Although sleep is a vital part of a healthy life, it is estimated that over 100 million Americans do not get the rest they need due to a sleep disorder. Although sleep medicine was officially recognized as a specialty by the American Medical Association in 1996, interest in sleep goes back centuries.
In ancient Egypt, opium was a widely offered treatment for insomnia. In 400 B.C., Hippocrates outlined his theory of sleep in Corpus Hippocraticum. In 1836, Charles Dickens authored a character suffering from obstructive sleep apnea depicted by an excessively sleepy, overweight boy named Joe who snored in The Posthumous Papers of the Pickwick Club.
Today, United Sleep Medicine, L.L.C. seeks to answer the needs of this patient population, which is still widely under-served and undiagnosed.
The Business of Sleep
Over the last decade, the information gained from sleep studies has become an increasingly important part of medical research and patient treatment. Dr. Hemanth Rao has watched the rapid growth of the sleep medicine industry over the past 13 years. His company, United Sleep Medicine, has grown from one of the first independent sleep medicine practices in the Carolinas to a leader in the industry.
“When United Sleep Medicine was founded in 1998, sleep medicine was gaining recognition as a field, and by 2002 there were 1,500 sleep programs in the United States,” Rao reports. “In 2006 that number had quadrupled to more than 6,000.”
Putting a focus on patient care, United Sleep Medicine (USM) provides diagnostic and treatment services to patients suffering from a wide array of sleep disorders such as sleep apnea, insomnia, narcolepsy, restless leg syndrome, as well as pediatric sleep disorders. It has grown from a single sleep lab to a provider of sleep and neurophysiology services with a national presence. USM currently owns and/or operates sleep centers throughout the southeastern and southwestern U.S.
The Sleep Lab Management Services provides numerous hospitals and physician groups the startup and development expertise and support necessary for implementing their own sleep centers. USM is also an accredited member of the American Academy of Sleep Medicine.
Dr. Rao grew up in southeast India, receiving his M.D. from Madras Medical College in 1988. He came to the United States to complete post-graduate work in internal medicine and neurophysiology.
He completed his internship at Elmhurst Medical Center, Mount Sinai School of Medicine; his residency, epilepsy and sleep training at Long Island Jewish Medical center, Albert Einstein College of Medicine, where he also served as chief resident of the residency program; and a fellowship in EMG Neuromuscular Diseases from Washington University School of Medicine in St. Louis, Mo.
From St. Louis, Rao relocated south to Charlotte, in large part because of “the friendliness of the people” and “the green, beautiful, scenic city.” Rao began focusing on the need for a holistic approach to treating people with sleep disorders that was not being met.
“Too many centers provide testing and diagnosis,” says Rao, “but don’t follow up on why it is important to use the recommended equipment.
“Often the patient receives a machine in the mail and is simply told to make sure to use it. USM has created sleep centers where patients are educated on the application and use of their therapy under the direction of a caring, professional staff. Patient involvement is the key to compliance, so we encourage our patients to ask questions and to follow up with any problems that may arise at home.”
Two and a half years ago, Rao met Alan Campbell, who has an extensive background in emerging health care platforms, working most recently with an innovative company providing outpatient therapeutic care for stroke and brain injury patients. The two shared a common philosophy for creating patient care centers in which patients would receive the treatment and oversight they needed from an empathetic team in a homelike atmosphere.
Based on their shared vision of offering value to patients in a company built on integrity and compassion, Campbell soon joined USM as chief executive officer. Campbell has raised the level of sophistication and maturity of the company, striving to set new standards in the highly fragmented sleep industry.
“Our goal as a company is to increase awareness of the effects of sleep deprivation,” says Campbell. “We want to educate the patients and health care professionals that while diet and fitness may be pillars of wellness, sleep is also a significant contributor.”
Campbell refers to the latest research information indicating that by treating patients with sleep disorders, they can become less burdensome to the health care system. “Once a person is diagnosed and treated, medical costs such as medications and hospital stays can be reduced by an estimated $1,300 a year,” reports Campbell.
Knowing the Symptoms
Most Americans suffering from a sleep disorder are not diagnosed because they are not aware of the signs and symptoms. The effects of sleep deprivation can be both short and long-term and may include cardiovascular disease, hypertension, obesity, depression, headaches, anxiety, personality changes, and/or excessive daytime sleepiness.
The most common sleep disorder is obstructive sleep apnea. This is a medical condition characterized by collapse of the upper airway musculature leading to snoring and breathing cessation or significantly reduced airflow. The American Academy of Sleep Medicine reports that 80 percent of people with sleep apnea are unaware they have the disorder.
“Over 30 percent of people in the U.S. have a sleep disorder. Of that group, 5 percent of them, at a minimum, suffer from obstructive sleep apnea,” asserts Rao.
The first step to diagnosis and treatment is recognizing the signs and symptoms of a sleep disorder. In recent years, the mass media has helped publicize the warning signs, which include frequent loud snoring, pauses in breathing during sleep, difficulty falling asleep and/or staying asleep, uncontrollable daytime sleepiness, excessive sweating during sleep, fatigue, frequent trips to the bathroom to urinate at night, morning headaches, sleep walking or talking, and/or involuntary limb movements during sleep.
A patient suffering from one or more of these symptoms may seek help from a primary physician and then be referred to USM or may seek treatment directly.
On the first visit to USM, the patient receives an extensive evaluation with a sleep specialist and may be scheduled for one or two nights at the center for testing. The overnight test, called a polysomnogram or PSG, is conducted in a private, very comfortable and homelike room, equipped with specialized equipment to monitor heart and breathing rates, brain waves, leg movements and eye movements.
After the sleep test, the patient has a follow-up appointment to review the test results and to develop a customized treatment plan. Treatment options can include weight-loss programs, mouthpiece devices, surgery or CPAP (continuous positive airway pressure) therapy. Many patients with obstructive sleep apnea are prescribed the use of a CPAP facemask, which keeps the airways open with a gentle stream of air, facilitating better breathing during sleep.
Susan Kincaid was referred to USM by her doctor who recognized her hypertension might be a symptom of a sleep disorder. Kincaid was tired all the time and couldn’t seem to get enough sleep. Her social life was nonexistent. At the end of a typical day, it was all she could do to eat dinner and crawl into bed.
After testing, the USM staff recommended Kincaid use a CPAP device. At first she was apprehensive of the facemask, afraid of disconnecting the machine or crimping the tubing during the night. But she quickly adjusted to it.
With nightly use of the CPAP, Kincaid’s irritability and need for naps during the day has ceased. She is sleeping through the night, has more energy during the day, feels like exercising and has regained an interest in social activities. And, her blood pressure has stabilized with no change in her medicines.
“At USM, the test is an extension of the clinical exam,” reports Rao. “Our treatment is tied to our post-test diagnosis. That is why we have a 91 percent compliance versus an industry average of 51 percent.”
Whether child or adult, USM staff is totally focused on finding the specific etiology or reason the patient is having difficulty sleeping and then designing an individualized treatment plan. Their goal is to help the patient get the treatment needed for restful sleep and a healthier life.
“We want patients to feel they have become a patient for life—a part of the USM family,” says Campbell. “We want them to know they have access to other programs here, such as weight management, nutrition management, and insomnia treatment and encourage them to call us whenever they have a concern with their sleep treatment or to just give us an update on how they are feeling.”
Rao adds that patients who are better educated about sleep disorders, interface more often with their primary care and other physicians. “Once they feel healthier by getting the benefits of restful sleep,” he says, “they seek out ways to solve other medical problems. They are motivated to lead healthier lives.”
Better Sleep for All
When USM began in 1998, it staked out its role of providing a high level of service in a field that lacked recognition and industry regulation. New research and technology have broadened interest in the field and hospitals and doctors, some facing legal action from post-surgical complications related to sleep apnea, have become more aware of the importance of sleep medicine. Campbell and Rao believe USM is well positioned to provide leadership to this growing industry.
“We have the platform in place to partner with hospitals and other physician groups,” asserts Campbell. “Because of our highly trained, elite group of technicians, cutting edge technology and operational efficiency, we are considered a strong regional provider.”
USM created their Sleep Lab Management services to provide medical expertise and technical know-how to hospitals and physician groups interested in adding sleep medicine to their practices without the capital expenses and overhead of starting their own sleep center. With its professional model, USM can provide a quick start-up for these groups with a business plan, market analysis, equipment and space design. Using registered and certified technicians and AASM-approved protocols and procedures, USM can also provide accreditation assistance to its new partners.
“While our initial focus was in establishing a practice for sleep medicine,” explains Rao, “our interest has expanded to include forming partnerships with hospitals and physician teams in an area stretching from Texas to Virginia. We have both the clinical and technological expertise to help design, staff and service their own sleep centers, and we manage the center for them.”
In Austin, Tex., USM helped Dr. Said Soubra expand his practice, Williamson Pulmonary, to include the treatment of sleep disorders. Soubra wanted to include sleep medicine in his practice, but didn’t want the burden and headache of managing a business plan, designing lab space, hiring staff and training them.
“I chose United Sleep Medicine because they had the know-how and expertise we wanted,” says Soubra. “The two most important aspects I wanted were quality and reliability. USM allows me to treat and care for my patients within a best practice model to achieve optimum outcomes.”