Posted by Thomas Hawkes on May 26, 1998 at 18:02:46:

In Reply to: CPAP or Somnoplasty? posted by Sleepy Bob on May 10, 1998 at 14:04:55:

After reading through all the responses to your posting, I feel compelled to point out that your question should (still) be: "What is wrong with me?" Until you answer this question, the choice of C-PAP or anything else is irrelevant.

And, I have never heard of diagnosing OSA with a tape recording of snoring. You should insist on a nighttime oximetry test (keeps a record of the level of oxygen in your blood). This can be done with a portable machine that simply clips a sensor on your fingertip (no hospital stay). If that test doesn't show a drop in oxygen levels, you can start looking for another explanation for your problems. However, you have the CLASSIC symptoms of sleep apnea, regardless of what your doctor told you. If you snore and are sleepy, that should be enough to send you for more definitive tests. The fact that you were sent off with "advice" to lose weight and cut your drinking was (in my opinion) both insulting AND incompetent. I know this is strong talk, but I learned the hard way.

I suffered for 8 years longer than I should have because I listened to uneducated, uninformed, and unsympathetic doctors (three of them). In fact, I diagnosed my malady myself, and actually had to demand an oximeter test to "prove" it. Only after the oximeter showed hundreds of dangerously low readings in a 6 hour recording period would my doctor (who I later "fired") refer me to a sleep clinic. My troubles with my insurance were another long story, but I won't go into that now, thank goodness! The bottom line is that in spite of all the advancement in this area, most doctors know little or nothing about sleep disorders and will send you on your way without a second thought of what they are condemning you to. The hassle over getting diagnosis and treatment for sleep disorders is one of the most shameful testaments against the state of affairs in medicine today.

So, as I get down off my soapbox, here's what I think you should do:

1- If your insurance requires a referral from a "primary care doctor", do this: Call your doctor (the one who taped your snoring) and demand a referral to two specialists (a Pulmonary MD and a Ear, Nose, Throat MD). Say you aren't willing to wait for months for a diagnosis. Say that the quality of care you have been given is substandard and you demand a referral. If that doesn't get you anywhere, call your insurer and tell them you want to switch primary care doctors because the one you have is incompetent. (If that doesn't get their attention, let me know. I can give you some ideas of how to escalate things so you will get help.)

2- If your insurance doesn't require a referral, find another doctor yourself right away. Call the major hospitals in your area and ask about a sleep clinic. Ask for the names of doctors who treat sleep disorders. Demand an appointment immediately. Take charge of your health care now because if you do have a treatable sleep disorder, you're going to have to get used to manipulating the healthcare system instead of waiting for it to help you. This is sad to hear, I know, but it is the truth.

3- Call your insurer and ask EXACTLY what they do and don't cover regarding sleep disorders. That way, you will know beforehand what to expect. Ask for a written list of exclusions, if any, to treatment options and the purchase of "durable medical equipment." Ask now, because your doctor won't do the asking for you (they might, but it doesn't hurt to act for yourself in every case, too).

Again, your question about CPAP vs. somnoplasty is meaningless until you are properly diagnosed! I hope I have made that point clear if nothing else. (And, by the way, I think all surgical options are the worst thing happening in the field of sleep apnea. They don't typically work, but as they are very lucrative for the surgeons, they are advertised quite shamelessly. Do you see the same number of ads for C-PAP machines? I didn't think so!)

Good luck, and please don't delay getting the help you need and deserve. You may have to be more than a bit assertive to get help, however, because that's the state of affairs in medicine right now.

You can e-mail me directly if you want to discuss this issue further outside this forum.

-Tom

Follow Ups:

• Re: What you need is a better doctor! Bob O'Brien 5/27/98 (0)

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