What kind of doctor should you see for sleep apnea?

[cherylann]

I started out with a pulmonologist. After the first study and several months of no success, he sent me to a "sleep specialist" who switched me from a CPAP to a BIPAP. That didn't work. The last time I was in his office and told him that wasn't working and asked what we did next, he said he didn't know. Out of frustration, I said "So am I just supposed to go home and die?" He shrugged his shoulders and walked out of the exam room. I never went back. I've seen an ENT doctor who is the one who switched me to a full face mask since I am a mouth breather.

This was all with the St. Johns system in Tulsa, but I recently changed primary care doctors and he ordered another study through the OSU Medical sleep center and had me see another ENT who said I have acid reflux (I hiccup a lot and have trouble swallowing). He put me on medication for that.

What kind of doctor should I have managing my apnea?

Does anybody on here live in Tulsa and can you recommend someone?

[zoocrewphoto]

I'm in Seattle, so can't help with actual doctor suggestions, but I can you tell how it worked with me. My primary doctor did a referral for a sleep study and doctor. The sleep study was associated with a nearby hospital, and the doctor was associated with that sleep lab. He is a neurologist and specializes in sleep issue and headaches. He also has sleep apnea himself.

He prescribed an automatic machine that starts out at 11 and goes up to 17 as needed. It sounds like you have had a normal cpap and a bipap, but have you had an auto machine? Maybe you need to have a range of pressures.

[Julie]

Hi - two things might help you - a doctor trained in sleep disorders (preferably a pulmonologist or neurologist), and a machine that lets you follow your progress at home, beyond just giving stats on compliance (for the insurance co.). Do you have a family doctor to help refer you?

You didn't give any indication of what your problems are, but there are many very knowledgable people here who might be able to help - not playing doctor, but with all the issues surrounding OSA and cpap.

[greatunclebill]

my thought is if you are going to doctors you don't like or trust, that you should change primary physicians because he is the one that is sending you to them. the answer is you need to see a good sleep specialist no matter what his specialty is. look for one that is board certified in 2 or 3 things and a sleep specialist.

your quattro fx is in the list of choices. see it in mine? the for her mask is right next to mine in the list.

[JohnBFisher]

Greetings! I am sorry you've had a less than ideal adventure with our healthcare system. Unfortunately, just because a doctor has graduated, it does not mean they graduated at the top of their class.

If someone like you starts to have serious problems, then you probably need to hunt for a board certified sleep specialist. You can use any search engine to search for certified sleep specialist in "location" (changing the location to your home location). For example, "sleep specialist in tulsa" yields answers for you. And to see how other patients rank the doctors in Tulsa area, use the search "reviews of sleep specialist in tulsa". For example, one of the sites might be very helpful:

http://www.healthgrades.com/sleep-medic ... homa/tulsa

And don't be afraid to add your thoughts about doctors. It can help the next patient.

I can not offer specific advice for you, but hopefully this will help you get started.

[Gerryk]

I started out with a sleep doc. I had no success and about four years later my doc told me I had to get on the cpap. He is a respiratory specialist and got involved in treating sleep apnea. Once I was on cpap and using it with many problems, he sent me to an ENT who specialized in sleep apnea and thyroid disorders. I ended up having two surgeries and am successfully on cpap now for a while. Both of my doctors manage my sleep apnea together. They share information on my visits.

[cherylann]

Until I found my current PC doctor, I'd had really rotten luck with doctors here in tulsa. Just assembly line medicine. The challenge with my new PC is that I just don't think he know that much about it.

Somebody said something about dental appliances, so I think that is my next avenue. I'm going to call my dentist tomorrow.

I also like what someone said about a sleep neurologist. What I now know is apnea started right after I was diagnosed with epilepsy three years ago. I thought I was having seizures during the night or having reactions to the seizure medication. My neurologist just kept changing it, but never said anything about apnea. It wasn't until I stopped breathing in the recovery room after having my gallbladder removed that somebody thought of that. Neurologist just brushes me off when I ask if there could be a connection.

[ems]

Until I found my current PC doctor, I'd had really rotten luck with doctors here in tulsa. Just assembly line medicine. The challenge with my new PC is that I just don't think he know that much about it.

Somebody said something about dental appliances, so I think that is my next avenue. I'm going to call my dentist tomorrow.

I also like what someone said about a sleep neurologist. What I now know is apnea started right after I was diagnosed with epilepsy three years ago. I thought I was having seizures during the night or having reactions to the seizure medication. My neurologist just kept changing it, but never said anything about apnea. It wasn't until I stopped breathing in the recovery room after having my gallbladder removed that somebody thought of that. Neurologist just brushes me off when I ask if there could be a connection.

IMHO, your current neurologist is an absolute idiot! If I felt a doctor brushed me off I'd brush him right back in a hurry... especially when you asked such a relevant question.

I'm sure there are good sleep specialists in the Tulsa area. I just read a post here that suggested a good way for you to start finding a competent doctor.

Dental appliances don't work for everyone. Most people who get a dental appliance end up on CPAP anyway, but I guess it never hurts to give it a try.

Best wishes.

[purple]

I also have issues with acid reflux, and now its consequence, Aerophagia, I get air in my stomach, which heads south with everything else.

My latest Sleep Doc, who said he used to teach Internal Medicine (translate that to, Internists have perhaps the highest IQ's of MD's, and teaching in a Medical School is only allowed by the best of the best) gave me me a long description what has been going on in my body for a very long time.

The short version is, He did another titration study, which seemed to suggest I could get by with less pressure (11 straight). He said if I needed 12 or above he would suggest I go to Bi Pap. I have a feeling I would not do real well on Bi Pap.

Moral of this story for you is that I still had some symptoms of GERD (Acid Reflux), and the sleep docs assistant immediately called me on the phone and said he wanted me to see a Gastroentrologist, and they would help me make the appointment.

I actually volunteered that I would find a Gastroentrologist through my Primary Care Physician (my General Practitioner) with the hope I could find someone good that was physically closer to me. I was also stalling until I can get qualified for Medicaid to go with my Medicare. I told PCP, and said I guessed the Gastro guy would want to do an EGD (test where they stick a tube down my throat to take a look see at my esophagus and stomach. PCP said, actually the gastro guy would probably double my dosage of Omeprazole to a prescription strength of twice the OTC dose. Which the PCP could just do.

Pharmacist warned that Omeprazole at that dose caused in some individuals less calcium in the bone, as we need stomach acid to absorb calcium. He suggested that one could Osteporosis by taking Over The Ccounter (OTC), Citracal.

Gerd is lessened in that I have less of that ugly taste in my mouth when I get up. The Aerophagia is still with me though, and I am certain that I am not getting enough O2 with 11 straight.

Pick of this what is useful to you. Well to be more direct, try to start on fixing the GERD. If they are amiable, ask the RT at your DME to help with the issues you have the Bi-Pap treatment. Meaning, often the issues are, from my own experience, I have had problems with leaks and such while I wanted the doc to find a magic, simple change to make this stuff work.

When you say it is not working for you, what exactly do you mean? If you mean you are still foggy headed, then you might try anti-oxidants in food, OTC pills.

[ProfessorEd]

It is hard to find out much about doctors in advance, but among those specializing in sleep, you can usually find what other field they specialized in (often neurology, phonology, or psychology).

If you have problems clearly related to another specialty I wold prefer one who knew that specialty. with an issue related to epilepsy, looking for a neurologist seems wise. I have notice an epilepsy, sleep combination is common probably because handling both involves brain wave measurements.

[cherylann]

thanks, purple.

I am looking for a new neurologist. This doctor won't even give you test results over the phone even is they are negative. You have to make an appointment which coudl take as long as three weeks - time you spend worrying about whether or not something has gone wrong.

When I say it's not working, I mean that I can only tolerate the machine/mask for a couple of hours. The results from those two hours are good and of course the DME gets all exicted because they think that means the therpay is working. But, for the rest of the night, I am not sleeping well, tossing and turning, aware that I am not breathing, but in kind of a stupor and unable to completely wake up and put the mask back on - I don't even realize when I have taken it off. I get up in the morning with a blinding headche, heaving chest, fogginess that doesn't clear for a couple of hours and bedsheets that are a tangled mess!!! Then I'm groggy all day.

[VikingGnome]

I think the specialty of doctor doesn't matter as much as the doctor's willingness to work with the patient to solve their problems. The paternal type that dictates what to do just doesn't fly anymore. The ones that are in and out the door before you can ask a question aren't any good either. You want a doctor that understands the frustrations of sleep apnea treatment and can see you through the hard stuff at the beginning. You also need one that is willing to do decent followup. None of this, seeya in a year business.

[Carrion]

I don't know if this was ever resolved for you, but there are a lot of Doctors in Tulsa dealing with sleep.

Dr. D'Souza is over at Dr. ZZZ's
Dr. Alrabbat over at Southcrest
Dr. Lewis at Oklahoma Heart Institute
Dr. Loveless at Oklahoma Heart Institute

There are many more, but I can't think of them all at the current time. Hopefully you don't need this list and someone has properly taken care of you, but if you haven't seen results yet or are having to still wait, here are a few of the ones I think are good.

[Suddenly Worn Out]

I think it is easier to tell you what kind of doctor you should not see. The ones Ive found who are duds are the ones for whom sleep medicine is merely a sideline of their practice. For example, I have found that quite a few pulmonary specialists, even some who are board certified in sleep medicine, they practice sleep medicine only a percentage of the time. The rest of the time is spent treating traditional pulmonary medicine. Lung diseases of a wide type, asthma, bronchitis, smoker lung, pneumonia. Sleep medicine might comprise 25% of those doctor's focus. And compared to a pneumonia patient or a bad asthma attack, which are very dramatic and can lead to sudden death, lets face it. Sleep medicine is pretty lame compared to treating asthma attacks and pneumonia.

Another kind of doctor Im not enthusiastic about using for sleep medicine are the ones who originally started out as psychiatrists. Even if they went on and got full board certification in sleep medicine, Im leary of using ex psychiatrists as sleep docs. Why? The mindset psychiatrists are trained with. EVERYTHING IS "in your mind." EVERYTHING "is somatic." You dont want that, sleep apnea is a physical illness not a psychological or psychiatric illness. Unfortunately, I believe once a doctor has that "everything is in your mind" mentality that shrinks have pounded into them, there is little hope for them to change. I used one sleep medicine doctor who was actually quite good about keeping up with the sleep medicine gear. However, I noticed he liked to somatize his patients sleep apnea too much. He was originally trained as a psychiatrist and I felt sorry for him as I could tell he liked sleep medicine but could not fully break from the mentality of the mental health profession.

The ones to use are 1) board certified in sleep medicine and 2) all they do is practice sleep medicine. They do nothing but sleep medicine. THOSE are the sleep medicine docs who usually are the more enthusiastic doctors, the ones who keep up with the latest stuff in sleep medicine and are the ones who seem to have more enthusiasm for treating sleep medicine patients.

I have had several duds who were pulmonary specialists who did sleep medicine as a sideline, probably just to make some extra medicine. One I found relied almost entirely on the DME for ALL equipment issues and advice regarding equipment. I fired that guy.

Hopefully as time goes on, more pulmonary specialists will go into sleep medicine 100% of the time and not use sleep medicine as a sideline for easy money. Do not confuse sleep medicine with any psychiatric, psychological or neurological specialty. Most cases of sleep apnea are 100% pulmonary/internal medicine based. Some are a mix of pulmonary and ENT, such as deviated nasal septums and enlarged tonsils and narrowed airways.

My list of sleep docs to use is in this hierarchy:

1) use sleep docs who practice sleep medicine 100% of the time, it is the ONLY thing they do!

2) board certified in sleep medicine, if they are not board certified in sleep, dont use them.

3) pulmonary specialists are probably best for most, with Internal medicine docs being a close second

4) neurologists are probably best if you cant find a good full time pulmonary SM specialist. I think Neurologists are also without a doubt the best for the sleep movement disorders such as RLS, PLMD and narcolepsy. As those are neuro sleep disorders, not related to the lungs or being fat or having a narrowed airway.

5) ENT specialists are not too good because they want to cut on you and there is not a single surgery around that has the "gold standard" efficacy of CPAP. Yet ENTs who do sleep medicine will push sleep apnea surgery, because thats how they make their money.

6) psychiatrists are also not good, even if board certified in sleep med, because of the reasons I laid out above.

Eric

[ughwhatname]

Wow, that's for posting that link. I just checked because I am seeing an ENT who suggested I had apnea. When I went to that site and posted my area, he showed up first! That's comforting.

Greetings! I am sorry you've had a less than ideal adventure with our healthcare system. Unfortunately, just because a doctor has graduated, it does not mean they graduated at the top of their class.

If someone like you starts to have serious problems, then you probably need to hunt for a board certified sleep specialist. You can use any search engine to search for certified sleep specialist in "location" (changing the location to your home location). For example, "sleep specialist in tulsa" yields answers for you. And to see how other patients rank the doctors in Tulsa area, use the search "reviews of sleep specialist in tulsa". For example, one of the sites might be very helpful:

http://www.healthgrades.com/sleep-medic ... homa/tulsa

And don't be afraid to add your thoughts about doctors. It can help the next patient.

I can not offer specific advice for you, but hopefully this will help you get started.