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Never Saw an Actual 'Sleep Doctor'
#1
Never Saw an Actual 'Sleep Doctor'
In late 2019 I brought to the attention of my PCP some readings from my O2Ring which suggested I was having frequent low O2 Saturation levels through the night that hinted at an apnea problem. My PCP agree the readings didn't look good and setup an initial sleep study at the hospital for Jan 2020. At the sleep study I met the technician that administered the study. The results of the initial sleep study warranted a second sleep study with titration for Feb 2020 and again only person I saw was the technician. The results of both studies were forwarded to a doctor whose specialties are sleep medicine and pulmonary diseases (board certified in both). This sleep doctor forwarded both these reports to my PCP. My PCP called me and stated the sleep study indicated I should probably consider a CPAP machine. There was no conversation of the specifics of the study and I didn't know what to ask at this point. He suggested a DME which I was good with after a bit research into their patient ratings/reviews and he wrote a prescription which he sent to them. I suspect the DME selected the CPAP machine (Dream Station). As this was very early on in COVID, the DME scheduled an RT to come to my house in March 2020 and to give an overview of the setup and operation of the unit, select a mask, and incidental paperwork for the rental and insurance. (The RT was forthright in recommending to not use an ozone type 'cleaner'!).
I did have a followup re-evaluation with my PCP per Medicare to show my symptoms had improved. This re-evaluation amounted to me telling my PCP I was sleeping better and he did not pursue any data records from my CPAP that I was aware of (I don't believe he could have accessed the data records on the Philips server and bringing the SD Card would have been fruitless).
Now 74 yrs old, I've been on the CPAP (initially a DS1 and then a DS2 in Oct '21) for about two years and my AHI's are typically 1.0 or less and O2 desaturations haven't indicated any issues.

Is this a typical scenario where a primary care patient may not be referred to a consult with the actual sleep doctor, unless the initial appointment for a diagnosis may have been setup with one? I have a pretty good PCP, but I don't think he would be able to answer some questions about CPAP therapy, recommend a setting change if needed, or be able to interpret graphical data if presented to him.
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#2
RE: Never Saw an Actual 'Sleep Doctor'
As per my experience, Original Medicare will allow you to visit any physician that will accept Medicare as payment. I am not aware of any prerequisites before contacting a sleep doctor. However, Medicare Advantage has its own rules and restrictions regarding the use of PCPs as gateways to specialists.

As for interpreting your data, that's unlikely. A cursory glance maybe.

Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#3
RE: Never Saw an Actual 'Sleep Doctor'
I didn’t see a sleep Dr. I just told my PCP I wanted to do a home sleep test. She faxed request to a company that sends a test unit to your home, you hook it up and sleep one night, the sleep data is transmitted to same company, there in-house sleep tech faxes script of pressure setting back to PCP. My PCP is clueless about sleep apnea. I have to guided her along on what I need. I like it that way!
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#4
RE: Never Saw an Actual 'Sleep Doctor'
Completely normal. As you noted your sleep study results were reviewed and interpreted by a doctor and recommendations given to start CPAP. You did so and treatment was successful so an appointment with doctor is not warranted. Even if you did a follow up with doctor they would just look at your AHI, note it is under 5 and say congratulations. This would also be further supported by your good SPO2 now.

There are the odd patients that talk to a doctor first before sleep study if their PCP refers them to one to see if a sleep study is warranted rather than ordering a sleep study like yours did. The only other patients that usually end up seeing a doctor are ones that fail PAP treatment or still have sleep issues after apnea is treated.
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