Who is your sleep doctor?

[gary1231]

A little over a year ago, I had a sleep study done at a center owned by the major medical network in my area. The center itself is housed in a neuroscience building (but has other types of doctors and specialists in it as well). I had a neurologist read my sleep study, and then I met with him and he prescribed my cpap machine.

Fast forward a year. I lapsed pretty quickly, and now I decided I needed to restart using the machine after discussions about it with it with my primary care and my endocrinologist (thyroid/autoimmune/prediabetes). I contacted the neurologist's office, and was told that he had transferred his patient load to another doctor. I scheduled an appointment to see her. She is really great - friendly, knowledgeable, etc. She also discussed delayed sleep phase syndrome with me (which is something I have had my whole life). I mentioned having issues with the full face mask, so she opened up a cabinet and had various mannequin heads with different types of masks on them to show me. She recommended the Wisp.

I scheduled a fitting with Apria for the Wisp (which was unnecessary, since the Wisp comes with all three sizes of nasal masks), and the respiratory therapist i met with suggested I come in for a reteach. So I called the toll free Apria number again (you can't call branches directly anymore, all calls have to be routed through the call center. They then connect with the branch and speak to someone, and then they connect the two of you on a call).

So, I went to my appointment the other day, and saw a different respiratory therapist. I mentioned my neurologist, and she seemed almost shocked that I was not seeing a pulmonoligist. I didn't even know what that was! I thought it had something to do with your heart (pul.. pulse...). Turns out they deal with respiratory diseases.

My neurologist is great. But should I be seeing a pulmonologist instead? Keep in mind that this same RT said to dump my humidifier chamber every morning, which is quite unnecessary. She was pretty helpful otherwise, suggesting methods to help me get more comfortable with the mask and setting goals to work my way up to using the machine for the full night, etc. We also discussed cleaning the machine and the parts, and I told her about reading on here to use a hose connector to attach the two ends of the hose together to make a big loop and to swish the soapy water around that way. She hadn't heard of that before.

[Pugsy]

Unless you are have specific and other issues with your lungs there is no need to see a pulmonologist sleep doctor.

[gary1231]

Thanks. No other issues here.

[BlowingWithTheWind]

Sleep medicine is practiced by a number of specialties. Obviously, your MD does have a lot of experience in it. If you are comfortable with her and her knowledge, that would be fine to me. One other option is to look for a doc who is in the American Board of Sleep Medicine. They are at ABSM.ORG.

[JDS74]

If your sleep doc is booard certified, then they are qualified to treat you.
The choice between a pulmonologist and neurologist does't have meaning unless you have one of the forms of central apnea. Then the neurologist has the edge since central sleep apnea is more likely to be neurological in origin. If you also have other conditions such as peripheral neuropathy, for example, the choice tips even farther to the neuro doc. If your apnea is obstructive only, then is likely the choice doesn't matter. If your other condition are things like asthma, the tilt is the other way to the pulmno.

So, "normal OSA" and no other special conditions -> Board Certified and either.
"Normal OSA" and pulmonary problems such as asthma -> Board Certified & Pulmonology speciality.
"Complex Apnea" and no special problems or other neurological problems -> Board Certified and Neurology speciality.

[photonic]

JDS74 - perfectly stated!

Mine is board certified neurologist, board certified two year fellowship sleep medicine.

I have complex sleep apnea.

[bwexler]

Mine is a CPAPtalk certified non doctor group led by Pugsy and RobySue.

I get most of my info here and other Apnea boards and occasionally get verification from some random medical source or DME (yes a Wisp does exist).

I mostly manage my own therapy. I had my sleep study done in Las Vegas and the report was handed to me through my drivers window in the parking lot of the sleep lab as a left town. I never saw the doc who ordered it again. He was a GP, not a specialist. A friend of mine, an MD in San Diego, who also has sleep apnea wrote my prescription and sent me to his DME, who was great. I used that DME for masks and supplies until my insurance told me they would no longer pay out of network providers. About a year and a half in I saw a sleep doc, no idea if his specialty was pulmonary or podiatry.
Then last October I saw a sleep specialist who ordered my new ASV machine. He has since fired me since he is out of network. I think he was a pulmanologist.

[palerider]

He has since fired me since he is out of network. I think he was a pulmanologist.

ya know, i've seen this usage of the term before, and it bothers me. he wasn't paying you, you were paying him, he didn't fire you, he quit.

first time i heard it was a pompous money grubbing doctor (who's since had her license lifted) that my ex worked for for a while, who would talk about "firing" her patients.

[bwexler]

You are correct, but the concept is becoming popular in the current lexicon. I had had a dentist fire me by writing a formal letter to me and my insurance provider. I was in the process of deciding never to see him again but he was quicker.
The sleep doctor simply ignored my calls until I persisted, and was informed he was out of network and could no longer see me.
My sister recently was told her doctor would no longer see her, because she was non compliant with the doctors suggestion to loose weight.
More and more doctors are finding reasons to terminate patient relationships. I suspect reduced compensation from Medicare, ACA Obama Care, and some insurance companies will fuel the acceleration of this.

[Craig-Tx]

Until three days ago, I hadn't seen a doctor about my sleep apnea for about 6 years. But I only have a basic OSA, nothing complex.

When I saw my new doctor (pulmonologist), I brought my data card, and my previous titration reports with me. He looked at it and said, "looks like your doing real well". I'm not against going to specialists, but considering my deductible, for me it's not typically worth it.

[SleepyToo2]

My doc is a pulmonologist of the minimalist breed (you are doing real well, keep on doing it!) when it comes to annual check-ups. I was originally referred for a sleep study by a neurologist after the cardiologist failed to find any reason(s) for my passing out on the bathroom floor. The neurologist came to the conclusion that the only thing left was a sleep study - AHI of 31 and SaO2 of 76, and declining. I am sure my PCP could do a better job of advising me - coupled with this forum! So, bottom line is go with whoever you are comfortable with.

[Captain_Midnight]

The choice between a pulmonologist and neurologist does't have meaning unless you have one of the forms of central apnea. Then the neurologist has the edge since central sleep apnea is more likely to be neurological in origin. If you also have other conditions such as peripheral neuropathy, for example, the choice tips even farther to the neuro doc. If your apnea is obstructive only, then is likely the choice doesn't matter. If your other condition are things like asthma, the tilt is the other way to the pulmno.
.

Respectfully, I do not agree. Neurological sequellae are consequences of a cause. Peripheral neuropathy is likely just that.

Although I am reluctant to give advice, especially med advice; in this case, I might err on the side of seeing a qualified pulmonologist first.

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