Family MD vs. Sleep MD

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Wed Feb 16, 2005 11:28 pm

I would like feedback regarding sleep MD's. I am now being seen by a regular family MD.

Would it be beneficial to see sleep MD? If so how would I go about finding one?

Thanks

Liam1965 · Post by **Liam1965** » Thu Feb 17, 2005 3:19 am

That depends on a whole lot of things, but my gut feeling would be "yes".

Most primary care physicians don't seem to be particularly well versed in sleep disorders.

However... If yours seems to be, and if he/she is managing to be pretty effective, and at the same time your insurance won't cover the specialist, you can probably get away with your current doctor... It's probably not your best move, but sometimes financial factors play in more than we'd like.

Also, I forget (not having slept since the glaciers receded... or my hairline) what machine you're on. If you have the APAP and all of the software, and are actively managing your own treatment, then maybe you can skip the sleep doc.

But most importantly, I guess, is whether you feel you're making significant progress. If you are, maybe staying the course is fine. If you feel like you're not getting anywhere, see the specialist.

Liam, whose last name is "Washy". Can you guess his middle?

Mikesus · Post by **Mikesus** » Thu Feb 17, 2005 6:36 am

I would say it depends... I have both, but the one would requested the study was my family doc, and he is also the one that wrote the rx for the cpap. I think the qualifier is, are you getting the proper treatment? If you have an auto with a family doc and the range is set right, I don't personally feel the need to see the sleep doc. If I had a single set cpap was having difficulties I would definately be seeing my sleep doc.

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Thu Feb 17, 2005 9:11 am

I have a Remstar Auto w C-Flex--the John Deere of CPAPs. Anyway, I'm getting rid of my MD. My old MD, the one from Canada was "let go" from the clinic. Remember he is the one who spent too much time with his patients....I wrote about this in an earlier thread.

I'm not sure what he is going to do as far as a new job or where. I just can't go on with this uncaring, insensitive MD I have now. I have another MD in mind who I have worked with and have heard wonderful things about concerning his character. He also is affiliated with Mayo.

I was just wondering how many of us actually have sleep MDs that they are working with to manage things. I need to buy the software, but can't afford it right now.

chrisp · Post by **chrisp** » Thu Feb 17, 2005 9:37 am

I was sent to the sleep clinic by my GP. He also wrote the Rx for an Auto unit. He was a cpaper himself. This was 3 years ago. My Gp has since moved on.
I recently went to 2 different Pulminary /sleep specialists. Showed them the data from my auto . They were clueless. One just wanted me to be on 11 plain]. The other just nodded looking at my graphs.

Its a crap shoot. Shop around and hope for the best.

Cheers,

Chris

gailzee · Post by **gailzee** » Thu Feb 17, 2005 11:09 am

My GP while great for managing other health issues, outright admitted that in med school, sleep disturbances, etc.were laughed at. The sleep doc (pulmonary/allergist) handed me off to the RT, who was busy, and he just called over his shoulder, SEE YOU IN 3 mos. So that was my input from him. To give them both their due, they are both very busy, but hey, "we're patients" too, and paying the bills to them to boot!

If you find one that even seems 1/2 way interested, let alone knowledgeable, LET US KNOW.

Today, it's all about, billing, insurance, and how fast can they get away from a person. It's called managed care, here in the US.

I'd call it something else, but I'll let Liam do that for me.

Good luck with whomever you choose, and let us know, ok?

hhunt wrote:I would like feedback regarding sleep MD's. I am now being seen by a regular family MD.

Would it be beneficial to see sleep MD? If so how would I go about finding one?

Thanks

Dave Hargett · Post by **Dave Hargett** » Fri Feb 18, 2005 1:00 am

The average medical school student in 4 years of med school gets 2 hours of training in sleep medicine -- if he/she didn't sleep through that class!

Most primary physicians don't get exposed to sleep issues till they hit the real world and because they don't have the background, they don't pick up sleep issues in the context of real life.

My personal opinion is that if you have SEVERE sleep apnea you should have a sleep specialist on your medical team. If you have a heart issue, you most likely see a cardiologist, right? Why not have a sleep specialist, then, if sleep apnea is a major health issue for you.

In an ideal world (according to me), you would:

see a sleep specialist before you have a sleep study
get the results of your sleep study from the specialist
consult with the specialist on your treatment options
assuming PAP therapy:
have a one month follow up appointment to resolve immediate problems
follow up at 3 months
follow up at 6 more months
annual office visits after that
consultation at other times if something unusual occurs.

I've followed this process and found it very beneficial.

While I was sure it wouldn't make much difference, I went to see the sleep doc for a special follow up about 6 weeks after my bypass surgery, just to be sure he knew about it, one, and to see if I needed to take any special precautions, two.

Certainly you would see the specialist if you had recurring symptoms, major weight gain, etc.

In this scenario it helps if that physician is in your PPO network and you can visit without a referral.

This gets more difficult within an HMO system.

If you have mild to moderate apnea, perhaps your family physician can care for you, but too often I hear of a primary doc writing a prescription for the CPAP and never, ever asking the patient about it again - or even whether the patient's sleep is better.

I strongly advocate that apnea patients talk to their primary doctors about their apnea and their therapy. Let them know the successes as much as the problems. We want them to begin to recognize and treat apnea in their other patients as well. Then they may be able to at least help you manage your situation.

Over the years I've managed to train my primary (a family practioner) about apnea. I know he's told nurses to watch patients at night in the hospital (and the nurse called him panicked at how long the guy quit breathing). Once while he was training a medical student (who did my exam on a non-sleep issue and came up with the treatment), this doc leaned back and said, "I've got a patient on bi-pap who I can't motivate. What can you tell me to help him out?" You should have seen the jaw drop on the medical student!

I've also managed to train my cardiologist a little bit at a time -- it's hard to talk about apnea while you're on the treadmill going 90 miles per hour! I know he has begun to order some sleep studies that he never would have before he met me.

So each of us can have a major impact on getting apnea diagnosed in others if we all work at educating and training our own personal physicians.

Dave

MartiniLover · Post by **MartiniLover** » Fri Feb 18, 2005 3:29 pm

I belong to an HMO.

My primary care doctor ordered the initial test after a Rumitologist recommended to him, that I have one.

After the initial test, he was very honest in saying it "looks like you have a problem" and sent me to a specialist.

The specialist is a lung specialist, and does sleep studies regularly.

I saw him, he sent be back for the second step, and two days later I had a CPAP machine. I tried that for three months. After complaining during a check up about keeping the mask on at night, he sent me back for a BiPap test and the next day I had a BiPap machine.

I love it.

I still had problems keeping the mask on longer than 3-4 hours and during a check-up he gave me this wisdom. "GET OVER IT! YOU NEED TO KEEP THE MASK ON."

From that day on, I got over it and kept the mask on. I now regularly sleep 8 plus hours a night with the BiPap, and keep the mask on.

I have woke up in the night, and had a little discomfort from the Nasal Aire II, with it bothering me, so I got another regular type mask and I will switch it in the middle of the night if need be. I have been on a machine now for about six months.

I take Allegra, I use Flonase, and if needed I use Ipratropium to keep my nose dried up. I use a humidifier always. I also take Mirapex Tabs for my leg movements, which was waking up. All of these scripts written by my Sleep Specialist.

I know people bad mouth HMO's, but I have been using the same one for almost twenty years and am very satisfied with having a primary care doctor, and a specialist whenever I need one. My doctor is very agreeable to sending me when I have a question that is beyond the norm.

Get a Specialist, and don't be afraid to ask questions of them, and at the first sign them not being forthright with you, find another. I have done that also.

RubyKat · Post by **RubyKat** » Sat Feb 19, 2005 7:12 am

I am very happy with both my GP and my sleep specialist. Basically, he figured I should have a sleep study, referred me to the sleep specialist, and she referred me to the hospital for the study. Both of them are very good at listening and being encouraging (especially the sleep specialist!) There was a lot of follow-up with the DME too -- for about a month after I got the CPAP, I was supposed keep a sleep diary, and ring him up once a week and say how I'd been doing, and ask him questions. He passed the info onto my sleep specialist. It helps that he's also a hose-head himself! And, yes, my sleep specialist went over my sleep study results with me, and gave me a copy to take home with me.

After hearing some of the horror stories on this forum, I am doubly grateful.

loonlvr · Post by **loonlvr** » Sat Feb 19, 2005 12:52 pm

You got the good machine huh? yippee!!!!!!!! I was sent to a sleep doc by my reg doc. I didn t know much about the machines. He gave me the reg straight pressure machine. After 15 months I was tired of the mask leaks and not knowing how I was doing. So I requested an auto from my sleep doc. He flatly refused. So i went to my reg doc who listened to me and wrote the prescrpition. Its great knowing whats going on. Save your milk money and soon you will be able to afford the software. Well worth it

VancouverBreeze · Post by **VancouverBreeze** » Sun Feb 20, 2005 1:50 am

Hi Everyone,

I just wanted to add my two cents to this, especially if anyone is in the Vancouver BC area and wondering what to do.

I was referred by my GP (who 'diagnosed' my apnea based on my swollen tonsils and the symptoms I was experiencing. (He'll stay in my good books for that one forever!)

He referred me to a Ear Nose Throat specialist, who in turn referred me to a sleep specialist at the University of British Columbia Hospital Sleep Disorders test. That wait list was 6 months to get an initial consultation, and my sleep study was scheduled about one week after that.

After the sleep study, I had a consultation with the sleep doctor, went over the results in good detail, and he emphasized the important of treatment, managed my expectations, and 'primed' me to adapt to the CPAP. He also referred me to a company who's Respiratory Therapist has been absolutely wonderful. Helpful, supportive, responsive, and professional.

I will have a 3 month follow-up visit with the RT soon, followed by a meeting with my sleep doctor. If I knew it were appropriate, I'd freely post the names of the individuals involved in what I consider to be great care!(ok, aside from the 6 month wait to get in the sleep lab...yes that is somewhat ridiculous...but trade-offs must be made....O)

If you are in the lower mainland and want more information, let me know. You can email me at darren24_74 at yahoo .spammers leave me alone! . com

(please read between the junk, trying to avoid the spam, feel free to send me a message if you want the names)

Darren

Family MD vs. Sleep MD

Family MD vs. Sleep MD

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Re: Family MD vs. Sleep MD

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