What Should I Ask Sleep Medicine Doctor on First Visit

My primary care doctor sent a referral to a sleep medicine doctor last month. I have an appointment in October. Two hospital systems merged their departments so it takes three months to get an appointment.

I would appreciate suggestions about what to ask the sleep medicine doctor on the first visit. I anticipate that she will want me to do a sleep study since I have sleep apnea symptoms. Edited to add: The sleep study will be after the first appointment with the sleep medicine doctor since she has to meet me first and decide if my symptoms warrant a study. I am thinking that this may be only time I have to talk to the doctor since it seems that there are several physician assistants working for the practice as well.

As an aside, I notice that several of the sleep medicine doctors in the system also have training in psychiatry.

Hi - it's not clear whether or not you'll have had the sleep study before seeing the doctor (or not?). The psych docs may have been affiliated with the 'other' merged dept. re some neuro. problems not directly related to sleep... i.e. they may also be sleep docs, but save the psych stuff for their other specialty. Or they may deal with people who e.g. have night terrors, sleep walking/eating, etc... ask your MD about them.

Hi Julie, no I don't get a sleep study prior to seeing the sleep doctor. The sleep doctor will order the study if she thinks it's needed. I have to talk to her and fill out a questionnaire too.

jaycee2 wrote:My primary care doctor sent a referral to a sleep doctor last month. I have an appointment in October. Two hospital systems merged their departments so it takes three months to get an appointment.

I would appreciate suggestions about what to ask the sleep doctor on the first visit. I anticipate that she will want me to do a sleep study since I have sleep apnea symptoms. I am thinking that this may be only time I have to talk to the doctor since it seems that there are several physician assistants working for the practice as well.

As an aside, I notice that several of the sleep doctors in the system also have training in psychiatry.

Hi jaycee2,

See this thread started by sleepy1235 on selecting a sleep doctor

viewtopic.php?f=1&t=99428&p=924262#p924262

Yup, either the sleep doctor has training in psychiatry, pulmonology, or neurology. A few come from internal medicine backgrounds. Psychiatry to sleep medicine seems like a natural transition because so many psychiatric issues involve sleep.

Because of my negative experiences with psychiatry, I would never pick a sleep doctor who came from that field. But that is my own bias and I certainly would understand if people disagreed with me on that.

Best of luck.

49er

Since you really have not been diagnosed yet, I would read the posts in the announcements section at the top of the main page. There is no way your "sleep doctor" can diagnose you until you have had a sleep study. You will wait till Oct for your appointment and then may have to wait a month or two for the sleep study and then possibly weeks again to see the sleep doctor again for the diagnosis. What makes you and your doctor feel you have a sleep problem?

I asked my primary doctor for referrals to an ear doctor (ENT) for a hearing test, and a sleep doctor for a CPAP test. She gave me two different referrals but when I went to the ENT for the hearing test he told me he could evaluate me for a sleep test as well. Too late I already had the appointment with a pulmonologist.

Primary doctor first gave me a written questionnaire about sleepiness and snoring before giving me the referral to the pulmonologist. Pulmonologist asked me some of the same questions plus some family history questions (my grandpa's apnea was horrible) and examined my throat before giving me the referral to the sleep center. Sleep center said - he snores and has apnea, 10 cmwg fixes it, recommend CPAP with efficacy data. Then the doctor wrote the prescription, I got my machine, and I had a one-month checkup.

So having been through all that recently, I think I'd suggest that you ask: 1) if there's anything unusual about your situation that might make PAP not be effective 2) if it's OK to take the Ambien for the sleep study, and 3) how do you feel about patients keeping track of their own data and being active in management of their treatment?

Great responses and quick too!

I don't get much of a choice when it comes to what sleep doctor I see. But I will review their training since it's posted online and then decide if I want to change.

My primary care doctor thinks I need to see a sleep doctor because I have fibromyalgia, snore, and have increasingly bad insomnia. To top it all off, my husband observed my sleep the other night while I was backsleeping. I stopped breathing many times then started back up again, choked at one point and snored. But on my side none of these things happened.

It does seem like a long time to wait to get started with the xPAP equipment if I need it. But I don't know what the standard is in this new insurance environment.

jaycee2 wrote:My primary care doctor sent a referral to a sleep medicine doctor last month. I have an appointment in October. Two hospital systems merged their departments so it takes three months to get an appointment.

I would appreciate suggestions about what to ask the sleep medicine doctor on the first visit. I anticipate that she will want me to do a sleep study since I have sleep apnea symptoms. Edited to add: The sleep study will be after the first appointment with the sleep medicine doctor since she has to meet me first and decide if my symptoms warrant a study. I am thinking that this may be only time I have to talk to the doctor since it seems that there are several physician assistants working for the practice as well.

As an aside, I notice that several of the sleep medicine doctors in the system also have training in psychiatry.

Normally, in the US if that is where you are, the Primary Care doc orders a sleep study. Then you can have either the PC or sleep doc can take it from there. Why not see if you can get your PC to order the sleep study. That will speed things up for you.

Until you see the MD and possibly have the test, do everything you can not to sleep on your back because it provokes many more apneic events than side or stomach sleeping. Also, if you get a chance, try sleeping in a recliner as raising your top half can help as well.

I called directly to a sleep doctor "in network" to schedule my initial consultation rather than wasting a visit to my PCP. Filled out a form asking about sleep and such, consulted with the doctor and scheduled the sleep study. I asked for an at-home study rather than at a clinic since I've used vpap since 2001.

Got the sleep study device in the mail about three weeks later. Wore it for two nights then mailed it back. Followup appointment a week later. Walked out with prescription for the same type of device I've used all these years--resmed vpap (I recommended it) so she wrote the script for it. DME called next day. Had to get authorization from insurance provider since it exceeded $1k. A week later got a call that it was approved, a week later machine arrived and RT came to my office to deliver and go through the instructions, sign docs. Brand new resmed vpap with humidifier and a resmed airfit p10. He also had a copy of the sleep study and copy of the prescriptio. A good experience overall but probably atypical after reading all these forum threads.

Like any prescription a sleep study can be ordered w/o a visit to the doc, if the doc is so inclined. Maybe the OP should try another doc whether sleep or primary, or cardiac, or whatever, just to get the sleep study in.

Another thing to do if the sleep lab is backed up asked to be put on their cancellation list. Just keep your bag packed and ready to go.

Guest wrote:Like any prescription a sleep study can be ordered w/o a visit to the doc, if the doc is so inclined. Maybe the OP should try another doc whether sleep or primary, or cardiac, or whatever, just to get the sleep study in.

Another thing to do if the sleep lab is backed up asked to be put on their cancellation list. Just keep your bag packed and ready to go.

The cancelation list did wonders for me. They not only got me in soon, they sent me to the sleep lab 10 miles further away, that actualy had the necessary equipment to titrate me for ASV. The original lab did not, and no one noticed until I accepted the cancelation and asked if they also had the right equipment.

Great suggestions! Thank you.

After getting the necessary referral from my primary care doctor, I called the sleep lab and was told that they couldn't see me until I'd seen a sleep medicine doctor. I called the number for that and couldn't even talk to a real person. Had to leave my information with a promise for a call back in "1-2 business days". After three business days I called the sleep lab back and got the direct number for the sleep medicine doctor's office, called them and was given an October appointment. I also got on their cancellation list in case an appointment with the sleep medicine doctor is available earlier. This is the way it is here with two hospital systems merging their sleep medicine departments. I would love to speed this along since I am sick and tired of feeling sick and tired but I think I've done what I can do so far. Once I get an appointment with the sleep lab I can get on their cancellation list too.

Most of the sleep medicine doctors also have a specialty in psychiatry. One is neurology, another pediatric pulmonology, and one (40 miles away) is internal medicine.

How about buying cpap straight out, some did it, myself included. Otherwise you seem to have a long wait times.

tmr wrote:How about buying cpap straight out, some did it, myself included. Otherwise you seem to have a long wait times.

It's funny you should say that. My husband has a ResMed S9. By the on/off button it says "Autoset" and "EPR". It is his but he gave up because of mask issues and trouble with the DME. He wasn't using it enough. He wants me to try one of his masks.

As for back sleeping, it's difficult not to sleep on my back. I have cervical dystonia on one side and it really aggravates it if I sleep on that side. As for the other side, no more than two hours at a time otherwise I get vertigo.

I have multiple medical problems and this apnea is one more added to the mix.