Cushy surroundings and consistent follow-up result in  high compliance rates

If Sleep Insights, Rochester, NY, were a hotel instead of a sleep clinic, it would probably have a five star rating. Each room has a memory-foam mattress, mints on the pillow, a thick Turkish terry cloth bathrobe, a desk, and satellite TV. The sleep equipment is undetectable, because it is discreetly tucked inside a nightstand.

Most patients’ first face-to-face interaction at the clinic is with Ken Plotkin, MD, president and CEO, who asks potential sleep apnea patients a number of questions: “Do you find yourself in the middle of night trying to catch your breath?” “Are you tired during the day?” “Do you feel like you’re falling asleep when you’re driving?” Following the interview and physical examination, Plotkin will suggest a sleep study if he believes the patient might have a disorder. In most circumstances, appointments are available within a few days.

These patients arrive in the early evening and are given a brief overview of the procedure by a sleep technician. A few hours after arriving at the clinic, at about 9 pm, patients are connected to the sleep monitors. They leave in the morning and come back a few days later to discuss the results with Plotkin. Patients who are diagnosed with sleep apnea or similar conditions undergo another test while connected to continuous positive airway pressure (CPAP) equipment. The night of the second test is often the beginning of the end of poor quality sleep.

Every evening that Sleep Insights runs a CPAP study means an early morning for Tim Berns, RRT, respiratory coordinator for the laboratory. At 6 am, shortly after patients complete their CPAP tests, Berns meets with them to discuss a home version of the equipment. Sleep Insights collaborates with three local home medical equipment (HME) providers, which store equipment at Sleep Insights. Berns is responsible for making sure that customers know the benefits of using the equipment as well as the necessary, day-to-day basics of how to clean the device, before helping the patients pack it up and take it home. This collaboration has benefits both for patients and Sleep Insights. The most important is making compliance as easy as possible for the patient. Sleep clinics that rely on the patients to acquire their own equipment sometimes find out that they never do.

Before they leave the sleep clinic, Berns asks patients to commit to using the CPAP unit for at least 1 month. This is something of a magic number at Sleep Insights: If the patients use the equipment for 30 days, Berns believes, they will notice such a monumental shift in the quality of their slumber that they will not be willing to return to bad sleep. Getting patients to make such a commitment is not always easy, however. Many patients—some experts believe that number is between 40% and 60%—do not want to deal with the hassle of the therapy and end up putting the units in a closet and forgetting about them. Despite these odds, Plotkin claims that the compliance rate for Sleep Insights’ patients is approximately 92%.

What accounts for the excellent rate? Regular phone calls can mean the difference between compliance and noncompliance, and Berns regularly calls patients during the first year of therapy.

The History of Sleep Insights
The concept for Sleep Insights was born more than 3 years ago. Scott Blodgett, a former paramedic and now operations manager at Sleep Insights, was working with epilepsy patients in a local university when he met Plotkin. Blodgett enjoyed his work, but, after more than 5 years on the job, he felt that the potential for growth in the university hospital was limited. Plotkin had similar feelings. He had been brought to the hospital to work with epilepsy patients and set up a sleep laboratory that never materialized. Plotkin was frustrated and, as the two got to know each other better, they realized that they had a professional goal in common: They both wanted to do something bigger and better, and they wanted to do it their way.  So, in the spring of 2003, they conceived of a plan to create a sleep clinic that was more luxurious than the offerings of local clinics with uncomfortable twin beds, which Blodgett describes as “clinical” and “cold feeling.” Sleep Insights aimed high, modeling itself after luxury hotels. After 18 months of planning, the pair left their respective posts on the last days of December 2004. A few days later, early in the new year, Sleep Insights was born.

Starting a sleep clinic has its own unique set of challenges, and, although retrofitting an existing building with features like soundproofing can be done, building out a new space makes the process easier, because there are fewer preexisting features to work around or undo. Blodgett and Plotkin took possession of a 5,700-square-foot shell and got to work on building it to their own specifications.

Sleep Insights found an architectural firm that would help the company navigate through its ideas and needs. The list included two examination rooms, at least four offices, a spacious lounge/conference room for staff, a patient lounge, and private bathrooms.

Rochester is home to a number of large corporation, and the sleep clinic wanted to tailor to the corporate customer. Blodgett had a vision of a clinic where the client would leave work at 5 or 6 pm, come directly to the clinic, get hooked up to the necessary technology, have a good study, and wake up and return to work the next morning.

Blodgett hopes that all of the amenities will help alleviate some of the anxiety that accompanies any medical test.

“Sleep is a personal thing to people. Animals, human beings: We’re all our most vulnerable when we’re sleeping,” Blodgett says.  

Stephen Krcmar is a contributing writer for RT Magazine.