I was diagnosed with sleep apnea in 2000 and have used a CPAP since then.
Since using my CPAP, I have not had the experience of feeling a lot more alert during the day. Everyone told me I was going to feel a lot better, but the only thing I noticed is that I don't wake up during the night as much. The initial doctor who sent me for the sleep study was an ear, nose and throat doctor, and my pcp wrote prescriptions for me to get new masks, etc.
I have recently begun to feel much more tired during the day, so thought I'd go directly to a sleep specialist who is a neurologist. When I made the appointment they told me the doctor himself wasn't available, but another person who had a certification in sleep disorders and a Phd, I believe, could see me, so i said OK.
I spoke with him April 28th and he told me I needed a new sleep study done, since I hadn't had one in about 4 years, so I did that on May 15th. The doctor didn't have an available appointment until June 30th (to get the results), partly because I told them I wanted to see the actual doctor, because I didn't want to have to go back AGAIN if they decide I need some kind of medication, since the doctor would have to write a prescription.
I got a call from the doctor's office Friday stating that the doctor won't be able to see me after all, because he has to go out of town on business (unexpectedly), but that I could see the nurse practitioner or PA. I told them I wanted to see the doctor. Well, he doesn't have another available appointment until the end of July, and I need help NOW. I didn't think this whole thing was going to take over 3 months to figure out when I started it, not to mention a $40 copay for each visit, including the sleep study.
I'm trying to find another doctor who can help me, but I don't know if I should see an ear, nose and throat doctor who specializes in sleep apnea or a neurologist, or what?
Any suggestions, advice, comments would be very appreciated; I'm feeling very frustrated!
Dana B. in Houston, TX
Best Doctor to Manage Sleep Apnea?
Best Doctor to Manage Sleep Apnea?
Dana B in Houston TX
Re: Best Doctor to Manage Sleep Apnea?
I see a pulmonologist for asthma, and he happens to be a sleep doc, so that was an easy decision. I also see an ENT for sinus and ear problems, and although both are good docs, I much prefer my pulmonologist to the ENT for sleep issues.
_________________
| Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: CPAP 6/5/2009, Rx: 11-16, OSCAR |
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twasbrillig
- Posts: 76
- Joined: Fri May 30, 2008 1:39 pm
Re: Best Doctor to Manage Sleep Apnea?
Would it be too hard to go to the appointment with the PA or nurse practitioner, and then see the doctor later if things don't seem right?
First of all, if the doctor were to adjust your CPAP pressure based on your new sleep study results, he or she would want you to try it out before deciding anything more (like whether you need meds) The sleep study is really just a beginning point for further adjustments that need to be made based on how you respond. You want to make sure your treatment is optimal, that is, it's really getting your AHI down as low as possible. Sounds like maybe that was not done before?
One thing you will learn from this site is that almost everyone has to go through adjustments to CPAP to get their treatment right. Masks, pressures, comfort features, etc. CPAP machines now come with data recording features, too, so you can see exactly how you are doing from night to night.
It's been over a year since I was diagnosed, have had four different sleep doctors and three titration studies. I have had three different masks, and have learned how to adjust my own machine (which isn't data capable) and I am expecting to do more adjustment. Whew! Makes me tired thinking about it.
But your health is really important. You need to give yourself the time with your doctors, working through the issues, in order to get WHAT YOU NEED.
First of all, if the doctor were to adjust your CPAP pressure based on your new sleep study results, he or she would want you to try it out before deciding anything more (like whether you need meds) The sleep study is really just a beginning point for further adjustments that need to be made based on how you respond. You want to make sure your treatment is optimal, that is, it's really getting your AHI down as low as possible. Sounds like maybe that was not done before?
One thing you will learn from this site is that almost everyone has to go through adjustments to CPAP to get their treatment right. Masks, pressures, comfort features, etc. CPAP machines now come with data recording features, too, so you can see exactly how you are doing from night to night.
It's been over a year since I was diagnosed, have had four different sleep doctors and three titration studies. I have had three different masks, and have learned how to adjust my own machine (which isn't data capable) and I am expecting to do more adjustment. Whew! Makes me tired thinking about it.
But your health is really important. You need to give yourself the time with your doctors, working through the issues, in order to get WHAT YOU NEED.
Why does everyone else post cutesy avatars, and I'm the only one who posts a picture of myself?
Re: Best Doctor to Manage Sleep Apnea?
My thoughts may be a little off, but here is life as I see it.
Some sleep docs are very hands on, some are not. If you need hands on, or want hands on, that should be what you look for. But in my opinion, some very good sleep docs may be more the distant types who are very busy doing other things, and some of the hands-on docs may not know so much. So it all depends on what you want. Unless you have complications that appeared in your sleep study or have other complications related to a particular area, like neurology or pulmonology, I don't think it matters so much what other specialties a sleep doc may be involved in. To me, it is more important that the doc be associated with a good sleep-study-lab operation with good people doing the real work, and that the doc have a good eye for other problems that might affect your sleep or your breathing.
You may get more time and more helpful information out of the nurse practitioner, as far as that goes. If you make it known you may have some concerns and questions, they may have someone there who is known to have the knowledge, the patience, and the caring manner to give you the info you need. The best person for that is not always the big cheese at the place. Most of the best medical advice and practical insights I've gotten on medical matters in general have come from nurses, techs, and therapists, the people in the trenches fighting the war, moreso than from the captains and generals who oversee the battle from afar.
If you get an efficacy-data machine that allows you to see for yourself how you are doing as far as leak and how many breathing events you are having at night, that may end up being the key to your getting good therapy from the machine. I think a sleep study made sense for making sure other problems aren't affecting your sleep, but having good data over time from your machine and your acting on it, hopefully with the support of your doc, may turn out to be the more important factors.
Some sleep docs are very hands on, some are not. If you need hands on, or want hands on, that should be what you look for. But in my opinion, some very good sleep docs may be more the distant types who are very busy doing other things, and some of the hands-on docs may not know so much. So it all depends on what you want. Unless you have complications that appeared in your sleep study or have other complications related to a particular area, like neurology or pulmonology, I don't think it matters so much what other specialties a sleep doc may be involved in. To me, it is more important that the doc be associated with a good sleep-study-lab operation with good people doing the real work, and that the doc have a good eye for other problems that might affect your sleep or your breathing.
You may get more time and more helpful information out of the nurse practitioner, as far as that goes. If you make it known you may have some concerns and questions, they may have someone there who is known to have the knowledge, the patience, and the caring manner to give you the info you need. The best person for that is not always the big cheese at the place. Most of the best medical advice and practical insights I've gotten on medical matters in general have come from nurses, techs, and therapists, the people in the trenches fighting the war, moreso than from the captains and generals who oversee the battle from afar.
If you get an efficacy-data machine that allows you to see for yourself how you are doing as far as leak and how many breathing events you are having at night, that may end up being the key to your getting good therapy from the machine. I think a sleep study made sense for making sure other problems aren't affecting your sleep, but having good data over time from your machine and your acting on it, hopefully with the support of your doc, may turn out to be the more important factors.
Re: Best Doctor to Manage Sleep Apnea?
If I was you....drb1999 wrote:
Any suggestions, advice, comments would be very appreciated; I'm feeling very frustrated!
Dana B. in Houston, TX
1. Get a copy of your sleep study
2. Get a copy of your Rx.
3. Get a data capable, Apap machine.
4. Read and get educated here.
5. Become your own best therapist.
...but that's just me.
"If your therapy is improving your health but you're not doing anything
to see or feel those changes, you'll never know what you're capable of."
I said that.
to see or feel those changes, you'll never know what you're capable of."
I said that.
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2ndGenCPAPgal
- Posts: 79
- Joined: Tue Jun 23, 2009 3:56 pm
- Location: Rockville, MD
Re: Best Doctor to Manage Sleep Apnea?
Overall, I have to agree w/ what jnk said.
I recently met with the nurse practicioner that works with my sleep doctor and I found that I got a lot better information from her than I did from the doctor himself (who spent 1/2 of my appointment on his cell phone ). I was expecting to meet w/ him, but he his wife was having a baby that day. I am glad I met with the NP instead and will probably end up asking to see her again in the future. I was considering changing sleep docs because of the cell phone issue, but since the nurse practicioner is so good and they are part of the same practice as my PCP I'll be sticking around. I have to deal with lawyers regularly for my job and have found that I get better responses from their paralegals, so I guess I just look at this as the same thing.
That being said, she emphasized that she works with the Doctor on all of his patients and they review all of the sleep studies together. Hopefully, it works the same for the doctor you are trying to see. Perhaps you could ask the NP if the doctor might be available to answer some questions by phone if she isn't able to answer everything for you.
I recently met with the nurse practicioner that works with my sleep doctor and I found that I got a lot better information from her than I did from the doctor himself (who spent 1/2 of my appointment on his cell phone ). I was expecting to meet w/ him, but he his wife was having a baby that day. I am glad I met with the NP instead and will probably end up asking to see her again in the future. I was considering changing sleep docs because of the cell phone issue, but since the nurse practicioner is so good and they are part of the same practice as my PCP I'll be sticking around. I have to deal with lawyers regularly for my job and have found that I get better responses from their paralegals, so I guess I just look at this as the same thing.
That being said, she emphasized that she works with the Doctor on all of his patients and they review all of the sleep studies together. Hopefully, it works the same for the doctor you are trying to see. Perhaps you could ask the NP if the doctor might be available to answer some questions by phone if she isn't able to answer everything for you.
Re: Best Doctor to Manage Sleep Apnea?
I agree with the above.carbonman wrote:If I was you....drb1999 wrote:
Any suggestions, advice, comments would be very appreciated; I'm feeling very frustrated!
Dana B. in Houston, TX
1. Get a copy of your sleep study
2. Get a copy of your Rx.
3. Get a data capable, Apap machine.
4. Read and get educated here.
5. Become your own best therapist.
...but that's just me.
Although getting an APAP rather than a CPAP may be problematic insurance-wise, unless you are going to be the one paying the whole tab on that part. I wish now that I had an APAP but the CPAP is doing fine atm.
I would go see the nurse practioner myself. My doctor is originally a pulmonologist. But, his nurse is WELL trained. His nurse knew more than my original GP who was my original sleep doctor. Then, I learned a few things and made the switch to my present sleep doctor. Make sure they are certified sleep doctors!
Re: Best Doctor to Manage Sleep Apnea?
Insurance-wise, aren't they still the same code, CPAP and APAP?taberge wrote: . . . getting an APAP rather than a CPAP may be problematic insurance-wise, unless you are going to be the one paying the whole tab on that part . . .
viewtopic/t43042/viewtopic.php?f=1&t=42 ... 59#p375259
Re: Best Doctor to Manage Sleep Apnea?
Dana,
Welcome to the forum! My criteria for selecting doctors is this. I prefer someone who does what I am being treated for every day as opposed to some one who does it as a sideline. The sleep doctor that I had does only sleep medicine, he doesn't do ENT, Cardio, etc. with sleep medicine as his second job. In any case, you should get someone who is board certifed in sleep medicine. Your Doc sounds very talented, as neurology is a tough field. It seems obvious that he is busy, so since lots of people want his services he is probably a good doc. His plan for your care seems reasonable, since you are feeling tired again. Did you have a split night study, where you spent the first part of the night without and the second with a cpap, or was it all night one way or the other? If you spent any part of the night hooked up to a CPAP, then all that is probably needed is for someone to write you a RX for a new machine set at X cm pressure. If not, then the next step is for someone to prescribe a titration study. In either case, IMHO, either the NP or PA (who are probably supervised by the doc and have better access to him than you do at this point), or your own PCP, could prescribe this for you and move you along the road. It would be preferable to see the original doc, but if it were me I would prefer getting treatment faster. Your only other options seem to be to wait a month or change docs in mid stream.
Carbonman's advice is excellent. Once the RX and sleep study reports are written and you have copies, you have tools that will help you with your treatment all your life. I hope things work out well and quickly for you.
Alan
Welcome to the forum! My criteria for selecting doctors is this. I prefer someone who does what I am being treated for every day as opposed to some one who does it as a sideline. The sleep doctor that I had does only sleep medicine, he doesn't do ENT, Cardio, etc. with sleep medicine as his second job. In any case, you should get someone who is board certifed in sleep medicine. Your Doc sounds very talented, as neurology is a tough field. It seems obvious that he is busy, so since lots of people want his services he is probably a good doc. His plan for your care seems reasonable, since you are feeling tired again. Did you have a split night study, where you spent the first part of the night without and the second with a cpap, or was it all night one way or the other? If you spent any part of the night hooked up to a CPAP, then all that is probably needed is for someone to write you a RX for a new machine set at X cm pressure. If not, then the next step is for someone to prescribe a titration study. In either case, IMHO, either the NP or PA (who are probably supervised by the doc and have better access to him than you do at this point), or your own PCP, could prescribe this for you and move you along the road. It would be preferable to see the original doc, but if it were me I would prefer getting treatment faster. Your only other options seem to be to wait a month or change docs in mid stream.
Carbonman's advice is excellent. Once the RX and sleep study reports are written and you have copies, you have tools that will help you with your treatment all your life. I hope things work out well and quickly for you.
Alan
Re: Best Doctor to Manage Sleep Apnea?
Hi Dana...welcome aboard!
I love my apnea doc; he's a pulmonologist, director of the certified sleep lab, and some sort of director across the street at the hospital I prefer. He's approachable, conservative in his approach to treatment, brilliant (important to me), and has his photography all over the offices & sleep bedrooms. His staff return my calls soon after I call as does he. I see his PA and then he and the CPAP tech (if needed).
I love my apnea doc; he's a pulmonologist, director of the certified sleep lab, and some sort of director across the street at the hospital I prefer. He's approachable, conservative in his approach to treatment, brilliant (important to me), and has his photography all over the offices & sleep bedrooms. His staff return my calls soon after I call as does he. I see his PA and then he and the CPAP tech (if needed).
ResMed S9 range 9.8-17, RespCare Hybrid FFM
Never, never, never, never say never.
Never, never, never, never say never.
Re: Best Doctor to Manage Sleep Apnea?
Perfect. That is what you need to do. The docs and PAs can't do it for you. How you slept in the strange environment of a sleep lab, hooked up to many wires, with weird night shift workers listening to you and watching you via infrared cameras, for just one night, is nothing like the way you sleep at home. Get a machine with software and figure out over many nights what the best settings are.carbonman wrote:If I was you....drb1999 wrote:
Any suggestions, advice, comments would be very appreciated; I'm feeling very frustrated!
Dana B. in Houston, TX
1. Get a copy of your sleep study
2. Get a copy of your Rx.
3. Get a data capable, Apap machine.
4. Read and get educated here.
5. Become your own best therapist.
...but that's just me.
It's the diabetes model: the patient gets educated, gets a blood-glucose monitor, decides on when and how much insulin to inject or drugs to take, and occasionally reviews with the doctor or nurse how things are going. Some diabetics do a good job with this and live long healthy lives. Others do a poor job and live shorter unhealthy lives. Sleep apnea and CPAP therapy is no different.
Good luck,
Rooster
I have a vision that we will figure out an easy way to ensure that children develop wide, deep, healthy and attractive jaws and then obstructive sleep apnea becomes an obscure bit of history.https://www.youtube.com/watch?v=0ycw4uaX ... re=related
I have a vision that we will figure out an easy way to ensure that children develop wide, deep, healthy and attractive jaws and then obstructive sleep apnea becomes an obscure bit of history.https://www.youtube.com/watch?v=0ycw4uaX ... re=related
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BeanMeScot
- Posts: 588
- Joined: Fri Aug 01, 2008 11:05 am
Re: Best Doctor to Manage Sleep Apnea?
I agree wholeheartedly. I have never seen a sleep doctor. One read my sleep study and dictated a report, but that's it. At this point, I don't see a need to see one. My PCP wrote my prescription as I requested (for a data capable APAP). My machine and I are doing just fine .carbonman wrote:If I was you....drb1999 wrote:
Any suggestions, advice, comments would be very appreciated; I'm feeling very frustrated!
Dana B. in Houston, TX
1. Get a copy of your sleep study
2. Get a copy of your Rx.
3. Get a data capable, Apap machine.
4. Read and get educated here.
5. Become your own best therapist.
...but that's just me.
If I were having the problems you are, I would look at the data my machine records and make adjustments to my treatment. No having to wait months to see anyone or have another sleep study to provide the information my machine can. You can take charge of your treatment and be your own sleep doctor. As long as your case isn't complicated, and I see nothing in your OP to indicate that it is, you can do it yourself and feel better quickly.
If you still want to see someone, I would say the NP is probably as good a person to see as anyone, as indicated by others. You might be surprised by how good they are.
Re: Best Doctor to Manage Sleep Apnea?
My Ear Nose & Throat doctor diagnosed me and sent me for the sleep study after an emergency surgery.I'm sure it added many years to my life.
_________________
| Mask: Mirage Activa™ LT Nasal CPAP Mask with Headgear |
| Additional Comments: Wife has same setup & Have Respironics DS100 M series & DS500 auto W/C-flex Backup Machines |
Re: Best Doctor to Manage Sleep Apnea?
Carbonman,
May I have permission to continue to use a paraphrase of your post in my signature for a while?:
"Get a copy of your sleep studies; get a copy of your Rx; get an APAP; get educated here; become your own best therapist."--carbonman, 6/09.
jeff
May I have permission to continue to use a paraphrase of your post in my signature for a while?:
"Get a copy of your sleep studies; get a copy of your Rx; get an APAP; get educated here; become your own best therapist."--carbonman, 6/09.
jeff
Re: Best Doctor to Manage Sleep Apnea?
jnk wrote:Carbonman,
May I have permission to continue to use a paraphrase of your post in my signature for a while?:
"Get a copy of your sleep studies; get a copy of your Rx; get an APAP; get educated here; become your own best therapist."--carbonman, 6/09.
jeff
JNK, you sick, twisted, guitar play'n, paraphrase'n freak.....
I would be honored.
"If your therapy is improving your health but you're not doing anything
to see or feel those changes, you'll never know what you're capable of."
I said that.
to see or feel those changes, you'll never know what you're capable of."
I said that.