sleep test and scored a AHI of 95 on their fancy 54 connector system, I questioned it. Doc said he had never seen a number so high, but here take these pills. Then when I got the BPAP he ordered, new and still sealed in the box I just could not use it. The two e/i pressure settings were 18 and 22. That might be ok for an old timer using the machine, but this was my first time. I took it in and they said "the doctor sets those numbers and you have to be a doctor to change them!" BS! I called Respritronics and they walked me through changing the pressures.

The sleep test I had was in a bed that smelled like a wet dog had been sleeping in it. Lumpy, noisy, steel coil. The room was cold, and being underground (basement) was far to quiet to sleep in. And way, all considered, the sleep test I had could not of possibly provided good data.

[eviltim]

IMO no need to go out of your way if you are happy with how your treatment is going, but I really love that my doctor (a GP) is incredibly well informed on sleep medicine. In fact I was so impressed with his knowledge and attitude that I dumped my old doc for him after initially only seeing him for the apnea.

[DocWils]

Being one of those guys in white coats (actually I never wear one, much to the consternation of my staff and my superiors, but I always hated it as I do the current fashion of wearing scrubs even if you are not in surgery or in a messy procedure - there is no reason on earth to put on whites unless you need to do something that you need to protect your cloths from or to lend you an air of authority that I really don't need at my age - I've always hated uniforms - I'd probably show up to work in tie-dies, cut off chinos and sandals if I could), I know a lot about how little one speciality knows about another - our training gives us a very good overview of each region of medicine, but it takes years of practice and experience to understand the nuances of many these branches of medicine, and few GPs have enough training to accurately prescribe the right machine and pressure settings for a CPAP. It ain't rocket science, believe me, but it does take experience and knowledge and a good "feel" for what works in each given situation.

That said, the basics can usually be easily understood by a trained physician pretty quickly, because we already have the ground understanding of the subject and know how to read and understand the technical jargon involved, but any GP worth their salt, if they didn't send you to a specialist, would check with one anyway to be sure of the script. We have a lot of quid pro quo in our business, and I certainly benefit from consulting with my colleagues, as do most docs I know. How much sleep specialist consult with one another is something I couldn't say, but it certainly has raised my curiosity, so I may ask around. The problem here in my country on that score is that there are practically no accredited sleep specialists in private practice at all - most work through the hospitals here so there is bound to be a lot of cross consulting, as hospital environments encourage that if only because of proximity. So if that is also true in the US I cannot say.

I would suspect that private practice might encourage a more insular attitude to some sleep specialists, as it does DMEs in the US (here we only have the LungenLega and the hospitals themselves to distribute the devices, and the LL is spectacularly helpful and kind, but they are in the business of being activists for public awareness and treatment of lung problems and government sponsored, to boot, but not OF the government - they remain a private organisation), but I should hope that most are open to questions from their patients. The one thing to remember is that they are very busy people, have seen it all a few thousand times, so make quick judgements a lot, and because they are not in a "caring" branch of the profession, in the sense that they don't deal with nasty and scary areas (to them, at least), bedside manners tend to be, well, let's say, less well developed. Hand holding is not going to be their thing. And that is one of the big reasons for this forum. But they still know their stuff and should, if not over-busy or burned out or having a bad day, give you good advice and good treatment. They don't do this for the big money - there isn't big money in sleep research. But at least it ain't a messy gig. And trust me, there are branches of medicine where you gotta love mess, 'coz there's lots of it.

[cbramsey]

I have asked for (and received) XPAP machines from my primary care physician as well as a sleep medicine specialist.

In 2007, my previous DeVilbiss CPAP died. Luckily, I had a sleep study performed the month prior that verified I still had OSA. My primary care ordered a CPAP machine. I got the machine from the DME but got no instructions on the data capabilities, etc.

In 2011, I was referred to a sleep specialist to see if I still needed CPAP after my weight loss. Turns out I still need the machine. I got my APAP from the DME and they talked about how I needed to bring in my SD card so they could download my data.

I have been using a sleep medicine specialist ever since. Your mileage may vary, but I am sold on the value of visiting 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?

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)

The bottom says REMstar Pro, DOM 460P. Sleepyhead says my machine is a "System One RemStar Pro with C-Flex+ (460P)" Sleepyhead says min pressure is 4 and max is 20.

[bwexler]

Does SleepyHead show a pressure graph with a straight line or a line showing varying pressures?

[SabrinaFaire]

Does SleepyHead show a pressure graph with a straight line or a line showing varying pressures?

Varying pressures.

[RonWessels]

Does SleepyHead show a pressure graph with a straight line or a line showing varying pressures?

Varying pressures.

The REMstar Pro has an Auto-Trial mode which performs as an Auto-CPAP for a maximum of 30 days total. [ This counter is not resettable. ] The duration of the Auto-Trial mode is configurable with a default of 7 days, but cannot exceed the number of total days remaining. Once the Auto-Trial completes, it transitions into CPAP-Check mode which is a fixed-pressure treatment at the 90% pressure point from the Auto-Trial. CPAP-Check mode will automatically increase the pressure setting by 1 cmH2O every 30 hours of treatment if required, up to a maximum of 3 cmH2O above the initial setting.

It was the use of Auto-Trial on my machine that prompted me to buy a real Auto machine as my 30 days came close to expiring.

[SabrinaFaire]

Does SleepyHead show a pressure graph with a straight line or a line showing varying pressures?

Varying pressures.

The REMstar Pro has an Auto-Trial mode which performs as an Auto-CPAP for a maximum of 30 days total. [ This counter is not resettable. ] The duration of the Auto-Trial mode is configurable with a default of 7 days, but cannot exceed the number of total days remaining. Once the Auto-Trial completes, it transitions into CPAP-Check mode which is a fixed-pressure treatment at the 90% pressure point from the Auto-Trial. CPAP-Check mode will automatically increase the pressure setting by 1 cmH2O every 30 hours of treatment if required, up to a maximum of 3 cmH2O above the initial setting.

It was the use of Auto-Trial on my machine that prompted me to buy a real Auto machine as my 30 days came close to expiring.

This would explain why all of a sudden there's a hurricane coming out of my mask.