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a supplement to Sleep Review

Our annual prole of

some of the industry’s

top sleep doctors

and facilities

A national directory

of sleep doctors

committed to excellence.

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2 Sleep Review | Best of 2012

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Table of Contents

4 Inventing the Future of Sleep

Medicine

Sleep professionals at Washoe Sleep Disorders Center are

exploring how sleep deprivation affects cognitive abilities

and neurological disorders. Using the Eye-Comtm Biosensor,

Communicator and Controller eye-tracking system, developed

by William Torch, MD, researchers are gaining insights into

yet another fertile area of sleep research.

By Tina Page

10 Sleeping Giants

Prabhat Soni, MD, FCCP, DABSM, tackles issues of awareness

and screening in sleep medicine in the United States and India.

By Renee Diiulio

14 The Team Approach

Under the leadership of Sunil Sharma, MD, DABSM, the East

Carolina University Sleep Disorders and Research Center is

taking a truly multidisciplinary approach to sleep disorder

treatment.

By gReg ThomPson

16 The Broad Approach: Patient Care,

Education, Research

The Cleveland Sleep Centers: Improving sleep health care from

every angle.

By alison WeRneR

18 Continuity of Care

Douglas Livornese, MD, FACP, FCCP, FAASM, designed a

resourceful CPAP compliance program that makes it difficult for

patients not to adhere with therapy.

By Tina Page

SLEEP REVIEW BEST OF 2012 PROGRAM PANEL

Edward Grandi, executive director, American Sleep Apnea Association

Michael Goldman, sleep health evangelist and creator of www.SleepGuide.com

Tracy R. Nasca, founder and senior vice president of Talk About Sleep Inc

20 Proactive Patient Care

As health care evolves, Alexander Villareal, MD, keeps

Geisinger Health Systems, Sleep Disorders Centers, ahead of

the curve.

By Phyllis hanlon

22 Putting Care into Health Care

The International Institute of Sleep has implemented a myriad of

programs that support both patients and the sleep profession.

By Tina Page

24 Rooted in Health Care

Business acumen and ambition to work in health care led Steve

Cela to form Apnix Sleep Diagnostics.

By Tina Page

25 A Commitment to Comprehensive

Care

Pulmonary Associates of Richmond’s Sleep Disorder Centers

have made a commitment to providing comprehensive and

individualized care to local sleep patients.

By alison WeRneR

26 Motivated Drive

Ahmad M. Ibrahimbacha, MD, an inspired physician with

Syrian roots, delivers optimal care to a vast network of

sleep disorder patients.

By nina silBeRsTein

27 Making Things Better

The Weill Cornell Center for Sleep Medicine seeks to advance

sleep medicine through comprehensive care, quality processes,

and intense research.

By Renee Diiulio

SRBest_Toc_List.indd 2 4/6/12 2:47:09 PM

Best of 2012 | Sleep Review 3

BEST

2012

of

Abbasi-Feinberg, Fariha, MD

Charlotte Eye Ear Nose & Throat Associates

Belmont, NC

704.295.3700

www.ceenta.com

Abraham, Sunoj, MD

Citrus Pulmonary Consultants

Crystal River, Fla

352.795.1999

Ahmed, Mansoor, MD, FCCP,

FABSM

Cleveland Sleep Centers

Middleburg Heights, Ohio

440.243.8044

See

page 16

www.clevelandsleeps.com

Ahmed, Qanta, MD

Winthrop-University Hospital Sleep

Disorders Center

Garden City, NY

516.663.3907

www.winthrop.org

Ajayi, Akinyemi, MD

The Children’s Lung, Asthma and

Sleep Specialists

Winter Park, Fla

407.898.2767

www.childrenssleeplab.com

Amin, Mohammad, MD

St. Charles Hospital Sleep Disorders

Center

Port Jefferson, NY

631.474.6277

www.stcharles.org

Barthlen, Gabriele M., MD, PhD

Sleep Center Hawaii

Pearl City, Hawaii

808.456.7378

www.sleepcenterhawaii.com

Bogan, Richard, MD

SleepMed

Columbia, SC

800.373.7326

www.sleepmed.md

Boota, Ahmad, MD

Bon Secours St. Francis Health System

Sleep Center

Greenville, SC

864.269.2801

www.stfrancishealth.org

Brown, Stephen E., MD

Memorial Pulmonary & Sleep Con-

sultants

Long Beach, Calif

562.290.8888

www.memorialcare.org

Carstensen, Steve, DDS

Bellevue Dental Sleep Medicine

Bellevue, Wash

425.746.0021

www.stevecarstensendds.com

Cataletto, Mary, MD

Winthrop-University Hospital Sleep

Disorders Center

Garden City, NY

516.663.3907

www.winthrop.org

Chalaka, Sridar, MD

The Everett Clinic

Everett, Wash

800.533.7035

www.everettclinic.com

Chandra, Anuj, MD

Advanced Center for Sleep Disorders

Chattanooga, Tenn

423.648.8008

www.sleepforhealth.org

Chang, Samuel, MD

Delta Waves Inc

Colorado Springs, Colo

719.262.9283

www.deltawaves.org

Charnock, Edwin, MD

Medical Sleep Solutions

DeSoto, Tex

972.709.7190

www.medicalsleep.com

Coll, John B., DO

CNMRI Sleep Disorders Center

Dover, Del

302.678.8100

www.cnmri.com

Conroy, Robert, DO

Hawthorn Medical Associates, LLC

Dartmouth, Mass

508-996-3991

www.hawthornmed.com

Cooke, Jana, MD

The Everett Clinic

Everett, Wash

800.533.7035

www.everettclinic.com

Delgado, Humberto R., MD

Lake Pulmonary/Sleep Disorders

Leesburg, Fla

352.728.0709

Desai, Avinash, MD

Lung and Sleep Center, PC

Waterford, Mich

248.681.7909

www.lungandsleepcenter.com

Draw, Azmi, MD

St. Vincent Salem Hospital

Salem, Ind

812.883.5881

www.stvincent.org

Eagle, Rebecca, MD

Oklahoma Sleep Associates

Norman, Okla

405.307.1000

www.normanregional.com

El-Gendy, Alaa, MD

Florida Lung & Sleep Associates

Lehigh Acres, Fla

239.369.3333

www.chestinstitute.net

Escobar-Cordoba, Franklin,

MD, PhD

Fundacion Sueno Vigilia Colombiana

IPS

Bogota, Colombia

www.fundasuvicol.org

Espiritu, Joseph, MD

SLUCare Sleep Disorders Center

St Louis, Mo

866.977.4440

www.slu.edu

Esther, M. Susan, MD

The Sleep Center at SouthPark

Charlotte, NC

704.295.3000

www.ceenta.com

Gardner, Jack, MD

Medical Sleep Solutions

DeSoto, Tex

972.709.7190

www.medicalsleep.com

Garwood, Mark, MD

Greater Ann Arbor Sleep Disorders

Center

Brighton, Mich

810.534.1170

www.gaasleep.com

Gilbey, Jack, MD

Texas Pulmonary Sleep Center

Arlington, Tex

817.461.8772

www.tpsctr.com

Greatens, Todd, MD

Sleep Center of Central Minnesota

Baxter, Minn

888.481.3652

www.baxtersleepclinic.com

Green, Ronald, MD

The Everett Clinic

Everett, Wash

800.533.7035

www.everettclinic.com

Greenberg, Harly, MD

North Shore-Long Island Jewish

Health System Sleep Disorders Center

Great Neck, NY

516.465.3899

www.northshorelij.com

Greif, Paul, MD

Pulmonary and Sleep Medicine of

Norwich

Norwich, Conn

860.204.9735

www.norwichpulmonary.com

Grinman, Lev, MD

Comprehensive Medical Services PC

New York, NY

888.929.7533

www.isleepprogram.com

Haas, Jamie, MD

Patients First Health Care Sleep

Center

Washington, Mo

636.390.1776

www.patientsrsthc.com

Sleep Review’s annual prole of some of the

industry’s top sleep doctors and facilities

BEST OF 2012

sleep doctors

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Continued on page 9

SRBest_Toc_List.indd 3 4/9/12 12:39:22 PM

4 Sleep Review | Best of 2012

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BY TINA PAGE

Sleep professionals at Washoe Sleep

Disorders Center are exploring how sleep

deprivation affects cognitive abilities and

neurological disorders. Using the Eye-

Com

tm

Biosensor, Communicator and

Controller eye-tracking system, developed

by William Torch, MD, researchers are

gaining insights into yet another fertile

area of sleep research.

Heart and lung specialists have increasingly

focused on the consequences of poor sleep,

but what about brain researchers? For

neurologist William Torch, MD, the sleep/brain

connection is a chief area of concern, and that

interest has simmered since the early days of

sleep medicine.

When Torch came from New York City

to Nevada in 1979 to join the Pediatrics

Department at the University of Nevada

School of Medicine in Reno, he became the

Silver State’s first pediatric neurologist. In

addition to his MD from the University of

Rochester School of Medicine, he brought

credentials as a researcher with an MS degree

in biochemistry.

Evolution of a SlEEp Doctor

During his neurology residency in 1974,

Torch met Dr Elliott Weitzman, chairman of

neurology at the Albert Einstein College of

Medicine, sparking a lifelong dedication to

sleep medicine research. Torch had always

been intrigued with the curious EEG brain

waves associated with pediatric and adult

sleep states, especially Weitzman’s pioneering

research on rapid eye movement (REM) and

the mysteries of sleep neurophysiology, also

being explored by Dr William Dement at

Inventing the Future

of Sleep Medicine

Washoe Sleep Disorders Center

Stanford University.

At the time, sleep medicine was a “dark

science” and few doctors recognized the

importance of sleep in daytime functions.

From that point on, Torch and sleep

medicine would unwittingly cross paths,

resulting in many research innovations.

Once settled in Nevada, Torch started the

Neuro-Developmental & Neuro-Diagnostic

Center (NDC) as a multidisciplinary clinic

treating neurological disorders, and

performing regular and 24-hour ambulatory

and quantitative EEGs on children and

adults with attention deficit disorder (ADD),

epilepsy, sleep, and other neuropsychiatric

disturbances, while also serving as the

medical director of the Northern Nevada

Muscular Dystrophy Association clinic.

Torch and sleep medicine began traveling

the same path after a fortuitous 1984 meeting

with experimental psychologist Dr John

Zimmerman, who had previously worked in a

Colorado sleep lab. When Zimmerman offered

to start the first sleep disorders clinic in Reno,

Torch agreed, and the Washoe Sleep Disorders

Center (WSDC) was born. The venture brought

sleep medicine and neurology under one roof,

while laying the groundwork for Eye-Com

Corporation (ECC) in 1998.

HumblE bEginningS

Torch and Zimmerman started the WSDC

from scratch with the support of the Washoe

Medical Center, which provided space

for a one-bed sleep lab. Together, they

built their own primitive sleep recording

polysomnographic equipment, attaching a

camera to a makeshift paper tracing EEG

machine that they lugged around the hospital,

while performing less than five inpatient

polysomnograms (PSGs) each month. “It was

an expensive joke,” Torch says, and “when

we started a sleep medicine grand rounds

teaching program, we also found that no one

believed in sleep medicine as a discipline, and

only a few would come.”

Nevertheless, after 3 years the lab was

performing about five to 10 inpatient sleep

studies per month. By 1994, the WSDC had

grown into a two-bed lab performing 20 to 30

inpatient and outpatient sleep studies each

month.

Soon afterwards, it received its first

5-year accreditation from the American

Academy of Sleep Medicine (AASM), with

three more 5-year reaccreditations to come.

Torch finally moved the NDC/WSDC into its

new four-bed facility in the Renown Center

for Advanced Medicine, while gradually

SRBest_4_8_Washoe.indd 4 4/5/12 12:12:52 PM

Best of 2012 | Sleep Review 5

BEST

2012

of

expanding its staff of two to 12, including

the Lab Director, Dr Paul Saskin, six board-

certified sleep and EEG technicians, and

two nurse practitioners. The NDC/WSDC

now accommodates more than 400 patient

visits and performs 70 to 90 sleep studies

each month, with expectations of doubling

in size over the next 2 years. In recognition

of his Nevada accomplishments, Torch was

elected as the first president of the AASM-

sponsored Nevada Sleep Society.

EVOLUTION OF AN INVENTOR

Torch wears three hats as a clinician,

researcher, and inventor, and he has dreamed

up a number of sleep-related inventions

during his own REM sleep. This included the

Sleep Manager

tm

—a hardware and software

calculating system (soon to become an Apple

App), which can help prevent jet lag and shift

work fatigue, and the Eye-Com

tm

Biosensor,

Communicator and Controller.

Torch’s goal has always been to deploy

new technologies to help neurologically

disabled children and adults with progressive

neuromuscular disorders such as muscular

dystrophy or ALS, as well as more static

conditions like cerebral palsy, stroke, and

traumatic spinal cord or brain injury, to

achieve independence and freedom of

movement.

Torch’s vision to help such victims

materialized in 1998, when asked to consult

on a young man named Glen, who awoke from

a coma on a ventilator in an ICU, following a

stroke to his cervical spinal cord—the result of

viral encephalomyelitis. The condition left him

totally quadriplegic. “The only way he could

communicate was to move his eyes and blink

once or twice in response to yes/no questions

… and cry,” Torch says. “The patient was in a

near locked-in-state.

“I went down to Radio Shack and bought

about $2.50 worth of IR emitter-detectors

and electronic components and built a blink

detector, now known as Eye-Com 1 (EC-1). I

figured that if I could capture the short and

long blinks of this unfortunate fellow, convert

them into computerized Morse code dots and

dashes, and then into text on a computer, this

would give him the gift of communication with

loved ones and caretakers. Thus, the passion

to develop the Eye-Com as a Biosensor,

Communicator and Controller stepped out of

my neurology practice.”

After creating the EC-1 “blinkometer,” Torch

realized that the simple device that helped

Glen could be modified to help other paralyzed

individuals with different degrees of disability

as well, and at the same time it could be

used to identify the long and short blinks and

other oculometrics associated with drowsiness

and microsleeps for use in transportation and

industrial safety applications.

REINVENTING SAFETY BEHIND THE

WHEEL

EC-1 incrementally evolved through a series

of progressive EC-2 through EC-7/8 iterations,

as a Biosensor, Communication and Controller

device and technology, to its current to-be-

commercialized EC-8 HawkEye Model. Torch’s

passion for invention, and love for teaching,

won the respect of his colleagues in the

Nevada Inventors Association (NIA), and he

was soon elected as NIA vice president, and

then president.

While NIA president, his EC-4 system was

featured in Forbes ASAP, in an article titled

“The Inventor Next Door.” Because of the

Eye-Com research he had been doing, he

was then invited to a “New Technologies in

Driver Vigilance Conference” sponsored by

the American Trucking Association (ATA) and

US Department of Transportation (USDOT)

in Washington, DC. By that time, EC-4 had

evolved to the point that it could transmit

drowsy blink signals through walls by RF

telephonic and satellite connections, trigger

local audible alarms for emergency responses,

as well as connect by wired or wireless

connection with EEG and PSG machines

in the vicinity, or to remote receiving or

monitoring stations 3,000 miles away, as it

did in Cambridge, Mass, by setting off eye-

blink triggered Lifeline alarms at that site.

Operating as a drowsiness detector that

could alert a sleepy driver, EC-4 could also,

as a communication-controller device, be used

to type messages on a computer screen by

purposeful eye blinks.

Torch brought his EC-4 to the conference

where he was first introduced to the term

“PERCLOS,” an acronym for the percentage

of time one’s eyes are closed over a period

EC-1 EC-4

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6 Sleep Review | Best of 2012

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of time. Torch instantly realized that he

had, without awareness, already created

a wearable, wireless PERCLOS-monitoring

eye-blink Biosensor, Communicator and

Controller. The PERCLOS algorithm had

been developed by other researchers in the

sleep and transportation safety field, out of

video analysis of a sleepy driver’s eyes in a

research driving simulator. Soon thereafter,

the PERCLOS metric was announced by the

USDOT as the best bio-physiological measure

of drowsiness available, even over EEG,

Torch says.

At the conference, Torch met colleague Col

Michael Russo, MD, a neurologist who was

to become a section chair of the AASM Sleep

Deprivation Committee. Russo immediately

recognized that Eye-Com technology could

contribute to solving the problem of soldier

and military truck drivers falling asleep on

long truck convoys, as had occurred during

Desert Storm operations, or of army helicopter

pilots falling asleep at the controls of a

multimillion-dollar Black Hawk or Apache

helicopter.

After attending the conference, Torch

realized that there were other ocular

manifestations relating to sleepiness and

arousal, where, for example, slow downward

lid movements might indicate gradual

falling asleep, while a sudden upward

eyelid movement might signify an arousal

or startled response. He also realized that

the rate and diameter size change of a pupil

was important as a predictor of progressive

drowsiness where, as shown in experimental

pupillometry studies, the sleepier you

become, the smaller and less reactive your

pupil gets over time.

Based on these realizations, Torch went on

to develop the EC-5, which could measure

PERCLOS and upward and downward lid

velocities. Next, by attaching two Eye-Com

“micro-endocameras” to an eye-frame,

one below and aimed at each eye, and a

single “exo-camera” aimed forward from the

nasal bridge just above the nose, he could

monitor pupils, eyeball movements, and

gaze characteristics as well. These were the

oculometrics that might be associated with

microsleep intrusions, brain fog, and tunnel

vision.

One year later, Torch was invited to

another USDOT-sponsored conference on

driver vigilance that spurred him to create

the “ideal sleep detection and safety

response device.” During that 1-year

interval, the USDOT had realized the

importance of eye movement and gaze,

announcing a second follow-up conference

called “New Ocular Technologies in Driving

Vigilance.” This time the NDC/WSDC and

Eye-Com Corporation came, not as a

spectator, but as a participant, displaying

its ground-breaking technology in a booth

next to that of another company, Real Time

Technology, which was looking for a device

that could trigger their proprietary tactile

race-car seat to vibrate a person awake.

The match “made in heaven,” Torch says,

resulted in an EC-6 vibrating seat that was

eventually installed into a Dodge-Ram Eye-

Com truck simulator that was built over the

next year in the WSDC.

William Torch, MD, wearing EC-7/8

EC-7

SRBest_4_8_Washoe.indd 6 4/5/12 12:13:30 PM

Best of 2012 | Sleep Review 7

BEST

2012

of

FUNDING THE FUTURE OF SAFETY

While Torch was serving as NIA president,

he also was told of an upcoming Phase I

Small Business Innovation Research (SBIR)

Solicitation Grant sponsored by the Centers

for Disease Control and Prevention (CDC)

Division of Accident and Injury Protection.

The solicitation called for new technology

that could: 1) identify drowsiness; 2) call for

emergency assistance for elderly individuals;

and 3) assist in the neuro-rehabilitation

process of those injured in an accident.

Realizing the “hand-in-glove” fit of

EC-6, he applied for the grant, and on what

Torch calls a “magical day,” September

10, 2001, he was awarded the $100,000

grant to further develop and validate the

Eye-Com 6 for the defined SBIR Tasks. ECC

successfully completed the CDC SBIR Phase

I Grant within a year, demonstrating that a

wired or wireless EC-6 could clearly identify

and respond to the drowsy oculometrics of

sleep-deprived subjects with sleep apnea or

narcolepsy, and normal controls, in a simple

desktop computer drive simulator program

called Steer Clear.

In that CDC study, it was shown that the

PERCLOS measurements of sleepy subjects

tested in that 24-hour sleep deprivation

study had the same eye characteristics as

patients previously diagnosed with ADD

and attention-deficit hyperactivity disorder

(ADHD). This led to Torch’s conviction that

ADD/ADHD may, in many cases, be the

“functional expression” of underlying states

of sleepiness associated with the growing

epidemic of insufficient sleep in the United

States—in both the civilian and military

worlds. According to military professionals,

long hours on duty, and missions associated

with sleep deprivation, are the rule—and

frequently the cause of irritable or aggressive

behavior, road rage, and human factors-

related performance-vigilance failures

leading to the unwanted consequences of

friendly fire and collateral damage, Torch

says. With these considerations in mind,

the Department of Defense (USDOD) invited

the WSDC and ECC to apply for a US Army-

sponsored 2003 Phase I $75,000 SBIR Grant,

and as before, the two were once again

awarded.

During the Phase I study conducted in 2004,

ECC refined the EC-6 and developed Eye-Com

Eye-See

tm

oculometric software that could be

used to study the eyes of drivers and pilots

in a more advanced desk-top STISIM Drive

simulator installed in the WSDC/NDC. It was

demonstrated that Eye-See

tm

had the potential

of tracking more than 30 different eyelid,

eyeball, and pupil movements, including

PERCLOS, in real time as well as from

previously recorded video of an EC-6 wearer’s

eyes. During the Army Phase I study, EC-6 was

deployed within a full immersion UH-60 Black

Hawk helicopter flight simulator at Ft Rucker,

Ala, and the US Army Aeromedical Research

Laboratory Engineering Directorate approved

its use in further real and simulated helicopter

studies.

Upon completion of Phase I study, Torch, as

principal investigator, was invited to apply for

a follow-up $750,000 US Army Phase II SBIR

Grant to further develop the EC-6 as a Soldier-

Mounted Eye-Gaze tracking technology, which

could be incorporated into glasses worn

under pull-down masks and visors, as well as

attached to night-vision scopes and goggles,

or physically incorporated into head-mounted

displays and scuba masks.

Upon receipt of the award, the WSDC

and ECC began to take center stage with

a full immersion Eye-Com Drive Simulator

within the WSDC. “I brought in a Dodge Ram

truck,” Torch says, “sliced it in half, took

out the guts, brought the two halves up in

an elevator to the seventh floor facility, put

it on a wooden frame, built a wrap-around

screen around it with three projectors, and

integrated the EC-6-Com with other bio-

physiological recorders, including EEG, into

the Eye-Com Truck Drive Simulator to monitor

drowsiness and effects of sleep deprivation

on patients with sleep apnea, narcolepsy,

and ADD, and normal controls with no sleep

disorder.”

During this Institutional Review Board-

approved 24- to 36-hour sleep deprivation

EC-6 Drive Simulator study, all subjects

demonstrated worsening performance

in six successive testing sessions,

administered every 6 hours, over the

36-hour sleep deprivation period. In each

of the six successive sessions, there were

progressive increases in EC-6 generated Eye

Blink Frequency, Eye Blink Duration, and

PERCLOS oculometrics, which correlated

with increasing drowsiness and micro-

sleeps, along with decreasing attentiveness,

increased numbers of errors of omission

and commission, and slower reaction times

to stimuli, all consistent with ADD/ADHD

symptomatology. As in real life, untreated

narcoleptic subjects were the most impaired

of the four groups, also showing the worst

ADD scores.

Artistic rendition of EC-9

SRBest_4_8_Washoe.indd 7 4/5/12 12:13:53 PM

8 Sleep Review | Best of 2012

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For all groups, EC-6 drowsiness

oculometrics were linearly correlated with

progressive performance-vigilance decline as

documented by proportional increase in drive

simulator crashes, center line and road edge

excursions, and erratic braking and driving.

Circadian changes also were noted, with

“second wind” recovery on the sixth testing

session for all groups. The findings were

consistent with police-reported transportation

accident statistics and observations, where

most of the simulator accidents occurred

in the early morning hours, when driving

performance is most impaired in real world

driving. Because of its successes under the

Federal CDC and US Army’s SBIR Program,

ECC and Torch were awarded the coveted

National Tibbetts Award in 2006, with further

acclaim in the September 2006 Congressional

Record. This was followed by receipt of a

2008 Nevada Entrepreneurship Award for

Medium Sized Business.

Another EC-6 study funded by the National

Highway Traffic Safety Administration Heavy

Truck Division of the USDOT and the USDOD

included a head-to-head comparison of

the wearable EC-6’s PERCLOS-measuring

capabilities with Co-Pilot, a dashboard-

mounted eye-tracker. The comparative

study performed in the Eye-Com Dodge Ram

simulator conclusively demonstrated EC-6’s

superiority as an unobtrusive wearable

eye-frame, which was capable of operating

in very demanding environments, as, for

example, where the movement of the

trucker in a cab might confound a fixed,

dashboard-mounted eye-tracker as it loses

contact with the driver’s face and eyes, or

when the driver is looking away from the

dashboard-mounted camera, or wearing

obtrusive glasses causing unwanted glints,

Torch says.

One of the many innovations to come out

of the combined USDOD/USDOT-sponsored

study was a new mathematically derived

Eye-Com Composite Oculometric Fatigue

Index (COFI) and an Eye-Com COFI Safety

Response Algorithm, which could trigger

audible or tactile alarms of increasing intensity

dependent on the degree of sleepiness (eg,

mild, moderate, severe) as measured by

increasing PERCLOS and longer eye-blink

durations associated with drowsiness-impaired

driving. The Eye-Com COFI Safety Response

now has the potential to be used in the real

world to alert a sleepy operator or passengers

in the vehicle, to alert surrounding vehicles

in danger, or, for that matter, a dispatcher or

air controller at a remote monitoring site, to

prevent a fatal accident.

A Vision TAkes shApe

The EC-6 has evolved into the EC-7 and

a futuristic EC-8 to be released this year for

Augmentative and Alternative Communication

(AAC) applications to help any individual

with any degree of disability, whether totally

or partially paralyzed. Making all of this

possible is EC-7 and EC-8’s newest eye-gaze

capabilities, integrating binocular Eye-Com

endo-camera eye movement with Eye-Com

exo-camera head-pose coordinates, allowing

the wearer to control a computer cursor by

“point and drag” Eye-Mouse

tm

as well as

purposeful eye-blink or eye-dwell functions,

which can be used in combination with

scalable “click activation” by any functional

body part (eg, finger, hand, foot, face, or

mouth, etc).

As has already been demonstrated, the

EC-7 and future HawkEye EC-8 model,

designed to help ALS-afflicted individuals

such as Professor Stephen Hawking, will

allow users to virtually control any off-the-

shelf or specially designed AAC software

programs using typing, text, and speech

generating keyboards, and an infinite number

of software programs.

“Perhaps by reversing the sleep deprivation

epidemic that is universal in scope,” Torch says,

“we can reverse the unnecessary dependence

on stimulants and sleep medications and also

drastically reduce the number of near-fatal

accidents—the cause of millions of disabling

injuries world-wide.”

If you or your company is interested in

integrating the Eye-Com technology in your

own research applications, or have interest

in becoming a beta test site for the new

Eye-Com or Sleep Manager technologies,

please contact Eye-Com Corporation or

William Torch at (775) 329-2006. For more

information, please visit the ECC Web site:

www.eyecomworld.com.

Tina Page is a freelance writer based

in Lomita, Calif. She can be reached at

sleepeditor@allied360.com.

William Torch, MD

Washoe Sleep Disorders Center

Renown Center for Advanced Medicine - Building C

75 Pringle Way # 701

Reno, NV 89502

775.329.4060

The Eye-Com COFItm Safety Response Algorithm showing drive simulator accidents as a

function of Eye-Com generated PERCLOS oculometrics in subjects with OSA, narcolepsy,

and ADD and normal controls, who were tested every 6 hours over a 36-hour sleep depriva-

tion period.

SRBest_4_8_Washoe.indd 8 4/5/12 12:13:54 PM

Best of 2012 | Sleep Review 9

BEST

2012

of

Haeger, Eric, MD

Central Washington Sleep Diagnostic

Center

Wenatchee, Wash

509.663.1578

www.cwsleepcenter.com

Hales, J.D., DO

Sleep Solutions of New Iberia

New Iberia, La

337.606.0041

www.sleepsolutionsofnewiberia.com

Hare, Kelly, FNP

Pulmonary Associates of Kingsport

Kingsport, Tenn

423.247.9075

www.pak-kpt.com

Haynes, J. Brevard, MD

Saint Thomas Health Services Center

for Sleep

Nashville, Tenn

615.284.7533

www.tncenterforsleep.com

Hegde, Korgi V., MD

Clayton Sleep Institute

St Louis, Mo

314.645.5855

www.claytonsleep.com

Hertz, Gila, PhD

Huntington Medical Group Sleep

Disorders Center

Huntington Station, NY

631.425.3895

www.hmgpc.com

Horowitz, Sandra, MD

Sleep HealthCenters

Framingham, Mass

508.270.6020

www.sleephealth.com

Howell, Michael, MD

Fairview Sleep Centers, University of

Minnesota Medical Center-Fairview

Minneapolis, Minn

800.824.1953

www.fairview.org

Huang, David Y., MD

Tallahassee Memorial HealthCare

Sleep Center

Tallahassee, Fla

850.431.4400

www.tmh.org

Hudson, John Douglas, MD

Sleep Medicine Consultants

Austin, Tex

512.420.9900

www.sleepdoc.net

Hudson, John Douglas, MD

The Sleep Center of Austin

Austin, Tex

512.697.9896

www.thesleepcenteraustin.com

Ibrahimbacha, Ahmad, MD

SkyRidge Medical Center

Cleveland, Tenn

423.476.2212

See

page 26

www.skyridgemedicalcenter.net

Ingmundson, Paul, PhD

South Texas VA Health Care System

San Antonio, Tex

210.617.5300

www.southtexas.va.gov

Janata, Kelli Rae, DO

Banner Health-North Colorado

Medical Center

Greeley, Colo

970.350.6587

www.bannerhealth.com

Joshi, Rajan, MD

Total Lung Care

Richmond, Ky

859.623.8981

Kaelin, Thomas, Jr, DO

South Carolina Sleep Medicine, LLC

Summerville, SC

843.871.4006

www.scsleepmedicine.com

Kaimal, Janardana, MD

Sleep Disorder Center of Louisiana

Lake Charles, La

877.597.7378

www.sleepdisordercenteroa.com

Koops, Maureen, MD

South Texas VA Health Care System

San Antonio, Tex

210.617.5300

www.southtexas.va.gov

Kravitz, Richard, MD

Duke University Medical Center,

Children’s Health Center

Durham, NC

888.275.3853

www.dukehealth.org

Livornese, Douglas, MD, FACP,

FCCP, FAASM

Comfort Sleep

Neptune City, NJ

732.455.3030

See

page 18

www.comfortsleep.net

Lombardo, Gerard, MD

Nocturnal Sleep Diagnostics, LLC

New York, NY

718.803.7222

Lynch, Elizabeth A., MD

Sleep Institute of New England

Kingston, NH

877.550.7463

www.sleepne.com

Makki, Hassan, MD

DMC Sinai-Grace Sleep Disorders

Center

Detroit, Mich

313.966.4800

www.sinaigrace.org

Malhotra, Raman, MD

Saint Louis University School of

Medicine

St Louis, Mo

314.977.9870

www.slu.edu

McArdle, Robert, DO

Chest Medicine Associates

South Portland, Me

207.828.1122

www.cmamaine.com

Milchak, Richard, MD

Northern Colorado Pulmonary

Consultants PC

Fort Collins, Colo

970.224.9102

www.ncpcpulmonary.com

Milstone, Aaron, MD

Williamson Pulmonary and Sleep

Medicine

Franklin, Tenn

615.790.4159

www.wpsmed.com

Mostafavi, Said K., MD

Advanced Sleep Medicine Services

Los Angeles, Calif

877.775.3377

www.sleepdr.com

Moufarrej, Nabil A., MD

The Sleep Clinic

Shreveport, La

318.797.1585

sleepcliniconline.net

Nicholson, Dennis H., MD

Pomona Valley Hospital Adult and

Children’s Sleep Disorders Center

Claremont, Calif

909.865.9152

www.pvhmc.org

Panossian, David H., MD

Klamath Sleep Medicine Center

Klamath Falls, Ore

541.885.2201

www.klamathsleepmedicinecenter.com

Paranjothi, Subramanian, MD

Mercy Hospital-St. Louis

St Louis, Mo

314.251.6000

www.mercy.net

Paruthi, Shalini, MD

SSM Cardinal Glennon Children’s

Medical Center

St Louis, Mo

314.577.5600

www.cardinalglennon.com

Pascual, Frederick, MD

The Everett Clinic

Everett, Wash

800.533.7035

www.everettclinic.com

Patel, Anit B., MD

REM Sleep Diagnostics

Vacaville, Calif

707.469.8400

www.mysleepscore.com

Perkin, Ronald M., MD

Vidant Medical Center

Greenville, NC

252.847.4100

www.vidanthealth.com

Polsky, Michael, MD

Pulmonary Associates of Richmond

Sleep Disorders Center

Richmond, Va

804.320.4243

www.paraccess.com

Potts, Richard, DO

St. Vincent Regional - Sleep Disorder

Center

Green Bay, Wis

920.431.3041

www.stvincenthospital.org

Puri, Amitab, MD

Pima Lung & Sleep, PC

Tucson, Ariz

520.229.8878

www.pimalung.com

Razavi, Mehrdad, MD

Advanced Sleep Diagnostics

Red Bluff, Calif

530.242.9273

www.reddingsleepdisorders.com

Reda, Fouad, MD

St. Louis University School of

Medicine

St. Louis, Mo

314.977.9870

www.slu.edu

Reid, Jeffrey, MD

Tanner Center for Sleep Disorders

Carrollton, Ga

770.836.9146

www.tanner.org

Ringler, Jack, MD

Sleep Disorders Center at Berkshire

Medical Center

Pittseld, Mass

413.447.2000

www.berkshirehealthsystems.com

Rinn, Andrea, DO

United Sleep Medicine Centers

Charlotte, NC

888.876.0129

www.unitedsleepmedicine.com

BEST OF 2012

sleep doctors

Continued on page 28

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10 Sleep Review | Best of 2012

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BY RENEE DIIULIO

Prabhat Soni, MD, FCCP, DABSM, tackles

issues of awareness and screening in

sleep medicine in the United States and

India.

Sleep physicians like Prabhat Soni, MD,

FCCP, DABSM, a top doctor in sleep medicine

today, are well aware of the importance of

sleep. “Poor sleep can lead to a higher risk

of disease, including diabetes, high blood

pressure, and obesity,” Soni emphasizes

whenever asked. Unfortunately, however,

many primary care physicians and even more

patients are unaware of the many health

problems associated with poor sleep—and

may not even think to ask.

“Patients don’t know about sleep apnea,

and if they do know about it, they don’t

want to go to the doctor. But even if they

do go to the doctor, many primary care

physicians are not aware of the seriousness

of sleep apnea,” Soni says.

Soni has made it a mission to turn

this situation around, not only here in

the United States, but also in his native

country of India. Recognition for his work

has landed him among Sleep Review’s

honorees 2 years in a row and garnered

accolades from the NRI (Non-Resident

Indian) Society of India. On a recent trip to

India, Soni was honored by the NRI Welfare

Society of India with a Hind Ratan Award

and NRI of the Year 2012.

The attention is useful in generating and

maintaining momentum for his mission. On

that same trip, while in New Delhi, Soni’s

hometown (and the country’s capital), he

met with the core team of President Smt

Pratibha Devisingh Patil to discuss the issues

surrounding sleep and how to expand the

field of sleep medicine within the country.

His work and interviews were aired during

Indian news programs highlighting his efforts

to diminish the impact of sleep disorders;

additional audiences were captured with

online versions.

Soni is driven to help others by a desire

that started close to home, with a family

history suffering its own impact from sleep

disorders. His grandfather had multiple

health problems, which Soni now believes

were related to sleep apnea. “He snored

so much my grandmother would sleep in

another room,” Soni recalls. But no one

associated his sleep problems with his

hypertension, diabetes, or strokes.

The connection between sleep and

mortality was more evident for another

family member who fell asleep behind the

wheel and crashed. The accident occurred

while Soni was studying medicine, and he

gravitated to the still growing field.

Today, Soni loses sleep trying to fix the

slumber of others. His methods reflect

some growing trends in the industry (eg,

one-stop shopping and a modernized sleep

lab) as well as new directions (a broader

focus and team approach). And his efforts

spare no one: whether a patient is rich or

poor in New York City or New Delhi, Soni

will find a way to get everybody a good

night’s sleep.

Working ToWard a FiFTh Board

Soni has been practicing medicine in the

United States for more than 20 years. After

obtaining his MD from Sardar Patel Medical

College in Bikaner, India, he completed his

board certifications in chest and TB at the VP

Chest Institute and in diagnostic radiology at

Safdarjung Hospital in New Delhi.

He relocated to New York in 1989,

completing residencies in pediatrics/medicine

at Lincoln Medical Center in the Bronx and

internal medicine at Kingsbrook Jewish

Medical Center in Brooklyn. Fellowships

followed: one in pulmonary medicine at

Cabrini Medical Center in New York and

one in critical care medicine at Maimonides

Medical Center in Brooklyn.

Today, he is quadruple board certified by

the American Board of Internal Medicine

in sleep, pulmonary, critical care, and

internal medicine and is working toward

a fifth board certification in bariatrics. He

expects to take the exam in November

and is currently completing a fellowship in

bariatric medicine. His goal is to expand his

understanding regarding obesity and sleep

apnea.

Just as he has multiple boards, Soni

also has multiple roles. He is chief of the

pulmonary department and co-chair of the

intensive care unit at New York Community

Hospital (NYCH) of Brooklyn; he is affiliated

Sleeping Giants

Prabhat Soni, MD, FCCP, DABSM

SRBest_10_13_SleepUSA.indd 10 4/5/12 12:15:06 PM

Best of 2012 | Sleep Review 11

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with Beth Israel Medical Center in New York

City and New York Methodist Hospital in

Brooklyn; and he is an assistant clinical

professor at Weill Cornell Medical College

in New York. He directs four sleep centers,

including his own sleep and pulmonary

practice, which is located just outside of

NYCH of Brooklyn and has been in business

since 2000.

EXPANDING PRACTICE PARAMETERS

In the past year, Soni has not just

expanded the number of sleep clinics he

manages but also the scope of his practice.

A main focus remains on drowsy drivers, but

he has extended his services to the pediatric

patient population, typically 8 years of age

and older. “A lot of pediatric sleep apnea

is related to large tonsils, and my excellent

ENT team knows how to take good care of

them,” Soni says.

In fact, Soni has a multidisciplinary

team he can call on whenever a specific

need arises. The group includes an ENT, a

bariatric surgeon, cardiologist, neurologist,

pediatrician, psychiatrist, sleep dentist,

translators (Chinese, Hindi, Spanish, and

Russian), and a psychologist, who can offer

cognitive behavioral therapy. “They are all

available if somebody has a problem, so we

can address the issue right away,” Soni says,

noting each one is an expert in their field.

If, however, the team lacks a certain

expertise, Soni’s clinic is located next to

NYCH of Brooklyn with its wealth of

resources nearby. Of course, Soni’s four

board certifications make him a unique asset

as well. “In the management of sleep apnea,

comprehensive and total care is important.

When somebody comes in with sleep apnea,

I look at everything from head to toe,” Soni

says.

Soni prefers to supervise patients himself

when possible and typically stops by nightly

during sleep studies after finishing up at

the hospital. “If I can find the problem right

then, we can begin treatment sooner,” Soni

says.

State-of-the-art equipment helps to

diagnose sleep disorders, including

employing home-testing devices. Once

a patient is diagnosed, Soni will work to

create a plan that is effective for the patient

from all perspectives: diagnosis, compliance,

and budget. For instance, when appropriate,

dental appliances are prescribed and made.

Soni also has created a weekly insomnia

clinic that helps to target this large but niche

population, while weight loss programs have

been developed to help obese patients slim

down.

DEVELOPING EXPERTISE

IN BARIATRICS

Soni’s focus on sleep-related bariatric

disorders has grown with his knowledge

of bariatric medicine. His Web site (www.

sleeptobeslim.com) notes that patients

enjoying fewer than 10 hours of restorative,

deep sleep a week could see a weight gain of

almost 20 pounds over the course of a year.

To properly diagnose overweight patients,

Soni will review diet and medications as

well as check thyroid function, endocrine

function, and metabolic rate along with the

sleep study.

Treatment can include a medically

supervised weight loss program that will

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12 Sleep Review | Best of 2012

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be backed by a guarantee. Pending patient

preferences, components can include

meal supplements, replacements, and/or

diet regimens. Patients who follow their

programs and complete their check-ins

(where they meet with a bariatric specialist

on the team) will have their money refunded

if they do not lose weight within the first 6

months.

Soni feels the growing numbers of

obese people are contributing to the rising

incidence of sleep apnea. He is currently

undertaking a 6-month study that will look

at the relationship between metabolic

syndrome and sleep in morbidly obese

patients. “One of the biggest challenges

[facing sleep medicine today] is that sleep

apnea is becoming epidemic because of the

increase in obesity,” Soni says.

Creating awareness about

sleep

One solution, he strongly believes, is

awareness, so Soni reaches out on multiple

levels.

He conducts seminars regularly within the

community, for both primary care physicians

and patients. His PowerPoint presentation

has seen the insides of physician offices,

community centers, and churches.

Soni continues to run newspaper and

television advertisements, although he is

currently updating his on-air commercials.

His shocking drowsy driver commercial has

run its course. In 2011, he ran it just twice a

month. The new version will be modified to

allow it to run during daytime hours, while

two new commercials with different angles

will be added to the roster.

A new Web site showcases Soni’s embrace

of bariatric medicine: www.sleeptobeslim.

com blends obesity concerns with education

on sleep disorders in general. Topics include

sleep disorders (including sleep apnea) and

their impact along with statistics and tips.

Videos and bullet points deliver short but

effective messages.

The home page features a questionnaire

designed to quickly identify whether

a person may have a sleep disorder; the

television commercials and newspaper

advertisements also provide a quick quiz and

call to action. Internet responses or phone

queries receive an immediate follow-up from

Soni or a member of his team.

The goal is to determine who is at high

risk for a sleep disorder and then to properly

evaluate those patients who fall into

this category. “We can quickly set up an

appointment for a sleep screening. If it’s

mild, they can be home tested. If it seems

more serious, they can come into the sleep

clinic. Awareness and screening—these two

things are important right now,” Soni says.

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Best of 2012 | Sleep Review 13

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TAKING THE MESSAGE ABROAD

Awareness and screening are also two

issues Soni would like to tackle in his native

India. The population in the United States

numbers more than 313 million people;

Soni estimates 50 to 70 million are affected

by a sleep disorder. More than one sleep

association has been established, including

the American Academy of Sleep Medicine

(AASM), founded in 1975 (as the Association

of Sleep Disorder Centers).

Compare these numbers to India, where

the population numbers more than 1 billion.

Although no clear statistics exist on the

prevalence of sleep disorders in the country,

a similar ratio would indicate 159 to 224

million people could be impacted. Today,

however, this population is not likely to be

treated.

Sleep medicine is still relatively new to

the nation. Two of the field’s prominent

associations were founded in the 1990s;

the Indian Sleep Disorders Association

(established in 1995) boasts more than

200 members, a healthy number for a new

organization but allowing room for growth.

During his meeting with the Indian

president’s team, Soni discussed how the

growing sleep epidemic, which is aggravated

by obesity, comes at a high economic cost

and with serious public health concerns.

“Diagnosing and treating sleep problems

will save money and lives and create a huge

market for new jobs in India,” Soni says.

Soni aims to increase awareness in the

Indian patient population and medical

community through education, with a focus

on distance learning for physicians and

technicians. Soni believes the method can be

designed to work internationally as well as

domestically. He has opened a school, called

New York Sleep School International, to

offer both Internet education and hands-on

training to help sleep professionals improve

their skills.

The school is expected to begin A-STEP

classes in the second quarter of 2012 (likely

April). Members of the faculty include

Satyasagar Morisetty, MD, board certified

in sleep medicine, and Robby Williams, RRT,

RPSGT. Soni’s wife, Rita Carpenter Soni,

PhD, RPSGT, who is currently finishing a

post-master certification in sleep disorders

at the University of Massachusetts Boston, is

the school’s director.

The institution will train overseas students

on sleep technology, including physicians

who want to learn the specialty. “Students

can come to New York for 2 to 6 weeks to

get an introduction and expert hands-on

sleep tech experience through webinars,

books, and videos,” Soni says. He believes

the growing knowledge base in sleep

technology along with its implementation

in the screening, diagnosis, and treatment

of patients not only will improve patient

health but also will create a new job

market. “I prepared an abstract for the

President of India on the potential that the

sleep medicine market has to help reduce

unemployment while improving population

health,” Soni says.

It answered questions the average patient

wouldn’t think to ask and helped to deliver

a positive message regarding the importance

of sleep. The attention is welcome for a

physician dedicated to increasing awareness

about a little understood field that matters

to everyone, everywhere.

Renee Diiulio is a freelance writer based in

Manhattan Beach, Calif. She can be reached

at sleepeditor@allied360.com.

Prabhat Soni, MD, FCCP, DABSM

Sleep & Weight Loss Institute

2519 Avenue O

Brooklyn, NY 11210

718.787.1900

www.SleepToBeSlim.com

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14 Sleep Review | Best of 2012

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BY GREG THOMPSON

Under the leadership of Sunil Sharma, MD,

DABSM, the East Carolina University Sleep

Disorders and Research Center is taking a

truly multidisciplinary approach to sleep

disorder treatment.

Patient demand is sky high these days at the

East Carolina University (ECU) Sleep Disorders and

Research Center, Greenville, NC. Thanks to the

facility’s growing reputation for excellence, much

of it fueled by the leadership of Sunil Sharma, MD,

DABSM, director of the center, existing space will be

used for two additional beds.

Sleep apnea sufferers are hearing about the center

primarily due to a steady stream of enthusiastic

area physicians who appreciate Sharma’s efforts to

create a state-of-the-art sleep center that provides

comprehensive care in all aspects of sleep medicine.

Considering that the center opened its doors just

a little more than 3 years ago, the rise has been

consistently fast with no signs of slowing down.

With the new beds still not quite in use as of press

time, the existing six-bed, full-service unit is located

on the first floor of the new ECU Moye Building. The

sleep center is equipped with advanced in-house

diagnostic and home monitoring devices (Cadwell

Laboratories Inc). A multidisciplinary team composed

of sleep physicians from various disciplines manages

all types of sleep disorders.

As part of the Brody School of Medicine, the

center serves as a training site for medical staff

interested in sleep disorders. The list of specialties

seems to grow each year as medical professionals

discover ever more maladies that are made worse—

or perhaps even caused by—sleep apnea. “We

are pushing the envelope in all directions of sleep

medicine, which I think should be the true nature

of academic sleep medicine,” says Sharma, also

director of the Vidant Sleep Center. “We don’t focus

on just one agenda, and we don’t just focus on the

elements that are paying. We are educating and

training young doctors and technicians to become

certified at national levels, and doing research.”

As one example of that research, Sharma and his

team recently published that the prevalence of sleep

disorders is high in patients undergoing cardiac

rehab. “And that is important because the burden

of a comorbid condition like OSA may slow down

recovery during rehabilitation,” he says. “Our sleep

center program is among the first to find out and

establish that there is lung inflammation involved in

patients who have sleep-disordered breathing. This

has never been reported in the past.”

Yet another study with Medical University of

South Carolina, Charleston, examined whether

those who have sleep apnea have more blockages

in their coronary arteries, and thus more heart

disease. “We found these patients had seven times

higher odds of having a blood vessel blockage (soft

plaque) in the heart as compared to people who

did not have sleep apnea,” Sharma says. “This has

not been shown before. This is the type of original

research that helps us understand the impact of

sleep apnea on our community.”

According to Sharma, who also serves as an

assistant professor of medicine at the Brody School

of Medicine, the center’s overarching mission is

clinical, research, teaching, and training. “A vast

majority of private sleep disorders centers are

clinically oriented,” he says. “As an academic

center, our mission is above and beyond to educate

our entire community about sleep, and train

young physicians and sleep technologists about

sleep medicine and continue to push the limits of

understanding sleep disorders and their impact on

our society. We have a training school for sleep

technicians in eastern North Carolina, and our sleep

disorder center is a training ground for those sleep

technicians before they finish their training. We

are involved in a much broader manner than just

patient care.”

The ever-widening tentacles of sleep apnea can

be seen at ECU’s sleep clinic among people who

have high blood pressure, diabetes, and congestive

heart failure and have been referred due to daytime

sleepiness. One such patient came to Sharma after

several years of symptoms.

The man’s physicians attributed his symptoms

to underlying heart failure, but a chicken-or-egg

scenario increasingly emerges where apnea may

worsen, or even cause, many ailments. “In this

patient, we had severe sleep apnea,” Sharma says.

“It’s remarkable that these patients have dramatic

improvement in a matter of months after putting

them on treatment. Their blood pressure gets

controlled, heart failure symptoms resolve, and

daytime tiredness resolves.”

Problems Down south

In eastern North Carolina, stroke is the fourth

leading cause of death. It’s part of a “stroke belt”

that also includes a high burden of congestive heart

failure, hypertension, and diabetes in eastern North

Carolina—and in much of the South.

Sleep disorders are strongly associated with these

comorbidities, and ECU’s multidisciplinary sleep

center is an increasingly important tool in the fight

against cardiovascular disease. “Sleep apnea could

very well be the driving engine for many of these

cardiovascular disorders,” Sharma muses. “We

The Team Approach

Academic Prole: East Carolina University

SRBest_14_15_CadWell.indd 14 4/5/12 12:16:06 PM

Best of 2012 | Sleep Review 15

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of

don’t know now because this sector of medicine is

still relatively new. Fixing sleep-disordered breathing

may slow down the progress of many of these other

cardiovascular diseases—and in the process may

improve survival.”

As director, Sharma embraces community

involvement through his yearly symposium (see

sidebar) and multiple talks to diabetic groups and

heart health forums. With the help of three board-

certified pulmonary (and sleep boarded) physicians,

one pediatric (sleep board certified) physician,

and three neurology-based (sleep board certified)

physicians, he uses the multidisciplinary approach to

educate patients and physicians alike.

He is currently working on his vision of a

multidisciplinary team providing care under one

roof, an approach that aims to step away from

the current reality of fragmented care. “Different

specialties tend to operate as independent silos,

but the best care will come together when the

patient can get all his sleep care under one

roof,” Sharma says. “The multidisciplinary

approach involves several different specialties—

pulmonologist, psychologist/psychiatrist, dentist,

neurologist, and ENT physician. This is even more

true as more treatment options from surgery to

dental devices are available to the patient. If they

are not in close proximity with us, or working with

us, care can get disrupted.”

CPAP AND ORAL APPLIANCES (MULTI-

FACETED MANAGEMENT OF SLEEP-

DISORDERED BREATHING)

When ECU opened its first school of dentistry last

year, Sharma took his multidisciplinary approach to

the burgeoning field of dental sleep medicine. Unlike

more established dental schools around the country,

ECU’s students will not be ignoring sleep medicine.

Refusing to indulge in rigid therapy preferences,

Sharma believes oral appliances can definitely be

beneficial for those who do not tolerate conventional

CPAP therapy. “I am engaging our dentists to

our sleep disorders center,” Sharma enthuses. “I

am working closely with the faculty at the dental

school of medicine to recruit dentists to come over

and treat patients who have failed conventional

treatment. This is a new opportunity to engage

dentists from the beginning. The dental school

faculty is arranging educational sessions and grand

rounds and coordinating activities with the sleep

disorders center. As director for sleep medicine, my

job is to engage these different specialties. In the

last year, I have engaged most of these specialties

as we move toward a one-roof model.”

In addition to ENTs, pulmonologists, cardiologists,

and now dentists, pediatricians are part of the mix

at ECU. Indeed, teachers who identify students with

attention deficit may yet be seeing the effects of

sleep apnea. “In adults, you tend to have sleepiness

during the day,” Sharma says. “In children, they can

get hyper-aroused and lose focus. Falling grades

could be a sign of underlying sleep disorders.

Involving pediatricians improves the outreach of

sleep into the world of children, which is usually

swept under the carpet.”

Relying on durable medical equipment (DME)

companies can be a source of anxiety for many

sleep physicians who fear the level of education

provided and service may not be adequate. Sharma

aims to deal with this familiar problem by asking

DME providers to come to his center for setups and

education. It may sound like a tall order, but many

providers are willing.

“Compliance is an important quality parameter,

and is ultimately a reflection of the sleep disorders

center,” Sharma says. “Now we are setting

standards so we know what they are doing and

what kind of education and training they are giving.

We plan to have them come to the clinic to set

those patients up so we can supervise. The DME is

still making the sale, but the whole quality aspect

is better controlled. It’s a bit of a pain for the DME

company, but they are getting more accepting.”

The center is truly the one place to be, and

Sharma believes the one-roof ethic will be a

nationwide trend. In addition to a patient sleep

mecca of sorts, ECU’s center is a training ground

for medical students (Brody School of Medicine),

residents, fellows, and students of the Pitt County

polysomnography school in Greenville, NC. “Many

of these bright students have stayed back to serve

the community,” Sharma says. “The sleep center

serves 29 counties, and is the largest academic

center in eastern North Carolina. I am helped in this

venture by an extremely dedicated and passionate

faculty and staff who push the boundaries of

excellence every day.”

Greg Thompson is a contributing writer for Sleep

Review. The author can be reached at sleepeditor@

allied360.com.

Sunil Sharma, MD, DABSM, ABIM

Director, ECU Sleep Disorders Center

East Carolina University/Brody School of Medicine

521-A Moye Boulevard

Greenville, NC 27834

252.744.4653

www.ecu.edu

Spreading the Word

Tracking down Sunil Sharma, MD, DABSM,

director, East Carolina University Sleep

Disorders Center, on an average day is no

easy task. Factor in the extra duties of Sleep

Awareness Week, plus preparations for a

day-long symposium, and it becomes almost

impossible.

The hours

are long, but

Sharma has

a passion

that he is

determined

to bring to

the center,

and by

extension to

patients. In

recognition

of ECU’s

outstanding results, the Sleep Disorders and

Research Center recently received program

accreditation from the American Academy of

Sleep Medicine (AASM).

At press time, Sharma’s symposium at

the Hilton Hotel in Greenville, NC, will be

over, and hundreds will be wiser. After a

wide range of sleep, pulmonary, and critical

care programs, attendees learned just how

far sleep has penetrated into the general

medical realm.

Offered by the Division of Pulmonary,

Critical Care and Sleep Medicine, the

conference provided the most current,

practical, and concise information available

on recent advances in clinical sleep and

pulmonary medicine.

Sharma and his colleagues offered lectures

and discussion periods for both formal

and informal exchanges between faculty

and participants. Targeted for internists,

family medicine and emergency medicine

physicians, PAs, and NPs providing primary

care management, those who completed

the course got continuing education credits

and knowledge of strategies to identify sleep

disorders.

—G.T.

SRBest_14_15_CadWell.indd 15 4/5/12 12:16:07 PM

16 Sleep Review | Best of 2012

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BY ALISON WERNER

The Cleveland Sleep Centers: Improving sleep

health care from every angle

In 1998, Mansoor Ahmed, MD, FCCP, FABSM

founded the Cleveland Sleep Centers, a coordinated

network of community-based sleep programs, to

provide clinical care and promote sleep education

and research in the field of sleep medicine. The Sleep

Centers also developed a collaborative sleep program

with University Hospitals system at Bedford and

Lutheran Hospital (Cleveland Clinic Health System).

“We are the only health care entity in the history

of Cleveland that enjoys a true bilateral relationship

with the two competing academic giants,” quipped

Ahmed.

In the 1990s, sleep medicine was primarily

confined to the large academic and teaching

hospitals. There were virtually no community-based

sleep health care programs and education initiatives

in the Greater Cleveland Metropolitan Area. Having

served on the faculty of medicine at Case Western

Reserve University, Ahmed felt that the rapid

developments in sleep medicine that were taking

place within academia were not being translated in

a timely fashion into community practices.

“How is an academic center defined? Look at the

Mayo Clinic. They have three levels: patient care,

education, and research,” Ahmed says. The sleep

program at Cleveland Sleep Centers, developed by

Ahmed and his team, was modeled on these best

academic attributes.

Comprehensive Care

As Ahmed points out, sleep medicine is a true

multidisciplinary specialty. There is hardly any

medical, mental, or psychiatric condition that doesn’t

affect sleep and there is hardly any system physiology

that is not affected by sleep disorders.

“Improving sleep health is not all about sleep apnea

and CPAP,” says Ahmed. “Most of the patients do

not present with a single disease process. You can’t

just give them CPAP or an insomnia pill and be done.

A large number of patients have a complex sleep

pathology that requires an integrative approach.”

To effectively treat a patient, and improve

sleep health, sleep professionals need to look at

underlying or comorbid conditions, Ahmed says.

From the psychological factors—including mood

disorders like bipolar disorder and depression—to

medical conditions like chronic fibromyalgia and

Alzheimer’s disease: all these conditions have

profound implications for sleep.

“In order to practice sleep medicine in a real

sense, you have to look at it more broadly,” says

Ahmed, who has been frustrated by the focus on

sleep apnea as the defining condition of sleep

medicine in recent years—a focus that has led some

sleep centers to ignore other health issues, and, thus,

prevented patients from getting a good night’s sleep.

“Even sleep apnea is not a homogenous disorder. It

requires more in-depth pathophysiological analysis

and subsequent therapeutic interventions.”

The Cleveland Sleep Centers, which have

been recognized by the American Association for

Respiratory Care as one of the top three community

sleep centers in the United States, make it their

mission to always look at the whole patient and to

integrate disciplines outside of sleep medicine into

patient care to most effectively treat the patient.

That includes a staff orthodontist consultant and

other trained dentists in the community who can

work with patients for whom CPAP has failed and

who would be better treated with an oral appliance,

and close working relationships with area psychiatric

specialists who may need to be brought in to discuss

any underlying psychiatric conditions affecting a

patient’s sleep. According to Ahmed, this in-depth,

integrative approach, which is often found in

academic-based sleep centers, was missing at the

community level when he first opened the Cleveland

Sleep Centers’ doors.

“After my transition from a teaching hospital to a

community practice, my challenge was to integrate

other disciplines to help these patients who have

multiple pathologies for their sleep disturbances.

An integrated approach wasn’t there, and it’s still

largely not there. There are hardly any sleep centers

at the community level, where other disciplines have

been integrated to evaluate and manage patients,”

Ahmed says. “This [approach] is specific to our

program.”

While the facility’s bedrooms feature home-like

décor, including paintings, decorative window

treatments, and high-quality mattresses, and are

designed for patient comfort, the Cleveland Sleep

Centers pride themselves on being more than just

nice labs. It is a facility that makes patient comfort,

treatment compliance, and long-term patient health

equally important elements.

“What is the point of having a beautiful sleep

center, or how many studies a center is performing,

when at the end of the day, the outcomes of these

patients are terrible because people are not using

their treatment,” says Ahmed.

As is the case with many other medical disciplines,

compliance is also a problem in sleep medicine.

The Broad Approach:

Patient Care,

Education, Research

Mansoor Ahmed, MD, FCCP, FABSM

SRBest_16_18_Cleveland.indd 16 4/6/12 11:51:57 AM

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of

Yet, unlike most other disciplines, patient follow-up

for patients suffering from sleep-related problems

is not always a consistent component of patient

care. The Cleveland Sleep Centers, however, have

made compliance and patient follow-up a part of

their clinical protocol. The facility has a respiratory

therapist on staff who is specialized in sleep and

who works with patients following diagnosis to not

only make sure that their mask fits, but that they are

educated about their disorder and the risks of not

following through with treatment. The sleep staff

even makes a point of including a patient’s spouse

in this education to further stress the importance of

CPAP compliance. Many sleep disorders, including

sleep apnea, are chronic conditions like hypertension

or diabetes that don’t disappear following diagnosis.

They require follow-up and every effort to encourage

and improve patient compliance with treatment.

“Just like with someone with a heart condition,

you don’t give them Lipitor and then say, ‘Goodbye.

You’re done,’” Ahmed points out. “[Sleep patients]

are not completely done after you have made the

diagnosis and given them CPAP.” The Cleveland

Sleep Centers maintain regular contact with patients,

typically seeing CPAP patients for a follow-up visit

6 weeks after their titration study and compliant

patients at least every 6 months thereafter.

AWARENESS THROUGH EDUCATION

But the reality is that this attention to

comprehensive patient care can be effective only if

people are aware of the effects of sleep disorders

on general health. Sleep disorders often receive

short shrift outside the sleep community, making

diagnosis and treatment, and, more importantly,

better health elusive for many patients. As Ahmed

puts it, the impact of sleep disorders on overall

health and their role in other conditions often are

not appreciated by both the medical community and

the general public. This, in large part, stems from a

lack of education. Since their inception, Cleveland

Sleep Centers have seen themselves as first and

foremost a community-based program, and have

made public and physician education beyond their

doors a fundamental component of their patient care

and commitment to sleep health.

At the general public level, the staff has

undertaken a robust public education program aimed

at improving the understanding of sleep health in

the community, in a variety of settings, including

presentations on insomnia to nursing homes and

assisted living facilities, and on shift work to nursing

and police departments and major corporations,

such as Goodyear Tire and Nestlé. In addition, the

Centers have launched various educational initiatives

aimed at the Hispanic community in Cleveland, a

segment of the population with a higher prevalence

of sleep apnea, hypertension, and diabetes. Efforts

have included training Spanish-speaking interpreters

and translation of patient literature into Spanish.

Within the medical community, Cleveland Sleep

Centers make an effort to share their knowledge

and keep non-sleep medicine specialists, especially

referring physicians, up-to-date on the current

research trends in sleep.

“Within academia, we have great research going

on—for example, in narcolepsy at Stanford. But the

knowledge being put out by those academic centers

does not translate into the community practices in a

timely fashion. It takes years and years before [non-

sleep specialists] start to realize what is going on at

the academic level,” Ahmed says. He adds that for

many physicians practicing at the community level

today, there was no sleep curriculum during their

education 5 to 10 years ago. This has led to situations

where non-sleep specialists often underestimate or

overlook the impact of sleep on a patient’s underlying

disease process. For example, Ahmed points out,

rheumatologists and pain specialists often don’t

appreciate the negative impact pain and chronic

fibromyalgia can have on a patient’s sleep. If a

patient’s sleep problems are not addressed, neither

condition will improve. This knowledge vacuum keeps

patients from receiving effective care. Education

programs can improve this situation.

“If we don’t improve the knowledge of the

physicians in the community, we won’t be able to

serve the bigger picture of sleep medicine and meet

the needs of the large number of patients who are

served within communities outside academic walls.

So we focus on education,” says Ahmed, adding

that Cleveland Sleep Centers have put on hundreds

of sleep symposiums, roundtable meetings, and

conferences in their 14-year history to better educate

community physicians. In addition, Ahmed and his

staff invite primary care physicians to come and work

with them for a half day as part of a preceptorship

program so they can get a better feel for what sleep

medicine is all about, why it is important, and better

serve the needs of their own communities when they

return home.

And the Cleveland Sleep Centers’ educational

efforts aren’t limited to the local community. As a

former chair of the international affairs committee for

the AASM, Ahmed and his colleagues developed a

6-week mini-fellowship sleep training program that

invites physicians from around the world to spend time

training at Harvard, the University of Pennsylvania,

Stanford University, the Cleveland Clinic, and the

Mayo Clinic. In addition, Ahmed and his staff welcome

an international fellow to spend time at the Cleveland

Sleep Centers to see how their facility works and to

learn more about sleep medicine. The goal, Ahmed

says, is for these fellows to take their new knowledge

back to their home countries and start similar sleep

programs there. For more direct impact, Ahmed, who

is currently serving as an honorary advisor to India’s

King George Medical College as they develop their

own sleep program, hopes to soon take his team to

that country to help the medical college establish an

integrated program modeled after the Cleveland Sleep

Centers. The Centers take pride in the fact that the

first sleep program in one of the oldest cities in the

world—Aleppo, Syria—was started by a fellow who

received his training at the center.

RESEARCH AND DEVELOPMENT

But as important as educating the community

is, the staff at the Cleveland Sleep Centers also

recognize that they need to educate themselves

to best serve the sleep patients and the larger

community. To do this, Ahmed and his staff stay

actively involved in research and development in the

sleep field. Through the Cleveland Sleep Research

Center, an affiliate of Cleveland Sleep Centers, they

participate in a number of short- and long-term

research studies, including those looking at restless

leg syndrome, shift work, insomnia in children with

attention deficit hyperactivity disorder, and sleep

disturbances in fibromyalgia. Some of these research

projects are funded by investigator-initiated grants.

Throughout their work, the Cleveland Sleep

Centers maintain a commitment to excellence and

to serving the community. In doing so, they hope to

serve as a model for other sleep centers everywhere

and to bring their brand of academic sleep care to

everyone in the community.

Alison Werner is associate editor of Sleep Review. She

can be reached at sleepeditor@allied360.com.

Cleveland Sleep Centers

17900 Jefferson Park Road, Suite 102

Middleburg Heights, OH 44130

440.243.8044

www.clevelandsleeps.com

SRBest_16_18_Cleveland.indd 17 4/6/12 11:51:57 AM

18 Sleep Review | Best of 2012

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BY TINA PAGE

Douglas Livornese, MD, FACP, FCCP, FAASM,

designed a resourceful CPAP compliance

program that makes it difficult for patients

not to adhere with therapy.

Sleep medicine fascinated Douglas Livornese,

MD, FACP, FCCP, FAASM, from the very start

of his medical career. But in his words, the path

to becoming the director of the comprehensive

sleep disorder center, Comfort Sleep, is a

“backwards story.”

“When I was in high school, I started snow

skiing, and I hated waiting in line at the lifts,”

Livornese says. “Then I saw these people skiing

by and getting right on the lifts and I said, ‘Who

are those people?’”

After discovering that ski patrolmen do

not need to wait in line at the lifts, Livornese

became an emergency medical technician

while still in high school in hopes of someday

becoming a ski patrolman.

“And it kind of snowballed from there,”

Livornese says. He worked as a paramedic

during college and then decided pursuing a

career in medicine was what he was meant

to do.

Livornese’s relaxed and conversational manner

belies his status as a chronic overachiever. While

most kids were happy to ski in high school, he

served on the rescue squad and got to leave

class when an EMT was needed for a rescue.

From the Ground up

Livornese, who spends half of his time

working in his primary practice as a

pulmonologist, became interested in sleep

medicine when he was doing his residency

training in the early ’90s at the Medical College

of Pennsylvania, which had one of the few sleep

medicine fellowships at the time.

“Sleep was interesting,” Livornese says.

“Also, it was kind of an emerging field. It was

somewhat unique to get involved in something

that wasn’t 1,000 years old. I sat and had

conversations with the fathers of sleep medicine.

The guys who wrote the original books in sleep

medicine, I’ve actually met and heard lecture. I

thought that was kind of a unique thing—to be

involved in something from the ground floor up

really had an appeal to me.”

Livornese went on to be board certified in

sleep medicine by both the American Board

of Sleep Medicine and the American Board of

Internal Medicine, receiving his first board in

1997.

patient-centered

Livornese refers to his two practices as his

“dual personalities.” At his main practice,

Monmouth Pulmonary Consultants at Monmouth

Medical Center where he has been since 1997,

he is one of two doctors who are truly trained

in sleep.

In 2006, Livornese was able to help build the

novel, patient-centered program that makes his

other practice at Comfort Sleep Lab so successful.

“Our Comfort Sleep Lab is really a turnkey

program,” Livornese says. “For our area, we have

a pretty unique process where people get referred

from their primary care physicians and we take care

of everything else.”

And the unique program literally does. While

many sleep medicine patients end up running

around from one office to another for doctors’ visits,

sleep studies, and picking up CPAP equipment,

Comfort Sleep provides patients with the continuity

of care they deserve by providing all aspects of

sleep medicine in one building.

“Patients have their first sleep study, then they

decide if they want to go the CPAP route, and if

they don’t, then we have a dentist whose practice

is limited to sleep dentistry,” Livornese says. “I can

tell patients, ‘If you’re not happy with your CPAP,

then if you have half an hour, you can go next store

and meet our dentist.’ He’s literally in the exam

room next to me.”

The fact that patients can get all aspects of their

sleep medicine care addressed in one building

makes Comfort Sleep successful with those it treats.

Livornese points out that not only can patients

physically access all their care in one place, they

also have only one phone number to remember.

Continuity of Care

Douglas Livornese, MD, FACP, FCCP, FAASM

SRBest_18_19_Comfort.indd 18 4/5/12 12:22:25 PM

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of

“Whether they want to talk to me, or they

have a question about their CPAP or their bill,

it’s all one phone number,” Livornese says. “This

[program] is what I wanted to do, and it has

taken a long time to really get it working this

way. My bosses have given me a lot of support

and latitude to do what I want to do. I’ve got an

exceptional support team and a great group of

doctors working next to me.”

And not only are all of Comfort Sleep Lab’s

patients’ needs met in one place, the program is

meant to make the internist’s life easier as well.

“We make it easy for them,” Livornese

explains. “We say, ‘If you have a hunch that

one of your patients has sleep apnea, we will

do the rest.’ We help with all the insurance

work from the sleep study to the CPAP or oral

appliance. We don’t have insurance problems,

and I think for physicians and patients one of the

biggest problems nowadays is getting everything

approved by insurance.”

A GAME CHANGER

For patients who have been suffering from

sleep disorders, receiving successful treatment is

a “game changer.”

“Since sleep apnea is somewhat of a chronic

disease, people don’t realize how tired they

are,” Livornese explains. “They come in and

say, ‘I’m a little tired during the day’; that’s just

because they’ve been severely tired for many

years, and they’ve modified their life. All of a

sudden, when we really correct the sleep apnea,

they have a new life.”

Patients who have been treated by Livornese

are often surprised by the improvement

in attentiveness and cognitive function they

experience after treatment.

As part of the sleep lab’s multidimensional

approach to sleep medicine, the program offers

behavioral therapy with a clinical psychologist

whose specialty is sleep disorders. This aspect of

the treatment is meant to support patients who

may be less likely to be dedicated to using their

CPAP because they are struggling with problems

like depression.

“A lot of times someone who is sleep deprived

is depressed,” Livornese says. “More often

than not, when you fix their sleep apnea, their

depression goes away. I’ve had a lot of patients

who have been carrying around a diagnosis of

depression for many years; we treat their sleep

apnea, and all of a sudden they are no longer

depressed.”

BUILDING A BETTER MOUSETRAP

Comfort Sleep’s CPAP compliance program

is built to be patient centered. Livornese makes

it clear that “no treatment works if the patient

does not use it.” The team’s goal is to find the

correct treatment for each individual patient and

to make it difficult for them not to use it.

“We make it so that it’s less painful to use

the CPAP machine than have to tolerate us

trying to make you use it,” Livornese says. “We

have always been trying to figure out how to

build a better mousetrap. One of the few things

that helps people improve their usage is having

support.”

And Comfort Sleep’s support is like a

mousetrap. There is almost no way of escaping

the program’s support team. After someone gets

a CPAP unit, they are set up with an appointment

with the doctor or nurse practitioner. Along with

face-to-face interaction in the office, patients are

also set up with coaching calls each week until it

is clear they are committed to using the machine.

A technician calls them, and if the technician

detects any issues, the patient is passed on to

one of the lab’s respiratory therapists. Also,

when the patient is initially handed the CPAP,

the respiratory therapist fits all the equipment on

the patient and, according to Livornese, “They

are not allowed to leave until they say that they

are comfortable with it.

“We have tremendous follow-up,” Livornese

says. “Now we can download [a patient’s] CPAP

information through the phone, and we can

see if the person is using it, and if not, we will

concentrate more work toward them.”

The lab has therapists on the road every day

stopping by patients’ houses to find out why

they are not using their CPAP. Thanks to all of

the support a sleep lab patient can expect to

receive, the compliance rate is very high.

“Many times patients just want to know what

they are going through is normal,” Livornese

says.

SUCCESS

One of the most rewarding parts of working

in the field of sleep medicine for Livornese is

to actually witness the core improvements his

program makes in patients’ lives.

From improving cognitive function to relieving

depression, Livornese has seen the transformations

that have taken place after successfully treating

sleep disorder patients. Most notably, two particular

cases stand out in his mind. In the first case, he

saved a marriage, and in the second, he may be

continuing to save lives.

“I saved the marriage of one of my favorite

patients,” Livornese said. “He came in a grumpy

old man. He and his wife actually had a fight in

my office because he didn’t want to be there. I had

to step in between them because I thought it was

coming to fists.

“I treated his sleep apnea and he just became a

teddy bear afterwards. Every time they came into

the office, his wife would hug me and say thank

you for giving me my husband back. It’s the kind of

thing that makes you want to get up in the morning

and keep going.”

The other case that stands out as a notable

success was when Livornese treated a limo driver

for sleep apnea after he fell asleep at the wheel and

almost crashed. The driver started using a CPAP and

has since changed jobs.

“He’s so awake now he wanted to get out of

[limo driving]; now he’s a long haul truck driver,

and his CPAP unit sits in his sleeper cab and he uses

it every night,” Livornese says. “He’s an instructor

for a trucking school, and he’s actually ‘diagnosing’

people with sleep apnea and sending them to their

doctors. He’s my advocate in the field.”

A TOP DOCTOR

Aside from his pulmonary and sleep medicine

practices, Livornese still finds time for fun as a pilot,

flying for the Coast Guard Auxiliary in the New York

Metropolitan Area. Livornese also still hits the ski

slopes, thankful for the inspiration he received that

led him to ultimately build a program that makes

it almost impossible for people suffering from sleep

disorders to fail at improving their quality of life.

Tina Page is a contributing writer for Sleep Review.

She can be reached at sleepeditor@allied360.com.

Douglas Livornese, MD, FACP, FCCP, FAASM

Comfort Sleep

2240 Hwy 33, Suite 114

Neptune City, NJ 07753

732.455.3030

www.comfortsleep.net

SRBest_18_19_Comfort.indd 19 4/5/12 12:22:25 PM

20 Sleep Review | Best of 2012

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BY PHYLLIS HANLON

As health care evolves, Alexander Villareal,

MD, keeps Geisinger Health Systems, Sleep

Disorders Centers, ahead of the curve.

The Centers for Disease Control and

Prevention (CDC) reports that an estimated

50 to 70 million American adults suffer with

some type of sleep disorder. Moreover, sleep

insufficiency has been linked to motor vehicle

accidents, industrial disasters, occupational

errors, and medical issues, such as diabetes,

obesity, hypertension, cardiovascular disease,

and depression. CDC statistics also indicate that

the alarming increase in pediatric obesity—

in 2008, more than one-third of children and

adolescents were overweight or obese—can

be linked to other medical conditions, including

sleep apnea.

1,2

Fortunately, medical advances

have resulted in more accurate testing methods,

more effective treatment options, and improved

patient outcomes. Leading the way in diagnosing

and treating a variety of sleep-related disorders

is the Geisinger Health Systems, Sleep Disorders

Centers, in Danville, Pa.

One of the first accredited sleep centers in

central Pennsylvania, Geisinger Sleep Disorders

Center was founded by Andrew P. Matragrano,

MD, in 1984. The facility began as a two-bed

operation and in the past 4 years has grown to

25 beds with six locations throughout central

and northeast Pennsylvania. Accredited by the

American Academy of Sleep Medicine (AASM)

and the Joint Commission on Accreditation of

Healthcare Organizations (JCAHO), the Centers

boast 10 board-certified sleep specialists;

advanced practitioners in neurology, psychology,

and pulmonary medicine; registered or registry-

eligible technicians; and an integrated scheduling

team. Geisinger Sleep Disorders Centers also

feature an experienced otolaryngologist, oral

surgeons who can deliver surgical solutions,

and a dentist with 10 years’ experience who

can suggest client-specific oral appliances. This

multidisciplinary approach enables the Centers

to provide their adult and pediatric patients

more choices when scheduling appointments

and sleep studies, a range of treatment options,

and, ultimately, better results.

Through an active community and physician

awareness program, Geisinger Sleep Disorders

Centers utilize a grassroots approach to

increasing mindfulness of sleep-related problems

and to fostering collaborative relationships

among patients and primary care physicians and/

or other practitioners and sleep physicians to

determine the presence of an underlying sleep-

related issue, which might be affecting daytime

performance and well-being.

ExpErtisE DElivEring

ComprEhEnsivE Diagnosis

anD trEatmEnt

Determining the cause of a sleep disorder

requires expertise and experience in the field. The

sleep specialists at Geisinger pride themselves on

treating all cases, from the most straightforward

to the most difficult, including those with

comorbid conditions or previously unresolved

sleep issues. The Centers offer evaluation,

diagnostic and treatment services, behavioral

sleep medicine, comprehensive evaluation and

nonpharmacological management of insomnia,

and an all-inclusive patient compliance program.

The Centers also provide diagnostic and

therapeutic services at the Janet Weis Children’s

Hospital for high-risk children (newborn and up).

Moreover, Geisinger Sleep Disorders Centers

offer a full panel of sleep studies, including split

studies; out of center sleep testing; nocturnal

polysomnography; nasal CPAP (continuous

positive airway pressure) titrations; and day sleep

studies to accommodate night shift workers.

Since on-site studies may be inconvenient for

some patients, the Centers offer home testing.

All together, the Centers have the capacity to

conduct 26 studies per night.

Not only do the Centers offer several

comprehensive sleep studies, the facilities also

strive to maintain a turnaround time on test

results of fewer than 24 hours; the Centers have

achieved a 94% success rate.

Follow-up ranks high on the Centers’ to-do

list. Experienced sleep technicians call all CPAP

patients at 72 hours, 30 days, and 6 months

to ensure that equipment is in working order

and that the patient’s condition is stable. This

process helps to identify patients who may be

experiencing more serious problems or who are

in need of supplies or additional help.

Geisinger Sleep Disorders Centers participate

in several community events, sponsor sleep

disorder support groups, and partake in “meet

Proactive Patient

Care

Alexander Villareal, MD

SRBest_20_21_GHS_Sleep.indd 20 4/5/12 12:23:08 PM

Best of 2012 | Sleep Review 21

BEST

2012

of

and greet” occasions. For the last 3 years,

the Centers have organized a sleep medicine

conference that offers American Medical

Association credits to attendees. This year’s

conference will be held in May and is designed

to educate all medical professionals, regardless

of current sleep medicine expertise status.

DEDICATED TO SLEEP MEDICINE

Since 2007, Alexander Villareal, MD, has

been an integral part of the multidisciplinary

team at the Geisinger Sleep Disorders Centers.

He earned his medical degree from Nuestra

Senora de La Paz University in Bolivia in 1999.

In 2005, he completed a 3-year residency in

internal medicine at Henry Ford Hospital in

Detroit, followed by a 2-year fellowship in

sleep medicine at the same institution.

Board certified in internal medicine and

sleep medicine and director of sleep medicine

at Geisinger Sleep Disorders Centers, Villareal

became interested in this health niche during

his pulmonary medicine residency. “I found

the topic of sleep apnea fascinating and asked

to have an elective in sleep medicine. That

[experience] increased my interest and passion

in the subject,” he says.

Villareal treats adult patients who present

with sleep apnea; insomnia; parasomnias,

including sleep walking, night terrors, teeth

grinding, and other sleep issues; restless legs

syndrome; and narcolepsy. Additionally, his

patient load includes adolescents and school

age children with non-sleep apnea problems,

such as narcolepsy, insomnia, and delayed

sleep syndrome.

Villareal bases his treatment options on

standard medical care and scientific evidence

in collaboration with the patient. “I always

involve the patient in the decision. I ask

them their preference,” he says, adding

that he attempts to increase the patient’s

understanding of their particular sleep

condition. “I educate them about the

diagnosis and treatment options and share the

reasons behind my advice. If they understand,

they can make better choices, which leads to

better compliance.”

For many sleep apnea patients, CPAP masks

are the first line of defense, but Villareal

believes treatment doesn’t end with CPAP.

“It begins there,” he says. For example, all

obese patients are offered a referral to an

obesity clinic. “Some patients undergo gastric

bypass, which might cure the problem,”

Villareal says. He points out that with the

variety of sleep specialists on staff, patients

have the advantage of combination therapy,

eg, a dental appliance and surgery, whenever

appropriate. “We also pride ourselves

on providing therapy that helps patients

previously determined to be CPAP-intolerant.

In those cases, other specialists may not have

worked long enough with the patient. We have

an evidence-based technique to help patients

adapt to using CPAP,” he says. “We identify

the specific problem that’s not allowing

the patient to use the device. For example,

patients with severe nasal congestion find it

hard to use the CPAP machine or they could

be claustrophobic. So we use a nasal pillow

or desensitization techniques. These help the

patient ‘grow into’ the CPAP.”

Some sleep conditions—sleep apnea

and insomnia, for instance—are chronic

and require medium to long-term follow-

up, depending on response to therapy,

according to Villareal. “We partner with the

referring physician or PCP. We keep the line

of communication open and also relieve the

patient from having to do paperwork and

calling in prescriptions.”

PROFESSIONAL PASSION

Villareal considers Geisinger Sleep Disorders

Centers as an institution “a blessing.” He

says, “We are a nonprofit, multispecialty

group committed to raising awareness of sleep

disorders and educating non-sleep providers

about these issues,” he says. “We employ a

mature electronic medical records system and

practice system-based medicine, which is one

of the core competencies recommended by the

Accreditation Council for Graduate Medical

Education (ACGME).”

Villareal’s passion for and commitment to

his work is evident. But he prefers to shine

the spotlight on his colleagues. “Without that

team, we couldn’t accomplish a fraction of

what we do,” he says. “My goal is to make

the Centers the best place to provide help

for those with sleep issues, contribute to the

knowledge in this field, and develop cost-

effective ways of treating sleep problems.”

MEETING FUTURE

CHALLENGES PROACTIVELY

As changes to the existing health system are

implemented, every health care discipline will face

challenges, and the Centers will also be subject

to some of the same challenges. Reimbursement

from insurance companies will undergo changes,

and the way in which facilities schedule

in-laboratory sleep studies is being overhauled to

be more cost effective, according to Villareal. “The

economy is affecting labs significantly,” he says.

Additionally, more attention will be focused on

outcomes and proof that quality of care meets

or exceeds industry standards. “So we may

need to provide more documentation regarding

percentage of improvements, medications, cost

savings, and other aspects that prove our care

is outstanding,” Villareal says. “We’re working

proactively to get ready for the economic

challenges and quality projects, so we’re ahead

of the curve.” The Centers have been monitoring

outcomes for 3 years and have compiled a

significant amount of data.

In the future, Villareal hopes to create more

elective internal medicine rotations for pediatric

and family medicine residents at the Centers to

help educate these practitioners, increase their

existing knowledge base, and enhance patient

care.

Phyllis Hanlon is a freelance writer based

in Charlton, Mass. She can be reached at

sleepeditor@allied360.com.

REFERENCES

1. Ogden CL, Carroll MD, Curtin LR, Lamb MM,

Flegal KM. Prevalence of high body mass index in

US children and adolescents, 2007–2008. JAMA.

2010;303(3):242–249.

2. National Center for Health Statistics. Health,

United States, 2010: With Special Features on

Death and Dying. Hyattsville, Md: US Department

of Health and Human Services; 2011.

Alexander Villareal, MD

Geisinger Sleep Disorders Center Woodbine

109 Woodbine Lane

Danville, PA 17821

877.507.4957

www.geisinger.org/services/sleep/index.html

SRBest_20_21_GHS_Sleep.indd 21 4/5/12 12:23:08 PM

22 Sleep Review | Best of 2012

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BY TINA PAGE

The International Institute of Sleep has

implemented a myriad of programs that

support both patients and the sleep profession.

The International Institute of Sleep (IIS) puts

patients before profits, a principle that has guided

the company well since its founding in 1999. In

that time, the company not only has earned a

reputation as an industry leader in patient care and

professional development but also has grown to

include eight locations servicing more than 10,000

patients annually across Florida and a network of

hundreds of sleep labs.

When Glenn Becker, CEO and president of the

Florida-based company, set out to create IIS, he was

an outsider looking into an industry that he knew he

could make better. He was confident that he could

raise the bar in patient care for people suffering

from sleep disorders.

“As opposed to the traditional way people do

sleep medicine, I decided to put my spin on it and

create a comprehensive approach to sleep medicine

as opposed to the patient-in, patient-out approach

to sleep,” Becker says. “We like to say we put the

‘care’ back in health care.”

And that approach extends beyond patients

to a commitment to nurturing the professional

development of sleep medicine practitioners. Relying

on a myriad of programs, IIS has set a high bar for

itself, but it’s a bar the staff seek to surpass in every

endeavor they undertake.

Serving PatientS

IIS, always at the forefront of optimizing patient

care, utilizes every means available to the industry

to ensure patients are treated successfully. The

company not only offers traditional in-lab tests

any hour of the day or night but also was an early

adopter of home sleep testing (HST) and remotely

attended sleep studies.

The company’s pursuit to optimize care doesn’t

stop at the diagnostic stage. “I wanted to create

a more comprehensive approach and design a

disease management program following the

patient from start through life,” Becker says.

And that’s exactly what Becker did. IIS’

disease management program for patients with

obstructive sleep apnea (OSA) begins with a

clinical assessment by a licensed respiratory

care practitioner with special training in sleep

disorders. This assessment provides the basis

for development of an individualized care plan,

designed to ensure successful compliance with

treatment.

The care plan includes a mask desensitization

program for those reluctant to wear a mask, a

replacement part program where patients are

resupplied with the appropriate disposable parts

when needed, and a retitration program, which

monitors patient PAP device pressure adequacy

and ensures each is adjusted to its optimal and

therapeutic levels according to the physical

changes that people experience throughout

their lives.

In order to guarantee that patients are receiving

the level of care that the IIS requires of itself, the

company also provides home medical equipment

(HME). As an HME/durable medical equipment

(DME) provider, IIS can offer alternatives to

patients who cannot tolerate CPAP, including oral

appliances and new therapies like Provent.

“Not everyone wants to deal with a CPAP

machine, which is fine,” Becker says. “We have

other means to help them, like Provent therapy,

a fairly new direction to take, which we’ve been

extremely successful with.” Provent fits over

both nostrils and uses a MicroValve to keep the

airway open.

“It’s an alternative that most sleep programs

don’t offer because it’s not in their niche,” Rick

James, former director of IIS, explains. “[The ability

to offer alternatives] is just the reason IIS got into

DME. It’s something the patients need for that

continuum of care. It doesn’t just end at doing the

sleep study.”

The variety of alternatives that IIS offers allows

for a truly individualized approach to therapy,

where tailored treatments lead to satisfied

patients. Becker credits the numerous programs

supporting the patient—as well as the lab’s caring

staff who work for the good of those patients—

for IIS’ success and its impressive 90% CPAP

compliance rate.

“I am very passionate about what I do,” Becker

says. “I truly care about every single patient. I

personally get on the phone with patients who are

refusing to come in because they don’t want to

put a mask on their face. I do what I can to ease

their minds about the process and to reinforce the

tremendous life-saving benefits of completing the

program. I assure them, if it’s about money, don’t

worry about it.”

Putting Care into

Health Care

Glenn Becker, CEO

SRBest_22_24_intl Inst.indd 22 4/5/12 12:23:46 PM

Best of 2012 | Sleep Review 23

BEST

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of

Because of IIS’ phenomenal success, Becker has

generously been able to provide more than 20% of

its services for little or no cost to patients.

NICHE CARE

For Becker and IIS, success is not to be limited

to the patient’s walking through the doors. IIS

has a history of reaching out to those who are at

the greatest need, throughout the country. The

company boasts a variety of programs aimed at

raising awareness and improving treatment of

sleep disorders in transportation, occupational, and

perioperative settings.

IIS’ transportation program targets truckers,

pilots, train conductors, and bus drivers. The

company creates customized solutions for

managing sleep disorder screening, diagnosis,

and treatment of any of the more than 80 sleep

disorders possibly afflicting such professionals.

With more than $12 billion a year spent on

dealing with accidents due to drowsy driving,

many large transportation companies have shown

a great deal of interest in working with IIS to

address this problem.

When an organization partners with IIS to

institute a comprehensive wellness program for

its employees, results are astounding. Well-rested

transportation industry employees not only result

in reduced crash rates and severity but exhibit

improvements in overall health and cognitive

function. Companies also benefit from reduced

legal and insurance expenses, and ultimately

improve profits because employees become more

productive as they become better rested.

In the event that an accident does occur, IIS

is there for its clients to answer to insurance

companies, investigators, and attorneys, confirming

the company’s dedication to preventing accidents.

IIS also offers an Occupational Risk Education

program. Proving once again that addressing sleep

problems is key to improving performance and

saving lives, this program is available to public

safety workers, high-risk employees, those in the

medical fields, and any company looking to combat

absenteeism and reduce workplace accidents.

Studies have shown a link between medical

mistakes and loss of sleep or poor-quality sleep.

Numerous workplace disasters have been

associated with preventable sleep deprivation.

Companies choosing to employ IIS’ Occupational

Risk Education program are provided with tools

meant to combat injuries, accidents, concentration

loss, moodiness, and health problems related to

poor quality and lack of sleep.

Many of the organizations taking advantage

of the Occupational Risk Education program are

self-insured and so are looking to save millions of

dollars on overall health care costs.

“There’s been a lot of interest from self-insured

employers who offer a comprehensive wellness

program to their employees,” James explains.

“They are so impressed with our outcomes that

they are pretty quick to consider our program

standard protocol for all employees, not just the

ones who are at risk for occupational hazard, but

[also] clerical [employees] who may have a number

of health claims that suddenly diminish because we

uncovered that they were at risk for sleep apnea.”

IIS also has a Perioperative Program aimed at

implementing measures to ensure the safety of

people with undiagnosed sleep apnea receiving

anesthesia during surgery. Often these patients do

not have enough time to go through a complete

sleep study prior to surgery. Instead they are

given a home sleep testing device for a quick

preoperative assessment.

“The patient can come in that day and get the

HST, and the very next day we can have them

on an auto PAP machine until after the surgery,”

Becker explains. “Then, if necessary, we can have

them come in for a proper CPAP titration study. But

at least they’re covered preoperative, throughout

surgery, and postoperative.”

SERVING THE PROFESSION

While the eclectic range of IIS’ programs

has helped to save lives, improve performance

and productivity, reduce health care costs, and

combat disease, IIS aims to do even more. The

company wants to further the reach and perfect

the administration of sleep medicine. All of its

programs are created to serve as road maps for

other sleep labs, with the aim of improving patient

care and sleep medicine.

Sleep labs have the opportunity to benefit from

IIS’ credibility and knowledge through its formal

sleep school developed in 2007. The Business

Training component designs an exclusive program

to train sleep center employees to be prepared and

enthusiastic about their role in providing patients

with a compassionate, productive, and simple sleep

lab experience.

IIS believes a well-trained, sympathetic staff

means better patient outcomes, less staff turnover,

more effective operations, and an increase in the

bottom line.

Education, however, does not stop at the

sleep lab. IIS also offers training and webinars

to physicians looking to learn more about sleep

medicine, which has increased disease awareness

and advocacy.

Beyond education, IIS has made itself available

to actually manage sleep labs and centers across

the country, sharing its training and operations

protocols, assisting with accreditation, and leading

labs through every step needed to create a strong

and profitable program that leaves patients

satisfied and confident in their care.

“I’m trying to give these companies that can’t

do it on their own a leg up and we’ll help lead

them through what they need to do,” Becker

says. “There are so many things that we’ve spent

years and years doing that we have it down to a

science.”

The Consulting program offers all of the expertise

IIS has accumulated throughout the process of

building itself into a gold standard sleep center

operation. As an industry leader in offering turnkey

solutions, joint ventures, management services, and

consulting services, IIS offers programs customized

to each client’s particular situation.

How is IIS able to do all these things successfully?

The company is willing to step away from the norm

for the sake of the patient. Because of their pursuit

of new avenues of diagnosis and treatment, it has

been able to treat a broad population of patients,

from truckers to surgical anesthesia patients, and

to educate those involved in the sleep industry,

from lab managers to sleep technologists. IIS’ two-

tiered approach of focusing on professionals and

patients has led to successful patient outcomes not

only for IIS but also for the many sleep labs IIS has

partnered with and educated.

Glenn Becker, president and CEO of IIS, can be

reached at (800) 481-3870, gbecker@intlsleep.com.

Tina Page is a freelance writer based in Lomita, Calif.

She can be reached at sleepeditor@allied360.com.

Glenn Becker, CEO

International Institute of Sleep

Multiple Locations

Greater Florida

800.481.3870

http://intlsleep.com/

SRBest_22_24_intl Inst.indd 23 4/5/12 12:23:47 PM

24 Sleep Review | Best of 2012

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BY TINA PAGE

Business acumen and ambition to work in

health care led Steve Cela to form Apnix

Sleep Diagnostics.

When Steve Cela founded Apnix Sleep Diagnostics

in 2000, it was an opportunity to return to his health

care roots. Although he’d aspired to be a doctor, life

took him in a different direction—business, to be

precise. After completing a Master’s in Business at

the University of Texas, Cela’s professional path

took him down a road that included private equity

and investment work, as well as acquisition and

growth of a manufacturing company. Little did he

know his background would affect thousands of

lives for the better.

In 2000, Cela met a respiratory therapist who

helped treat a friend for sleep apnea. Cela was

skeptical about the effectiveness of any treatment

that involved wearing a mask. He doubted anyone

would do it, but soon saw the improvement his

friend experienced.

That’s when Cela got the offer that brought him

back to his health care roots. The same therapist

who treated his friend was looking for investors to

start a sleep diagnostic company. Cela, seeing first

hand how this service transformed his friend, started

researching to see if this was a business path he

wanted to take. He soon discovered that 70 million

people suffered from some sort of sleep disorder

and would be more than willing to use CPAP to

treat a problem like sleep apnea. He also discovered

how this therapy could impact other aspects of

health. It was an opportunity to combine his health

care ambitions with the business acumen he had

developed throughout his professional career; and

soon after, Apnix Sleep Diagnostics was born.

“Immediately, I saw patients’ lives being

changed. I actually saw a guy come in and hug my

partner saying that he saved his life, that really had

an impact on me personally,” Cela recalls.

Growth of a Commitment

Now, after 11 years in business, Apnix Sleep

Diagnostics, an American Academy of Sleep

Medicine-accredited lab, has grown to nine

locations in the greater Houston area. Apnix has

gone from conducting 40 sleep studies a month

to more than 300 monthly studies, and is still

growing. That growth is a direct result of Cela and

Apnix’s commitment to their patients and a focus

on providing a “wow” factor when it comes to

customer service.

Apnix sees itself as “a hospitality business in

which we provide medical care or diagnostic

services to patients,” Cela says. This philosophy,

coupled with its continued commitment to customer

service, has created a company that makes sleep

diagnostic testing a more pleasant experience.

“One of the top values we offer that makes us

so different is exceptional customer service. We

strive to really exceed patients’ expectations and

satisfaction. That value is pervasive to the whole

company,” Cela says.

But Apnix is not just about customer service

and aesthetics. At its core, it’s a sleep diagnostic

lab on a mission to help patients overcome sleep

disorders through diagnosis and treatment.

That mission continues beyond its doors. Apnix

is committed to educating people on sleep

awareness by advocating the value of good sleep

health. This is being done through participation

in local events and health fairs, and directly with

local primary care physicians by helping educate

them about the importance of good sleep health

and its effects on other medical issues, making

Apnix the first line of defense in combating

sleep-related disorders. Plus, Apnix, to further its

educational mission, has cultivated relationships

with a number of the most nationally recognized

experts in the field of sleep medicine. Some of

these authorities are now included as facility

medical directors as well as consultants on its

clinical advisory board.

Another key practice Cela put in place is a patient

satisfaction survey. This ensures that Apnix is living

up to the highest of standards and patients are

consistently receiving the best service. The final

question on that survey: Would you refer a family

member or friend to us? “The answer is consistently

yes, and they do refer people! I think that is the

ultimate question that gives Apnix the seal of

approval,” Cela says.

The patient’s total experience is the company’s

focus. They don’t want the patient’s experience to

feel like they’re in a lab. “We want it to look good,

feel good, and even smell good, nonclinical,” Cela

says. “That’s one of the major factors that set us

apart.”

Apnix’s labs are run by devoted professionals and

feature luxurious surroundings, spacious patient

rooms, flat screen TVs, private baths and showers,

and hotel-quality toiletries; according to its patients,

coming to Apnix for a sleep test is much like staying

in a five-star hotel.

The Apnix mission, Cela says, is “to continually

improve our services, exceed customer expectations

and the care experience, and ultimately change our

patients’ lives for the better.”

Tina Page is a freelance writer based in Lomita, Calif.

She can be reached at sleepeditor@allied360.com.

Apnix Sleep Diagnostics

Greater Houston, Texas

713.349.9767

www.apnix.com

Rooted in Health

Care

Apnix Sleep Diagnostics

SRBest_24_27_SinglePage.indd 24 4/5/12 12:31:12 PM

Best of 2012 | Sleep Review 25

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BY ALISON WERNER

Pulmonary Associates of Richmond’s Sleep

Disorder Centers have made a commitment

to providing comprehensive and individual-

ized care to local sleep patients.

For over 30 years, Pulmonary Associates of

Richmond (PAR) has provided comprehensive

and individualized care to Richmond, Va-area

pulmonary patients with acute and chronic

disorders, including critically ill patients who

require more directed and monitored care. It

was this commitment to individualized care

that led PAR to expand its services into sleep

medicine in 2006. Having seen first hand the

lack of patient compliance in stand-alone

diagnostic facilities in the area, PAR’s physicians

sought to create a sleep disorder center that

offered patients both diagnostic as well as

clinical care to improve their lives, their sleep,

and their health.

Since PAR’s expansion into sleep medicine,

its Sleep Disorder Centers have grown to three

locations, with four beds each, and seven

physicians, who are uniquely board certified in

sleep, pulmonary, and critical care medicine, as

well as 16 sleep technologists—half of them

are registered—and five medical assistants.

This team, which conducts more than 250 sleep

studies per month, makes a point of being

there for patients throughout their experience,

according to Ashley Weeks, marketing

coordinator at PAR.

“They love sleep medicine and are very

involved in patient care. They are there to answer

all questions that the patients may have,” she

says, adding that the staff at PAR makes a

point of putting in the extra effort to ease the

apprehension or nervousness of hesitant patients.

This commitment to making the patient

experience as comfortable and easy as possible

carries into the lab setting itself. All of PAR’s

Sleep Disorder Centers, which are accredited

through the American Academy of Sleep

Medicine, feature identical patient bedrooms for

testing. Every room, as Weeks describes them, is

“comfortable” and features hardwood floors, a

queen-sized bed, satellite TV, and a full private

restroom. In addition, patients meet with the

technician administering their sleep study in

advance to go over the testing process and all the

equipment involved, including the masks, belts,

and sensors, so that the patient understands

what is going to happen on the night of their

study. This combination of a homey environment

and personalized interaction before the study

even gets under way goes a long way to making

the patient’s testing experience, which can often

be stressful, as comfortable as possible.

Because PAR’s Sleep Disorder Centers are full-

service, a sleep physician is available the morning

after the patient’s sleep study to look over the

preliminary results with the patient and discuss

diagnosis and treatment options. While PAR is

not a provider of durable medical equipment

(DME), it works closely with a number of home

health care companies in the Richmond area,

one of which sends representatives to the facility

in the mornings to set patients up with CPAP

or other DME equipment if the results of their

overnight sleep test warrant it. In other words,

“Patients have their results and equipment that

very morning after their study,” Weeks says.

But once a patient walks out with their CPAP

equipment, that’s not the end of their experience.

The staff follows up with patients in the clinic

about 4 weeks after their study to see how

they are doing with their equipment. Because

PAR uses “higher models of CPAP and BiPAP

that record a patient’s AHI, hours of usage, and

mask leak,” staff is able to effectively look at

compliance, according to Weeks.

“[Using these models] helps us to understand

where patients are running into problems and

get compliance up. We are very aggressive in

achieving compliance,” Weeks says.

Patients then receive additional follow-up

as warranted. And should a patient for some

reason end up in one of the area hospitals

with sleep or pulmonary-related issues, PAR’s

physicians are able to provide inpatient care

as well since they round at both the hospitals

in the HCA Virginia Health System and Bon

Secours Richmond Health System.

Throughout the patient experience at PAR, the

underlying theme is commitment to the individual

patient’s care and health—a focus that has been

there since the beginning of PAR’s expansion into

sleep care and will continue on into the future of

serving Richmond area sleep patients.

Alison Werner is associate editor of Sleep Review.

She can be reached at sleepeditor@allied360.com.

Pulmonary Associates of Richmond

Sleep Disorder Centers

1000 Boulders Parkway, Ste 101

Richmond, VA 23225

804.320.4243

www.paraccess.com

A Commitment to

Comprehensive Care

Pulmonary Associates of Richmond

SRBest_24_27_SinglePage.indd 25 4/5/12 12:31:14 PM

26 Sleep Review | Best of 2012

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BY NINA SILBERSTEIN

Ahmad M. Ibrahimbacha, MD, an inspired

physician with Syrian roots, delivers optimal

care to a vast network of sleep disorder

patients.

As a boy growing up in Syria, Ahmad M.

Ibrahimbacha, MD, became interested in

medicine while watching his mother give his

grandfather insulin shots. Ibrahimbacha’s mother

picked up on her son’s curiosity, and as good

parents do, she inspired Ibrahimbacha, telling

him she would send him to London or America

to be a famous doctor. That inspiration led

Ibrahimbacha to study in the United States to

become a sleep physician where today he uses

the same kind of motivation to help patients

achieve optimal sleep health.

After graduating from the Aleppo School of

Medicine in Syria in 1982, Ibrahimbacha came

to the United States to further his education and

focus his scope of practice. “I came to the United

States because it is the best place on earth to

achieve your dream and goals and the country

offers the best education,” he says.

In the United States, Ibrahimbacha completed

his residency in internal medicine at St. Barnabas

Hospital in the Bronx, NY. He finished his

fellowship in pulmonary and critical care medicine

at New York Medical College in Valhalla, NY.

Practicing sleep medicine since 1995

and achieving board certification in internal,

pulmonary, critical care, and sleep medicine,

Ibrahimbacha now serves as the director for

the Sleep Disorders Center at SkyRidge Medical

Center, Cleveland, Tenn, as well as a physician

adviser and chairman of the utilization review

committee for the SkyRidge Medical Center.

In addition, he is director of Sleep Labs of the

South, also located in Cleveland. The Sleep

Disorders Center at SkyRidge Medical Center

features six beds and is accredited by the

American Academy of Sleep Medicine (AASM).

The fact that Ibrahimbacha is certified in four

subspecialties gives him an edge when delivering

high-quality care to his patient base in Cleveland.

“It’s a one-stop shop for my patients,” he says.

Ibrahimbacha sees the full spectrum of sleep

disorder patients including sleep-disordered

breathing (SDB), insomnia, restless legs syndrome,

and a wide variety of other disorders. With SDB

being the most commonly treated disorder,

Ibrahimbacha has structured an individualized

approach to care. SDB patients who are treated

with continuous positive airway pressure

(CPAP) are carefully managed by Ibrahimbacha.

For patients who struggle with the therapy,

Ibrahimbacha has established an effective

network of physicians that can offer patients

alternatives to CPAP treatment. Ibrahimbacha

has developed relationships with dentists who

specialize in offering oral appliances and ENTs

who can offer patients surgical treatments for

obstructive sleep apnea. This network will serve

the facilities well as health care reform takes place

and as proposals like the American Academy

of Sleep Medicine’s Integrated Delivery Model

potentially take shape.

The Integrated Delivery Model starts with a

patient referral to a sleep specialist who decides

the patient’s treatment pathway. Within the

context of this model, not only would the sleep

specialist provide durable medical equipment

(DME), but they would also have a network of

dental sleep medicine and surgical specialists to

whom to refer patients. Having these established

relationships and direct access to DME would

close the treatment loop, creating a more

seamless management process that keeps the

sleep specialist at the center with the patient.

“We need to figure out how sleep medicine

will fit in health care reform, and more

specifically, how to deliver a more integrated

sleep management model to keep doctors

more engaged throughout a patient’s care

period,” Ibrahimbacha says. “Integrated sleep

management is important because it creates a

patient management system that stays with the

patient from beginning to end.”

As sleep medicine evolves, Ibrahimbacha looks

forward to advancing the facilities where he

is based to ensure patients are receiving top-

notch treatment. Although keeping up on a

rapidly changing health care profession takes

time and commitment, Ibrahimbacha has not

forgot his roots in Syria. “I visit every 2 to 3

years to do work by giving free consultations to

the community and to exchange knowledge and

experience with doctors,” he says.

Nina Silberstein is a contributing writer for Sleep

Review. She can be reached at sleepeditor@

allied360.com.

Ahmad M. Ibrahimbacha, MD

SkyRidge Medical Center

Blue Ridge Pulmonary Medicine, PC

110 Dunhill Place

Cleveland, TN 37311

423.476.2212

www.skyridgemedicalcenter.net

Motivated Drive

Ahmad M. Ibrahimbacha, MD

SRBest_24_27_SinglePage.indd 26 4/5/12 12:31:15 PM

Best of 2012 | Sleep Review 27

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BY RENEE DIIULIO

The Weill Cornell Center for Sleep Medicine

seeks to advance sleep medicine through

comprehensive care, quality processes, and

intense research.

At the Weill Cornell Center for Sleep Medicine

in New York, NY, the staff is not just dedicated

to improving patients’ sleep—they are focused

on improving patients’ overall health, today and

tomorrow. This means not just diagnosing and

treating patients’ sleep disorders, but providing

comprehensive care, implementing smart practice

processes, and completing research intended to

advance the discipline of sleep medicine.

“We try to move the field ahead,” Arthur

J. Spielman, PhD, co-director of the Center for

Sleep Medicine and adjunct clinical professor of

psychology in neurology at the Weill Cornell Medical

College of Cornell University, also in New York, says

of the clinic’s philosophy.

The center first opened in 1985 at Weill Cornell

Medical College and moved to the Manhattan

area in the 1990s. About 2 years ago, the sleep

center moved again, into a new facility designed

specifically for the sleep team’s use. Located in the

Upper East Side of the city, it is near the Memorial

Sloan-Kettering Cancer Center and The Rockefeller

University.

The Weill Cornell Center for Sleep Medicine

collaborates with both institutions on research

designed to advance sleep science. Currently, it is

enrolling patients for two clinical trials in sleep apnea

and recently closed enrollment on a third study on

sleep bruxism and desensitization in myofascial

face pain. “We don’t want to just stand on current

knowledge. We actively investigate,” Spielman says.

Center basiCs

The team at the center is comprised of a number

of specialists, including Spielman, a clinical

psychologist and a noted expert in insomnia. Ana

Krieger, MD, MPH, Spielman’s fellow co-director,

is a pulmonologist with expertise in sleep apnea.

Other team members specialize in neurology,

internal medicine, pulmonary medicine, ear, nose,

and throat (ENT), pediatrics, psychiatry, bariatric

surgery, nutrition, and endocrinology.

A nurse practitioner and technologists round out

the clinical staff. With studies running 6 nights a

week, there can be up to five technologists working

through the night, Spielman notes. A support staff

manages the office and proper paperwork, and

visiting physicians perform research and hone their

sleep medicine skills.

Patients come from neighboring institutions and

the associated medical facility, but also from the

metropolitan area. Patients may be referred or can

come in on their own.

expert treatment

With almost 50 years in the field (Spielman

was at the first sleep center certified in the United

States), he has seen it all—or nearly. “There is a

rare growling sleep disorder that I’ve never seen,”

Spielman says.

He is perhaps best known for his work in insomnia

and, subsequently, sees many patients with this

disorder. “Insomnia is the most prevalent sleep

disorder there is, but the health consequences of

obstructive sleep apnea, as well as the very effective

treatment regimens and management we have for

that, bring in many patients with that condition,”

Spielman says.

Sleep apnea patients are often treated with CPAP.

“CPAP is the most reliable treatment for obstructive

sleep apnea, but about one-quarter to one-third of

patients openly don’t use it,” Spielman says.

To improve patient compliance, the center offers

an intense adaptation program: patients come into

the lab to try on different masks; the staff work with

them to test the different pressures, show them

how to use the equipment, teach them relaxation

techniques, and evaluate what works best for each

individual. “It’s an extensive number of hours,”

Spielman says.

Spielman notes compliance is an issue

experienced and addressed by many sleep

centers, and solutions can be innovative.

Spielman has studied hypnosis as a method

to help patients adapt to CPAP during the first

month, with some success.

Quality measures

The adaptation program will likely be modified

moving forward. The staff is constantly seeking

ways to improve care, and no improvement is too

small. The process is evolutionary, and no procedure

is static—even the tools are dynamic. The new

space has installed state-of-the-art equipment in the

12 sleep rooms and the control center.

“Everybody is concerned with making things

absolutely right,” Spielman says. And while

perfection is a constant objective, while they pursue

it, the staff at the Weill Cornell Center for Sleep

Medicine are definitely making things better.

Renee Diiulio is a freelance writer based in Manhattan

Beach, Calif. She can be reached at sleepeditor@

allied360.com.

Weill Cornell Center for Sleep Medicine

425 East 61st Street, 5th Floor

New York, NY 10065

646.962.7378

http://www.weill.cornell.edu/sleepcenter

Making Things

Better

Weill Cornell Center for Sleep Medicine

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28 Sleep Review | Best of 2012

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Rosen, David B., DMD

Dental Sleep Medicine of New

England

Lexington, Mass

877.447.6673

www.dentalsleepapnea.com

Rotenberg, Joshua, MD

Texas Medical & Sleep Specialists

Houston, Tex

713.464.4107

www.txmss.com

Roth, Heidi, MD

University of North Carolina Sleep

Disorders Center

Chapel Hill, NC

919.966.4401

www.med.unc.edu

Salizzoni, Jeffrey, MD

Aspen Medical Associates PA

Teaneck, NJ

201.928.0200

Shang, Jingzi, MD, PhD

UPMC Hamot Sleep Disorders Center

Erie, Pa

814.877.6000

www.hamot.org

Sharma, Sunil, MD, DABSM,

ABIM

East Carolina University Sleep

Disorders Center

Greenville, NC

252.744.4653

See

page 14

www.ecu.edu

Shippey, Ford, MD

Sleep Center Hawaii

Honolulu, Hawaii

808.456.7378

www.sleepcenterhawaii.com

Simmons, Michael S., DMD

Simmons Dental Care

Palmdale, Calif

661.947.3163

www.simmonsdentalcare.com

Smith, Larry F. , MD, JD

Appomattox Medical Center

Appomattox, Va

434.352.3003

www.appomattoxmedicalcenter.com

Soni, Prabhat, MD, FCCP, DABSM

Sleep & Weight Loss Institute

Brooklyn, NY

718.787.1900

See

page 10

www.sleeptobeslim.com

Sorresso, Dennis P., MD

Shands Starke Regional Medical

Center - Sleep Disorder Center

Starke, Fla

904.368.2300

www.shandsstarke.com

Stack, Richard, MD

Mercy Sleep Center, Mercy San Juan

Medical Center

Carmichael, Calif

916.979.0347

www.mercysanjuan.org

Strohl, Kingman P., MD

University Hospitals Case Medical Center

Cleveland, Ohio

866.844.2273

www.uhhospitals.org

Su, Henry, MD

Evergreen Sleep Disorders Center

Kirkland, Wash

425.899.4280

www.evergreenhospital.org

Torch, William, MD

Washoe Sleep Disorders Center

Reno, Nev

775.329.4060

See

page 4

Tucker, John H., DMD

Erie Dental Sleep Therapy; Tucker

Dental Excellence

Erie, Pa

814.836.2866

www.eriedentalsleeptherapy.com

Valsamis, Christina, MD

Winthrop Pediatric Associates

Mineola, NY

516.663.4600

www.winthroppeds.com

Vaughn, Bradley V., MD

University of North Carolina Sleep

Disorders Center

Chapel Hill, NC

919.966.4401

www.med.unc.edu

Villareal, Alexander, MD

Geisinger Sleep Disorders Center

Woodbine

Danville, Pa

877.507.4957

See

page 20

www.geisinger.org/services/sleep/

index.html

Weingarten, Jeremy A., MD

New York Methodist Hospital; Weill

Cornell Medical College

Brooklyn, NY

718.780.3000

www.nym.org

Westerman, Jan, MD

Pulmonary & Sleep Associates of

Jasper, PC

Jasper, Ala

205.387.7555

www.sleeprst.com

Winde, James, MD

Oregon Sleep Center

Hermiston, Ore

541.667.4104

www.hermistonsleepcenter.com

Wise, Merrill S., MD

Methodist Healthcare Sleep Disorders

Center

Memphis, Tenn

901.516.7000

www.methodisthealth.org

Yuen, Kin M., MD

Bay Sleep Clinic

Menlo Park, Calif

866.887.6673

www.baysleepclinic.com

Zureikat, George, MD

Mid-Michigan Sleep Center

Grand Blanc, Mich

810.953.3600

www.midmichigansleep.com

Apnix Sleep Diagnostics

Greater Houston, Tex

713.349.9767

See

page 24

www.apnix.com

Athens-Limestone Hospital

Sleep Disorders Center

Athens, Ala

256.771.7378

www.athenslimestonehospital.com

Auxilio Mutuo Hospital Sleep

Laboratory

San Juan, Puerto Rico

787.758.2000

www.auxilio.com

Ballantyne Diagnostic & Sleep

Center

Charlotte, NC

704.943.5075

www.ballantynesleepcenter.com

Center for Sleep Medicine at

Raritan Bay Medical Center

Old Bridge, NJ

732.360.4255

www.rbmcsleepcenter.org

Cleveland Sleep Centers

Middleburg Heights, Ohio

440.243.8044

See

page 16

www.clevelandsleeps.com

Children’s Hospital of

Wisconsin Sleep Center

Wauwatosa, Wis

414.266.2000

www.chw.org

Colorado Sleep Center of the

Rockies

Loveland, Colo

970.619.6000

www.sleepcenterotr.com

BEST OF 2012

sleep facilities

BEST OF 2012

sleep doctors

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Best of 2012 | Sleep Review 29

BEST

2012

of

Diagnostic Clinic of Longview

Longview, Tex

903.757.6042

www.dcol.net

East Carolina University Sleep

Disorders Center

Greenville, NC

252.744.4653

See

page 14

www.ecu.edu

Erie Dental Sleep Therapy

Erie, Pa

814.836.2866

www.eriedentalsleeptherapy.com

Fundacion Sueno Vigilia

Colombiana IPS

Bogota, Colombia

www.fundasuvicol.org

Fusion Sleep

Atlanta, Ga

678.990.3962

www.fusionsleep.com

Geisinger Health Systems

Sleep Disorders Centers

Danville, Pa

877.507.4957

See

page 20

www.geisinger.org/services/

sleep/index.html

Integra Sleep LLC

Raleigh, NC

919.838.7600

www.integrasleep.com

International Institute of Sleep

Greater Florida

800.481.3870

See

page 22

www.intlsleep.com

Life Care Sleep and Health

Center

Kalamazoo, Mich

269.353.3187

www.lifecaresleep.net

Mary Washington Hospital

Sleep and Wake Disorders

Center

Fredericksburg, Va

540.741.7846

www.marywashingtonhealthcare.com

Mease Countryside Sleep

Disorders Center

Safety Harbor, Fla

727.725.6111

www.mortonplant.com

Medias Sleep Center

Galax, Va

276.676.3360

www.mediassleep.com

Medical Sleep Solutions

DeSoto, Tex

972.709.7190

www.medicalsleep.com

Merit Center for Sleep Health

of Prairie Stone

Hoffman Estates, Ill

888.637.4848

www.meritsleep.com

Merit Center for Sleep Health

of Streamwood

Streamwood, Ill

888.637.4848

www.meritsleep.com

Mid-West Center for Sleep

Disorders

Lansing, Mich

517.887.6733

www.mwcsd.com

Mid-West Center for Sleep

Disorders-Brighton

Brighton, Mich

810.225.7595

www.mwcsd.com

Morton Plant Mease Sleep

Disorders Centers

Largo, Fla

727.734.6716

www.mpmhealth.com

Munson Healthcare Sleep

Disorders Center

Traverse City, Mich

800.358.9641

www.munsonhealthcare.org

National Jewish Hospital

Denver, Colo

303.270.2708

www.nationaljewish.org

North Puget Sound Center for

Sleep Disorders

Everett, Wash

425.252.3693

www.ilikesleep.com

Northwestern University Sleep

Disorders Center

Chicago, Ill

312.926.2650

www.nmh.org

Oniro Sleep Labs

San Antonio, Tex

210.826.4000

www.onirosleeplab.com

Pulmonary Associates of

Richmond Sleep Disorders

Centers

Richmond, Va

804.320.4243

See

page 25

www.paraccess.com

Rest of Your Life Sleep Evaluation

Center

Jasper, Ala

205.387.7555

www.sleeprst.com

Sky Ridge Medical Center

Sleep Disorders Center

Lone Tree, Colo

720.225.3100

www.skyridgemedcenter.com

Sleep Center at Cincinnati

Children’s Hospital

Cincinnati, Ohio

513.636.1077

www.cincinnatichildrens.org

Sleep Disorders Center - Santa

Rosa

Henrico, Va

804.282.1373

www.paraccess.com

Sleep Institute of New England

Kingston, NH

603.347.8810

www.sleepne.com

Sleep Labs of Texas

Beaumont, Tex

409.832.6934

Sleep Solutions of Lexington

Medical Center

West Columbia, SC

803.791.2683

www.lexmed.com

Sleep Therapy & Research Center

San Antonio, Tex

210.614.6000

www.sleeptrc.com

Sleep-Wake Disorders Center

of South Florida

Miami, Fla

305.661.5994

www.sleepwakes.com

SLUCare Sleep Disorder Center

St Louis, Mo

314.977.5337

www.slu.edu

Sound Sleep Center

Maple Grove, Minn

763.315.4300

www.soundsleepcenter.com

St. Charles Hospital Sleep

Disorders Center

Port Jefferson, NY

613.474.6277

www.stcharleshospital.chsli.org

St. Vincent Regional Sleep

Disorder Center

Green Bay, Wis

920.431.3041

www.stvincenthospital.org

Texas Medical & Sleep Specialists

Houston, Tex

713.464.4107

www.txmss.com

Texas Medical & Sleep Specialists

San Antonio, Tex

210.249.5020

www.txmss.com

Texas Pulmonary Sleep Center

Arlington, Tex

817.461.8772

www.tpsctr.com

The Everett Clinic Sleep Center

Everett, Wash

425.252.3693

www.everettclinic.com

The Sleep Center of Austin

Austin, Tex

512.697.9896

www.thesleepcenteraustin.com

University at Buffalo School of

Medicine

Buffalo, NY

716.961.6955

www.smbs.buffalo.edu

University of Utah Sleep-Wake

Center

Salt Lake City, Utah

801.581.2016

www.healthcare.utah.edu

Vanderbilt Sleep Center

Nashville, Tenn

615.343.5888

www.vanderbilthealth.com

Weill Cornell Center for Sleep

Medicine

New York, NY

646.962.7378

See

page 27

www.weill.cornell.edu/sleepcenter

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