Where to Start: Family Doctor or Sleep Specialist?


Doctors should routinely ask about sleep habits. If yours is too busy, bring it up yourself.(DAVID S. MEHAREY/ISTOCKPHOTO)With certain medical problems you know where to seek help. Sneezing and runny nose: allergist. Chest pains and shortness of breath: emergency room. Tossing, turning, and always feeling tired: not so obvious. When you have a sleep disorder, it's not always clear who to run to, or whether you should run at all.

Start with your own doctor
Primary care physicians should screen for sleep disorders at regular exams, according to the
American College of Physicians—especially since sleep problems may be linked to medical conditions including high blood pressure, stroke, heart disease, and obesity.

Ideally, as part of any routine screening, your doctor will have already asked you about your sleep habits and satisfaction. If you reported sleep issues, he may have used the Epworth Sleepiness Scale to gauge how sleepy you are. He may have prescribed medication for a short-term problem or helped you find a certified sleep specialist in your area.

More likely, though, you'll need to be proactive. "If sleep is not on their list of things to ask about and you don't bring it up, then it's not going to come up in the 20 minutes you're there," says Ralph Downey III, PhD, director of the Loma Linda University Sleep Disorders Center in California.

Why My Sleep Apnea Went Undiagnosed

amy-petrik amy-petrik , this patient got another opinion Read moreMore about sleep doctors

See a sleep specialist for hard-to-solve problems
Complaints of restless nights are no stranger to primary physicians, who prescribe most of the sleep medication sold in the U.S.—more than 48 million dollars' worth. In fact, more than one-third of the patients they see have trouble sleeping, found a 2007 University of North Carolina study.

But for long-term problems, your regular doctor may not be able to provide the best treatments, such as therapy and sleep hygiene counseling. Or if your problem is harder to recognize, your doctor may be completely in the dark.

"We're still behind where we should be in terms of physician education and awareness of sleep disorders," says Gary Zammit, PhD, director of the Sleep Disorders Institute in New York City. "Studies show that students in med school only get a few hours of sleep coursework—and that's everything: basic sleep science, physiology, disorders, treatment. It really doesn't equip them for what they'll see with patients."

If sleep is not on a doctor's list and you don't bring it up, then it's not going to come up in the 20 minutes you're there.

—Ralph Downey III, PhD, Sleep SpecialistThat being said, internists and primary doctors are far better informed about disorders such as sleep apnea and restless legs syndrome than they were five years ago. And whatever your problem might be, your own primary care physician is never a bad place to start, Zammit adds.

If you trust your doctor, there's no reason you shouldn't approach him or her about a sleep problem and decide on the next step together. Should you choose see a sleep specialist, ask your doctor for a referral whether it's required or not. The specialist will appreciate the background information and primary opinion.