The first visit is a fairly extensive visit between the patient and myself. The patient will go through a very extensive sleep history, explain their sleep parameters, they are what we call sleep hygiene, we will evaluate their comorbidities; do they have diabetes, high blood pressure and other parameters. We will assess whether they have had a sleep study; is it complete; is it current? Does the sleep study have all the parameters that we need to be able to make a good decision for the patient?
We will often ask them to bring their CPAP machine or their BiPAP machine to see what they are using. Some people are on three-generational machines with four-generational masks – things that are clearly outdated and may not be optimal for the patient and we want to know that in that first visit.
We will also find out some very particular things about history. Do they speak other languages where surgeries may impact their pronunciation? Do they play wind instruments, and these little sort of quirks that we need to know about the decisions that we make are important in assessing a patient.
Then we evaluate them thoroughly and that evaluation consists of a very complete ear, nose and throat examination, as well as an examination of the throat fiber optically where we basically look at the actual windpipe in the office to see where the blockage really is. And then lastly, we have developed a three-dimensional protocol to evaluate the entire windpipe radiographically and that’s a critical element in assessing the best method of treating that patient.