Friend: "Doc refused to prescribe sleep study.."

[OneSnorer]

An online friend gets quite tired during the day. We discussed apnea and C-PAP  machines, masks, etc.
His doctor refused to prescribe a sleep study, or even approach the questionnaire.

I specifically told him about the questionnaire that seems the mechanism used by docs to score the need for a study. So, no questionnaire, and apparently an insurance query turned down issuing the machine, as, in my view, there is nothing to go by, really.

Why would a doc not even contemplate doing the questionnaire?

Best advice I could give my friend is score C-PAP machine on CL, get basic supplies himself, and learn the ropes here on the forum.

Any other idea?
Note that my own doc looked at thyroid levels, along with prescribing the study.

[Dawnstar]

By questionnaire, are you referring to the Epworth sleepiness scale questionnaire? Or something else?

https://web.stanford.edu/~dement/epworth.html

This particular one led to misleading results in my case.

[Walla Walla]

I wouldn't even begin to question the Doctor's response without knowing the Doctor or your friend.

[OneSnorer]

By questionnaire, are you referring to the Epworth sleepiness scale questionnaire? Or something else?

https://web.stanford.edu/~dement/epworth.html

This particular one led to misleading results in my case.

Yes, that one.
Isn't it pretty standard, and fairly reliable?

I agree that we do not know a lot about the situation, and participants here.
hopefully I will hear more about it.

[srlevine1]

The obvious answer is to seek a second of opinion if a patient is concerned with their own well-being or has doubts about the medical advice they are receiving.

It has been my experience that some medical groups contracted with certain insurance companies are incentivized against providing extraordinary care or that the number of tests prescribed is measured and used as a metric in their compensation plan. Definitely an indicator of putting the group's interests above those of the patient.

IMHO, the suggestion to simply purchase and use their own xPAP device is not an optimal one as it can mask serious underlying cardiac, pulmonary, and endocrine systemic issues that are best detected sooner than later. Assuming a competent doctor, a full systemic workup is indicated.

[Fats Drywaller]

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[Dawnstar]

If someone has Insomina, which seems to correlate with Sleep Apnea for reasons that are likely not fully understood, their Epworth scores can be misleadingly low. This happened in my case. I ended up having a second opinion, which confirmed that my OSA was not cured, as my first doctor had assumed.

[Fats Drywaller]

I wouldn't even begin to question the Doctor's response without knowing the Doctor or your friend.

Then why post about it?

[Walla Walla]

I wouldn't even begin to question the Doctor's response without knowing the Doctor or your friend.

Then why post about it?

Why not?

[Fats Drywaller]

If someone has Insomina, which seems to correlate with Sleep Apnea for reasons that are likely not fully understood, their Epworth scores can be misleadingly low. This happened in my case. I ended up having a second opinion, which confirmed that my OSA was not cured, as my first doctor had assumed.

I seriously doubt that doctors are ever supposed to use the Epworth questionnaire to decide whether someone's sleep apnea is treated. (BTW, I don't think it's ever cured, just treated.) The Epworth doohickey is only a mickey-mouse gadget to provide an initial reason for a study. For one thing, it's not any kind of objective measurement. It's entirely subjective. What if the patient doesn't have any idea what he or she is doing while answering the questions? (I don't mean you; I mean in general, with any random patient.)

As far as I know, deciding whether OSA is treated is based on having AHIs consistently under 5, right? Not that that judgment is perfect, but it's a whole lot better than answers on a questionnaire.