By Sean B. Gipson, RPSGT
There are many sleep techs who ask me how I got started in running a sleep business and sleep diagnostic centers. Sparing readers a long story, in my pre-ownership days, I often thought at night while I was running studies that it couldn’t be too hard, right? A few years later I learned! And yet, even today I am still often asked the same questions from small business entrepreneurs, physicians and techs. So, I thought why not throw it out there for those of you who may have that same question and get some of those brain cells buzzing!
The first thing you need to think about is who your service is for and how you are going to market it. There are so many ways to go about this, but the key is how your market fits to your referring practices and the demographics of the area you are planning to serve. The location has to be appealing and convenient, and most importantly, you’ll want to consider what it looks like around that office in the late evening hours and early morning hours.
Ever heard of a sleep lab right down the street from a popular outdoor venue that had outdoor music? Yup, I had that one! It was a nightmare! You want your space to be well lit and safe enough that you’d send your significant other to their car in the early morning hours. If not, don’t do it! That being said, you also need to be cognizant of signage and the ability to see that signage clearly when the sun is going down, is already down, or is coming up in the morning.
Okay, so now we have the perfect office in the most perfect setting one could ever imagine. Let’s walk in the front door. What is your first impression? What do you see? Does it say “home,” “safe,” “clean”? As you know, that initial impression is a priority in setting the “mood” for your patient, often setting the stage for the rest of the visit. You want something inviting and comfortable for your patient to sit on, of course. But there’s so much more! Think about the population you are seeing. Your furniture needs to be more than just a few nice chairs. Some of our population falls into the morbidly obese category, and thus your furniture throughout the center will need to be able to handle the heaviest population. A nice comfy couch may seem appealing when initially thinking about seating options; however, what happens when your patient who sat on that comfy love seat cannot get up off of it? It’s tough thinking this all out!
Many of us have made and learned from these mistakes and became owners of extra furniture that had to be replaced! There are several manufacturers out there that specialize in seating made to handle 300 to 500-pound patients. Of course, a higher price tag typically comes with this type of furniture, but it beats the embarrassment to both you and your patient―or worse! Traditional waiting rooms have ample seating and common furniture pieces found in a living room type setting. TVs with smart technology are great ways to educate patients―or should I say a captive audience―with a video loop that covers any and all topics you could imagine.
Let’s move into the next area where your patients will spend the majority of their time. Staying with the furniture theme for now, you’ll need yet more seating for setups, bed prep and getting ready to leave after your study has been completed. The same idea as before applies here, with reinforced seating ideal. And that same ideal also applies to your bedding options. When it comes to beds, you have several options to work with. If you are going to use floor space efficiently, a wall bed may be an option. It allows you to conveniently fold the bed up to reveal a nice shelving unit and to use the bedroom for a clinical exam space by day. If space isn’t a problem, full bedroom sets are nice―keeping in mind in either format that you are looking for something that is sturdy and has the appropriate weight capacities to accommodate the population of your patients.
Another area where a sleep lab owner can make a plethora of mistakes is with the mattress set. Mattresses have so many features to pay attention to when it comes to implementation in a sleep lab. One of the most important is the construction of the mattress and box springs, if needed. Again, with a morbidly obese patient, many of the mattresses we might find on the showroom floor go right out the window. The mattress you choose will need to have a well-built sidewall along with a good support structure in the body of the mattress. Failure to buy an appropriate mattress will likely lead to a mattress that breaks down within a few months’ time. As far as firmness, the mattress needs to stay on the firmer side, with a pillow top feature. Some facilities require that the materials be fire-retardant as well, so be sure to check on any affiliated system’s bedding requirements. Even if not required, I always recommend a liquid barrier on the mattress surface for many reasons, but let’s just stick with the fact that the mattress surfaces will need to be wiped down. I also recommend a full coverage mattress and pillow protection system that can easily be wiped down if needed. There are multiple options, and they aren’t the crackly plastic ones you’re thinking about right now!
Okay, so we have beds and seating out of the way. Some labs like to have a bedside table or two. It completes the bedroom look that sets up the psychology of a patient seeing a room that is furnished for sleep. I found that within the bedside table I could confine things like headboxes and lab-based PAP systems as well as supplies for hookups. Doing this reduces the “clinical look” of a sleep lab and creates more of a hotel-type environment, which tends to be much more well-received from a patient’s perspective.
On that note, let’s talk about the most expensive purchase to be made in a sleep disorder center: the diagnostic system. There are many types of systems and many things to consider when deciding on the type of system your lab will use. The sleep specialist will have the biggest say in this, in most cases. Things to be considered include modalities (sleep, EEGs), how many, stationary or cart-based, neuro-based or pulmonary-based? Do you want your diagnostic system to “talk” to the PAP system? If it’s not the same manufacturer, can that be accomplished? Video integration is another important feature to consider, depending on the type of lab or types of sleep testing you are going to do. For instance, you would not spend too much on the video capabilities and features if you were running a simple sleep apnea center that didn’t include any seizure monitoring that may require use of an X10 zoom, pan/tilt or night/day feature.
Next, every sleep lab needs a PAP system, but which one? In today’s very popular PAP market, there are several systems to choose from; however, there are some very clear leaders in an industry that has shrunk and dealt with some frustrations over the last year.
Now we have to consider the side of the lab that creates a consumable or operations spend on a monthly and/or quarterly basis. This includes things like EEG electrodes, snap electrodes, head or cap placement systems, snore mics or sensors, RIP belts, pulse oximeter probes, position systems, etc. These items, along with pastes, gels, cleansers and disposable electrodes, can vary from a few dollars to a thousand dollars per piece! Yes, it gets expensive quickly, and the choices are limited to the interface with headbox of the system you purchase. It gives the tech who becomes an owner a new perspective of whipping those electrodes around when you realize those belts are $600 apiece!
Finally, the sleep lab, like any other medical clinic, will require medical-grade supplies and cleaners, often dictated again by whatever health system you may be affiliated with or want to work with. The cleaners we use in our homes are not comparable to the medical-grade or commercial-grade required by your state, affiliate, or accrediting body. Often these cleaners are harder on the surfaces of things like wood finishes, leather, paint, and so on. I’ve never found it more appropriate to purchase those extra warranties on things like mattresses or furniture finishes!
So, if you made it to the end and you’re still eagerly reading, then perhaps you have what it takes to embark on this adventure! I will tell you that in my more than 30 years in sleep medicine, I never meant for this to be my career, but I’m still here, and I love knowing that I can help with someone’s sleep―something that most take for granted. That is until they start having problems sleeping or causing those around them to have problems sleeping! Then it very quickly becomes first on the list of things to get taken care of. That’s when they walk into your sleep lab doors, taking in all that the waiting room offers. Is their initial impression what you wanted it to be? Did the patient make it through the process unscathed, with pertinent data for scoring and interpretation? Better get it cleaned up and ready for the next one! Now it’s time to bill the provider―oh wait, which software are you using to get your information to the billing exchange? Does it interface with your accounting and reporting software? This too is an important tool if needed in your center. Although it may cost a bit to get established, a sleep lab today can still do quite well when you have the right tools. It’s easy, remember? It’s just a sleep lab―I mean, how hard can it be?
Sean B. Gipson, RPSGT is an accomplished healthcare executive based in the Dallas Fort-Worth Metroplex.