Patient evaluation room at the Sleep Disorders Center at Virtua, Mount Holly.
Every Patient Welcome
According to SleepCare, Ryan oversees all clinical policies and procedures and has been instrumental in overseeing quality technical education. She continues to perform research and has recently produced educational presentations on the transportation industry.
“There are always things that have to be adjusted and updated,” Ryan says, but these policies and training procedures that have been developed for SleepCare as an institution are typically transferred to all of its sites, as well as within Ryan’s own practice.
PSPSJ serves a wide variety of patients, including pediatric patients as young as 3 years old. “I’m an adult physician by training, but I started to see children because there really wasn’t anybody here evaluating them or treating them,” Ryan says, noting this contributed to the growth of her practice. She is currently involved with research examining insomnia in pediatric patients.
Patients, young or old, present with a wide variety of symptoms and conditions. As with many sleep medicine centers, a large portion has sleep apnea, but Ryan has treated “narcolepsy, hypersomnia, unusual behaviors during sleep at night, possible seizure disorders, restless legs—really the whole gamut,” she says.
Today, Ryan believes the medical community is much more aware of sleep disorders than in the past, a major breakthrough of the last decade.
All the World’s a Classroom
Today’s physicians are more likely to note if a patient has sleep apnea or other sleep issues, such as snoring, than in the past, though Ryan does see a bias against referring thin patients for sleep apnea. “In fact, they can [have sleep apnea] if they have jaw abnormalities,” Ryan says.
Ryan addresses misperceptions such as these in her educational presentations, which she routinely gives to physicians in the community. SleepCare often approaches these doctors, particularly if they are new to the area.
“I’ve had many [physicians] say I helped educate them about sleep disorders. And I think that’s what we sleep physicians have to do—keep making sure referring doctors and primary care doctors are aware of the signs so that they won’t tell a patient there’s nothing the matter but will send them on to be evaluated,” Ryan says.
Patient education has occurred organically, with many referrals via word-of-mouth. The patient becomes aware, notices another’s sleepiness, and sends that person to PSPSJ. “I’ve been doing this for 16 years and have a lot of patients out there,” Ryan acknowledges.
Technician education has been much more formalized. A challenge for sleep medicine providers, according to Ryan, lies in recruiting the needed number of adequately qualified and trained sleep technicians. As a large institution, SleepCare had the resources to develop an A-STEP (Accredited Sleep Technology Education Program) focused on enabling participants to practice and perform sleep studies independently. The course is 2 weeks of intensive in-day training.
Ryan’s newest area of study has included fatigue and sleep disorders in transportation, including truck drivers and pilots. “Many of these people are getting insufficient sleep or have sleep disorders like sleep apnea that do need to be treated, but many of them do not want to come forward. They think they’re going to lose their jobs,” Ryan says. This is a misperception she addresses in her presentations on this topic, which are generally delivered to occupational clinics and trucking companies.
Cutting Edge of Practice
To test patients in transportation, home studies are often used in a more significant way. “We want to get them evaluated and treated in a very cost-effective manner,” Ryan says. Ryan’s practice performs these evaluations through SleepCare.
Home studies, however, have become an issue in regard to their use by primary care physicians, according to Ryan. Reimbursement issues are likely to further complicate matters.
“I think we’re shortchanging the patients, because I don’t think primary care doctors always know what the options are that can be offered to patients. And I don’t think that we’re helping them in terms of compliance with CPAP [continuous positive airway pressure]. The data shows that board-certified sleep physicians have much better compliance rates than other physicians,” Ryan says.
When a patient is diagnosed with sleep apnea, CPAP is often the treatment prescribed. “We primarily use CPAP because it’s the most effective. Surgical options haven’t been very effective,” Ryan says, citing overall correction rates related to surgery between 50% and 60%.
She has used position training (“sometimes it will work for some people,” Ryan says) and started employing Provent Therapy, from Ventus Medical Inc in Belmont, Calif. “We try to use whatever is out there that looks like there’s reasonable data to support use,” Ryan says.
While Ryan is often an early adopter of effective and innovative tools and approaches, her personal practice philosophy is to try to provide the best care to patients to help them get better. And that includes devoted attention.
The goal is always to help the patient in a clinically effective and cost-effective way. “I had somebody come in today and say, ‘This has totally changed my life.’ And it’s really exciting to see somebody who really feels different, sleeps well, and has the energy and enthusiasm to make changes in their life,” Ryan says. It’s one way she can share her energy with all of her patients.
Renee Diiulio is a freelance writer based in Manhattan Beach, Calif. She can be reached at .