NY sleep labs and sleep docs question

[parrotfish2]

I have had an overnight sleep study at an NYC lab and have some apneas but many more RERAs. I didn't do a titration night but tried ResMed autopap with a full-face mask for a month. I tolerated it but don't feel much better, so I think probably I should be titrated at a lab to get the correct machine/mask/pressure. Since I have more flow limitations than apneas, is there a sleep lab in NYC that does better at addressing this problem? I know that Dr. Krakow believes that many sleep labs don't increase pressure enough for flow limitations.

Also, although I have a diagnosis of apnea, I more fit the patient profile of UARS -- are there any sleep doctors in NY who trained at the Stanford clinic, where so much of the UARS research has been done? The optimal treatments for apnea and UARS may be similar but not identical. For example, Dr Avram Gold recommends that people with UARS should use a nasal mask, not a full-face one. I've also read that UARS patients typically require higher pressure to resolve their symptoms and that the may do better on bi-pap machines.

I am considering trying to see Dr. Gold at the Stony Brook sleep lab -- has anyone else done a sleep study there or worked with Dr. Gold? Or is there a sleep doc in NYC who believes UARS exists?

I would appreciate any thoughts on any of this.

[jnk]

I know Dr. Park believes in UARS:

Written by Steven Park · Filed Under Articles | 1 Comment

Expert Interview: Dr. Christian Guilleminault on UARS


July 21, 2011

This month, I interview Dr. Christian Guilleminault of Stanford University, who is one of the pioneers in sleep apnea diagnosis and treatment. We’re going to focus on Upper Airway Resistance Syndrome (UARS), which he discovered.

Here are some of the questions we covered:

- Describe to us what UARS is and how it’s different from OSA?

- Why is the AHI limited when it comes to picking up UARS.

- How to diagnose UARS: Esophageal manometry vs. nasal cannula.

- How UARS patients have intact nervous systems, whereas sleep apnea (OSA) patients have diminished nervous systems, and what may cause progression from UARS to OSA?

- How do you treat patients with UARS? How is it different from treating sleep apnea?

- What are the dental options for UARS?

- How common is UARS in children and how can they be treated?

- And much more…

http://doctorstevenpark.com/index.php?s=UARS

[SleepingUgly]

Yeah, but Dr. Park is not a sleep doc and can't re-titrate her if need be (as far as I know anyway). He may be able to recommend a sleep clinic if Dr. Gold is too far.

[jnk]

Yeah, but Dr. Park is not a sleep doc and can't re-titrate her if need be (as far as I know anyway). He may be able to recommend a sleep clinic if Dr. Gold is too far.

Park's bio says he is "a member of the American Academy of Sleep Medicine" and "board-certified in Sleep Medicine." (http://doctorstevenpark.com/about/my-bio) Good 'nough for me.

And personally, if I suspected I had UARS, I prob'ly wouldn't mind gettin' my shnoz scoped by an ENT dude who knew about sleep, just to see if something simple might help.

Just sayin'.

Doubt he's cheap, though.

[Rumbert]

I saw Dr. Park for the first time last week and he tentatively diagnosed me with UARS. He's quite interested in UARS and knows a lot about it. His wife has it, or had it during her pregnancies. He's written a book for lay people which discusses UARS extensively:

http://www.amazon.com/Sleep-Interrupted ... 0980236738

Like jnk says, he's board certified in sleep medicine but he's also an ENT, which is extremely nice because he was able to show me on the endoscope screen how my throat closes when I lie down and relax. It was great to see the problem with my own eyes. Endoscopes aren't just for noses.

is there a sleep lab in NYC that does better at addressing this problem?

I don't know anything about titration but Dr. Park told me that it can be difficult to detect UARS at a sleep lab and for that reason, he was sending me for a study to the Sleep Disorders Center in Manhattan with which he said he frequently works.

'Doubt he's cheap, though.

You're right. He sees patients at the otorhinolaryngology (ENT) clinic at Monterfiore Medical Center, and the center billed me $500 for my initial consultation with him. It was worth every penny. I've had this problem for nearly 50 years and he's the first doctor I've ever seen who was able to tell me anything useful about it.