C. Michael Gibson, MD: I’ve learned so much from you 2. I’m someone who has a sleep disorder with restless legs, going right into REM [rapid eye movement] sleep, and sleep paralysis, with some family members who have the same. Where are some of the resources? Where can I get help? Where can I turn to if my primary care doctor isn’t talking to me about it? Are there resources on the internet that I can look at?

Ashgan A. Elshinawy, DO: I start with the primary care physician to see if they have a referral reference in place. A lot of them will have sleep physicians in the area that they trust, or physicians that they have referred patients to if they’re not able to handle it. If they don’t have time to handle it, they’re usually happy to refer you to a sleep specialist. That’s the best approach. I don’t love sending patients to the internet. It’s not because there’s not accurate information there. There’s way too much information there, and then you’re letting them pick and choose what to read, what to follow, and what to believe. That requires a lot of guidance.

People will bring me printed articles and say, “What do you think about this?” I appreciate that so that we can have an intelligent conversation about it, but there’s not 1 specific place to go to. Most people just google: “I sleep bad,” or “insomnia,” or “how do I sleep better?” Then they get ads for marijuana and CBD [cannabidiol] oil, and it creates so much anxiety because then they start reading about the complications of insomnia. If it’s done in an office setting with a sleep specialist—someone who’s been trained to deal with this—they can gain some perspective and education personalized to their situation. As opposed to going on Google and reading anything that may not be very comprehensible to everybody. If insomnia is the issue, I’d rather have patients speak to a sleep specialist or a sleep psychologist to get the history and direct them the right place.

C. Michael Gibson, MD: If I’m in an underserved area, 5000 miles away from a big city, and there’s not someone in my area, is there a way to get directly in touch with a sleep specialist? Or do you have to go through the primary care doctor?

Nathaniel F. Watson, MD: There are a couple of things. One is sleepeducation.org, which is an AASM [American Academy of Sleep Medicine]–curated website that has good information. It helps you avoid Dr Google, which can send you into that spiral. There are huge swaths of the country that have no sleep medicine expertise. The pandemic increased the amount of telemedicine we do. In fact, we offer in-person or telemedicine to all our patients now, and a slight majority prefer telemedicine. That’s opened things up a little for individuals in rural areas, where the expertise doesn’t exist or where they may not be able to travel to the metropolitan centers that have sleep doctors.

There’s a lot of direct-to-consumer entities developing that are FDA approved that can screen, diagnose, and help with the treatment of sleep apnea. You have to reconsider the model of sleep apnea diagnosis and care. In some instances, board-certified sleep doctors are still involved in the interpretation of the test. The test isn’t always a completely traditional, at-home sleep apnea test or a laboratory-based polysomnogram, but they’re validated, FDA approved, and fairly accurate. This is potentially paid for out of pocket by the patient, as opposed to having insurance cover it, but it’s a pathway to get their problem identified and treated. There are at least 4 or 5 entities that provide a…sleep assessment and treatment.

C. Michael Gibson, MD: I want to thank both of you. As a non–sleep specialist and a curious patient, I learned so much. If you enjoyed this conversation, please subscribe to our e-newsletters. You can learn about upcoming Peer Exchanges and get them delivered right to your in-box. Thanks to you 2. This was great. Thanks to all of you in the audience for joining us.

Transcript Edited for Clarity