The elusive "sleep doctor"

I met with the sleep doc before sleep study, and again for follow up 2 weeks after. (I did the split study). She was great. She went over my dx and what I could expect, talked about options. She even handed me a box of tissue when I started crying.....and understood that the crying was happy/relief tears. She knew that I had gotten to the point where I knew that if it wasn't sleep apnea then there had to be something really horribly wrong with me psychological. I don't know yet if I am supposed to go to them with any follow-ups. But I am sure that if I had a problem they would get me in.

DON'T KNOW WHAT KIND OF DOCTORS AND SLEEP LABS THAT YOU GUY'S GO TO.
Having had several sleep studies done, each time I have set down with the tech the next morning and gone over the prelims. On every occasion my pulmonary doctor has discussed the study in detail with me. I would estimate that he hsa spent around 45 minutes going thru the report with me in order that I could see exactly what was happening.

Because of drops in oxygen levels, he was considering putting me on an oxygen concentrator in addition to BIPAP. However we discovered that the only times that my oxy level dropped I was sleeping on my back. The only reason for me sleeping on my back was that the tech woke me up and asked me to sleep on my back for a while. I NEVER SLEEP ON MY BACK! [/img]

Christinequilts provides a good analogy with her "drive through" vs. "full service" sleep labs. Mine felt more like a "drive by." I did a two night study and the sleep lab was all over me, calling me at work each day, to get me scheduled. (When I saw how much they bill the insurance company for a study, I can see why they want to get you in.) After the 2nd night, they called and said I had to come in for a 3rd night, "because the tech did not get you to sleep on your back enough." (Lol - I did not feel like I slept at ALL on the titration study.) I asked if they intended to charge me and my ins. for the 3rd night and they said no. (To their credit, they did not.)

After the sleep study was sent to my PCP, the sleep lab scheduled me to get a machine and mask. Yes the sleep lab was also the DME. I did not know enough to question that. Got a basic machine. The tech told me they were low on masks in stock. He gave me a mask that he said would probably not work, he would immediately order a new one and it would be available in a couple of days.

I used the ill-fitting mask for 8 nights, and was a walking zombie from being awake all night with leaks into my eyes. I kept calling the DME about the new mask and stopped using my machine. It took another 3 weeks before another mask was made available to me. And that was with me calling the DME every couple of days.

What I learned was that they stayed in close contact with me until I got the machine, then they had no time for me. I never saw or spoke with the sleep doc.

After poor results with the basic machine, I asked my PCP for a referral to a different sleep doc. What a difference! I went to my first appointment and asked for an Rx for an APAP with data card. I got it immediately. I shopped around for a DME and have gotten much better service.

I honestly don't think I would still be making progress (slowly) and be compliant with my CPAP therapy if it were not for the support and information I have gotten at this forum.

Janna

Thanks Judy for the heads-up on this thread. This is a GREAT topic!

In my experience, a good number of sleep labs are just "CPAP factories" Meaning, you go in, get an OSA dx, and get a CPAP....."Now serving #16" LOL
I makes me wonder what they would do if confronted with a case requiring in depth intervention. Most of these labs were started by "Bizness Men" looking to cash in on the increasing field of sleep medicine/xpaps.

Unfortunately, the "sleep doc" usually isn't even boarded in sleep medicine (ABSM) but a pulmonologist or neurologist, though even a GP could legally do it.

HOW'S THAT FOR A REVEALING TRUTH??

They have a contract with the lab at a couple of hundred a pop for the report. To most lab owners, this is just to fulfill the legal requirement for the lab . To make life simple, the "sleep docs" take the tech's notes, fill the same numbers into their template report and cash their check at the bank. THIS IS WHY YOU NEVER SEE THEM!!! THEY KNOW LESS ABOUT YOUR STUDY THAN THE TECH DOES!!! They couldn't answer your questions if they had to.

I've seen both the tech notes AND the docs reports, over and over and over, on many patients, so I know this is true.

My questions to those who actually spoke to a sleep doc before or after their study and found it useful......(in the purpose of my research)

1-WERE THESE DOCS ACTUALLY BOARDED BY THE ABSM??

2-WAS THE SLEEP LAB FULLY ACCREDITED BY THE AASM??

To find out #1, go here...
http://www.absm.org

To find out #2, go here...
http://www.sleepcenters.org

I would LOVE LOVE LOVE to know this!!

Thanks!!

[quote="darthlucy"]Is it unusual that I haven't met with any sleep doctor during my OSA evaluation? My primary doc scheduled the sleep study, I only saw the tech at the study. The sleep doc sent the report to my doc with the OSA diagnosis, then I scheduled the titration. Same thing with this study, tech only, no doc. Now they're going to mail the report and Rx, so I assume no meeting now, either. Should I care? Is there any value to meeting this person, or is the report/Rx all I really need from him/her (not even sure which!)? Has anyone else had this type of experience?

I was referred to Oregon Sleep Assoc. in Portland, Or by my GP. I couldn't have been happier with the service. Meet with the sleep doc who evaluated me. Had me come back for a sleep study a couple of nights later. The tech woke me up at 2:00 am and told me it would be a split night study and put me on a cpap. When I awoke, the tech told me to shower and then the sleep doc would be in to see me. He came into the room with a laptop and reviewed my results (AHI 55.5). He told me I should have a cpap and I could get it anywhere i wanted, but they could set me up right there if I wanted. I said sure, and I walked into the next room where I was given a remstar M series pro, with recording capabilities. He said to come back in 2 months for a follow up. So I walked out of the sleep study less than an hour after I had woken up and had talked to the sleep doc and had a machine under my arm. I came back and my numbers were a little high (ahi 6-7) so they swaped my m-series pro with an auto. ( My insurance had already paid for the Pro) they did this at no charge. Followed up again with good numbers. I also signed up to have them automatically send out new mask pillows and other supplies. I am amazed when I read how long others have had to wait for equipment or to even see the sleep doc, but I sure have empathy for them.

[quote="BrianRT"]Thanks Judy for the heads-up on this thread. This is a GREAT topic!

In my experience, a good number of sleep labs are just "CPAP factories" Meaning, you go in, get an OSA dx, and get a CPAP....."Now serving #16" LOL
I makes me wonder what they would do if confronted with a case requiring in depth intervention. Most of these labs were started by "Bizness Men" looking to cash in on the increasing field of sleep medicine/xpaps.

Unfortunately, the "sleep doc" usually isn't even boarded in sleep medicine (ABSM) but a pulmonologist or neurologist, though even a GP could legally do it.

HOW'S THAT FOR A REVEALING TRUTH??

They have a contract with the lab at a couple of hundred a pop for the report. To most lab owners, this is just to fulfill the legal requirement for the lab . To make life simple, the "sleep docs" take the tech's notes, fill the same numbers into their template report and cash their check at the bank. THIS IS WHY YOU NEVER SEE THEM!!! THEY KNOW LESS ABOUT YOUR STUDY THAN THE TECH DOES!!! They couldn't answer your questions if they had to.

I've seen both the tech notes AND the docs reports, over and over and over, on many patients, so I know this is true.

My questions to those who actually spoke to a sleep doc before or after their study and found it useful......(in the purpose of my research)

1-WERE THESE DOCS ACTUALLY BOARDED BY THE ABSM??

2-WAS THE SLEEP LAB FULLY ACCREDITED BY THE AASM??

To find out #1, go here...
http://www.absm.org

To find out #2, go here...
http://www.sleepcenters.org

I would LOVE LOVE LOVE to know this!!

Thanks!!

Thanks for sharing that Snoredog.

I don't want anyone to think I'm saying that the above certifications are a gurantee of anything. I am curious if those that DO have them are the ones more likely to have consultations and follow ups.

Brian,

Your question here asked regarding information from those who had a sleep doc consultation. I never saw my sleep doc, and didn't even know his name before I got a copy of my study from my family doc.

Both my sleep doc and sleep center are accredited. My report was from a template, inaccurate in spots, and sorely lacking.

My doctor was on the first list. My lab was noton the second one. Of course I am in california and the nearest one on that list is over 2 hours away. But regardless of the certification....my lab was great.

JimW wrote:Brian,

Your question here asked regarding information from those who had a sleep doc consultation. I never saw my sleep doc, and didn't even know his name before I got a copy of my study from my family doc.

Both my sleep doc and sleep center are accredited. My report was from a template, inaccurate in spots, and sorely lacking.

yeah same here, you mean like:

patient is overweight, needs to loose some weight

during that time, my ex remarked; you look like you just got out of a concentration camp. I said well we did recently just get divorced now didn't we? As I was leaving from my Sleep doc's I asked about that finding on my report, I said do I really need to loose more weight? He laughs, says no I don't think so.

Yep - only they didn't mess up regarding my weight. Just little things like - The patient is not receiving any medication; which can potentially alter the sleep architecture. Then later: Medications: YES
and Tonsillectomy: YES (but I've still got 'em, and told them so at intake.)

Not major discrepancies, just enough to let me know that this report was not carefully prepared. I've used templates for assessments before, and it is possible to create a report which is both accurate and person-specific.

Interesting responses. I'm more inclined to say that proper credentials MAY help in your care and study, but NOTHING is absolute. Especially in medical care. That's why I'm curious to see if there is a trend or if it's just wide open like a 4-20cm Apap ROFL!!

Regarding the templates, it's an honest fact that the director at the one lab uses them. He always end the report saying things like "As always, other factors should be considered, such as reversible weight gain, current medications etc."

It's like reading from a script.

BrianRT

I am glad to hear I am not crazy as I could have sworn that my reports were templates. Really irritating when I get billed a couple hundred for each one.

What a scam. Could have just sent my tech reports to my primary care physician since he is who sent me to the sleep study anyway and saved everyone a bundle. No value add at all in my opinion for a sleep doc.

BrianRT wrote:
In my experience, a good number of sleep labs are just "CPAP factories" Meaning, you go in, get an OSA dx, and get a CPAP....."Now serving #16" LOL
It makes me wonder what they would do if confronted with a case requiring in depth intervention. Most of these labs were started by "Bizness Men" looking to cash in on the increasing field of sleep medicine/xpaps.

Yeah Brian, can you imagine what could have happened to me if I had ended up at a drive through lab? I cringe to think about...though I bet I could also make a good 'secret shopper' for testing labs ability to deal with non-obstructive apnea sleep issue

And yes, as you probably guessed from my previous post, both my sleep doc & lab are certified (doc since 1994, lab since 1990- a couple of the earliest in my state).

BrianRT wrote:Unfortunately, the "sleep doc" usually isn't even boarded in sleep medicine (ABSM) but a pulmonologist or neurologist, though even a GP could legally do it.

My best friend got sent to a lab like that. I went along with her to an early follow up and wasn't getting the best vibes- the hand printed poster-board 'educational' OSA poster that was so faded you couldn't read it was my first clue-lol. If asked if they are a 'certified sleep center' they replied yes. And the doctor? Yes again. Funny, not on any sleep certification lists I could find. My friend & I did some more digging into it and it seems the doctor who own the labs (multiple, throughout the state) was a the only doctor (though he did have several PA's working under him), wasn't certified at all. The only certification we could come up was supposedly they contracted with a certified sleep doc, who scored their PSG. But considering the only report my friend could ever get was a 2 line that basically said she OSA with a AHI of x, a low desat of Y. Titrated to Z on CPAP successfully, I have to wonder. That was all that was in her treatment chart the doctor/owner used to treat her, less then most PCP would have to go by from a sleep lab. I guess in the end she did finally push and was able to get slightly more details, but that information was kept by the 'scoring doc' where ever he was (if even in the US?).

The owner/doc did if for the money only. If he wanted to become a real sleep doctor, he would have become certified. He just wanted to play sleep doctor and rake in the money from his labs...we figured between all his 'labs' he was probably running 60-100+ studies a week (they loved that my friend & her husband worked nights so that they could do a daytime sleep study ).

Its too bad that there is that side of sleep medicine and that anyone has to use places like that for treatment. I wish everyone could find a doctor & lab like mine, and in fact, I've referred several people to my sleep doctor.