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.


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.


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.

“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.”


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.”


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.


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.”


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 .

Douglas Livornese, MD, FACP, FCCP, FAASM
Comfort Sleep
2240 Hwy 33, Suite 114
Neptune City, NJ 07753