Board-Certified Sleep Medicine, Delivered Virtually

Q: How does virtual sleep medicine work?

Virtual sleep medicine at WISH works through secure video appointments with a board-certified sleep physician. Your initial evaluation covers your full sleep history, symptoms, and medical background. If a diagnostic sleep study is needed, we coordinate home sleep testing — a device shipped to your address for overnight use at home. Results are reviewed at a follow-up visit, and your treatment plan is built and managed entirely via telemedicine. Prescriptions are sent electronically to your local pharmacy.

Q: Is telemedicine sleep medicine as effective as in-person sleep medicine?

For the majority of sleep disorders including obstructive sleep apnea, insomnia, restless legs syndrome, and circadian rhythm disorders, telemedicine delivers equivalent clinical outcomes to in-person care. Home sleep testing has been validated against in-lab polysomnography for OSA diagnosis. CBT-I delivered via telemedicine produces outcomes comparable to in-person CBT-I in randomized controlled trials. Remote PAP data monitoring allows the same therapeutic adjustments that in-person visits would enable.

Q: Do I need a referral to see a WISH sleep physician?

Most insurance plans including Premera Blue Cross, Regence, Aetna, UnitedHealthcare, and Medicare do not require a referral for sleep medicine consultations. We verify your specific benefit coverage before your first appointment. Patients on managed care plans that require a referral should check with their PCP.

Expert Care Across Washington, Oregon, and Montana — Without the Wait

The Wellness Institute for Sleep and Health (WISH) provides fellowship-trained, board-certified sleep medicine to patients throughout Washington, Oregon, and Montana via telemedicine. Founded by Dr. Ankur N. Patel, M.D., M.S., dual board-certified in Sleep Medicine and Internal Medicine by the American Board of Internal Medicine (ABIM), WISH brings the diagnostic rigor and clinical depth of a major academic sleep program to your home — without the two-to-four month wait times typical of hospital-based sleep services.

From sleep apnea to insomnia to narcolepsy, we diagnose and treat the full spectrum of sleep disorders using evidence-based protocols. Home sleep testing is coordinated to your door. Prescriptions go directly to your local pharmacy. Ongoing PAP therapy management is handled remotely. This is comprehensive sleep medicine — not a questionnaire and a prescription.

ABIM Board-Certified

Dual board-certified in Sleep Medicine and Internal Medicine by the American Board of Internal Medicine (ABIM). Fellowship-trained specialist.

WA · OR · MT Coverage

Active telemedicine licenses in all three states. Care that continues when you travel or relocate.

Home Sleep Testing

FDA-cleared devices shipped to your door. Test in your own bed. Results within 48–72 hours.

Days, Not Months

New patient appointments typically available within days — not the months-long queue of hospital programs.

Sleep Disorders We Diagnose and Treat

Sleep medicine is a subspecialty requiring fellowship training and board certification — because the diagnostic and therapeutic landscape is far more complex than most patients realize. WISH physicians evaluate and treat the full spectrum of sleep disorders, not just sleep apnea.

Obstructive Sleep Apnea (OSA)

The most prevalent sleep disorder in adults, affecting an estimated 26% of people ages 30–70 — the majority undiagnosed. OSA is characterized by repetitive upper airway obstruction during sleep, resulting in oxygen desaturation, fragmented sleep, and downstream cardiovascular and metabolic consequences. WISH provides complete OSA care: diagnostic evaluation, home sleep testing, PAP therapy initiation and remote optimization, and management of complex or treatment-emergent presentations.

Insomnia Disorder

Chronic insomnia — defined as difficulty falling or staying asleep at least three nights per week for three or more months — affects approximately 10–15% of adults. WISH delivers Cognitive Behavioral Therapy for Insomnia (CBT-I) via telemedicine, the evidence-based first-line treatment recommended by the American College of Physicians. CBT-I produces durable improvement without the tolerance, dependence, and rebound effects associated with sleep medications. Pharmacotherapy is available when clinically appropriate, managed with attention to long-term risk.

Central and Complex Sleep Apnea

Central sleep apnea — including idiopathic, Cheyne-Stokes, and treatment-emergent presentations — requires subspecialty expertise to diagnose and manage correctly. WISH physicians have experience with complex PAP titration strategies and the clinical nuances that distinguish central from obstructive presentations on home sleep testing and polysomnography.

Restless Legs Syndrome (RLS) / Willis-Ekbom Disease

RLS affects approximately 5–10% of adults and is one of the most commonly undertreated sleep disorders. WISH provides thorough evaluation for underlying causes — particularly iron deficiency, which is clinically actionable — and offers both pharmacological and non-pharmacological management strategies.

Periodic Limb Movement Disorder (PLMD)

Distinct from RLS, PLMD involves repetitive limb movements during sleep that fragment sleep architecture without the patient’s awareness. Often identified on sleep studies during the evaluation of unexplained insomnia or daytime sleepiness.

Narcolepsy and Idiopathic Hypersomnia

Disorders of excessive daytime sleepiness require careful clinical history, appropriate testing (including multiple sleep latency testing coordination), and subspecialty management. These are underdiagnosed conditions that respond well to treatment when correctly identified.

Circadian Rhythm Disorders

Including delayed sleep phase syndrome, advanced sleep phase syndrome, shift work sleep disorder, and irregular sleep-wake rhythm disorder. WISH provides structured light therapy protocols, chronotherapy, and melatonin timing strategies — all deliverable via telemedicine with high efficacy.

REM Sleep Behavior Disorder (RBD)

A parasomnia with important clinical implications, including its association with neurodegenerative conditions. RBD requires specific polysomnographic confirmation and clinical management with attention to safety and long-term monitoring.

Upper Airway Resistance Syndrome (UARS)

A spectrum of sleep-disordered breathing that often falls below the diagnostic threshold for sleep apnea but produces significant sleep fragmentation and daytime symptoms. UARS is frequently missed on standard home sleep testing — WISH physicians understand its clinical presentation and management.

Parasomnias

Including sleepwalking, sleep terrors, confusional arousals, and sleep-related eating disorder. Evaluation focuses on accurate characterization, safety, and identifying underlying precipitants — including medications, sleep deprivation, and comorbid sleep disorders.

Evidence-Based Treatment — Tailored to the Patient

WISH does not operate on a protocol. Every treatment plan is built by a fellowship-trained sleep physician around the individual patient — their diagnosis, comorbidities, preferences, schedule, and realistic goals. Below are the evidence-based therapies we deploy.

PAP Therapy Management (CPAP, BiPAP, APAP)

Positive airway pressure therapy is highly effective for obstructive sleep apnea when properly initiated and managed. WISH handles the complete clinical management: prescription, equipment coordination through our clinical affiliate Sleep and Health Medicine, remote PAP data access and interpretation, pressure adjustments, mask troubleshooting, and optimization of therapy adherence. We do not just hand you a prescription and send you off elsewhere.

Home Sleep Testing

For most patients with suspected obstructive sleep apnea, in-laboratory polysomnography is not necessary. WISH coordinates FDA-cleared home sleep apnea testing — a portable device can be shipped to your address, you complete the test at home in your own bed, and the device is returned by mail. Results are interpreted by a board-certified WISH physician within 48–72 hours. In-lab testing is arranged for clinical presentations requiring full polysomnographic evaluation.

Sleep Pharmacotherapy

Medications have a role in sleep medicine — for insomnia, narcolepsy, RLS, parasomnias, and circadian disorders — when prescribed and monitored by a physician with subspecialty training. WISH manages sleep pharmacotherapy with an emphasis on appropriate indication, lowest effective dose, monitoring for tolerance and dependence, and transition to behavioral approaches wherever possible.

Circadian Entrainment Protocols

Light therapy, strategic melatonin timing, and chronotherapy are effective interventions for circadian rhythm disorders. WISH provides structured protocols tailored to each patient’s specific circadian disorder and lifestyle — all delivered and monitored via telemedicine.

How Virtual Sleep Medicine Works at WISH

Step 1: Schedule — Appointments Within Days

Book online or call (360) 345-3175. New patient appointments in Washington, Oregon, and Montana are typically available within days. No referral is required for most insurance plans. Our team verifies your insurance benefits before your first visit.

Step 2: Comprehensive New Patient Evaluation

Your board-certified sleep physician conducts a thorough clinical evaluation via secure video — covering your full sleep history, presenting symptoms, relevant medical history, current medications, prior sleep studies, and any specialist notes. This is a real physician consultation, not an intake questionnaire reviewed asynchronously.

Step 3: Diagnostic Testing (When Indicated)

When a diagnostic sleep study is clinically appropriate, WISH coordinates home sleep testing for most patients. A portable, FDA-cleared testing device is shipped to your address. You complete the test at home in your own bed, return the device by mail, and your physician reviews results within 48–72 hours. In-lab polysomnography is arranged for clinical presentations requiring full overnight recording.

Step 4: Diagnosis and Treatment Planning

Your physician reviews findings directly with you — explaining your diagnosis, the clinical significance of your results, and the complete range of evidence-based treatment options. You leave this appointment with a clear understanding of your condition and a personalized treatment plan, not a form letter.

Step 5: Treatment Initiation

Whether your plan involves PAP therapy, CBT-I, pharmacotherapy, circadian entrainment, or a combination, WISH coordinates your complete care. Prescriptions are transmitted electronically to your local pharmacy. PAP equipment is coordinated through our clinical affiliate, Sleep and Health Medicine.

Step 6: Ongoing Management

Sleep medicine is longitudinal specialty care. WISH provides ongoing follow-up: PAP data review and therapy optimization, medication management, CBT-I course delivery, and annual evaluations for chronic conditions. All follow-up is via telemedicine.

Serving Patients Across Washington, Oregon, and Montana

WISH was designed for the patients who most need specialty care and have had the least access to it — communities without local sleep specialists, rural regions hours from the nearest academic center, and patients whose schedules make traditional clinic appointments impractical.

We provide sleep medicine to patients throughout our three-state coverage area, including dedicated service pages for the following communities:

Washington

Wenatchee and Chelan County — North Central Washington
Spokane and Eastern Washington
Moses Lake and Grant County — Columbia Basin
Seattle metro area
Vancouver, WA and Southwest Washington
Yakima Valley
Tri-Cities (Kennewick, Pasco, Richland)
Bellingham and Northwest Washington
All Washington communities

Oregon

Portland metro area
Eugene, Salem, and the Willamette Valley
Bend and Central Oregon
Medford and Southern Oregon
Oregon Coast communities
All Oregon communities

Montana

Missoula and Western Montana
Bozeman, Billings, and Eastern Montana
Great Falls, Helena, Butte
Kalispell and Northwest Montana
All Montana communities

Contact Our Sleep Clinic for Consultations and Sleep Studies

Fax: (360) 230-4780

3517 NW Camas Meadows Dr., Suite #210

Camas, WA 98607

Meet Your Team

Lorrie Howe, MA-C

Lorrie has what seems like an endless supply of patience and caring, along with an exceptional ability to organize and remember everything. She is the main point of contact for anyone trying to reach the practice, and, perhaps even more importantly, she is a personal guide through every step of the patient journey.

Miranda Fezer, PA-C

Miranda is an extremely compassionate and highly knowledgeable sleep specialty provider with an endless motivation to go the extra mile for her patients. She believes strongly in listening and developing highly individualized approaches to ensure the absolute best for everyone under her care.

Ankur N. Patel, M.D., M.S.

Dr. Patel is a fellowship-trained, board certified specialist sleep physician. He is highly skilled and deeply passionate in caring for his patients, especially in the context of Sleep Medicine. He believes in hearing your story and working together to bring forth the best results.

He is always excited to meet new patients of all ages and talk sleep!

We never stop working for you.

Board-Certified, Fellowship-Trained Sleep Medicine Physician

WISH is led by Dr. Ankur N. Patel, M.D., M.S. — dual board-certified in Sleep Medicine and Internal Medicine by the American Board of Internal Medicine (ABIM). ABIM Sleep Medicine certification requires completion of an accredited sleep medicine fellowship, a rigorous board examination covering the full diagnostic and therapeutic scope of sleep medicine, and ongoing maintenance of certification. Every patient seen through WISH can be assured they are receiving this highest standard of care. This distinction matters clinically. Sleep medicine involves the interpretation of polysomnography, home sleep testing, actigraphy, and multiple sleep latency testing — studies that require subspecialty training to interpret accurately. It involves the management of CPAP therapy failure, the clinical differentiation of central from obstructive apnea, the delivery of CBT-I, and the long-term pharmacotherapy of narcolepsy and RLS. These are not generalist skills.

Dr. Patel's Credentials

Board Certification in Sleep Medicine — American Board of Internal Medicine (ABIM)
Board Certification in Internal Medicine — American Board of Internal Medicine (ABIM)
M.D., M.S. — Fellowship-trained in sleep medicine at accredited academic programs
Clinical interpretation of polysomnography, HSAT, actigraphy, and MSLT
CPAP, BiPAP, and APAP titration and remote data management
CBT-I delivery — both structured course and abbreviated protocol
Sleep pharmacotherapy: insomnia, narcolepsy, RLS, parasomnias
Complex PAP failure management and alternative therapy protocols

WISH is a physician-owned and physician-operated practice. Our clinical affiliate, Sleep and Health Medicine, provides CPAP equipment and supplies to patients throughout Washington at 1900 116th Ave NE, Suite 200, Bellevue, WA 98004.

Frequently Asked Questions — Virtual Sleep Medicine

How does virtual sleep medicine work?

Virtual sleep medicine at WISH works through a series of secure video appointments with a board-certified sleep physician. Your initial evaluation covers your full sleep history, symptoms, and medical background. If a diagnostic sleep study is needed, we coordinate home sleep testing — a device shipped to your address for overnight use at home. Results are reviewed at a follow-up visit, and your treatment plan is built and managed entirely via telemedicine. Prescriptions are sent electronically to your local pharmacy.

Is telemedicine sleep medicine as effective as in-person sleep medicine?

For the majority of sleep disorders — including obstructive sleep apnea, insomnia, restless legs syndrome, and circadian rhythm disorders — telemedicine delivers equivalent clinical outcomes to in-person care. Home sleep testing has been validated against in-lab polysomnography for OSA diagnosis. CBT-I delivered via telemedicine has been shown in randomized controlled trials to produce outcomes comparable to in-person CBT-I. Remote PAP data monitoring allows the same therapeutic adjustments that in-person visits would enable. In-lab studies remain appropriate for complex diagnostic presentations, including narcolepsy workups and certain pediatric evaluations.

Do I need a referral to see a WISH sleep physician?

Most insurance plans — including Premera Blue Cross, Regence, Aetna, UnitedHealthcare, and Medicare — do not require a referral for sleep medicine consultations. We verify your specific benefit coverage before your first appointment so you know exactly what to expect. Patients on managed care plans that require a referral should check with their PCP; we can often facilitate this coordination quickly.

Does WISH accept insurance?

Yes. WISH accepts most major insurance plans for patients in Washington, Oregon, and Montana — including Premera Blue Cross, Regence, Aetna, UnitedHealthcare, Cigna, and Medicare. We conduct a benefit verification before your first appointment. Self-pay rates are available for patients without insurance coverage or who prefer to pay directly.

What is the difference between WISH and Sleep and Health Medicine (SHM)?

WISH (Wellness Institute for Sleep and Health) is a telemedicine-native healthcare institute providing sleep medicine across Washington, Oregon, and Montana via virtual consultations. Sleep and Health Medicine (SHM) is our clinical affiliate practice in Bellevue, WA, which offers in-person sleep medicine appointments and provides CPAP equipment and supplies directly to patients throughout Washington. Both organizations are served by the same board-certified physicians. Patients who need in-person evaluation or CPAP equipment can be coordinated through SHM.

Can WISH treat patients in rural areas of Washington, Oregon, and Montana?

Yes — this is precisely what WISH was built for. Many rural communities in our coverage area have no local sleep specialists and historically have required patients to drive two to four hours for specialist appointments. WISH eliminates that barrier entirely. Home sleep testing ships directly to your rural address. Video appointments require only an internet connection. Prescriptions go to your local pharmacy. If you are in Washington, Oregon, or Montana, you can access board-certified sleep medicine care through WISH.

Expert Sleep Medicine Is Closer Than You Think.

WISH brings board-certified, fellowship-trained sleep medicine to patients throughout Washington, Oregon, and Montana — with appointments within days, home sleep testing delivered to your door, and ongoing care managed entirely via telemedicine. You do not need to wait months. You do not need to drive hours.