Is there a different type of Sleep Doctor? A Neurologist?

[azmanatheart]

Hi-
I've posted recently and been reading a lot of what is here and this is the most mature and helpful online forum I've ever seen. Thanks and congrats to everyone!
My question- I'm concerned that I don't seem to get any stage 3 or 4 sleep, and my pulmonary doc doesn't seem to know or care what it means. He is only concerned about the physical situation and apneas and pressures. Is there a different type of sleep doctor who can help me figure out why I don't get any Restorative Sleep, and only small amounts of REM sleep?

My last sleep study only showed 2 short REM events in 459 minutes and 0% NREM3 & NREM4. Is there a 'Sleep Neurologist who nderstands brain waves and brain function instead of, or in addition to lungs?

Clearly, even if I got an x-pap with full recording capabilities, it would not show sleep stages, would it? So all I have to go is 3 sleep studies done in my entire life to try to figure out what is normal. I only developed severe OSA 3 years ago, and ....I'm too tired and confused to finish writing my thought without going off aimlessly. I gotta get to the bottom of this.
Right now I'm in limbo; my sleep doc wants my old ResMed S7lightweight raised to 16cm, I've tried it, I can't exhale. The Horizon BCBS info posted elsewhere is right, the sleep center said becuase I slept for 30 minutes at 16cm, before they woke me up and kicked me out, the study was a success for CPAP. No Deep Sleep, only 2 REMS and over 150 Apneas on titration? Why did they wait so long to raise it to 16?

Well, my question really is, does Anyone understand sleep stages and what blocks entering deep sleep,. and what to read or who to see about it?

Thanks,
Jeff in NJ

[Julie]

When you get your Cpap working properly and consistently for a time - along with using a machine with cflex that allows you to exhale more easily (the M series do that), you will get proper sleep - all stages of it. I think you're too confused right now to be able to see the sequence of what should be happening, and are trying to answer all the questions at once without necessarily understanding it enough to make proper sense out of it. Get one aspect of things working well (such as the mask, or machine, or regular hours of sleep, then the next, and pretty soon it will (should) all come together. A neurologist can talk til doomsday about sleep stages and all the various aspects of diagnosis, treatment, neurological implications, but I don't see how he can help you much until you e.g. have got 99% of the Cpap routine going, but have what (at that time) still seems like an inexplicable problem (which I think would be highly unlikely).

[john_dozer]

Sounds you need a new doctor regardless of what your underlying issue is.

Your lack of REM is probably apnea related. You could be getting "centrals". Central Apnea, if I've picked this up correctly, aren't related to the physical obstruction of your airway during sleep but related to your brain not telling your lungs to inhale adequately. You stop breathing or shallow out your breathing and effectively need to wake up, like the obstructive sleep apnea case, to do some make up breathing and resume breathing normally (for a while).

Waking to breath interferes with REM sleep. Its part and parcel of apnea (obstructive or otherwise), so the lack of identified REM sleep isn't something unique. It may or may not mean your obstructive sleep apnea is not being treated effectively.

Your treatments or assessments don't seem thorough. It could be multiple reasons related to a leaking mask, pressure too high triggering Centrals you wouldn't normally have had, or genuine Centrals.

A data capable machine would go a long way to helping people here help you.

[jules]

I realize this isn't the best site to find a doc, but if you start browsing - click on a letter of the alphabet, you see all kinds of other specialties

http://www.absm.org/Diplomates/listing.htm


This is a listing of sleep centers - you can get names of their staff on the pages there.

http://www.sleepcenters.org/

It would be nice to have a list of certified sleep docs by state - maybe someone knows of one.

[mindy]

Lack of deep sleep and lack of REM sleep are, I gather, not uncommon when you have a PSG in the sleep lab. It's a strange place and we're all wired up. When I have that kind of sleep I feel like I've been awake most of the night and just gotten little cat naps. At home I sleep more deeply so I don't worry about what I did at the sleep lab.

I've heard of various medical specialists working in sleep labs - pulmonolgists, psychiatrists, neurologists. Often there is more than one specialty so one can always ask for a consult.

Mindy

[jnk]

Jeff in Brooklyn to Jeff in Jersey:

I agree with the advice here that sleep stages aren't the thing to worry about right now. It is too early in your process to concentrate on that one piece of data, the lack of deep sleep in one titration where you were in a strange bed with strange sounds, strange smells, and wires everywhere.

Once you find a way to get a full-data machine (preferably a full-data autobilevel; hopefully at least a full-data bilevel; or, at minimum, a full-data CPAP with some sort of exhale relief), then you can start the process of sticking to the routine of good sleep hygiene and tweaking your own PAP therapy based on data. That is when you should begin to get some deep sleep and REM sleep, in your own comfy bed. Maybe then a nice warm soak in the tub before hitting the hay will bring on some NREM3 for ya.

After a few months of sleep that is as event-free as possible (as documented by your full-data machine), then your thinking will be clearer on what the next step might be, should some other step be needed. But don't start now trying to solve a problem that will likely go away on its own if you do what you know you need to do now.

[Debjax]

There are neurologists that specialized in sleep disorders, including apnea. Although my sleep doc is not a neuro, he explained that when he did his sleep fellowship at University of Michigan, it was in the neurology department under the neuro sleep docs.....

[azmanatheart]

Yes, those of you who have reminded me to take care the big picture first are right on.

I do have a tendency to get frustrated and freak out and try to 'eat the elephant' all at once, rather than 'one bite at a time'. In this case, I need to get my basics under control; the correct machine at the right setting with the ability to track and adjust results and treatment. Once that is done, I can then re-assess my situation and see if these other things are still problems, or a 'sub' problem that was resolved by taking care of the main issue.

I've learned that from this forum and you people. I don't know what I would have done otherwise.

Thanks to all for talking me down from the ledge.

With gratitude,
Jeff