Critically selecting your sleep doctor.

[sleepy1235]

When I mean "critically" I am not using the popular meaning of the work, but the academic meaning referring what is critically important.

So I would like to propose these criteria for consideration.

1. If the doctor is going to request a sleep study, ask him for a copy of the written protocol of the test and what it is based upon. In regards to what it is based upon I mean from which medical papers was it derived. Preferably it should be a standard protocol that has a name and reference number. They have been published. http://www.aasmnet.org/resources/clinic ... 040210.pdf

If the doctor doesn't have a written protocol you can stop the discussion right there and leave.

2. Ask your doctor your doctor what he or she expects to learn from the study. Is it just going to be the pressure that your apneas disappear? Is there going to be considered Respiratory Effort Related Arosuals (RERA) due to upper airway resistance syndrome? What about flow limitation related arousals?

3. Ask what type of result and report you will receive after the sleep study. Just getting a pressure setting isn't enough. Ask if the report will be in writing. It is important that you get the report, because the next sleep doctor will want to see it.

4. Insist that the CPAP machine be data recording. Not just the hours of sleep you used it, but detailed data. Ask the doctor what data does it record and what statistics it provides.

5. Ask about how the CPAP machine is chosen and the range of choices. If the range of choices is just one brand, inquire why. The doctor, the sleep center, medical institution might have some deal with a single brand locking them in. Ask them if there is this type of agreement.

6. Ask what the options are for purchasing the CPAP yourself through a supplier you find.

7. Ask about the follow up. When you get your CPAP, or maybe just a new setting, how will effectiveness of treatment be assessed? How long will it take to have an impact? If "sleep debt" is brought up, at what point will this will definitely ruled out as an issue if you still feel sleepy?

What will be the action taken if in the period in which the treatment is expected to be effective isn't working?

What is the doctor's plan to get you from point A (sleepy) to point Z (rested).

To you the goal is feeling rested, and if this isn't the doctors objective then I think there is a problem. The goal isn't to get a pressure for a CPAP machine, or to get a CPAP machine, or do a sleep study. The goal is to get a good night's sleep. The doctor should be clear at this.


If during your questioning you get a dismissive attitude or the attitude that "I am the doctor and you are the patient" get another doctor.

In particular watch out for the "sleep is mysterious" attitude. Yes, scientists are very challenged by the phenomenon of sleep, but either the doctor is effective or not and either you are going to get a good night's sleep or not. This "sleep is mysterious" attitude is often an excuse in which the doctor feels that he or she isn't accountable for a positive outcome.

I think that sleep treatment could be much better if patients raised their expectations.

Perhaps there should be a sleep doctor assessment document made up.

[sleepy1235]

if it comes to the point later where an additional sleep study is proposed, that is a 2nd sleep study I think some things should be asked.

1. Why was the first sleep study inadequate such a 2nd sleep study was necessary?

2. If a 2nd sleep study is going to be done, what will be done so that a 3rd sleep study isn't necessary.

[sleepy1235]

Additionally, I think the sleep doctor should be knowledgeable on how CPAP machines implements the therapy.

A pressure is just a number until the CPAP machine applies it to you. The nurses should also know how the machines work and the implications of the set ups.

[SleepyToo2]

The doctor needs to be familiar with all of the different kinds of machine - CPAP, APAP, BiPAP, AutoBiPAP, ASV - and when each one is appropriate, keeping in mind the restrictions placed by many insurance companies that a patient needs to "fail" with each level before they can move to the next (except for CPAP to APAP, which are the same supplier code).

Also, you need to ask the doctor if you can do a home sleep study if the first one in the lab fails (or if you have good reasons for wanting to do one at home). The doc needs to explain why you need an overnight PSG if he thinks you do need one.

[sleepy1235]

Good points.