The Boston-based Newton Sleep Center maintains success by using an individualized approach to solve its patients’ sleep problems.

 From left, David White, MD, Elise Franko, MS, RPSGT, William Eckhardt, RPSGT, CRT, and Lawrence Epstein, MD.

When sleep centers were opening at an unprecedented rate in the 1990s, most were established to simply diagnose obstructive sleep apnea (OSA). At this time, two Boston business partners, David Barone and Stanley Goldstein, joined together to design a sleep program that would do more than just detect sleep disorders for its patients—it would offer a full range of services to treat the problems. As a result, Newton, Mass-based Sleep HealthCenters was launched in 1997 as one of the nation’s first one-stop shops for sleep disorders.

This concept was modeled after sleep centers that were already well established in Israel. Barone had heard a lecture from Peretz Lavie, PhD, who at that time was dean of the medical school at Technion, Israel Institute of Technology in Haifa as well as founder of Sleep Disorders Centers, a sleep medicine company in Israel. “After learning about how Israel treated sleep disorders, David wanted to start a sleep program in the United States that used the same methods as those in Israel,” explains Paul Valentine, president and CEO of Sleep HealthCenters.

According to Valentine, many of the first sleep laboratories in the United States would refer patients to other providers for treatment, which often resulted in a lack of follow-up, uncoordinated care, and poor outcomes. Sleep HealthCenters was one of the first providers that offered a seamless approach to sleep medicine.

Sleep HealthCenters’ founders recognized that one of the best ways to provide comprehensive, high-quality services was to affiliate with premier hospitals in the Boston area. After meeting with David White, MD, a nationally known sleep specialist at Brigham and Women’s Hospital and past president of the American Academy of Sleep Medicine (AASM), Barone, Goldstein, and White decided to open a sleep facility in the Boston suburb of Newton as an affiliation with Brigham and Women’s Hospital. White joined the organization as corporate medical director. After the success of the Newton Sleep Center, Sleep HealthCenters opened four other facilities, which are affiliated with Beth Israel Deaconess Hospital in Boston, McLean Hospital in Bedford (a nationally known psychiatric hospital), Hallmark Health in Malden, and Falkner Hospital in Boston. Certain laboratories are accredited by the AASM. Today, Sleep HealthCenters is the largest provider of sleep services in Massachusetts.

 Denise Clarke, RPSGT, (front) and Kevin Moore prepare patients for their sleep tests.

The seven-bed Newton Sleep Center is housed in a state-of-the-art digitized facility that offers a full range of services to diagnose and treat OSA, insomnia, narcolepsy, and restless legs syndrome. Due to the growth of this laboratory, another bed will be added in the near future. John Winkelman, MD, PhD, medical director, and Elise Franko, MS, RPSGT, laboratory manager, oversee the Newton facility, which is located in a freestanding building near Boston. Unlike many sleep centers in the country, the Newton facility treats a high number of patients with psychiatric disorders because three physicians trained in that area work out of that site.

Each of the centers employs technologists of many disciplines including RTs who possess working knowledge of all respiratory therapy functions and procedures, including the technical and physiological impacts and therapeutic alternatives pertaining to OSA. Although sleep technologists are generally assigned to one particular center, they do float among the five facilities based on staffing needs.

An Individualized Approach
In assessing and treating patients, Sleep HealthCenters uses an individualized approach. When a patient arrives at one of the centers, a trained sleep clinician obtains the sleep complaint, which ideally includes a history from the patient’s bed partner, as well as medical, psychiatric, and family histories. A physical examination is given and information is recorded about the patient’s use of medication and psychosocial status. In some cases, a specific diagnosis can be made and treatment prescribed; however, in other situations, the diagnosis is presumptive and must be confirmed or excluded by diagnostic studies. In many cases, patients are prescribed an overnight sleep test; however, since each case is treated individually, different laboratories and tests are used as needed. Depending on the patient’s diagnosis, a variety of treatments are utilized, such as continuous positive airway pressure (CPAP) therapy, bilevel therapy, medication, lifestyle changes (diet, weight loss, avoidance of alcohol/caffeine, exercise, stress management), and, in some cases, surgery.

Sleep HealthCenters offers a comprehensive program in which a patient meets with the physician both prior to and following a sleep study. In addition, the company has counselors on staff who are licensed respiratory therapists trained to assist patients with CPAP fittings and compliance.

Because of this broad approach, Sleep HealthCenters offers patients everything they need to solve their sleep problems. “There are several very specific sleep disorders in which we have particular expertise, such as OSA, central sleep apnea, nocturnal eating disorders, and sleep disorders associated with psychiatric disease,” explains White. “However, our ability to provide all aspects of patient care attracts patients with the full spectrum of sleep disorders.”

A Comfortable Environment
Each of Sleep HealthCenters’ sites offers patients hotel-style rooms with plenty of amenities to make them feel as comfortable as possible. Each diagnostic suite has a queen-sized bed, a comfortable chair, and television. Most rooms have a private shower and toilet. Rooms for handicapped patients are available with accessible bathrooms and beds with lifts. When patients are discharged, they are asked to complete a survey to provide feedback on the services. Follow-up office visits with a respiratory therapist are conducted for sleep apnea patients at intervals of 1 week, 1 month, 3 months, 6 months, and 1 year following the start of CPAP therapy. To accommodate patients’ needs, each center offers flexibility in scheduling sleep studies. Offering day studies is important for patients who work night shifts.

 Paul Valentine, president and CEO of Sleep HealthCenters.

One of the reasons Sleep HealthCenters has experienced impressive growth is its strong technical staff. Each technologist undergoes an extensive training program after they are hired. “Our program offers a 2-week didactic program and 2 months of practical training,” explains William Eckhardt, RPSGT, CRT, director of education. “We didn’t feel that on-the-job training was enough, and that by offering a comprehensive training program for sleep technologists, they would receive a broad spectrum of knowledge.” During the training program, new hires gradually start working directly with patients as their mentors observe. Before the training ends, they are given opportunities to work on more complicated cases with experienced sleep specialists.

Because Sleep HealthCenters conducts numerous research studies due to its affiliations with teaching hospitals, the staff has opportunities to assist with these projects. Eckhardt points out that because of these research activities, the company’s recruiters constantly seek individuals with computer or research backgrounds.

Due to its strong reputation in the sleep field, staff turnover has not been a problem since the company’s founding. “Employees tend to stay but when they do leave, we find that it is difficult finding experienced sleep specialists because the field is still relatively new,” Eckhardt says. “That’s one of the major reasons we decided to start the extended training program.” Sleep HealthCenters also places top priority on continuing education. Sleep technologists are encouraged to attend local and out-of-town seminars. The company also conducts monthly educational seminars covering a wide range of topics in the sleep field.

Eckhardt points out that many employees are attracted to Sleep HealthCenters’ affiliation with first-rate hospitals and expert physicians in sleep medicine. “Our high-caliber physicians are one of the reasons we’ve not only grown so quickly, we’ve also been able to hire top-notch employees,” Eckhardt says. The physicians affiliated with Sleep HealthCenters are board-certified sleep specialists who work in the areas of pulmonology, neurology, psychology, dentistry, and psychiatry.

Growth and Success
The success of the program has also meant that Sleep HealthCenters has not had to rely on advertising or other marketing vehicles. Physician referrals and word of mouth among patients have been largely responsible for the steady stream of business at each center. Despite such enormous growth, Sleep HealthCenters is still able to respond quickly to patients requiring sleep studies. “Typically, we are able to book a sleep study in 2 to 3 weeks and the absolute worst waiting period would be 1 month,” Eckhardt says.

 John Winkelman, MD, PhD, medical director.

Another reason Sleep HealthCenters has been extremely successful in the Boston area is that its services have been well received by managed care companies, which are the predominant payors for Sleep HealthCenters’ services. “Managed care companies in our area are very educated about the field of sleep medicine,” Eckhardt says. Payors especially appreciate the savings they receive by using an integrated delivery system like that at Sleep HealthCenters as opposed to a fragmented system involving many different providers.

With one third of the US population experiencing sleep-related problems, it is likely that Sleep HealthCenters will continue to grow significantly in the years ahead. Currently, the company is considering opening additional centers in the Boston area and has even contemplated entering other geographic markets. “We are always looking for new sites in order to meet patient demand,” Eckhardt says. “We feel we have an excellent model that can work in other areas with the right hospitals and physicians.”

Lawrence Epstein, MD, regional medical director for Sleep HealthCenters, concurs that the company’s ability to offer a comprehensive disease management system will enable it to continue to expand. “Our patients see specially trained physicians, sleep medicine specialists, pulmonologists, neurologists, psychiatrists, and psychologists; undergo diagnostic testing in a state-of-the-art laboratory; and are educated about and treated for their sleep disorders under the supervision of sleep specialists, CPAP therapists, and dentists,” Epstein explains. “No other place can offer this range of services.”

Carol Daus is a contributing writer for Sleep Review.