The addition of a full-time sleep specialist creates new opportunities for Cascade Valley Sleep Disorders Center.

By Sarah Schmelling

It is unusual when one person can completely change the vision and scope of a medical facility within a short amount of time, but at Cascade Valley Sleep Disorders Center in Arlington, Wash, this is exactly what happened.

Just about a year ago, sleep specialist Muhammad Sayed, MD, came on board at the center, which is housed within the Cascade Valley Hospital campus. With his arrival, the center, which for the previous 6 years had been a part-time laboratory, became a full-time clinic specializing in sleep. “It’s a completely new program since he has arrived,” says Leigh Anne Orcutt, the clinic and laboratory manager and coordinator.

She and Sayed make up almost half of a staff of five, helped by two sleep technologists within the hospital, and they expect to add two sleep technologists as the center’s patient base grows. Orcutt explains that they see patients throughout the week, conduct sleep studies on 5 nights weekly, and on Mondays offer free screenings to anyone interested within the community. The sleep services the center provides include polysomnography tests, CPAP and bilevel PAP titration, multiple sleep latency tests (MSLTs), and maintenance of wakefulness tests.

However, these are just a few of the ways the Sleep Disorders Center has become a vital addition to the hospital. Through a multidisciplinary approach, cutting-edge technology, a close adherence to evidence-based medicine, and a mission to spread the word on the importance of recognizing sleep disorders throughout its community, the center serves as a prime example of a facility designed for successful treatment modalities.

A Passionate Premise

When Sayed began his residency in neurology at Georgetown University Hospital, he did not plan on a career in sleep medicine. But once the fever of the political climate in Washington, DC, took hold and he started working on a committee of Senator Edward Kennedy’s that conducted research within the specialty, he says he soon “fell in love” with sleep. “Having the opportunity to learn about the huge numbers of people who have sleep problems while working with Congress made me start thinking about going 100% into sleep instead of general neurology,” he says.

Then, through a fellowship at the University at Buffalo, State University of New York, Sayed conducted a large stroke study, which is closely associated with sleep apnea, with more than 3,000 patients and learned of the great number of stroke patients who suffer from sleep apnea. He then dedicated a year to a fellowship in sleep at the Cleveland Clinic, “known as one of the best sleep centers on the planet,” he says.

“The year there was a real experience,” he adds, explaining how incredible it was to see patients flying in from different parts of the world to receive treatment. “It was a big exposure to all aspects of sleep medicine.”

The Cleveland Clinic also opened his eyes to a successful multidisciplinary approach to sleep medicine that he has worked hard to implement in his clinic. “Within the sleep center, there were neurologists, pulmonologists, [ear, nose, and throat (ENT)] physicians, dentists, psychologists, and psychiatrists,” he says. “And this is what we’re doing here, too. We’re working with all of these [specialists] to have multidisciplinary consultation.”

He adds that the center has initiated a program to start soon in which all of these specialists will meet on a monthly basis to discuss unique or challenging cases.

While helping to develop the center, Sayed has continued to stay active in the political arena. He is currently drafting legislation related to drowsy driving, one of the sleep-related causes he feels most passionately about. Sayed wrote about his involvement in a recent Guest Editorial that appeared in the May/June issue of Sleep Review. He is working to try to make Maggie’s Law, the National Drowsy Driving Act of 2002, a federal, not just a state, law. “We’re aiming at $100 million to increase public awareness nationwide, and second, to make it a crime to drive while you are sleepy,” he explains.

Shared Goals

One of the primary reasons both Orcutt and Sayed see the center as being unique is its dedicated staff. “We’re a small group, but we’re all extremely detail oriented,” Orcutt says. “Therefore, we make sure we’re following up on our patients, and we know every step of where they are and where they go from here.”

She adds that the staff members all have a strong focus on communication. “We have a say in what goals we want to make for the sleep lab,” she says. Plus, “being a small clinic like this, we can provide that extrafriendly atmosphere for the patients, so they don’t feel that they’re just patients coming through, but that they’re actually people we know personally, and we can take care of all of their needs.”

Sayed agrees that the staff is “very much on the same page.” He notes that Orcutt, who had not previously focused on sleep, has spent a “tremendous” amount of time traveling over the last year to attend conferences and learn about sleep products.

The medical assistant and sleep technologists are also aware of all the sleep-specific details of the practice, he says. “It’s very much what we can call a sleep team,” he adds.

Sayed sees other strong positive attributes of the center in its technology. “We have the state-of-the-art machine” in the laboratory, he says, as well as the latest in software and hardware. He also says the center’s location within a hospital makes it more convenient for patients than it would be if it was freestanding. “Here, you’re monitoring the patient, and if anything happens, you just take them immediately to the [emergency department],” he says, adding that this has happened more than once during his tenure there.

Cascade is affiliated with the National Sleep Foundation, so it stays connected with sleep centers throughout the country, Sayed explains. He says this is a great way to share research and discuss important issues. But he also says that the center’s own research makes it stand out. Last year, for example, he conducted a study related to the Epworth Sleepiness Scale, which Sayed believes does not work as well as it could in drowsy driving cases. “So I think we’re innovators when it comes to research,” he says. “And not just in academic research, but research when it comes to daytime activities and sleep disorders.”

The center’s overall mission, Sayed says, is to provide leadership in evidence-based medicine. By this, he means it follows closely to the recommendations of the American Academy of Sleep Medicine in gathering as much data as possible from the patients through studying their histories to learn of comorbidities, and conducting both general and neurological examinations. “So if, for example, you think the patient might have narcolepsy, not only do we do the MSLT and the clinical history, but we do some lab workup in genetic testing,” he says. “You put all of these pieces together, and this helps confirm your diagnosis.”

He believes that patient care should be shared between all of the specialists related to sleep, for example, consulting the ENT if the patient requires surgery, the dentist if a mandibular advancement is required, or the psychologist for behavior modification.

“We very much want to make sure the patient is being taken care of,” Sayed says. “And you cannot be a specialist in all of these areas, but if you make the initial diagnosis, and if the patient needs any or all of these, we do the consultations to take care of everything.”

Another key issue for the practice is the importance of follow-up with patients. “Again, we do it according to the book,” he says. “We do the first one in 4 weeks, 6 months if needed, and then on an annual basis.”

Sayed says all of these attributes make the center very close to being as good as it can be. “I think there’s always room for improvement, you cannot claim to be the best,” but he says if they continue in this way, they will make great progress.

Spreading the Word

In addition to all that goes on with the center, the staff has a strong focus on providing sleep information outside of their walls. In addition to attending and distributing information at local health fairs, the team meets regularly with local primary care physicians. “We’ll go to their offices, meet with their staff, and let them know what services we can provide,” Orcutt says.

They have also started outreach programs with local law enforcement and truck driving companies to provide sleep treatment services to employees. “The main idea behind it is to provide services to people who have long shifts, to check in to see how they’re doing, and to provide the tests required by a federal mandate to truck drivers,” she explains, adding that the center is looking into creating a similar program for airplane pilots.

“I think it’s essential,” Sayed says of these programs. “It’s very helpful, not only for them, but for everyone in the community.”

The same can be said for the free screenings offered every Monday at the clinic, he says. “So, if a patient doesn’t have insurance and can’t afford to pay for the service, not only do we see them here for free, but we also have an agreement with some companies to provide free CPAP machines to those who need them.” He adds that the center will be launching a “massive marketing” campaign in the coming months.

Orcutt attributes the growing public awareness of sleep disorders, along with the center’s own efforts to spread the word, to the surge in interest in the clinic, so that appointments are booked up for the next 2 months. “It makes a big difference that the public is hearing more about sleep disorders,” she says. “Before, it seemed that there was [some awareness] that maybe there was a problem, but all the media attention has helped reinforce that they are truly disorders that need to be taken care of. Now, people don’t feel as awkward coming in to talk about it with somebody. They’re more open to getting help.”

Sayed says the center, which currently has two beds, is tripling to six beds to accommodate the growth. “And, seeing that I basically started seeing patients in this center 7 months ago,” he says, “if we keep going at this rate, we’re going to need 20 beds pretty soon.”

A Look Ahead

Sayed concedes that several hurdles remain in getting information out on sleep. “For all sleep specialists, one challenge is that primary care providers need to screen all of their patients for sleep disorders,” he says. “It saves lives. And not just because sleepiness at the wheel can cost lives, but because sleep disorders are associated with many social and medical problems.”

This kind of awareness also needs to be brought to insurance companies, which should allow self-referral to sleep clinics more often, he says, as well as to the public at large. “People need to know that this is a problem and it can be treated,” he says.

But overall, Sayed finds his specialty extremely rewarding. “You hear from patients with narcolepsy, say, who were sleeping all day, that now they have their lives back,” he says. “It’s enough to hear that once to make you happy for the rest of the week.”

Orcutt, still new to the field, plans to expand her sleep education. “It’s extremely interesting and just exciting to see the difference you can make in a patient’s life by helping them with their sleep,” she says.

However, she also greatly appreciates her particular clinic, another testament to the one person at the center of it. “With Dr Sayed, you’re working with a physician who loves what he does and is excited about what he does, and that makes such a huge difference,” she says. “To be able to work with somebody who has that passion to really take this clinic and just grow with it and provide wonderful services, it’s been an excellent experience.”

Sarah Schmelling is a contributing writer for Sleep Review.