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Dr. Park,
What signs do you, in particular, look for in your patients that makes you think they may have sleep apnea or need a sleep study? And what is your specialty in the medical field, if you don't mind me asking? Also, what types of masks do you usually prescribe, and why? And how do you determine whether a patient has just obstructive sleep apnea or central sleep apnea?

My reason for asking is that, where I live - in Tennessee, it is usually the Pulmonologists that do most of the diagnosing for sleep disorders. They claim that it falls under "respiratory" illnesses. I have the "Central sleep apnea" and therefore I now require a Respironics Bi-PAP Auto SV unit with an oxygen bleed with a rate of 4 liters per minute. I also have emphysema/COPD, and numerous other illnesses such as systemic lupus.

I appreciate any response from you, sir.
Regards,
Melodie Aultman-Morris

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Hi Ms. Aultman-Morris,

Despite the classic description of a sleep apnea patient being an older overweight snoring male with a big neck, it's been shown in the past few decades that even young, thin women who don't snore can have significant sleep apnea. Unfortunately, most doctors still think the former. I have many very petite, thin women in my practice who don't snore and have significant obstructive sleep apnea. Ultimately, it's a jaw narrowing problem with obesity coming later. If you're chronically tired, no matter how much you sleep, and if you prefer to sleep on your side or stomach, almost invariably, the area behind your tongue when lying flat on your back will be very narrow. Because of the narrowing, when the tongue relaxes during deep sleep, one goes straight to obstruction without snoring, leading to an arousal. This is why many people with these issues don't like to sleep on their backs. If your jaws start off normal and you gain weight, then the partial narrowing will lead to snoring and later apneas.

I am an otolaryngologist, in private practice in New York City. About 80-90% of my practice is related to sleep-breathing disorders.

Since I work closely with my area sleep doctors, I don't usually prescribe masks. However, I counsel patients extensively on CPAP usage, and try to do everything to optimize compliance and patient satisfaction. Most of my patients do very well on CPAP, but some do not due to various reasons.

To determine whether or not someone has central vs. obstructive sleep apnea, one needs a formal polysomnogram. It's a relatively simple finding related to the sleep stage EEG, along with nasal airflow, chest and abdominal movements.

Up until recently, sleep medicine was under the auspices of neurology. Anyone who did a one year fellowship and passed an exam could be certified in sleep medicine. Now, sleep medicine is an independent specialty recognized by the American Board of Medical Specialties, cosponsored by the following five specialties: pulmonology, psychiatry, otolaryngology, neurology, and pediatrics. It really doesn't matter who treats someone with central sleep apnea, as long as he or she is certified in sleep medicine. Central sleep apnea is thought to be a neurologic disorder, with a possible obstructive component, as well as a cardiac component. This is why sleep medicine has to be an interdisciplinary field.

Your servoadaptive ventilation machine is the most current way of treating central sleep apnea. Since you also have emphysema and COPD, it's a good thing that your sleep doctor is also a pulmonologist.

Hope this answers your questions.

Steven Park
http://www.doctorstevenpark.com
Thanks for the information Dr. Park.

Considering how busy you are, I for one, would like to acknowledge your active participation on the forum!! It is very much appreciated!!!
Steven Y. Park, MD said:
Hi Ms. Aultman-Morris,
Despite the classic description of a sleep apnea patient being an older overweight snoring male with a big neck, it's been shown in the past few decades that even young, thin women who don't snore can have significant sleep apnea. Unfortunately, most doctors still think the former. I have many very petite, thin women in my practice who don't snore and have significant obstructive sleep apnea. Ultimately, it's a jaw narrowing problem with obesity coming later. If you're chronically tired, no matter how much you sleep, and if you prefer to sleep on your side or stomach, almost invariably, the area behind your tongue when lying flat on your back will be very narrow. Because of the narrowing, when the tongue relaxes during deep sleep, one goes straight to obstruction without snoring, leading to an arousal. This is why many people with these issues don't like to sleep on their backs. If your jaws start off normal and you gain weight, then the partial narrowing will lead to snoring and later apneas. I am an otolaryngologist, in private practice in New York City. About 80-90% of my practice is related to sleep-breathing disorders.

Since I work closely with my area sleep doctors, I don't usually prescribe masks. However, I counsel patients extensively on CPAP usage, and try to do everything to optimize compliance and patient satisfaction. Most of my patients do very well on CPAP, but some do not due to various reasons.

To determine whether or not someone has central vs. obstructive sleep apnea, one needs a formal polysomnogram. It's a relatively simple finding related to the sleep stage EEG, along with nasal airflow, chest and abdominal movements.

Up until recently, sleep medicine was under the auspices of neurology. Anyone who did a one year fellowship and passed an exam could be certified in sleep medicine. Now, sleep medicine is an independent specialty recognized by the American Board of Medical Specialties, cosponsored by the following five specialties: pulmonology, psychiatry, otolaryngology, neurology, and pediatrics. It really doesn't matter who treats someone with central sleep apnea, as long as he or she is certified in sleep medicine. Central sleep apnea is thought to be a neurologic disorder, with a possible obstructive component, as well as a cardiac component. This is why sleep medicine has to be an interdisciplinary field.

Your servoadaptive ventilation machine is the most current way of treating central sleep apnea. Since you also have emphysema and COPD, it's a good thing that your sleep doctor is also a pulmonologist.

Hope this answers your questions.

Steven Park
http://www.doctorstevenpark.com


Dear Dr. Park,
Thank you so much for your very thorough reply to my questions! I truly do appreciate your time and your participation in our group. You are so knowledgeable and helpful, we are very lucky to have you - especially with such an extensive reply.

I do feel very lucky to have my Pulmonologist being so proactive in finding the fact that I have the central sleep apnea, and for prescribing me the fabulous Bi-Pap Auto SV unit that he did. It truly is helping me, even more than I had imagined. At first I was given a regular C-PAP and it was not helping me to my physician's satisfaction and he ordered more tests and then found the central sleep apnea and I am very grateful that he did. He is also treating my other pulmonary problems very well and has a fabulous "bedside" manner. Also, my DME supplier is very proactive and explains things very well to me whenever they bring new equipment and give me very thorough instructions on how to utilize my equipment.

By the way, I AM a back sleeper, and was told after all three (3) of my sleep studies that I do not move at all during the night when sleeping, not even an inch. I have to sleep on my back, as I have degenerative disc disease in the lower back starting at L-3 through all of the S-discs, and I sleep on a heating pad on low every night to help ease the chronic pain. I am also in Pain Management for the back problems, which are progressing, and also for some other pain disorders. My physicians all work hand in hand, and consult with one another to make sure that my medications do not have any adverse interactions. I am also thankful that I have a great team of physicians here that DO interact with one another on my specific needs.

Thank you so much for your reply and I hope to hear more from you in the future!

Sincerely,
Melodie Aultman-Morris
Cleveland, Tennessee

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