Sleep apnea is not the secret it once was, and a respiratory care specialist in Los Angeles is unveiling this awareness.
Diana Guth, RRT
Sleep apnea is not the secret it once was, and a small respiratory care specialist in Los Angeles is growing right along with this awareness. Tonight and every night, an estimated 18 million Americans will not get a good nights sleep because they suffer from obstructive sleep apnea (OSA), a disordered breathing condition that can have consequences far more troubling than the snoring that often accompanies it.
OSA is associated with high blood pressure, congestive heart failure, irregular heartbeat, and increased risk of heart attack or stroke. It has been linked to diabetes, depression, epilepsy, and decreased quality of life caused by disrupted sleep patterns. Still, of the 18 million Americans believed to be affected by OSA, only 10% to 15% have been diagnosed, according to the University of California, San Francisco, a leading research institution in the field.
In fact, it was only in the mid 1980s that the medical community began to recognize OSA and develop treatments. Since then, doctor and patient awareness of the condition has grown, and treatmentsinvolving noninvasive ventilation and continuous positive airway pressurehave proven to be highly successful. But with so many people still undiagnosed, there is a long way to go.
Home Respiratory Care (HRC), Sleep Solution is playing its part in that national journey toward better OSA awareness, diagnosis, and treatment. Founded in 1995 by Diana Guth, RRT, a respiratory therapist with 3 decades of experience, Los Angeles-based HRC specializes in home respiratory therapy with particular emphasis on equipment and OSA care.
I was in on the ground floor and saw the evolution of sleep apnea, says Guth, who worked for 7 years at a major home medical equipment (HME) provider in the area, helping to build its business in the then-emerging field. I found it fascinating, and I learned everything I could about it.
Guths dedication earned her a good reputation among vendors, laboratories, and doctors in the local medical community. When the HME dealer she worked for experienced difficult financial problems, she left and soon after a vendor encouraged her to start her own business focused on sleep apnea.
I liked the idea of being able to treat the patients in the manner I saw fit, but I started on nothing, Guth recalls. I made three phone calls to the labs that I had worked with, and they were so glad I was back. They started sending patients, and that put me in business immediately.
HRC quickly outgrew its first homea 400-square-foot office on the west side of Los Angelesand moved three doors down into its current 1,400-square-foot office. But even within success, Guth has been able to maintain a lean operation that includes two other therapists and three office support staff.
I run the business more like a medical practice, Guth says. Its all respiratory and I dont have any other DME (durable medical equipment). We have a waiting room, and two sitting rooms with beds. Its homey here; its a very upbeat place for the patients to come in a good neighborhood.
One therapist, Glen Noble, RCP, RPFT, has worked with Guth for 4 years and helped build the business; the other, Brad Erickson, RCP, RRT, used to call on HRC as a manufacturers sales representative and has improved the marketing efforts since joining the company about a year ago.
Our referrals primarily come from sleep laboratories and individual physicians, and they cant send us patients if they dont know were here, Guth says. That was an area where I was weak. Brad and I were seeing patients and it was very difficult to divide my time anymore, so I needed someone to help with that part of the business.
Fit and Follow
HRC offers a wide selection of masks and machines for sleep apnea treatment. The key to success is proper fit of the mask, so we have a huge variety of interfaces; we probably have every interface known to man, Guth says. We let the patient try on a few different maskssometimes quite a few. We have beds so they can lie down to see what its like in a position that they typically sleep in.
HRCs customer base is as diverse as its inventory, with patients aged 20 to 90, although the most common profile is an older, overweight male. The patients arrive at HRC with a range of attitudes, Guth says. Some are reluctant or apprehensive; however, once they get a sample of a good nights sleep, they want to be set up right away.
As for patient comfort, almost all the machines have a feature called a ramp or delay whereby the patient presses a button and starts the unit at a low pressure4 centimeters of water for 10 to 30 minutes. As they fall asleep, the machine automatically raises the pressure.
Equipment variety is only one area where HRC distinguishes itself from other practitioners in the sleep apnea field. Equally important is the initial interaction with the patients and the ongoing follow-up after they take the equipment home.
You need to pay attention to all kinds of details, Guth explains. Before we do anything, we interview the patients to find out why they sought help, how they feel about it, if theyre claustrophobic or have sinus problems. As were speaking to the patients, were actually studying them to see what kind of mask or interface will best fit.
HRCs follow-up with patients starts within 72 hours after they leave the office and includes extensive clinical notes, Guth says. The first few days are critical. Then we follow up a week later and a month after that. Some people take to it like ducks to water; other people require a lot more attention. We might have to change a mask or add humidification, or we may need to call a doctor to change the pressure or setup.
We follow up until the patient is compliant and comfortable, or weve uncovered all the stones we can and they just cant acclimate for one reason or another.
With an unusually high 95% compliance rate, HRC usually finds a solution. Guth does not claim any special secret, just a steadfast focus.
The other companies that do what we do are part of bigger companies, Guth says. They use other DME, so sleep apnea is only one aspect of their business, and for the most part, they cant offer the total professionalism that we do.
Sleep apnea sufferers make up most of HRCs business, but the company has been able to extend its respiratory expertise to help patients with other conditions. HRC now provides noninvasive ventilation to people with muscular disorderspatients who have amyotrophic lateral sclerosis and postpolio syndrome, who are at great risk of complete respiratory failure.
The machines they use are different, but the way they are attached is the same; its a process called noninvasive positive pressure ventilation, Guth says. It keeps them out of trouble. They frequently use different masks, which are usually full-faced.
For these patients, HRC does make house calls. Theyre not ambulatory, so we go to their homes. The follow-up is longer; however, the rewards are the same, if not greater. They really are special people, Guth says. We get excellent results treating the patients, especially when we do a good follow-up. Its a mechanical approach to a serious problem that really works. It makes a profound difference in their livesthey really feel better and its nice to be able to help.
Guth still refers to herself as a clinician who happened to start a business and she wants others to share her success. In the process, she wants to contribute by helping the millions of undiagnosed sleep apnea sufferers as awareness continues to grow.
The medical community is recognizing sleep apnea more and the situation has gotten much better, but disorders are still underdiagnosed. Patients are not being treated the way they need to be, and thats a concern. I would like to be able to share what has been successful for me with other people around the country.
Aaron Smith is a contributing writer for RT Magazine.