A former Army paratrooper creates Somnograph Sleep Diagnostic Services providing complete polysomnogram testing, CPAP and bilevel PAP titration studies, and maintenance of   wakefulness testing.

NaiphonDuke Naipohn, CEO and president

Case backlogs at many metropolitan sleep laboratories run 60 to 90 days. Not so for the laboratories operated by Somnograph Sleep Diagnostic Services. Patients at those facilities typically encounter waits of just 14 days and seldom more than 30 for a night of observation and testing.

The comparatively short span between time of referral and date of study has helped make Wichita-based Somnograph much in demand in the American heartland markets where the 4-year-old company now operates nearly 70 fixed-position and mobile sleep laboratories.

Somnograph can hold its backlog to 2 weeks—even in the face of rapidly increasing referrals—because the enterprise has taken steps to ensure that its sleep laboratories have on hand state-of-the-art equipment in good working order.

“If a system goes down, you’re not going to be able to do the study as scheduled,” says Duke Naipohn, chief executive officer and president. “Before starting Somnograph, I observed that, for the typical sleep laboratory, something on the order of one out of every five studies had to be canceled due to unreliability of the equipment.”

Of course, Somnograph’s systems are not invulnerable; they do go down from time to time. But studies usually can proceed as scheduled because the company is able to immediately drop-ship complete replacement systems to its affected laboratories. Somnograph, Naipohn explains, has deployed equipment supply centers in five regions across seven states—each of these hubs sustains about a dozen nearby laboratories, so the longest a laboratory must wait for a replacement system to arrive is 2 hours.

“We require each sleep operation to call into headquarters at 7:30 nightly to give us a status report so we can know whether their equipment is up or down,” he says. “If we receive word that a system is down, a replacement is loaded into the runner’s vehicle and he’s on his way. Patients have no inkling that we’ve had an equipment problem; it’s entirely transparent to them.”

It costs as much as $200 in labor and transport costs to deliver a replacement system, but the cost is well worth bearing, Naipohn contends.

“Our reputation for being able to complete studies when we’re supposed to is protected this way,” he says. “In any month, only one-quarter of 1% of our scheduled studies have to be canceled because of a problem at our end.”

Military Operation
Naipohn, 34, approaches his sleep-laboratory business in much the same way he once tackled assignments as a leader in his days as an Army paratrooper.

“Somnograph is run just like a military operation,” he enthuses. “Each one of our sleep technicians is treated as a small fighting unit. That means we send them into the nightly fray appropriately equipped and given the necessary support and cover so they can do their job effectively.”

HendricksonRobert Hendrickson, director of clinical services, is responsible for all technical staff and training along with all operations.

The states in which the company operates are largely rural, which means the patient populations there are dispersed across vast stretches of territory. As such, Somno-graph relies on its mobility to extend the reach of its fixed-based facilities (all but one are situated inside partnering hospitals).

“This allows us to have the right technicians in the right places with the right equipment at the right time,” Naipohn says. “Our technicians are highly deployable, due primarily to our utilization of transport assets such as our vans, trucks, and even aircraft. The equipment they carry is packaged into different types of ready-to-go polysomnography kits so the one that’s right for a given night’s particular need is able to roll as soon as the traveling technician receives his or her orders.”

Whether stationary or transportable, all of the Somnograph laboratories offer identical sets of services, which are provided to patients mainly in the 30-65 age range. These services include complete polysomnogram testing (split nights, if requested), continuous positive airway pressure (CPAP) and bilevel PAP titration studies, multiple sleep latency testing, and maintenance of wakefulness testing.

The uniformity of each laboratory makes it easier for the company to manage operations involving such a large and growing number of units and, at the same time, promote brand loyalty among referring physicians, hospitals, and patients, Naipohn reports.

The laboratories operate 7 days a week, including holidays, and each one performs up to two sleep studies per night under the administration of a lone sleep technician who is supported either on-site or via phone by respiratory therapists, registered nurses, board-certified sleep physicians, or other sleep specialists such as psychiatrists.

Employees tend to be reliable long-term hires. Recruits are often recommended to the company by existing employees, which helps ensure that the people brought aboard will be a good fit. Somnograph also recruits through military job fairs. Naipohn says, “Folks who are separating from the military make great employees for us. They understand how our command and control structure works and, most important, they come to us with a strong sense of duty. They have been loyal to a unit [military] for 20 years and they are looking for another organization that will provide them with the same loyalty in return.

“We look for people who not only are good workers and self-starters, but who also are geared to working nights,” Naipohn divulges. “A lot of sleep laboratories are plagued by poor retention of their trained personnel and that’s largely because most employees hate the graveyard shift. Once you hire someone with that mind-set, they end up spending all their time trying to figure out how to get a day job.”

No matter how new personnel come to the company, all undergo extensive training in Somnograph’s systems and preferred methods of operation before being assigned to a laboratory. Then, twice each month, approximately 80% of the sleep technicians travel to Wichita for a day-long meeting, the purpose of which is to provide instruction in the latest clinical techniques as well as cultivate esprit d’corps.

Initially Chilly Reception
Before launching Somnograph in 1997, Naipohn was a premed student at the University of Kansas. His ambition was to become a military physician (at the time, he was still in the Army—a first sergeant then assigned to a mobile field hospital unit).

photoFrom left, Kory Tharp, account manager; Greg Rodman, CFO; Duke Naipohn, CEO and president; Robert Hendrickson, director of clinical services; Eric Bachman, account manager; and Shanna Roth, director of marketing.

While attending the school, he worked as an intensive care unit-based respiratory therapist at an inner-city Kansas City hospital, which happened to possess a sleep laboratory. “The sleep laboratory was plagued with several problems. Staffing and equipment issues were the most pervasive, but lack of organization and focus was also an issue. The laboratory had good people, just no real leadership,” Naipohn says.

“At the time, the laboratory wasn’t a primary focus for the hospital, so there wasn’t really any real pressure to implement change,” he says.

Still, Naipohn believed his notions about what it would take to set the sleep laboratory right were correct. Accordingly, for the next year, he toyed with thoughts of opening a sleep laboratory of his own, just to prove the validity of those ideas.

Only one thing stopped him from acting on it: he was 28 years old and earning a soldier’s pay—to launch a sleep laboratory would require lots of capital—something he lacked. But as a soldier, Naipohn had been taught how to overcome obstacles in order to achieve an objective. Soon enough, he had crafted a business plan, which he began to solicit to potential investors, banks, and venture capitalists.

“I started with a 365-page blueprint. I must have written a page a day for a year,” he laughs, “I later edited it down to a five-paragraph, military-style operations order in which I summarized the situation, the mission objective, my execution strategy, the command-and-signal process, and the method of providing service and support to my forces. I also tried to back this up with some financial projections.”

Though it was powerfully presented, Naipohn experienced difficulty getting prospective backers to warm to his laboratory concept. So he proceeded to scrape together whatever funds he could from personal resources and then set about the task of putting together a sleep center on his own. The money he had was a mere fraction of the minimum needed, but Naipohn was undaunted.

Eventually, a company involved in the manufacture and distribution of sleep-study equipment caught wind of Naipohn’s plan, liked it, and decided to help him find the financial support he needed.

The first laboratory Naipohn opened was a two-bed unit situated in a space within a Wichita hospital. The terms of the arrangement were simple enough: the hospital would send its sleep study patients to Naipohn who would bill the hospital for his services, leaving it to the hospital to seek reimbursement from—and do battle with—the insurance companies. The selling point as far as the hospital was concerned was Naipohn’s pledge to keep the laboratory’s equipment and technicians up and running to the fullest extent possible so that sleep studies could take place as scheduled.

Overnight Success
When Naipohn unveiled Somnograph (originally under the name SleepTec), his goal was not to establish a far-flung network of sleep laboratories. His intention was simply to operate the one laboratory for 4 years, sell it, and use the proceeds to pay his way through medical school. But within 2 months he was forced to abandon that plan.

“The laboratory volumes ballooned on me,” he tells. “The laboratory completed eight studies in the first month. That number tripled the following month, then nearly tripled again by the third. Before I knew what was happening, I was opening laboratory after laboratory to satisfy the demand for service. The business took off and snowballed.”

For the past few years, Somnograph has been doubling in size roughly every 8 to12 months, he discloses. “The trend is continuing without letup,” says Naipohn.

Recently, Somno-graph opened a 13,000-square-foot flagship laboratory in Wichita. Of all its sleep laboratories, this is the only freestanding facility.

“It’s equipped with space for four beds that can be expanded to accommodate a total of 16,” Naipohn says, adding that the facility also functions as the enterprise’s administrative headquarters and training center. “The laboratory does not have a clinical feel to it. We’ve designed the rooms to look like upscale, fashionably appointed hotel suites. They each have direct-from-off-the-street entrances, so the patients do not have to wander through a confusing and frustrating maze of hallways first. Each room has windows—important for patients who suffer from claustrophobia.

“Each room also has its own heating and air-conditioning, which is remotely controlled by the technician overseeing the study to ensure patient comfort at all times—this eliminates the need to enter the room and disturb the sleeping patient just to adjust heating and cooling settings. The rooms also have their own bathrooms and showers. The laboratory is supported by a full kitchen, which is used to provide a hot breakfast for the patients in the morning. The facility was designed from the start to meet the Americans with Disabilities Act requirements.

“We’ve gone to these lengths, providing home-like comforts, because one of the keys to success in sleep medicine is you have to convince patients that they will indeed be able to fall asleep. Which can only be accomplished, I believe, if they are comfortable.” This is also where Somnograph’s mobility truly proves its worth, he adds.

“We brought the service to the outlying patients, rather than insist they come to us,” he says. “Since they don’t have to drive hundreds of miles to reach us, patients can show up for testing less stressed out than they would be after spending hours fighting traffic.

“But, at the same time, allowing patients to remain in their own outlying areas for testing helped make our schedules in the city locations less crowded, so patients in metropolitan areas are able to undergo study much sooner—seldom waiting longer than 14 days after referral.”

Naipohn believes the 60- to 90-day wait that patients endure with other sleep laboratories is unacceptable, especially in instances where patients have been told by their referring physician that they have a potentially life-threatening condition.

“Those are the kind of cases that need to have a study completed right away, not 2 or 3 months later,” he contends. “Backlogs are also bad because they put tremendous pressure on technicians and interpreting physicians to work faster so as to trim the time patients must wait for an appointment. What happens then is the quality of service goes down. If you’re rushing to complete your work, you’re not able to look at each piece as closely and carefully as you should.

“We’ve been able to avoid that. Instead, we’re able to concentrate on what’s most important: improving the quality of life of people suffering from sleep disorders.”

Rich Smith is a contributing writer for Sleep Review.