In searching out a sleep doctor, should I try to find a

neurologist over a pulmonologist or internist or cardiologist since my apnea is heavily centrals and has responded best to an ASV machine. I also have no known lung or heart problems and i am not overweight and i have good blood pressure ( 115/55 this morning which is about average give or take 5 points ). I will pick a board certified sleep physician but i figure I'm better off with the secondary speciality being in neurology. Is this correct?

So far I've been totally treating myself with help from Dr. Pugsy and Dr. Grand-pap and the others here.

I didn't stay at a Holiday Inn Express last night so take this with a grain of salt.

My personal experience with sleep medicine physicians is that neurology/pyschiatry board certified ones seem to do a better job. My sample size is small ( 3 neuro's and 1 pulmonary ) so that's not a really big sample.

If your centrals are not related to wake/sleep arousal transitions, then they are more likely to be neurological in character rather than anything in the normal breathing aparatus.

Take a look at viewtopic.php?f=1&t=67900&p=631697&hili ... 74#p631580 where I posted a layman's explanation of centrals occuring during the sleep/awake transition. I get, for me, several centrals per hour on some nights related to an undiagnosed medical condition that wakes me at night two to five times. My CPAP is treating my OSA's just fine so I only get one of two during the night and the auto machine 'fixes' them.

After some discussions, I'm now quite satisfied with my pulmologist sleep doctor. We're now on the same page about how to proceed with my therapy.

Even if the cause of your central apnea is neurological, I suspect the solution is going to involve mostly mechanical handling of the situation in the lungs, and a lot of trial and error. You're not likely to find some way to manipulate your nervous system to fix it.

Now there are some thoughts about managing CO2 levels and such, but the solutions to that are usually mechanical things about your lungs and breathing as well.

In my opinion, it is often more important which lab/center you go to than which doc signs off on the study.

However, if I had a significant number of centrals, I would just want a doc (of any specialty) who was willing to take the time to figure out if there was a root cause for the centrals (as in: a cause that needed to be treated directly) and who was willing to work with my primary and my payers to send me to whichever specialist seemed necessary for doing that.

If looking for a root cause in not a concern, that I would want a doc and lab (or better yet a "center") very experienced with ASV if I had documented that ASV was the best modality for me and was set on continuing to use it.

But hey, that's just me.

I'm a big fan of a neurologist over a plumonologist. I've seen the work of both, after my first several studies with the pulm, he sent me to a neurologist that I still see to this day. the Pulm said my case was 'over his head' since several components were more neurological in nature. Especially if centrals are involved, the neuro is a brain specialist, and IMO best suited to treat these.

Just my opinion.
Jen

jencat824 : " I'm a big fan of a neurologist over a plumonologist. I've seen the work of both, after my first several studies with the pulm, he sent me to a neurologist that I still see to this day. the Pulm said my case was 'over his head' since several components were more neurological in nature. Especially if centrals are involved, the neuro is a brain specialist, and IMO best suited to treat these."

thanks and i tend to agree with you. All things being equal, the smarter med students tend to go into neurology. Here's a sort of shocking statistic ( at least it was to me and the data is about 10 years old so it may have changed) - the toughest area of medicine to get a residency in was: Dermatology - our lab was located in a dermatology research department funded by Shizado( sp?), a cosmetics company in Japan. Most of the scientists were dermatologists. When i asked why it was so desirable, i was told: " there are basically only 3 treatments: " 1. if it is wet, dry it 2. if it is dry, moisten it 3. otherwise or in addition, slop steroid creme on it. Send sample to pathology, if nasty, some other specialist will deal with it ( eg Oncology), they do the plastic surgery and botox injections - Very lucrative since insurance isn't involved and the sky is the limit and you never get called at 3am for an emergency

I think either type of Doctor could work with you. But I didn't stay at a Holiday Inn recently.

Personally, if I were in your shoes, I'd do some internet searches for doctors or sleep clinics with experience in ASV that are in your area. Check out credentials, etc...

Then do a check to see if the ones that pass your screening test are in your insurance network or get a referral.

Dave

Maybe both? In my experience, once respiratory conditons have been treated satisfactorily, ie obtaining a low AHI, and the patient still suffers from fatigue or EDS, the typical board certified pulmonologist has little left to offer. I have come across one board certified pulmonologist whose primary personal interest was sleep medicine. This doctor is willing to explore, and is familiar with, other conditions beyond those related to respiratory conditions which could lead to fatigue and EDS. I am still with her.
On the other hand, I visited a neurologist that was board certified in sleep medicine and he had very little interest in respiratory related sleep problems. His standard treatment, I gathered from talking with other patients, was to prescribe Cymbalta to everyone, including me, no matter the ailment. I didn't stay with him long.
So, it's difficult to say which one might be best. It comes down to, I think, which doctor has the interest, time, and expertise to treat you. I don't know any way to determine that except through a few visits - interviews, if you will, to determine if you want to hire them full time.

If you can at all do it, you might want to go to a Sleep Center where all of those doctors are part of a team. (Like the Sleep Center I go to.) There are a lot of issues with sleep apnea - and it's nice to see one or two doctors a visit if I need to for the different layers of care needed.