Question 1

How soon can I get an appointment to see the doctor?

Accepted Answer

With a Direct Pay practice model, we limit the number of patients we see so we can spend the time needed with each patient. That allows us to be easily accessible for appointments and follow ups.  We are scheduling out 2 weeks for in-person appointments and one week for telemedicine appointments. This is especially important for children given that wait times to see a pediatric pulmonolgist can be 6 months or more.

Question 2

How quickly can I get a sleep study if I need one?

Accepted Answer

Once you are seen in clinic, if a sleep study is indicated, the order will be placed either that day or the following day. The wait time for the sleep study once the order is sent will vary based on the hospital, we send the order to but in general the wait time is not more than three weeks.

Question 3

If my child has obstructive sleep apnea, what are the options for treatment?

Accepted Answer

The treatment for obstructive sleep apnea (OSA) in children will vary depending on the severity. If the OSA is mild without associated low oxygen levels you could elect “watchful waiting” as tonsil and adenoidal size shrink over time. Another option is a short course of an anti-inflammatory medication. If the child is overweight, then weight lose would be highly recommended regardless of the degree of the severity of the OSA.  If the OSA is moderate or severe then referral to an Ear Nose and Throat doctor for assessment of the anatomy of their airway would be recommended. If adenoids and tonsils are large and obstructing then removal could be curative if the child is not overweight. Being overweight could result in residual OSA in some patients after surgery. A follow up sleep study is always recommended in children with moderate or severe OSA after surgery. CPAP is another treatment option for moderate to severe OSA in children. Other options include the use of palatal expansion by a dentist or more extensive surgery when indicated. Myofascial therapies are being studied for treatment as well.

Question 4

If I am a restless sleeper and concerned about poor sleep quality, will you be able to help?

Accepted Answer

Restless sleep is not normal and causes for restless sleep would be explored by an extensive history in clinic.  If there is an underlying medical disorder such as asthma or eczema this could explain your restlessness. Two sleep disorders that quite commonly lead to restless sleep include restless leg syndrome (RLS) and Restless Sleep Disorder.  RLS is a clinical diagnosis determined by your history alone but is associated with periodic limb movements of sleep.  Restless Sleep Syndrome is associated with multiple large body movements. Both are associated with low ferritin levels. Obstructive sleep apnea and patients with Narcolepsy both can have restless sleep as well. Ultimately, finding out why a patient has restless sleep or poor-quality sleep requires an extensive investigation which we have time in clinic to explore as we take 60 minutes with all of our new patients.

Question 5

Can you help me figure out why I am so tired during the day?

Accepted Answer

This is a very complex question and takes a full assessment with review of an extensive history but one must keep in mind that the most common sleep disorder is Insufficient Sleep. Numerous patients come to my clinic and after spending 60 minutes with them I finally conclude they are skimping on the amount of sleep they are getting per night resulting in “catch up” sleep on the weekends. This can be described as Social Jet Lag. This is extremely common and easily remedied. We take an Epworth Sleepiness Scale which helps us determine the true degree of impairment a person is experiencing. Patient with insufficient sleep or obstructive sleep apnea may have a mildly abnormal Epworth Sleepiness Scale Score where someone with Narcolepsy the score is quite high. We then spend 60 minutes exploring the likelihood of the presence of a sleep disorder.

Question 6

Does every patient with sleep problems require a sleep study?

Accepted Answer

No. Most sleep problems can be addressed but spending time with a professional trained in Sleep Medicine. Sleep studies are reserved for diagnosing Obstructive Sleep Apnea, REM Behavior Disorder, and differentiating seizures from parasomnias. Unexplained non-restorative sleep may often benefit from a sleep study. A sleep study is also required prior to performing a Mean Sleep Latency Test used to diagnose Narcolepsy.

Question 7

Do you accept insurance?

Accepted Answer

Yes and no!   Insurance can be used for support services associated with your care such as labs and other tests.  (However, we offer some of those items at a very reduced price--often for less than the copay required if insurance is used.)  Insurance cannot  be used for our professional fee (office visits) as we  operate on a fee-for-service basis.  A "super-bill" is provided those submitting an insurance claim seeking reimbusement for our professional fee.

HSA and FSA cards can be used for our professional services.

Working with insurance companies drives the cost of health care up with high administrative costs. Insurance companies dictate how physicians must chart to meet billing requirements hence taking time from patients. Insurance companies reimburse very poorly forcing physicians to see more and more patients to make ends meet. Insurance companies dictate what care I can provide to my patients so we gladly do not work with insurance companies in our practice.   By not taking insurance, we can provide affordable care since we require much less overhead. The physician can spend time with the patient rather than time charting to meet billing requirements and can schedule longer time to spend with each patient.

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