California Sleep Institute


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About California Sleep Institute

The Chance Meeting

Doctors Nelson Powell and Robert Riley are the men behind the California Sleep Institute (CSI), formerly The Facial Reconstructive Surgical and Medical Center. They are internationally renowned pioneers in the surgical treatment of Obstructive Sleep Apnea Syndrome (OSAS). Both men hold D.D.S. and M.D. degrees.

Dr. Nelson Powell and Dr. Robert Riley both received their training at the Stanford University Medical Center in the early 80’s. Part of the training they received at SUMC included Head and Neck surgery. It is here that they also met Dr. William Dement, the father of Sleep Medicine, and Dr. Christian Guilleminault, a world leader in Sleep Disorders who was the first to describe Obstructive Sleep Apnea Syndrome (OSAS). These four physicians’ collaborative efforts established the current standards of practice for sleep medicine and surgery at Stanford University.

Their Work at Stanford

These physicians recognized that in Obstructive Sleep Apnea Syndrome the entire upper airway is diffusely involved in the majority of patients. This is why many patients do not respond favorably to isolated throat surgery, as it only treats one area of obstruction. To specifically address the other areas of potential obstruction, they were able to develop multiple surgical procedures, the most important of which was the base (back) of the tongue. Using this as a springboard, they developed a Phased Surgical Protocol to offer a systematic and comprehensive approach for those suffering from Obstructive Sleep Apnea Syndrome. This protocol minimizes the amount of surgery performed in any one phase, thus minimizing the risk of unnecessary surgery. A sleep study is used to evaluate the results from each phase.

Research Results

The results of this surgical protocol have been widely published and successfully used by Drs. Powell and Riley to treat thousands of patients. It is now widely recognized as a standard of care throughout the world. Each patient is encouraged to undergo medical treatment before surgery is considered. The mainstay of medical management is nasal continuous positive airway pressure (CPAP). Those patients who cannot tolerate nightly use of this device may be candidates for the staged surgical protocol.

Not all patients can tolerate or remain compliant using nasal CPAP. Surgery, like medical management, is not always an option. This can be caused by preexisting medical conditions, fear of surgery, concern over pain and discomfort, loss of work or income during recovery, advancing age, and/or cost.

Continued Research

Their research protocol saw tremendous success but this was not enough for Drs. Powell and Riley. They wanted to develop a treatment that was less invasive. This led them to a new technology known as radiofrequency energy. They, along with their team, collaborated with engineers who had extensive knowledge and experience with this technology. Radiofrequency had not previously been used to treat the delicate soft tissue of upper airway obstruction in patients with OSAS. However, it had been successfully used for several decades in the fields of cardiology, oncology, neurology, and urology.

This research team felt that radiofrequency held potential as a minimally invasive treatment for Obstructive Sleep Apnea Syndrome. This began with animal studies designed to better define the basic science of radiofrequency and assess safety parameters, and then progressed to human clinical trials. These trials, done in steps, allowed the research team to develop algorithms to manage the energy, and to assess the limits and potential risks of the procedure. Over a four-year period they complete four studies. These results substantiated that radiofrequency can now safely treat portions of the upper airway including the nose, palate, and tongue base for nasal airway obstruction, snoring, and Obstructive Sleep Apnea Syndrome.
Even though there has been much success, the team at the California Sleep Institute continues to research new options and procedures.

Another Choice for Patients

When looking for any type of procedure a patient enjoys having a choice. This new research and development of radiofrequencies has given patients another viable option against OSAS. It is an option that can, in most cases, be offered as an outpatient procedure in the office or hospital, and requires minimal time in treatment (actual treatment time of 2 to 10 minutes depending on the site) with little to no loss of work time. Minimal, if any, pain medication is required, and in the long run the procedure has proven to be cost effective.