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 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.”
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 .
Alexander Villareal, MD
Geisinger Sleep Disorders Center Woodbine
109 Woodbine Lane
Danville, PA 17821
- 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.
- 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.