In a perfect world, you would visit your primary care doctor once a year and spend a solid hour talking about your current health.
She’d ask how your family is doing, your marriage, are you getting regular exercise? Are you eating well and how are you feeling about your job? You might have a list of questions for her and you’d carefully go through each one together. She’d even ask how you’re sleeping at night and if you’re feeling rested.
In the real world, we’re lucky if we get a full 15 minutes of face-to-face time with our doctor each year.
Your doctor probably doesn’t remember your name until she sees your chart and she certainly doesn’t remember your spouse’s name or that you just sent your first child off to college. So, when is the right time to bring up your sleep issues? Should you even be talking to your primary care physician or do you need to see a specialist? Is there even such thing as a sleep doctor?
Who is a sleep doctor?
A sleep doctor is a medical doctor who has additional special training in sleep medicine. Typically, the doctor is primarily trained in internal medicine, pulmonology or neurology and then completed additional training in sleep medicine. In order to be boarded (ie: certified or credentialed) in sleep medicine, the doctor must pass a rigorous exam (you can check the certification of a doctor on the American Board of Internal Medicine site here).
Once a doctor is boarded in sleep medicine, he or she can interpret sleep studies and may build a sleep medicine practice. Usually this doctor will see patients with other medical conditions too such as pulmonary or neurological conditions (based on her training).
Alternatively, a physician may not obtain the sleep medicine credential required to interpret sleep studies, but has a special interest and pursues additional training in sleep medicine. These physicians can be primary care or internal medicine physicians, pulmonologists, psychiatrists, neurologists, ENTs or even dentists.
Your Primary Care Physician May or May Not Manage Sleep Issues
The primary care physician is usually considered a generalist who will refer patients with specific medical conditions out to specialist for disease management; however, many of these doctors are now managing many medical conditions, such as diabetes and hypertension themselves without referring to a specialist. This also applies to sleep.
Some physicians will manage the sleep issues of their patients. Some doctors will screen all of their new patients for sleep issues and incorporate sleep assessments into their new patient intake forms (check out the most common assessment, the Epworth Sleepiness Scale here). This doctor will ask how your sleeping. Better yet, she may ask your bed partner how you’re sleeping. Are you snoring? Gasping for air at night? Do you stop breathing during the night? These are all signs of sleep disorder. This doctor will then order a sleep study (either in-home or in a sleep center, read more about both options here). After your sleep study, she will receive the results and contact you to discuss next steps. If you have a sleep disorder like sleep apnea, this may include ordering CPAP therapy to treat your disease (learn more about that here).
With this type of doctor, you won’t need to see a specialist. It’s worth asking your primary care physician’s office staff if he or she manages sleep disorders. If not, you may wish to ask for a referral to a specialist or find one on your own (depending on your insurance, you may need a referral to see a specialist).
Now we’ll talk about which specialists will manage sleep issues.
Pulmonologists are very familiar with sleep disorders such as obstructive sleep apnea (OSA) because it’s basically when you stop breathing while sleeping due to a blockage in the airway (learn more about that here). Pulmonologists manage other diseases such as COPD, asthma and other breathing disorders that may be related to sleep apnea; therefore, some pulmonologists will elect to become boarded in sleep medicine. They may be affiliated with a sleep center or run with own and interpret sleep studies for their own patients.
While obstructive sleep apnea is primarily a breathing issue, other sleep disorders such as central sleep apnea, narcolepsy and insomnia can be related to neurological issues. While you won’t typically get referred to a neurologist if your primary care physician suspects obstructive sleep apnea is the cause of your sleep issues (such as excessive daytime sleepiness, morning headaches, etc., read more about symptoms here), you’ll probably get referred to a different specialist like a pulmonologist or ENT. However, if you have other symptoms that may indicate a neurological cause of your symptoms, you may end up with a neurologist.
Like pulmonologists, neurologists may also be boarded in sleep medicine and some are affiliated with sleep centers and interpret their own sleep studies.
An ENT (Ear, Nose and Throat) or otolaryngologist is a specialist who deals with issues in the ears, nose and throat. You may visit this doctor if you have a deviated septum or your child needs her tonsils removed or sticks a Lego up her nose. Because sleep apnea and snoring are caused by blockage in the throat, the ENT may actual see these issues during examination. ENTs have typically recommended surgery to treat sleep apnea or snoring. While these procedures work well for children (sleep apnea in children is usually caused by enlarged adenoids or tonsils that can be surgically removed to eliminate sleep apnea, learn more about that here) the surgery has mixed results for adults (learn more about surgery for sleep apnea here).
Many ENTs will order sleep studies and recommend CPAP for their patients with sleep apnea. If CPAP is not effective, isn’t tolerated, or the patient finds that he only suffers from snoring and not sleep apnea, surgery may be considered.
No doctor looks into more mouths on a daily basis than a dentist. On top of that, you’re likely to see your dentist twice per year, more than any other doctor. For these reasons, dentist have a great opportunity to address sleep issues from obstructive sleep apnea (blockage in the airway that affects breathing during sleep) and bruxism (grinding teeth while sleeping). Dentists are also very interested in offering options to the gold standard treatment for obstructive sleep apnea, CPAP. Although CPAP is the only treatment for sleep apnea that is 100% effective, it isn’t easy and there are some patients that may be able to reduce their apnea with an oral appliance (read more about that here). Oral appliances can work for some patients and may be covered by insurance, including Medicare. If you suffer from snoring only and not sleep apnea (learn about the relationship between the two here), you can learn about oral appliances that stop or reduce snoring.
Dental sleep medicine is growing. It is estimated that there are currently XXX dentists specializing in sleep medicine in the U.S. You can easily find one online (here’s a great resource).
This final category of doctors may sound surprising, but psychiatrists may have the largest share of patients with sleep disorders ranging from insomnia to narcolepsy and sleep apnea. Insomnia is very common and may be a symptom of sleep apnea. All of these sleep disorders can cause excessive daytime sleepiness which can affect mood, anxiety, depression, sex drive and more. Therefore, a psychiatrist is likely to ask you how you’re sleeping and has an opportunity to identify if you are at risk for a sleep disorder. If this is the case, he or she may refer you for a sleep study at a testing facility or to one of the other specialists we’ve discussed above.
Learn more about the physicians who interpret sleep studies for us here.
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