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My first Sleep doctor 13 years ago was a total ass. When I had no improvement from EDS after six weeks on CPAP, he said, "Then you don't have sleep apnea." This was after a sleep study showing moderate sleep apnea with AHI of 28. I went it alone for 12 years on the pressure he prescribed all on my own and eventually saw improvement after switching my blood pressure medication (ACE inhibitor).

When EDS returned last year with a vengence, I sought out a new sleep doctor associated with a new sleep clinic. When I had my first study 13 years ago, there were only two sleep clinics in my area and both were hospital based. I had to sleep in a room with glass windows for techs to observe (fish in fishbowl and too much light in room) and a portapotty at the bedside (techs could watch through glass) since the wiring could not be disconnected. Now there are 15 sleep clinics in my area and they are high tech with hotel-room like ambiance. They have video cameras instead of glass windows and quick disconnect to use the bathroom.

I chose a female sleep doctor who was also a board certified psychiatrist. I felt she could better understand the effects of my psych medications on EDS. Turned out my AHI had gone from 28 up to 71 over those years. At first she was adamant that she did not want her patients to have data-capable CPAP. Her explanation was that "patients don't understand any it anyway." I got a ResMed Elite anyway and when I returned after 30 days, brought graphs and had a great talk with her about what my data indicated. She upped my pressure at my suggestion. She totally changed her mind about patients having data-capable machines saying some can benefit from monitoring their own sleep data. I have a great relationship with her. She sees me every 6 months.

In January, I told her I thought I needed BiLevel because I was having difficulty exhaling against CPAP at 18. So she wrote an RX for BiLevel writing "failure at CPAP" on RX so Medicare would cover it. Also wrote "Mask of Patient's choice."

I have an appointment to see her in 1.5 weeks and look forward to reviewing my data with her.

I would hope that most people with OSA see a board-certified Sleep Doctor. Those that depend on general practitioner, ENT, or other specialists will NOT get the same expertise as a Sleep Doctor. They have far less experience with monitoring patients on PAP therapy and will be of little help in resolving adjustment problems.

After my experience with the first JACKASS, I've found a great Sleep Doctor to see as long as live in this area.

I am seeing that people here have largely the same perceptions I do in summary:

1. They expect that they will largely manage their Apnea on their own and with inputs from other Apnea suffers. Often if they have a sleep doctor there isn't much support.

2. Unless you live in a major urban area there is usually a limited supply of sleep doctors. I have exactly three of them in a 50 mile radius.

3. We have in our minds an ideal type of sleep doctor, but don't necessarily actually have such a doctor in practice.

A question arises in my mind how we might change the quality of clinical practice of sleep medicine. I think being more demanding and having higher expectations would be a start. I don't know how far that would go, but I think it would help some.

sleepy1235 wrote: A question arises in my mind how we might change the quality of clinical practice of sleep medicine. I think being more demanding and having higher expectations would be a start. I don't know how far that would go, but I think it would help some.

I think it would help if people stated why they weren't coming back, so that if a doctor is not doing a good job, they will start getting some feedback.

My sleep doctor is one of the good ones, so I brought him a new customer. My mom, who was not having success with her own treatment. She is now.

I did fire my vet a couple years ago. I was very clear in my email why I was unhappy. I have been considering a followup letter to let her know what the next vet once I had saved up enough money for a repeat dental surgery.

I also fired my DME for lying to me. I called them on the lie and went elsewhere.