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GP or Sleep Doc?
#1
Good Morning... just wondering who most people see to help manage their therapy,
Sleep Specialist
Other Specialist
Primary Care Physician/ General Physician

I ask because it was never suggested after my sleep study that I consult with a specialist, and although I love my GP, this isn't her specialty.

Thanks!
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Allynpsych --- Psychology Professor, wife, and mother of a 4-yr old... in need of a good night's sleep. Dreaming
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#2
Hubby is followed by his GP. I'm followed by a sleep specialist.

But Hubby had no trouble adjusting to CPAP and I had a lot of trouble which has manifested itself in a number of different sleep issues.

If your data looks good and you are feeling fine, the GP is fine.
Questions about SleepyHead?
See my Guide to SleepyHead
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#3
My treatment was managed by a sleep specialist the first few months, but now I'm on my own. He dropped me as a patient when I told him I was using a machine I purchased on Craigslist. He was OK with that, but he didn't like hearing that I did my own setup after searching for the instructions on the Internet.
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#4
Dropped you! no more $ heading his way.

We have a different system here, so called specialist nurse I saw three times was next to useless, the one I saw recently said she would reduce the max. pressure, which I had tried myself after advice given on this site, but she did give me a heated hose which has made the world of difference, they could have done this in the first place.

Advice form site members is likely to be more use than some of the so called specialists.
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#5
To use your GP, you or your doctor, need to have very good knowledge of sleep apnea and its treatment as well as potential complications of treatments. More to the point, you need to have documentation of your sleep disordered breathing, and a treatment plan that makes sense, including machine type and pressures. Finally, you must understand how insurance works with DME, and criteria for approval and establishing medical necessity.

If you cannot meet all of the above criteria then use the specialist. Treatment of sleep disordered breathing has become a specialty, not because it is terribly complicated in terms of medical practice, but because of requirements for insurance to reduce costs, and the natural business incentives for DMEs to maximize profits.

Use of a GP without specific sleep training, requires you to have a fair amount of medical knowledge, studying the insurance reimbursement guidelines of Medicare and your insurer, and good awareness of your needs in treatment. You need to have a very specific treatment plan in mind and be able to coach your doctor on how to make recommendations that will stand up to review, disapproval and further review. It can be done, but most people are just not prepared for that.

Looking for a specialist that will let you be a participant in your own treatment is a vetting process your GP can help with. Most people just go to the first and only referral. Good specialists that will work with you and be your advocate are out there. Clearly most specialists have been down this road many times, and they get to know what will be approved and what will not. They will even prescribe treatment that they know will not work, because the system requires patients to fail CPAP before bilevel or ASV can be tried or approved. However, most specialists will have no problem with auto CPAP, and if you're looking for a way to vet referrals, that is a good litmus test; how do you feel about auto CPAP vs fixed CPAP, and do you agree with patients using efficacy data generated by the machine to improve feedback?

Many GPs are accommodating, but unless you know how to coach them, you can end up with the wrong solution. Prescriptions need to be very specific, or DMEs will sell you the cheapest brick they can. Going back for upgrades is not easy.
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#6
I was mis-diagnosed by the first sleep specialist I saw (who I was referred to by my GP), the 2nd sleep specialist said I should probably use a cpap (AHI was 18 in the 1st study, 15 in the second) but that it wasn't critical... and finally 5 years later I'm seeing a neurologist. He's the one who said the CPAP (actually he just changed me to an ASV which is working) was critical and actually took the time to explain how important it was and how he couldn't really diagnose any of the other symptoms I had because lack of sleep often masquerades as other things. Finally over the past 6 days, as a result of his persistence, I'm getting AHI's under 1.0 and last night I had my very first 0 ever!

I say... see the doctor who is going to take the time to talk to you (very rare now in the US, not like it was 30 years ago), and who will go up to bat to play the insurance game when insurance inevitably pushes back.

If anyone needs a recommendation in the southern, NH area, PM me. This guy is really thorough!
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#7
(05-05-2016, 07:04 AM)allynpsych Wrote: Good Morning... just wondering who most people see to help manage their therapy,
Sleep Specialist
Other Specialist
Primary Care Physician/ General Physician

I ask because it was never suggested after my sleep study that I consult with a specialist, and although I love my GP, this isn't her specialty.

Thanks!

Sleep specialist. My GP won't deal with it at all because he has absolutely no training on it. My brother's internist manages his needs.
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#8
GP -> Sleep Doctor -> Pulmonologist. each stage helped. Now the Sleep Doctor is out of tricks and said I can change any and all settings, nothing more he can do. Pulmonologist is starting to suggest that she has done the breathing issues and that the Sleep Doctor should take back over and "will talk with him", nothing has come of this.

I, perhaps like many, am not your typical default patient.
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#9
Even with my sleep study in hand, my GP refused to write me a prescription for anything because he doesn't have the proper training and insurance wouldn't cover a prescription written by him.
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#10
(05-05-2016, 07:04 AM)allynpsych Wrote: Good Morning... just wondering who most people see to help manage their therapy,
Thanks!

You should ask yourself what am I most likely to die from and what kind of help do I need to make event later rather than sooner.

I my case I am diabetic with a history of acute repository infections. therefore I go to an Endocrinology, Diabetes & Metabolism Doctor who is associated with the leading respiratory disorders hospital in the USA which also has the oldest sleep center in Colorado.





2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
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