Obstructive sleep apnea, insomnia, narcolepsy, nocturnal paroxysmal dystonia, central alveolar hypoventilation syndrome .

Scores of troubling ailments fill the pages of the International Classification of Sleep Disorders-2, and the staff at Methodist Healthcare - Sleep Disorders Center in Memphis, Tenn., tests, diagnoses, and treats all of them.

That's really the only way to run a sleep center, said Manager Kristi Lester, BS, RPSGT.

"We do not want to have to turn patients down because of our inability to provide a service," she said.

Earning first-place honors in ADVANCE Newsmagazines' fourth annual Best Sleep Facility of the Year Competition, Methodist strives to maintain the high standards of all-encompassing care. New sleep technologists undergo intense on-the-job training, where they'll work closely one-on-one with seasoned vets for the first 16 weeks of employment.

The new hires take routine tests on what they've learned to make sure weaknesses can be addressed early on, said Supervisor Jim Donaldson, CRT, RPSGT. For their time and efforts, the preceptors receive additional compensation, and the rookies get a wealth of information they might not have otherwise received.

"From my understanding, a lot of sleep centers just throw techs out and say, 'This is how you do it,'" he said. "They don't really get the basics behind why things work the way they do."

Logistically, it makes sense to have a group well-versed in the sleep troubles of patients from 8 months to 80 years old, Donaldson said. If someone calls out sick, they don't have to scramble to find a qualified replacement. Night-shift techs also know how to score polysomnograms, so when patient cancellations occur, they can remain productive.

The three staff physicians frequently meet with everyone as well to provide tips and explain their overall expectations. "We offer near real-time feedback on how we need things done," said Medical Director Robert Aguillard, MD.

Eight of the 22 techs currently hold the Registered Polysomnographic Technologists credential. All techs are strongly encouraged to become registered within three years of entering the field, Lester said. She and Donaldson host a series of prep courses for the BRPT exam. Talks often focus on scoring and machine maintenance.

Moving Out and Moving Up
The staff's commitment to excellence has translated into the creation of a top-notch facility.

For years, Methodist's sleep operations resided in a clunky hospital setting, with 10 beds at two locations. The situation didn't have many fans among the employees or the patients.

"The problem was trying to make an outpatient facility work in an inpatient building," Dr. Aguillard said. "It would take a long period of time to do pre-certification, parking, and walking to the center. It was an activity that didn't fit in a hospital."

Patients also became frustrated with the backlog and sometimes went elsewhere, Lester remembered.

"At one time, if you came into the office today, we could not get you in for a sleep study for nine weeks," she said.

Following several years of planning, the sleep center moved in March to a state-of-the-art, 20-bed office complex with an easy access parking lot centrally located on the city's main thoroughfare.

By increasing the bed count, staff could process more patients. Before the expansion, they conducted between 2,500 and 3,000 studies a year; it should be at least double that in 2006.

"We cut our evaluation time down to a quarter of what it was before," Dr. Aguillard said.

Physicians also have noticed the improvements at the facility, accredited by the American Academy of Sleep Medicine since 1993. Dr. Aguillard recently fielded a phone call from an eager pediatric neurologist interested in joining the sleep center. Methodist happily obliged.

The addition will mean they now can offer an enuresis clinic and start focusing more on attention-deficit/hyperactivity disorder. "It gives us endless possibilities," Lester said.

Turning No One Away
Helping all patients is a common theme among the center's staff. They cite it again and again as what sets them apart from other facilities around the country.

Stressing the point, Dr. Aguillard said, the center always has a psychologist on hand for helping continuous positive airway pressure users who have problems with excessive anxiety or claustrophobia.

During the initial interview, the techs will see if any such issues exist, and if they do, patients will go to the psychologist for desensitization prior to CPAP titration.

"It's indispensable for that small group of people," Dr. Aguillard noted. "We're not going to have them come back and have an uncomfortable experience."

He estimated that more than 90 percent of patients find CPAP acceptable after they undergo mask desensitization.

Methodist's staff takes the same personalized approach with their pediatric population, Lester said.

Understandably, children may be apprehensive during the electrode application, especially when the air compressor looks a lot like a drill. So, the techs let their small patients operate the foot pedal that controls the device.

"This approach makes the parents and children feel much more at ease with what is about to happen," Lester said.

The patients seem to agree, as evaluations come in almost universally positive, Donaldson said.

"The staff really made me feel special," one satisfied customer wrote. "I was very irritable due to lack of sleep. (They) calmed me and made my sleep study possible. . One tech even carried my bags back to the room. This could have been a very bad night, but thanks to the staff, it was a wonderful experience."

Comments like these, as well as the few critical ones, get sent out to the whole staff. Donaldson does this so everyone gets the praise they deserve and so they can learn about possible areas that need improvement.

Being the best, after all, doesn't come easy.

Mike Bederka is senior associate editor of ADVANCE. He can be reached at mbederka@merion.com.

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Honorable Mentions
The Sleep Center and Sleep Laboratory, Children's Hospital of Philadelphia

The Sleep Center of Tulsa in Tulsa, Okla.

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Contest Details
ADVANCE solicited submissions from readers around the country for the best sleep facility. Short-answer essays describing how participants have demonstrated excellence in sleep medicine helped our judges pick the winners. Methodist Healthcare - Sleep Disorders Center received a $1,000 cash prize.

The judges for ADVANCE's 2006 Best Sleep Facility of the Year Competition were:

Neil Friedman, RN, RPSGT, center coordinator, Sleep Disorder Center, Morristown Memorial Hospital, Morristown, N.J.

Daniel Ventimiglia, RRT, RPSGT, manager of respiratory care services, Sleep Disorders Program, Tampa General Hospital, Tampa, Fla.

Sarah Zallek, MD, medical director, OSF Saint Francis Sleep Disorders Center, OSF Saint Francis Medical Center, Peoria, Ill.

All were winners in last year's contest.

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The Best Sleep Facility of the Year Competition was sponsored by: