North East Sleep Society (NESS) Annual Meeting, Newport RI

NESS 25th Anniversary Meeting

Newport, RI — April 1-2, 2011

The purpose of the 25th annual North East Sleep Society (NESS) meeting is to bring together members of AASM-affiliated state sleep societies in ten northeastern states and other sleep professionals to foster regional networking and educate sleep professionals in the latest innovations in the study of sleep disorders. Speakers include thought leaders in sleep medicine discussing developments in conditions impacting restful sleep in adults, adolescents, and pediatrics to include insomnia, shift work, RLS, circadian rhythm, OSA and how comorbidities such as diabetes, obesity, pregnancy, and cardiovascular disease impact treatment strategies. Attendees will gain understanding of where sleep medicine began and what to expect into the future as well as difficulties with consistently and comparatively scoring respiratory events.

Visit the NESS website

Friday, April 1

9:00-12:30: Registration
10:30-12:30: Exhibits Open
11:30-12:30: Lunch
12:30-1:00: Introduction: Sleep Medicine 25 Years Ago * — Richard Millman, MD
1:00-2:00:  & Cardiovascular Disease: What Have We Learned Over The Last 25 Years?— Stuart Quan, MD (moderator: Richard Millman, MD)
2:00-3:00: OSA & Diabetes — Naresh Punjabi, MD (moderator: Richard Millman, MD)
3:00-3:15: Break
3:15-4:15: Behavioral vs Pharmacological Therapy for Adult Insomnia * — Gary Zammit, PhD 
(moderator: Donn Posner, PhD)
4:15-5:15: The Elephant in the Nursery: Different Perspectives on Insomnia in Children * — 
Judith Owens, MD (moderator: Donn Posner, PhD) 
5:15-6:30: Exhibits Open w/Wine, Cheese & Cocktails
6:30-9:00: Dinner/Keynote: The Impact of Sleep Deprivation & Shift Work on Medical Errors— 
Charles Czeisler, MD, PhD (moderator: Mary Carskadon, PhD)

Saturday, April 2

6:30-7:30: Breakfast & Exhibits
7:30-8:30: Split Session

Pediatric Scoring Issues — Patrick Sorenson MA, RPSGT (moderator: Robin Moore, RPSGT, REEGT) 
Sleep Apnea & Pregnancy * — Ghada Bourjeily MD (moderator: Katherine Sharkey, MD, PhD)

8:30-8:45: Room Change
8:45-9:45: Split Session

Why Are Sleep Studies Important in Bariatric Surgery? — Richard Millman, MD 
(moderator: Robin Moore, RPSGT, REEGT)
School Start Times * — Kyla Wahlstrom PhD (moderator: Katherine Sharkey, MD, PhD)

9:45-10:15: Break
10:15-11:15: RLS — Arthur Walters, MD (moderator: Alice Bonitati, MD)
11:15-12:15: The Future of Sleep Medicine * — Barbara Phillips, MD (moderator: Alice Bonitati, MD)
12:15-12:30: Wrap-up & Box lunch

APA credit denoted with *

Risk Management Topics:
The Impact of Sleep Deprivation & Shift Work on Medical Errors (Dinner / Keynote)
Why Are Sleep Studies Important in Bariatric Surgery?

California Dreaming

bed California DreamingOfficials at the Orange County, Calif-based Judy & Richard Voltmer Sleep Center make sleep health a priority throughout the many specialties at Hoag Memorial Hospital.

Even in the population-dense region of Southern California, sleep labs used to be rare. When compared to 2011, sleep apnea awareness in the 1980s significantly trailed other conditions.

Officials at Hoag Memorial Hospital Presbyterian in Orange County, Calif, recognized early on that there was a need for a specialized center to evaluate and treat sleep disorders. The Judy & Richard Voltmer Sleep Center, backed by the resources at Hoag, filled this void back in 1987 in Newport Beach, Calif. More recently, the center moved to gleaming new quarters in an effort to modernize and accommodate more patients.

With considerable resources, expertise, and referrals flowing from Hoag, the state-of-the-art 8-bed facility never lacks for patients. Paul Selecky, MD, FACP, FCCP, FAASM, long-time medical director of the Voltmer Sleep Center, has tirelessly spread the message of sleep health among his colleagues. The result is that clinicians from diverse specialties appreciate the value of healthy sleep, and they don’t hesitate to ask for help when they need it.

Under the umbrella of Hoag Neurosciences Institute, the Voltmer Sleep Center is seamlessly integrated within the continuum of care. Sleep is not an afterthought. Neurologists, ENTs, pulmonologists, endocrinologists, and primary care physicians all readily send patients to the center.

Colleagues on Board

The evidence for the sleep/health connection seems to build each year, with ever-more co-morbidities related to poor sleep. The more apt question these days is what is not affected by sleep.

When the (ASA) came out with its 2006 guidelines on peri-operative management of patients with known or suspected sleep apnea, clinicians at Voltmer Sleep Center were ready. “Our anesthesiologists asked if we could help them develop a program to screen patients who were coming in for elective surgery,” says Selecky. “That protocol has now grown, and nearly every admission coming into Hoag is evaluated for the risk factors of sleep apnea.”

Hoag has taken a proactive approach, and patients who come in for other ailments benefit from the extra attention. “About 70% of stroke patients have sleep apnea,” says Selecky. “It’s a chicken-egg type of thing, but at least they get sent here to lower that risk. Others who come in for total knee, hip, chest pain—we ask them about sleep and the patient is educated about serious breathing problems.”

Not surprisingly, about 90% of all referrals to Voltmer Sleep Center come from Hoag, but outside referrals are growing. If a patient is referred by a Hoag neurologist for sleep problems related to that neurologic problem, a neurologist working on staff at Voltmer Sleep Center is the one to see that patient.

If COPD was the primary problem, a pulmonologist would visit with the patient. “This is not just an independent sleep center,” explains Trish Stiger, BBA, RPSGT, CRT, manager of the Voltmer Sleep Center. “It is part of Hoag, and they refer from the Center, the Cardiovascular Institute, and more. Even obstetricians are reminded that a snoring pregnant woman should not be ignored as if she merely has nasal congestion, as this can lead to complications of pregnancy.”

In line with the large body of evidence linking sleep apnea and congestive heart failure, Voltmer Sleep Center clinicians provide information and education to all Hoag cardiologists. “A lot of them have gotten the message,” says Selecky. “They ask every congestive heart patient, ‘Do you snore?’ If the patient snores, and has other features of sleep apnea,  he comes to us.” Cardiologists will also send patients whom they are treating for resistant hypertension, as is recommended by the American College of Cardiology and American Heart Association because of the link with untreated obstructive sleep apnea.

Much the same can be said for diabetes management. Endocrinologists who prescribe several different medications for diabetes have referred their patients to the Center, again because of the link between diabetes management and sleep apnea  . “The first thing that should be done is to rule out sleep apnea,” says Selecky.

Education and Follow-up

Every physician takes patients to the lab bedrooms to explain the diagnostic tests and procedures, and these in-person consultations provide vital information. Despite all the media attention on sleep, Selecky admits that some convincing is often part of the job. “Sometimes there is too much negative information out there,” laments Selecky. “People come in and say, ‘I don’t want that breathing machine. I know somebody that hated it.’ It gets a bad rap, so we must provide a lot of education.”

When it comes time to dispensing the actual CPAP machine, Selecky and Stiger work closely with trusted durable medical equipment (DME) providers who are known for their good service. “If they don’t provide good service, we don’t refer to them—it’s that simple,” says Selecky. “That means excellent follow-up, because if patients don’t have a positive experience in the first few weeks of CPAP use, they are more likely  to abandon it. Nationally, the average for CPAP users is that 50% drop it by the end of the first year. We have several of the DME RTs spend time in the Center so patients can try a dozen different masks. It’s like buying a pair of shoes. If it doesn’t fit well, you are not going to use it.”

In addition to the familiar sleep apnea/CPAP combination, officials at Voltmer are keen to address all sleep disorders and treatments. “Insomnia is not a huge percentage of our patient population at this point, but it’s significant enough and our physicians treat it,” says Stiger. “Patients may need extensive cognitive behavioral therapy, sometimes with the aid of  psychologists.

In addition to CPAP for apnea, we embrace as a valid option.  “Oral corrective devices have been used throughout our history with the help of local dentists who started treating some of our milder patients, or those who could not tolerate CPAP,” adds Selecky.

The Future

Unlike the 1980s, Selecky says it seems as though these days there is a sleep lab on every corner. Favorable demographic trends suggest that won’t change, despite the furor caused last year when Medicare approved home sleep studies—much to the chagrin of lab owners. “People said that might be the end of all sleep centers,” says Selecky. “But as time has gone on, that has not occurred at all. Part of it is that reimbursement for home sleep studies is low. However, it has made every lab consider whether it should be involved in home sleep studies. The answer is yes for certain populations.”

In 2011, Selecky believes the keys to success looks a lot like the keys of the past. Education, clinical excellence, follow-up, and compliance must be the driving forces. As understanding of sleep medicine grows and physicians know more about it, they will inevitably order more sleep studies.

Those who have worked to be a full service center will remain in the black as they gain the trust of physicians and patients alike. “There is a difference between establishing yourself as a sleep center vs a sleep lab,” adds Stiger. “A center deals with everything. You educate, go out and teach the community, and work with all the other specialties to care for patients—which should always be the number one goal.”

Tradition of Excellence
Hoag Memorial Hospital Presbyterian is accredited by the Joint Commission on Accreditations of Healthcare Organizations (JCAHO), and home to Centers of Excellence in cancer, heart, orthopedics and women’s health services. Orange County residents named Hoag the “Hospital of Choice” in a National Research Corporation poll, as well as the county’s top hospital in a a local newspaper survey.

The Voltmer Sleep Center is an accredited member of the American Academy of Sleep Medicine, and features a Web site ( where potential patients can view online sleep assessments, photos of the sleep center, and information about the physicians. “Many people simply don’t realize that an adequate night’s sleep is needed to maintain good health and stay fully alert throughout the day,” says Selecky. “We are excited about the opportunity to use the Internet to educate the public and to let them know there is help nearby.”

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

More Posts

Brand Takes Center Stage – Sleep Solutions Becomes NovaSom

slepp1 Brand Takes Center Stage   Sleep Solutions Becomes NovaSom may have changed its name to NovaSom and moved the company from California to Delaware, but the company’s intense focus remains the same.

More than a year after taking the reins at the largest national service provider of tests, Richard Hassett, MD, believes the time is ripe for a change. Specifically, the CEO of Sleep Solutions has decided to switch the company’s name to NovaSom®, a move designed to build on the familiar testing brand.

Changing a well-known moniker is no small decision, but Hassett believes the new name better reflects the company’s commitment to providing accurate and cost effective home tests. Factoring in some annoying name similarities to competitors and the change became a no-brainer. “Other entities had the name ‘Sleep Solutions’ as some part of their name, and that could potentially be confusing,” says Hassett. “If we were ever going to make a change, now was the time. At the same time, we reincorporated the company from California to Delaware.”

Recent years have seen a steady climb for the NovaSom® brand in its role as a full-service model for home sleep testing. The actual unit is a small device used in the home and typically shipped to patients via overnight carrier. After that, it is returned to the company when the patient completes testing, ideally for three nights. Upon return of the device the data are downloaded and the results are interpreted by a qualified or board-certified sleep physician. Results are provided to the prescribing physician within 48 hours.

The NovaSom Home Sleep Test is a Type III portable cardio-respiratory monitor with FDA clearance for of adults with possible . Predictive accuracy of the test, night for night, has been established in two peer-reviewed publications comparing the device to PSG.¹,²

Three sensors record the same five physiological parameters that use to diagnose OSA: , , heart rate, airflow (oral & nasal), and snoring. The first sensor is a belt that goes around the chest to determine respiratory excursions. The second is an oxygen sensor on the finger, and finally a sensor beneath the nose detects the snoring sound and air flow. This acoustic airflow sensor is a patented device utilizing noise cancellation technology, which has demonstrated a highly linear relationship to the Hans Rudolph pneumotachograph – a standard of airflow measurement used by pulmonologists.

Clinicians appreciate the unit’s capacity to store data for three nights, and users benefit from the device’s ability to literally speak via mechanical voice. “Similarly to a GPS, the NovaSom device talks patients through the procedure,” explains Hassett. “Even if patients have not had access to the Web site or seen the instruction materials that come with the test, the device will actually talk them through the set up and operation.” The company also provides technical and clinical services 24⁄7 by credentialed sleep technologist.

The consumer friendly nature of the test can mean the difference between diagnosis and failure. After all, says Hassett, potential patients often shy away from sleep labs, preferring the comfort and privacy of their own home. Factor in NovaSom’s lower price and it all points to more patients with proper diagnoses.

“Clinicians are starting to realize that we have a massive public health epidemic on our hands with OSA, and the community can’t handle all the patients,” says Hassett. “The fact that the device has the capacity for three nights of data eliminates the high false negative rate which is a problem with any one-night test, whether it is home or lab based. This turns out to be an advantage for providers and patients.”

Hassett and NovaSom’s customers believe the secret lies in the product’s ability to overcome the inevitable night-to-night variability that can hamper sleep testing results. “It’s been known for a long time that there was a burden of false negatives with one-night tests, perhaps even more so with labs than at home because of how daunting, unfamiliar, and uncomfortable it is to achieve natural sleep in the lab environment,” says Hassett. “With the 3-night test, we pick up a significant number of patients after the first night that would have been missed. With the high false negatives after one night tests, it just makes more sense.”

Provider education teams from NovaSom are dedicating time and energy to increasing awareness among (PCPs), ENTs, and pulmonologists. Since there are so many more PCPs out there, they have so far naturally benefitted a bit more from these educational efforts.

Particularly for uncomplicated patients at the primary level, PCPs are the main portal for a variety of patients with many different apnea severities. “We read statistics that say 7 out of 8 people with OSA are undiagnosed and unaware,” says Hassett. “Most providers in America do not have the level of vigilance for this condition that its public health implications would warrant.”

By now the statistics are familiar, but no less staggering. The costs and co-morbidities seem to multiply every year, and Hassett believes medical research will continue to confirm these findings. “We provide the resources that primary care physicians need to identify people at risk for OSA and determine appropriate candidates for both in-home and laboratory tests,” says Hassett. “We have a field-based medical education force and have made significant investments in CME and non-CME educational programs, aimed at primary care.”

The NovaSom home sleep test is offered as a turnkey service. There is no capital investment required of physicians. NovaSom provides rigorous infection controls, biomedical inspection, testing and calibration for each device in between patient uses, ensuring that every test sent to a patient will function accurately. Physicians view detailed study results through the online MediTrack® system.

“NovaSom has a large client care team and offers live clinical/technical support, 24 hours a day, 7 days a week, to patients undergoing the home sleep test,” adds Roger Richardson, vice president, Operations, for NovaSom. “We try to make testing as easy as possible, and are committed to raising consumer awareness of OSA through”

NovaSom, Inc. is fully accredited by The Joint Commission‘s Ambulatory Care Program, is a Medicare-approved Independent Diagnostic Testing Facility (IDTF), and is registered with the .


  1. Claman D, et al; Otolaryng Head Neck Surg 2001; 125: 227–230.
  2. Reichert JA, et al; Sleep Med 2003; 4: 213–218.

Richard Hassett, MD CEO NovaSom, Inc.

ScreenShot070 Brand Takes Center Stage   Sleep Solutions Becomes NovaSom

Sleeping Air Traffic Controller Suspended

An air traffic controller who was unavailable to help two jets land at a busy Washington DC airport has been suspended, an official has said.

The planes landed safely, despite being unable to make contact with the control tower early on Wednesday.

The lone nighttime controller at Reagan National Airport had fallen asleep, the Associated Press reported.

In response, regulators have ordered that two controllers be on duty on the midnight shift.

The jets carried a total of 165 people.

The FAA has launched a national inquiry into tower staffing, officials said.

Aviation officials told media the overnight shift at the airport was typically manned by a single controller.

The jet pilots were unable to raise the airport control tower on the radio as they approached to land. The efforts of other controllers elsewhere to reach the tower by telephone failed as well.

US Transportation Secretary Ray LaHood said that in response he had directed the FAA to put two controllers on the midnight shift at Reagan National Airport.

Source: AP

Are Scoring Sleep Techs No Longer Needed?

The new Out of Center Sleep Testing (OCST) in Adult Patients AASM Accreditation requirements were recently released. Although it does contain some very practical requirements for an entity wishing to be an AASM Accredited provider of OCST, it also contains some requirements (or some say, lack of requirements) when it comes to who will be scoring these recordings.

Of concern to many RPSGT’s is the lack of reference to the RPSGT credential anywhere in the document. In B-9 it does specify that CPSGT’s and other “non-specified” board or sleep certifications are “appropriate” to score OCST recordings. Also mentioned are holders of the respiratory “SDS” endorsement. Perhaps omitting the “RPSGT” credential is just an oversight by the AASM?

Furthering the controversy is F-4 which provides a pathway to exclude all scoring techs, regardless of credential, from scoring OCST recordings.

Below are paragraphs from the newly released standards. WHAT ARE YOUR THOUGHTS? Post a comment here

Standards for Accreditation of

Out of Center Sleep Testing (OCST) in Adult Patients

B-9–Scoring Personnel

Appropriate scoring technical personnel include sleep technicians, sleep technicians with the CPSGT certification or other board approved (non-specified boars) certifications, sleep technologists, respiratory therapists with the sleep disorders specialist (SDS) certification, or electroneurodiagnostic technicians with additional sleep certification.

F-4–Computer-assisted Scoring

If used, computer-assisted scoring of OCST recordings must be reviewed and edited for accuracy by a board certified sleep physician.

Here is the link to read the entire OCST Standards:

I know that there are many opinions about the validity of doing OCST recordings. This editorial does not focus on that controversy. We will leave that for another day. However, many of the sleep professionals that have contacted me are very concerned that there is no mention of the RPSGT credential in the acceditation requirements and the seemingling acceptance of auto scoring. Combine this with the recent announcement that there will soon be a fourth (RPSGT + CPSGT + Respiratory SDS + new ABSM) tech sleep credential and many RPSGT’s are feeling threatened by these recent events.

Many are asking “where is the AAST in all this?” I have begun to hear rumblings from many techs that feel they have wasted their $100 annual dues for representation they feel is not happening. I dont have an answer for you. Each RPSGT, CPSGT, and sleep professional needs to come to their own conclusions about the direction that our field is moving in. As an editorial writter I would very much like to hear from you.

In order to be properly represented you need to make your desires known. Staying silent whether against or in favor of any position does not send a clear message to those we pay to represent us.

No matter what your indivdual thoughts are, the industry deserves to hear from you. Let your thoughts be known to those that care to listen Join the discussion on the Sleep Scholar Linkedin site


Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

More Posts

A Wake-Up Call to Sleepy Workers

Marietta Bibbs, BA, RPSGT, Manager, Sleep Disorders Center

Did you know that lack of sleep can be deadly?  The loss of sleep can often be related to several issues, but the various causes of sleepiness can have a cumulative effect.  Any combination of these causes can greatly increase one’s risk for a fatigue-related workplace accident or an automobile accident.  The cause of sleepiness is most often related to undiagnosed or untreated sleep disorders, but there are other causes that are less often thought about.  These include sleep loss from restriction or too little sleep, interrupted or fragmented sleep, chronic sleep debt, circadian rhythm factors associated with driving patterns, work schedules, time spent on a task, using sedating medications and consuming alcohol when one is already tired.

Loss of sleep leads to daytime fatigue and poor functioning during the day.  Fatigue has a great impact not only in our workplace, but also in our daily lives.  The impact of fatigue leads to impaired reaction time, poor judgment and decision making,  problems with information processing and short-term memory, decreased performance, vigilance and motivation and increased moodiness and aggressive behaviors. Many hours of productivity are lost at work because of a chronically-sleepy population.

All of us are at risk for daytime fatigue and sleepiness since we require adequate sleep in order to function at peak.  Once we succumb to fatigue, we are at greater risk of having a microsleep–an unintentional episode of sleep that usually lasts 2-3 seconds but can last up to 30 seconds or more.  The most frightening thing about microsleep is that it can occur without your knowledge.  Only a few seconds of sleep is sufficient time for you to fall asleep at your desk, run off the road while driving or drift into another lane.

The population at greatest risk for fatigue and chronic sleep deprivation is those with undiagnosed and untreated sleep disorders like obstructive .   Other at-risk populations include young people under the age of 25, shift workers—particularly those working the night shift, and people who work long hours.  Commercial drivers (especially long-haul drivers) and business travelers who spend time driving or flying across time zones may be jet-lagged and have a greater tendency to fall asleep at inappropriate times.

Several tragedies and work-place accidents have been related to chronic fatigue and sleepiness—the Exxon Valdez accident, Three-Mile Island Accident, the ConAir Plane Crash and the Continental Connection Crash near Buffalo, New York in 2009 when pilot error lead to the death of 50 people.  Later investigations by the NTSB concluded that the pilots’ performance was likely impaired because of fatigue.  On the day of the flight, the captain commuted hundreds of miles and the first officer commuted from the other side of the country prior to reporting for duty.  The NTSB concluded that both pilots used an inappropriate facility during their last rest period before the accident flight.

New Jersey was the first state to enact a law (Maggie’s Law) that addresses drowsy driving.

The law was enacted in memory of 20-year-old Maggie McDonnell who was killed by a driver who fell asleep while driving and hit Maggie’s car head-on. The driver admitted that he had been awake for 30 hours and had been using drugs.  Maggie’s Law states that a sleep-deprived driver qualifies as a reckless driver who can be convicted of vehicular homicide. Several states now have similar laws in which drowsy driving can be a criminal offense. Driving drowsy also significantly increases the legal risks employers face from extended hours of operation.

March 7-13 is National Sleep Awareness Week.  Make a commitment to getting enough sleep at all times, but use this week to really focus on what you need to do to get the sleep you need.  Here are a few tips to better sleep and a better quality of life.

Ø    Don’t skimp on your sleep.  Go to bed at the same time and get up at the same time

Ø    If you are unable to fall asleep when you go to bed, get up and engage in a boring activity until you are sleepy.

Ø    Use the bedroom for sleep and sex only—no watching TV or having laptops in bed

Ø    Avoid driving long distances when you would normally be asleep

Ø    Avoid alcohol and medications that could make you drowsy when you are at work or when you need to drive

Ø    Avoid caffeine at night

Ø    If you are sleeping at night but tired during the day, consult your Physician

Ø    Have a sleep study if you snore and have high blood pressure, morning headaches, or excessive daytime sleepiness despite sleeping your typical hours or if you have any unusual nighttime behaviors while asleep, as noted by a bed partner .