Who We Are
The Marlborough Center for Sleep Disorders is a multidisciplinary center for the evaluation and treatment of sleep disorders. Founded in 1997, the center is nationally accredited by the American Board of Sleep Medicine. Care is provided by on-site board certified specialists in Sleep Medicine, Pulmonary Medicine, Respiratory Care, and Nutrition.
We offer coordinated care with board certified specialists in ENT, Allergy, Dental Sleep Medicine, Psychology/Behavioral Modification, and Psychiatry.
We have been privileged to serve the greater Marlborough and MetroWest community for the past ten years.
Sleep Disorders
Sleep disorders treated at our facility include sleep apnea, snoring, narcolepsy, restless legs syndrome, and insomnia.
In the adolescent and child, our focus is expanded to include the impact on fragmented sleep/insomnia that results from ADHD, learning disorders, and autistic disorders.
The Initial Evaluation
The evaluation in the Marlborough Sleep Center begins with a comprehensive history that includes characteristics of the sleep disorder and daytime symptoms such as sleepiness, narcolepsy, and diminished attention and concentration.
Frequently seen in the physical exam are contributing factors that include obesity, large structures of the pharynx, a large neck circumference, and a small recessed jaw. Medical conditions that contribute to sleep disordered breathing often include asthma, GERD, sinusitis, and neuromuscular disorders.
Diagnostic Studies
The Marlborough Sleep Center offers the most advanced technology in sleep diagnostics, in the setting of a sleep environment that simulates the comforts of a bedroom at home, as closely as possible, with a queen sized adjustable bed, private washroom, and shower. A sleep technician is assigned to each patient to ensure a study of the highest professional quality and to give attention to the patient's comfort. They are in constant contact with the patient using sophisticated audio and visual systems.
Standard Diagnostic Polysomnogram (PSG)
The PSG consists of the following:
Electroencephalogram (EEG):
Monitors are attached to the scalp to record brain activity and the stages and depth of sleep.
Electro-Oculogram (EOG):
These monitors record rapid eye movement (REM) sleep.
Air Flow:
A temperature gauge (thermistor) and air flow pressure transducer system record air flow at the nose and at the mouth.
Electromyogram (EMG):
The EMG records muscle tension at the chin and on the limbs.
Chest And Abdominal Strain Gauges:
These gauges record respiratory effort in order to distinguish central apnea from obstructive apnea.
Oximetry:
A finger oximeter records oxygen saturation levels during all events.
Electrocardiogram (EKG):
The EKG records heart activity throughout the entire study.
Microphone:
A microphone at the neck records presence, frequency, and depth of snoring.
Body Position:
A monitor records sleep position and its relation to the sleep disturbance events.
Multiple Sleep Latency Test (MSLT)
The MSLT is a daytime study of five short naps, in sequence, to document presence and quantify severity of hypersomnolence and narcolepsy.
Nocturnal Oximetry
Overnight oxygen monitoring can be performed in the home to measure the patient's oxygen saturation during the night in the home setting.
Pulmonary Function Testing (PFT)
The PFT is important in assessing the presence and severity of comorbid pulmonary disorders that may contribute to, as well as aggravate severity of, nocturnal respiratory events.
Sleep Apnea Treatment Program
The first line of treatment for sleep apnea is continuous positive airway pressure (CPAP). A positive flow of air is applied to the nose, or to the nose and mouth together, to prevent collapse of the soft palate and physical structures at the oral pharynx, which are the cause of obstructive sleep apnea. In some cases, a bi-level pressure system (BIPAP) is applied. In this system, the applied pressure during inspiration is greater than the pressure applied during expiration.
A monthly CPAP Clinic is held to monitor the patient's use of the equipment and the clinical response. Any problems that interfere with optimal use and effectiveness of the CPAP device are identified and corrected at this time, and appropriate interventions are made. The Clinic allows for education and support of the patient, and this is continued on a long term basis. We have a record of over ninety percent compliance with CPAP usage in our patient population.
A licensed respiratory therapist makes home visits to monitor patient's treatment in the home setting.
The successful treatment of sleep apnea decreases the risk of serious conditions that include systemic and pulmonary hypertension, stroke, cardiac arrhythmias, myocardial infarction, and attention deficit.
Oral Appliance Therapy
An oral appliance is a device similar to a football mouth guard. It is designed to move the lower jaw forward, thus opening up the oral pharyngeal airway. It is indicated for the treatment of mild to moderate sleep apnea and of snoring, as an alternative for patients who do not tolerate CPAP.
A dentist who has specialized experience in this area works with our team to provide an integrated care plan.
Oxygen Therapy
When the polysomnogram demonstrates the need for supplemental oxygen, we initiate oxygen therapy and monitor it subsequently.
Insomnia Treatment Program
Primary insomnia may result from poor sleep hygiene, sleep scheduling disorders, conditioned insomnia or idiopathic insomnia.
Our treatment program includes the following:
Conditioning Intervention:
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Sleep hygiene
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Stimulus reduction
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Address a consistent sleep schedule
Behavioral Modification:
● Progressive muscle relaxation
● Deep breathing exercises
● Visual imagery
● Meditation techniques
Light Therapy
Cognitive Techniques
Behavior therapy has been found to be at least as effective as hypnotic medications in the treatment of chronic insomnia, and long term prescribing of hypnotic medications should be avoided.
Insomnia may also be secondary to an underlying psychological or medical condition, including the following:
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Anxiety and mood disorders
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Chronic pain disorders
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Severe medical conditions
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Substance abuse disorders
A combined approach addressing both comorbid conditions is required.
Sleep Disorders In The Adolescent
Particular to the adolescent are insomnia and
delayed sleep phase disorders. These may be
due to a number of daytime factors:
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Hormonal changes
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Stress and peer group pressures
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Anxiety and mood disorders
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Learning disorders
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Attention deficit hyperactivity disorder
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Asperger's and high functioning autism
The Sleep Center has worked with board certified learning specialists and psychologists to assess the sleep disorder and its relation to these underlying daytime conditions. A coordinated treatment program is tailored to each patient.
Scientific Papers Presented In Abstract Form In National And Regional Conferences Of Sleep Specialists:
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CPAP Compliance in Sleep Apnea Correlates With Severity of Disease and Job Performance. – Invited address to the Northeast Sleep Society, 2000.
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Zalaplol in the Treatment of Primary Insomnia and of Insomnia In Patients with Dual Diagnoses. - Abstract presented to the Northeast Sleep Society, 2001.
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The Impact of Sleep Disorders On the Attention Deficit in the Adult: Part I: The Patient with Obstructive Sleep Apnea. - American College of Chest Physicians, 2005.
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The Impact of Sleep Disorders on the Attention Deficit Disorder In the Adult: Part II: The Non-OSA Patient. - American College of Chest Physicians, 2005.
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The Impact of the Attention Deficit, Mood, Learning, and Pragmatic Disorders and the Presentation of an Insomnia Disorder in the Adolescent. - American College of Chest Physicians, 2005.
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Evaluation and Treatment of Patients with Laryngeal Dysfunction in a Pulmonary Practice. - American College of Chest Physicians, 2005.
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Pilot Study of Anti-IgE Antibody in the Treatment of Severe Obstructive Disease - Two Year Update. - American Thoracic Society, 2006.
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Omalizumab in the Treatment of Severe Obstructive Pulmonary Disease: Year 3. Decreasing the dose.- American Thoracic Society, 2007.
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A Novel Technique for the Evaluation of Omalizumab Therapy in the Asthmatic with a Late Phase Response. - American Thoracic Society, 2007.
