Right Place and Time for Neal Aguillard to Help with Sleep Lab Shortage
When Louisiana native Dr. Neal Aguillard was completing his fellowship in pulmonary disease and critical care during the late 1980s at the University of Tennessee Health Science Center (UTHSC), he knew there was a critical need for pulmonologists in Memphis.
The city was also a one-lab town for patients with sleep disorders, a sub-specialty
field of medicine which at that time was largely unrecognized and had an underserved
patient population.
"When I finished medical school in 1984 at LSU, the only thing we had on sleep was a one-hour lecture on narcoleptic dogs, and that was it," Dr. Aguillard recalled. "While I was doing my fellowship, the man who ran the only sleep lab in town, Dr. Helio Lemmi, was at Baptist, and I just called him and said 'I think I'm going to go to
Methodist Hospital and I need to spend time in a sleep lab because I would like to take
the sleep board exam.'
"At that time there was no formal fellowship training, but if you wanted to study for and take the exam you could become board-certified. Dr. Lemmi was very gracious. He said, 'You can spend as much time in my lab as you want.' So part of my fellowship I spent in a sleep lab."
In clinics at the Veterans Hospital or at the Gailor Clinic, it was well known there was only one place to be tested for sleep apnea, and that was at Baptist.
"Everybody knew I was interested in it, so I would see all those patients, call Dr.
Lemmi, get them tested and then go over and read their sleep studies," Dr.
Aguillard said. "There was no other place interested in seeing them or testing them."
Now with Mid-South Pulmonary Specialists at 5050 Poplar, Dr. Aguillard is one of six board-certified sleep medicine physicians who see roughly 1,000 patients a month and conduct some 3,000 sleep studies annually.
The practice recently began construction on its own Sleep Disorders Center. They are still partners with Methodist Healthcare for inpatient pulmonary and critical care. However, with the addition of several new physicians to the group in 2019, they simply outgrew the current sleep center model.
"It was just a model that didn't fit anymore," Dr. Aguillard said. "It's almost the same situation orthopedic surgery was in 20 years ago at a hospital. Now it's much cheaper to do orthopedic surgery at an out-patient ambulatory surgical center. The cost is much less doing it at an off-campus place."
The pulmonology practice is opening a 12-bed sleep lab at the Poplar office, where it occupies the sixth, seventh and eighth floors.
"We can evaluate and test all age ranges, from little babies up to senior adults," Dr. Aguillard said. "Kids can have problems like bed wetting, walking or talking in their
sleep, night terrors and other disorders that you don't see as much in adults. With older people, you're going to see obstructive sleep apnea, excessive daytime sleepiness, snoring or insomnia from other medical problems."
"The amount of sleep a person needs changes with age," he added. Newborns typically need 14 to 17 hours of sleep per day. An active teenager should be
getting around eight to 10 hours of sleep, but that drops to around seven to nine hours in middle-aged adults.
"As you get older you still need that amount of sleep, but you end up sleeping less per amount of time you spend in bed," Dr. Aguillard said. "You might need to lay in bed nine hours to get seven hours of sleep because you have a hard time getting to sleep, or you might wake up because you're hurting or you need to go to the bathroom.
"Some people tell me 'I get by on four hours of sleep.' Well, no, they're not getting by on four hours of sleep. They're functioning very poorly because they force themselves to do only four hours of sleep, and then on the weekend they end up sleeping 10 hours."
Sleep experts estimate that more than 100 million people of all ages fail to get a good night's sleep, and there are at least 84 medically identified reasons why, ranging from restless leg disorder to Circadian rhythm disorders to the No. 1 problem, obstructive sleep apnea.
Sleep is important to almost every other area of mental and physical health, and affects productivity and quality of life. Lack of sleep also can endanger public safety by contributing to traffic and industrial accidents.
"We see more commercial airline pilots than any other sleep lab in the U.S. by virtue of FedEx being here," said Dr. Aguillard. "The No. 1 profession we see are over-the-road truck drivers. In some cases it's mandated, but in others a physician might think a pilot or driver is at risk of having sleep apnea (and) he'll send them to our sleep lab. We also have patients who are self-referred. We evaluate you and then provide the necessary sleep testing all in one location."
A sleep lab study may include measuring the body's responses while awake and asleep; recording a patient's snoring, teeth grinding, chewing and talking; and monitoring body movements with infrared cameras while the patient is asleep.
Dr. Aguillard says sleep medicine has advanced tremendously since his fellowship days more than 30 years ago, including in awareness by both the public and primary care physicians, better medications, surgical options and more sophisticated equipment.
"The medications that are available have a side-effect profile that is so much lower than it once was," he said, "and the machinery has drastically changed. The CPAP
(Continuous Positive Airway Pressure) machine we use adjusts itself while you're sleeping. It will even email us reports to let us know how the patient slept."
Dr. Aguillard himself tries to fit in a little sleep when he is not working or pursuing one of his many other interests. He's a ham radio licensee and flies a single-engine Cherokee to inspect two rice farms that he leases out in Arkansas.
He also has a degree from William R. Moore School of Technology in tool and die manufacturing, and spent another year in night school to learn welding.
"We live on 60 acres right outside of town, and I make implements and accessories for my tractor," said Dr. Aguillard, who grew up on a farm in the small French Catholic town of Eunice in southern Louisiana. "People also bring by lawn mowers, trailers and other things for repair."
He met his wife, Dr. Susan Aguillard, at LSU medical school "over a cadaver in anatomy lab." She is on the board of governors at St. Jude Children's Research
Hospital and chairs the annual Dream Home Giveaway raffle that her father, Dr. Donald Mack, started in Shreveport in 1991. It has now spread to more than 40 cities.
They have a daughter in Washington, D.C.
"We're expecting our first grandchild," said Dr. Aguillard, "so all is right with the world."
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