Doctors and Sleep Medicine

Below is a list suggesting how the Sleep Industry might like to see sleep study patients managed. While this may be the way the Sleep Industry would like to see things standardized, currently there are no well-recognized standards for this level of patient management. It’s up to the doctors and sleep labs how sleep study patients are managed and who handles what part of the professional/patient relationship. This can work to your advantage, or it can work against you.

  1. Primary Care Visit:
    • Primary Care Physician (PCP) sends you to a sleep specialist.
  2. First Specialist Visit:
    • Sleep doctor meets the patient for an initial assessment.
    • Doctor answers any questions the patient may have about the sleep study.
    • Sleep lab assistants set up date and time for sleep study and answer any additional questions.
  3. Sleep Study:
    • You show up at the sleep lab and get tested during your regular sleeping hours.
    • Sleep Lab Technicians set you up by gluing lots of electrodes all over your body so various responses can be recorded simultaneously via a computer down the hall.
    • You are asked to try a few different masks, including nasal and full-face.
    • You attempt to sleep through the night while the computer records your reactions using the electrodes.
  4. Follow Up Visit:
    • The sleep doctor speaks with you a second time to answer follow up questions.
    • The same doctor diagnoses you as either a healthy sleeper or with a sleep condition such as sleep apnea and/or restless leg syndrome.
  5. DME Visit:
    • If you have sleep apnea, you will meet the respiratory therapist or RT here. This is the person who is certified to make changes to your machine so that it fits the prescription given by your sleep doctor.
    • Respiratory therapists work at a Durable Medical Equipment (DME) vendor. Some are local. Others have a national presence.
    • Depending on your insurance coverage and what your doctor has prescribed, you’ll get some sort of CPAP machine, a mask and other paraphernalia that should help you sleep better at night.
  6. Other DME Visits:
    • At some point, you’ll have to have your pressure(s) adjusted because as the body adapts to CPAP usage over the first few weeks or months, pressure needs change.
    • DME”s may also want you to get oxygenation levels checked so they can get permission from the doctor to change your pressure up or down.

Part-Time Science

Currently, many sleep doctors are only part-time sleep doctors. In other words, the doctor’s main patient load could be neurology (study of the brain), otolaryngology (study of the ears, nose, and throat), pulmonology (study of the airways) or cardiology (study of the heart muscle). At this early stage in sleep science, it’s likely the sleep doctor you meet will specialize in something else. They explored sleep science to fill a need in a local community or because it is, frankly, a fairly lucrative area of medicine with reduced likelihood of medical liability law suits as compared with something like brain surgery or heart surgery.

The way it really happens…

Because measuring sleep is not surgery, there is a lot of leeway as to how patients can be managed. Some sleep doctors handle everything in their own office building, including providing the masks and machines. Others rely on local or national DME’s to provide patients with equipment after diagnosis.

Some sleep doctors use local hotel rooms to set up sleep studies. The overhead is low and hotels have showers to wash the electrode gel out of your hair before you go home. Other doctors lease or buy space in existing buildings. Some doctors build whole new facilities just for sleep science or as part of a combined effort with their preferred main profession. Yet others send a patient home with a machine and mask and have them send the data from the machine back to office for study.

Some people get their sleep study prescribed by their General Practitioner or Primary Care Physician (PCP). The patient goes go to the sleep study without ever having met the sleep doctor.

The closest some patients get to a sleep doctor prior to the sleep study is when they talk with one of the sleep techs during the electrode and mask fitting. If they are diagnosed with sleep apnea, the information goes back to the PCP who then relates the information about sleep apnea during the general follow-up visit.

In a nation where fifteen-minute patient visits are becoming ten-minute visits, sleep doctors often feel pressed to remove the specialist/patient interaction altogether. They just want to read the graphs and make the assessment divorced of the ‘pleasantries’ of talking with real sleep-deprived patients who are often irrational and incoherent.

In some cases, the first time a patient might actually hear the term ‘sleep apnea’ is when the DME calls to tell them they need to make an appointment to come see the RT, pick out a machine and try out a mask. This can be quite alarming for many people because here is someone who isn’t a doctor telling them they have to use a very expensive machine that will be rented to them through insurance. It’s likely they know nobody else who is using the same kind of machine and they feel embarrassed to have to use it, especially with a spouse in the same bed or when going on business trips and bunking in the same room with other work associates.

As a patient, you wouldn’t be considering sleep apnea therapy if you weren’t feeling like garbage. It really is up to you what path you want to take to find out whether or not you have sleep apnea. For me, it meant following a path fairly similar to the one outlined above. If you live in a small town, you may not even have a local sleep doctor, so you’ll have to go to nearest big city for the sleep study. If you live in a truly remote area, it may be better for the PCP to mail you a take-home test and let you send the data back to the specialist for diagnosis.

It is important to recognize that not even the so-called specialists know everything. In this internet age, it becomes important for you to educate yourself about your options so you can make informed decisions at every step of the process. Join a local CPAP users group to learn first-hand how others are making CPAP use practical.

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