Are there any good sleep doctors/clinics?

[joeljjk11]

I feel like from the get go I have had to take my CPAP treatment into my own hands. My sleep doctor prescribed me 4-20 pressure on my machine which doesn't even make sense so right from the beginning I had to adjust it. She has also made adjustments on my machine over time which did not work and made my treatment worse, so I had to readjust the machine. Are there actually good sleep doctors and clinics that know what they are talking about? I also live in an area of the country with awesome medical care but there are only a few sleep doctors around me. I am wondering if I am out of the ordinary or if everyone feels like this.

Joel

[Julie]

You haven't even said where you live.

[Pugsy]

The cold hard fact of life is that doctors aren't always effective doctors nor do they always keep up on the latest most educated therapy or way of doing things.....and they tend to resist change.

Yes...there are good doctors out there and there are crappy doctors out there....everywhere.....in all aspects of medical care.
Just because someone has MD behind their name doesn't mean they are good at what they do for any number of reasons.

[kbh209]

I'll say this: My doctor isn't perfect, he still feels CPAP is more beneficial to his patients than APAP...but he's good. He listens to concerns, and is willing to talk about what the trends are. More importantly he's willing to listen and learn too. He doesn't know about SleepyHead or OSCAR details wise but knows of the software.

It's going to be interesting how to give my sleep data to him from my brick via TeleHealth next month.

[Pugsy]

It's going to be interesting how to give my sleep data to him from my brick via TeleHealth next month.

He's already proven he has a wonderful crystal ball that can gather stuff from your brick that no one else can get.
Please stand up for yourself on your next visit. He's not doing you any favors at all telling you stuff that it is impossible to get from your machine.

I worry about you.

[Chris8243]

Yes. In Montana, I like my sleep doctor. He's an internal medicine guy who then studied sleep disorders & works in a "Sleep & Respiratory Center" in a hospital. I didn't know this from the beginning, but he told me he has sleep apnea, so he "gets it." Doesn't mind at all that I change my own settings in response to Oscar results, and suggestions on here. I like his advice and input, he's been helpful.

[kbh209]

It's going to be interesting how to give my sleep data to him from my brick via TeleHealth next month.

He's already proven he has a wonderful crystal ball that can gather stuff from your brick that no one else can get.
Please stand up for yourself on your next visit. He's not doing you any favors at all telling you stuff that it is impossible to get from your machine.

I worry about you.

Yeah, the crystal ball thing was a bit weird when you mentioned it. The following appointment he was more truthful and said he can only see the total hours used for the week/month (can't remember). If I smell a fish during the next appointment, I'll definitely bring it up in my soap box thread. That reminds me, let me send you a PM

[chunkyfrog]

My doctor "gets it", too.
He is a bit of a geek, and recognizes that I am good at research and sorting out the BS.

[DreamDiver]

The cold hard fact of life is that doctors aren't always effective doctors nor do they always keep up on the latest most educated therapy or way of doing things.....and they tend to resist change.

Yes...there are good doctors out there and there are crappy doctors out there....everywhere.....in all aspects of medical care.
Just because someone has MD behind their name doesn't mean they are good at what they do for any number of reasons.

Yes. In Montana, I like my sleep doctor. He's an internal medicine guy who then studied sleep disorders & works in a "Sleep & Respiratory Center" in a hospital. I didn't know this from the beginning, but he told me he has sleep apnea, so he "gets it." Doesn't mind at all that I change my own settings in response to Oscar results, and suggestions on here. I like his advice and input, he's been helpful.

Pugsy and Chris8243 have hit on two basic important considerations when choosing a doctor.
1. Most people -- including doctors -- are terrible at science, data and logic. We all too often rely on feelings, anecdote and suspicion to make choices that need to be made by logic and data. That's not okay for voting, diagnosis or prescription. If you can find a doctor who makes decisions based on data, you've hit gold.

2. Internists tend to be the "renaissance" doctors. They learn a little about everything, can probably talk to you about anything from American Sign Language to bets on when the James Webb Space Telescope will really launch, to the proper temperature for a specific type of Sake. This is the doctor who could probably lecture fifth graders and graduate students off the cuff equally comfortably on the Krebs cycle and make them understand the concept. This doctor understands organic chemistry and how various pharmaceuticals may or may not interact with brussels sprouts or green-apple jolly ranchers. Unlike House, this doctor actually has a bedside manner. An internist who specializes in sleep is a special case. They've seen it all, and now are focusing directly on sleep. That's good for the patient.

These are some other considerations about sleep docs that seem to go under-considered. I know they're cynical, but it gets hard to ignore:

a. In many areas, sleep docs seem to be some other speciality first and a sleep doc second. I had one sleep doc who was a heart specialist, so every time I went to him, I was supposed to get a cardiogram for an extra $250 on my insurance... Um. no. For cryin' out loud, I'm a sleep patient, not a heart patient. If you go to a pulmonologist who is also a sleep doc, they'll probably want to do some standard pulmonology tests every time you visit, again because your insurance will pay for it and it's their background -- not because you need it or anything indicates or warrants it. In other words, they're looking at your through the eyes of their preferred professional background and not from that of someone who is a sleep doc first.

b. Quite frankly, it begins to look to me that many sleep docs are more interested in the money that can be made in a sideline business. Just take a few extra courses, get certified as a sleep doc, open a sleep practice, hire competent techs and they'll make sure the practice keeps spinning. Just sign off on what looks correct as evidenced by the sleep techs and everything should sail quite nicely -- except it doesn't for a significant number of patients who have peculiar or unusual circumstances that need someone to look a bit closer. So these people fall through the cracks in what is little more than a sleep farm doc-in-a-box.

c. Frankly, in cases like the above, it seems like the sleep techs are more knowledgeable than the sleep doctors. You are soooo lucky if you can find a sleep doc is a somnologist first. If you are in a sleep-doc-in-a-box setting, it may be worth being really nice the the sleep techs. It's really in their hands, and if you get along with them famously, it will probably help you in the long run.

d. For me, it's an alarm bell when a sleep doc actually prescribes straight CPAP at 4-20. It's possible they want you to come back frequently so they can make as much money off your insurance as they can before the funding runs out. The other possibility is that they really truly don't understand CPAP, which is just as bad. If they're not giving me a thorough two-night sleep lab complete with polysomnography, a take-home polysomnography test, or at the very least an APAP, I would run far away.

e. In some sleep labs you may never actually see your sleep doc. Their techs do all the interfacing with you. They sign off after reviewing what the polysomnography tech has deduced. If you never meet your sleep doc, that's a warning sign to me of something approaching doc-in-a-box again.

So yeah, sleep labs techs are mostly fantastic. They live and breathe sleep tech. They probably know the best equipment, masks, fitting methods, etc. Ask them as many questions as you can while you have their ears. ... <sigh> ... Sleep lab docs vary quite a bit more in capability. If you ever find a good one, it's worth staying with that doc even if you move to another state and have to visit long-distance to see that doc.

Best of luck finding the right doc for you.

[zonker]

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[zoocrewphoto]

I got really lucky. My sleep doctor has sleep apnea himself, so he totally understands how it feels, how hard it can be to get used to the machine, etc. he only prescribes full data, auto machines. And he reviews the actual data, not just the compliance and ahi. He is also a headache doctor, and I had a lot of headaches before cpap. So, when I saw that in his office, I asked. We talked a little about the headaches. And he gave me a chart to log my headaches before the next visit. It was pretty detailed and also included what I took, and how well it worked. By the next appointment, I had very few headaches (most were sleep apnea related), and the few remaining headaches were smaller migraines due to weather changes. He was also thrilled to see that I had reviewed my own data, and he asked for the paper that had the cpaptalk info. He had not heard of it, but was pleased to hear about it.

After my return visit around 6 weeks, I let my mom use my machine for 2 partial nights. She had been using cpap on and off for about 20 years, but never felt better. Her current machine at the time just had basic compliance info on the screen. So, the first night, I set my machine to her prescription of 10. She slept for 4 hours and had an ahi of 3.4 with clusters of longer events. I printed the report before resetting the machine and going to bed myself. A few nights later, we did another partial night with it set for 10-13 to see what it wanted to do. I printed that report, and she made an appointment with my doctor. We went together, and the doctor shook my hand. He reviewed the two reports and her last sleep study (2 years earlier, somewhere else). He prescribed a new auto machine set for 10-15. She felt better right away.

I was also very luck to get a great sleep tech for my sleep study. She fitted me perfectly with the mask that I ended up being my go to mask. She had me used it for about 10 minutes at the beginning of the night so that I would know what it felt like. I was having a split night study. About an hour into it, I was awake and needed to use the bathroom. I didn't know this was common, and I was embarrassed that I would need to call to get unhooked from the wires. So, I tried to sleep, only I couldn't. The tech came in with some story that she noticed I was awake and wanted to fix a wire. She knew what was going on and how to move us along gently. Later, when it was time to move onto the titration, she woke me,told me it was time, and suggested I use the bathroom first. She then put the mask on me, and I slept over 5 hours straight, for the first time in decades. She helped me have a really good night. So, good that I had a taste of how good I could feel. As I struggled at home for the first few weeks, I knew what my goal was because I had experienced it at the lab. I also knew that the mask would work for me; I just hadn't mastered it yet.

I live in the Seattle area, but it is possible that my doctor has retired by now. I haven't seen him since 2012.

[DreamDiver]

My doctor "gets it", too.
He is a bit of a geek, and recognizes that I am good at research and sorting out the BS.

I'm fortunate to have an internist as my PCP who also recognizes someone capable of logic. It's like he's talking to a colleague about another patient. But when a decision is made, I feel informed and like the decision is logical. I've still not met a sleep doc who "gets" it.

I got really lucky. My sleep doctor has sleep apnea himself, so he totally understands how it feels, how hard it can be to get used to the machine, etc. he only prescribes full data, auto machines. And he reviews the actual data, not just the compliance and ahi. He is also a headache doctor, and I had a lot of headaches before cpap. So, when I saw that in his office, I asked. We talked a little about the headaches. And he gave me a chart to log my headaches before the next visit. It was pretty detailed and also included what I took, and how well it worked. By the next appointment, I had very few headaches (most were sleep apnea related), and the few remaining headaches were smaller migraines due to weather changes. He was also thrilled to see that I had reviewed my own data, and he asked for the paper that had the cpaptalk info. He had not heard of it, but was pleased to hear about it.

After my return visit around 6 weeks, I let my mom use my machine for 2 partial nights. She had been using cpap on and off for about 20 years, but never felt better. Her current machine at the time just had basic compliance info on the screen. So, the first night, I set my machine to her prescription of 10. She slept for 4 hours and had an ahi of 3.4 with clusters of longer events. I printed the report before resetting the machine and going to bed myself. A few nights later, we did another partial night with it set for 10-13 to see what it wanted to do. I printed that report, and she made an appointment with my doctor. We went together, and the doctor shook my hand. He reviewed the two reports and her last sleep study (2 years earlier, somewhere else). He prescribed a new auto machine set for 10-15. She felt better right away.

I was also very luck to get a great sleep tech for my sleep study. She fitted me perfectly with the mask that I ended up being my go to mask. She had me used it for about 10 minutes at the beginning of the night so that I would know what it felt like. I was having a split night study. About an hour into it, I was awake and needed to use the bathroom. I didn't know this was common, and I was embarrassed that I would need to call to get unhooked from the wires. So, I tried to sleep, only I couldn't. The tech came in with some story that she noticed I was awake and wanted to fix a wire. She knew what was going on and how to move us along gently. Later, when it was time to move onto the titration, she woke me,told me it was time, and suggested I use the bathroom first. She then put the mask on me, and I slept over 5 hours straight, for the first time in decades. She helped me have a really good night. So, good that I had a taste of how good I could feel. As I struggled at home for the first few weeks, I knew what my goal was because I had experienced it at the lab. I also knew that the mask would work for me; I just hadn't mastered it yet.

I live in the Seattle area, but it is possible that my doctor has retired by now. I haven't seen him since 2012.

Definitely a keeper. Actual experience with the masks and machines opens a whole other perspective. And what a great experience in the sleep lab! Sleep techs really are the best. It's so great that your doc was able to help your mom using data you provided without getting persnickety about getting it done in a lab. Cutting through the paperwork! What a concept!