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Sleep Medicine

The Sleep Lab at Kent Hospital

The Sleep Center at Kent Hospital has been in existence since 1991. The lab is located on Health Lane behind the main building. The lab provides sophisticated diagnostic testing and comprehensive treatment options for people struggling with sleep disorders. The Sleep Lab team’s mission is to provide the highest standard of clinical care.

The field of sleep medicine is constantly changing as we learn new information about sleep disorders from scientific research. Because our professional staff is involved in research and patient care, they are well-suited to diagnose and treat a variety of sleep disorders including, but not limited to, obstructive sleep apnea, insomnia, narcolepsy, and restless leg syndrome.

Patients referred to the Sleep Center can also be seen in our outpatient office for a consultation. Follow-up may include further testing or imaging related to your condition.

All test results are interpreted and evaluated by our board-certified sleep specialists, who then send recommendations for treatment to referring physicians.

Contact Information

The Sleep Lab at Kent Hospital
Kent Hospital
455 Toll Gate Road
Warwick, RI 02886
P: (401) 736-3727

Directions

From Toll Gate Road turn into the main visitor's entrance, and take the first right after the Emergency Room parking lot.

The Sleep Lab is located in the tan and green building on the left side of the roadway. Immediately past the building, a sign will direct you to the parking lot. Parking is available in the lot adjacent to the building. Enter the building through the door on the left of the glass enclosure.

Resources 

Learn More About At-Home Sleep Apnea Tests >>

Insomnia: Symptoms and Treatment Options >>

About the Sleep Lab

Enter into the comfortable waiting area where your technologist will be waiting to escort you to your bedroom for the night.

The bedrooms are comfortably appointed with double or queen beds. You will have your own private bathroom/shower and each room has a flat-screen TV for your viewing pleasure. Each room is very private and quiet, opening up into a corridor similar to a hotel.

Your sleep tech will thoroughly explain the testing procedure (sleep study or polysomnogram) to you and answer any questions or concerns you might have.

Signs of Sleep Disorders

The body heals and reenergizes itself while sleeping, and good rest can help protect against other health conditions, including obesity, diabetes, heart conditions, and depression.

A sleep disorder may be present if you experience symptoms such as:

  • Dozing off or feeling sleepy during the day
  • Feeling uncomfortable or restless in your legs
  • Having trouble staying awake while driving
  • Snoring or gasping for air during the night
  • Sweating while sleeping
  • Tossing and turning
  • Waking up with headaches
  • Sleepwalking/talking and night terrors
  • Difficulty initiating and maintaining sleep and nocturnal urination

Take the Next Step in Feeling Better

About the Study

During the StudyKENT_Sleep Lab_Room

During the course of the overnight study, sleep techs will monitor these parameters while you sleep. Once the night is over and all of the sleep parameters have been gathered and stored in the computer, the next step is to score the study. A technologist will review the entire night’s study and determines the sleep stages, the number of apneas, and correlates all the data.

All of the information gathered and correlated from the sleep study is now reviewed and interpreted by one of our reading physicians. They will make a final diagnosis and recommendations if needed. The report will be sent directly to your attending physician.

The sleep technologist will apply sensors and electrodes to measure these parameters:
  • Brain waves (surface electrodes on the head)
  • Heartbeats (surface electrodes on the chest)
  • Eye movements (surface electrodes above and below the eyes)
  • Muscle tension (surface electrodes on the chin)
  • Leg movements (surface electrodes on the lower leg)
  • Breathing (sensors attached to the skin near the nose or mouth)
  • Breathing effort and movement (small elastic belt placed around the chest and abdomen)
  • Blood oxygen levels (small sensor attached to the finger – not taken from actual blood samples)
Following the Study

Following a sleep study, if a patient is positive for a condition such as sleep apnea, a recommendation for treatment will be made. The most common treatment is a PAP device. Depending on the patient’s severity, they can get a CPAP, BIPAP, or Auto-PAP device and a wide variety of masks to choose from.  Mask fittings and obtaining PAP devices can be made through Kent Home Medical Equipment, located at 11 Knight Street, Building D-15 in Warwick. 

Learn More

Testing Options
  • In-Center Studies
  • At-Home Testing

In-center studies include baseline evaluations, CPAP and BiPAP titrations, and multiple sleep latency testing (MSLT). We also perform multiple sleep latency testing (MSLT), or daytime nap tests. Our center is fully equipped with state-of-the-art digital technology to record and interpret sleep studies. Our private rooms include a full/queen size bed, television, recliner, and a private bathroom with a shower.

Travel Arrangements 

Free Uber rides are available to patients who may not have transportation and are staying overnight in the Sleep Lab for a study. This service is prearranged during scheduling.

Currently, we are offering mail-out sleep testing devices. Referring physicians provide home sleep study orders to the Sleep Lab and, upon completion of insurance authorization, an appointment is scheduled and a device is mailed to a patient’s home. Patients have the convenience of sleeping in their own bed and eliminating travel time to pick up a device.

24-hour technical support is offered to all home sleep study patients. Most home sleep test devices are portable – about the size of a telephone handset.

Process for At-Home Testing

  • Consult with a physician to ensure that a home sleep test is the best option. All at-home kits should be approved by your physician, and this is particularly important if a patient has other medical conditions or taking any medication
  • Equipment will either be delivered to a patient’s residence or will need to be picked up at a designated location. The kit includes belts, a finger probe clip, and a small nasal cannula
  • Sleep with the home sleep test equipment for between one to three nights in order to collect enough data to be assessed
  • Return equipment to the service provider
  • Data will be then processed and interpreted, and a report will be created. The results will be discussed with patients by their physician

Advantages of an At-Home test

  • Convenience
  • Inexpensive
  • Less intrusive

Disadvantages

  • Can be less accurate
  • No additional diagnoses – home sleep tests only test for obstructive sleep apnea

Preparation Tips

  • Avoid caffeine after lunch
  • Do not nap
  • Sleep only on your back or sides

Home sleep Test Instructional Video >>

Program Integration 

A multifaceted team of experts from across the hospital system works with the Sleep Lab to provide the most comprehensive care for participants and provide patient-centered care to meet their needs.

These include:

Patient Self-Referral

Patients have the option of having a sleep study referral directly to the Sleep Lab if they have had a consultation with their provider or they can meet with a board-certified sleep doctor at the sleep clinic for a more thorough assessment of symptoms. The sleep clinic is located at Brigham & Women’s Pulmonary Associates at Care New England at 1407 South County Trail in East Greenwich.

What to Expect

  • Before coming to the hospital
  • Preparing For the sleep study
  • Day of your sleep study
  • During the Night
  • After the Sleep Study
  • Wash and dry hair
  • Pack an overnight bag, like if staying at a hotel
  • If oxygen is being used at home, please notify the center
  • If a CPAP machine is used at home, please bring the mask and headgear – there's no need to bring your machine
  • Do not use any hair spray, oils, or gels – hair should be clean and dry
  • Continue taking regular prescriptions, but the Sleep Lab team needs to be made aware of what they are so that they can determine if a certain medicine is affecting sleep. Please bring these medications to the study
  • Wear loose-fitting sleepwear
  • Blankets and pillows or other comfort items are welcome
  • Bring snacks since food will not be provided
  • When arriving at the Sleep Lab, the technician will show patients to their rooms. As the technician gets the equipment ready, patients can change into any sleepwear and get ready for bed as they would at home. During this downtime, Wi-Fi can be used or the television. There may also be paperwork to be completed at this time
  • Next, technicians will introduce patients to the equipment that will be used, the sleep study is explained in detail, and any questions may be answered
  • The equipment includes:
    • Approximately two dozen sensors that are applied to the skin using conductive paste and adhesive
    • Elastic belts that are placed around the chest and abdomen
    • A probe will also be placed on a finger

    About the sensors

    The sensors allow for the lab team to monitor the activities that are going on in the body during sleep, such as brain waves, muscle, and eye movements, snoring, etc. the elastic belts are used to measure the effort of breathing, and the finger probe monitors the level of oxygen in the blood and heart rate.

    These devices are typically not a barrier to falling asleep and are designed to be as comfortable as possible. Sleep at the lab may not be exactly like sleep at home, but the process usually doesn’t interfere with obtaining the necessary information to make an accurate diagnosis or assessment.

Lights are turned off at 11 p.m. During the night, patients will be able to roll over and change positions. The technician, who is in a separate room, will be available if sensors should need re-adjusting or if a patient needs to use a restroom. Most patients have to get up at least once during the night. Patients are awakened by 6:30 a.m. and are offer a complimentary breakfast in the morning. 

After the sleep study, a sleep technologist will process the data that was recorded and work with a physician who specializes in sleep medicine to interpret the data. Because the study provides extensive amounts of information, the technologist will review the study twice to ensure accuracy. The study provides over 1,000 pages of data so the interpretation process can take up to three weeks.

If a patient had a diagnostic sleep study, the physician will review the study and send the patient a basic letter of results, which will if someone tested “positive” or “negative” for sleep apnea. During the next appointment, this will be discussed further.

If a patient had a titration sleep study, the physician will review the study and a prescription for a PAP machine will be sent to Kent Home Medical Equipment, which will contact patients directly to coordinate the setup of the machine. The Center for Sleep Medicine will then be contacting patients to schedule a follow-up clinic appointment.

Sleep Medicine Resources

Sleep Medicine
Kent Hospital

About one in three adults don't get enough sleep. In some cases, this is due to having too busy a life, young kids, etc. In other cases, people find it difficult to fall asleep and stay asleep or have...

Sleep Medicine
Zulfi Alli RPSGT, RST

Sleep hygiene or good sleep habits can help you get a good night’s sleep and improve your overall mental and physical health. Sleep deprivation can have a major impact on how you feel and function.

Sleep Medicine
Zulfi Alli RPSGT, RST

Restless Legs Syndrome (RLS) is a nervous system disorder that causes an overpowering urge to move your legs. Restless Legs Syndrome is also known as Willis-Ekbom disease. 

Conditions

 

Obstructive Sleep Apnea

Millions of Americans experience sleep apnea, a common sleep disorder that is serious and potentially life-threatening. It can occur at any age and any gender. Sleep apnea is a breathing problem in which the soft tissues in the throat close down for about 20-30 seconds at a time during sleep. With each pause in breathing, the brain “wakes up” just enough to start breathing properly, although the person may or may not be aware that these obstructions are occurring.

Types of Sleep Apnea

  • Obstructive sleep apnea – Air can’t flow in or out of the nose or mouth while attempts to breathe continue.
  • Central sleep apnea – Inaccurate signals from the brain prevent the breathing muscles from starting to work.
  • Mixed sleep apnea – Mixed apneas have components of both obstructive and central sleep apnea.

Symptoms

  • Difficulty staying asleep
  • Dry mouth
  • Experiencing trouble staying awake while driving
  • Falling asleep while watching TV
  • Feeling sleepy or tired during the day
  • Hypopneas – Ten seconds or more of shallow breathing where one loses 30% to 90% of normal airflow
  • Legs feel uncomfortable
  • High blood pressure
  • Not feeling rested after sleep
  • Inappropriate sleep times
  • Snoring
  • Sore throat
  • Stopping breathing while asleep
  • Sweating excessively while sleeping
  • Tossing and turning
  • Trouble falling asleep 

Causes

  • Throat muscles and tongue relax during sleep and partially block the opening of the airway
  • When the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether
  • In overweight people when an excess amount of tissue in the airway causes it to be narrowed
  • With a narrowed airway, the person continues his or her efforts to breathe, but air can’t easily flow into or out of the nose or mouth

Risk Factors

  • Loud snoring
  • Overweight
  • High blood pressure
  • Physical abnormality in the nose, throat, or other parts of the upper airway
  • Alcohol and drug use
  • Sleeping pills

Diagnosis

A primary care provider, pulmonologist, neurologist, or another healthcare provider with specialty training in sleep disorders may make a diagnosis and start treatment. Sleep apnea is diagnosed after five pauses in breathing per hour is counted. The more pauses there are, the more severe the case. Patients who have an overnight sleep study are given a number or index of how many pauses occurred per hour of sleep.

Tests include:

  • Polysomnography -  This records a variety of body functions during sleep. This includes the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels.
  • Home sleep apnea test – A portable device can be used to diagnose sleep apnea.

Treatment

Treatment may include:

  • Physical or mechanical therapy - Continuous positive airway pressure (CPAP) is a device to be used nightly. A mask is worn over the nose or mouth and nose during sleep. Pressure from an air blower forces air through the nose and throat.
  • Oxygen
  • Behavioral changes, including not using alcohol or smoking, not use sleeping pills, lose weight, or change sleeping positions.
  • Dental appliances – The lower jaw and tongue are repositioned.
  • Orofacial therapy
  • Surgery, including the removal of adenoids and tonsils, nasal polyps, or other growths or tissue in the airway, or to correct structural deformities, to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate), or to reconstruct deformities of the upper jaw (maxilla) and lower jaw (mandible).
  • Nerve stimulator – An implanted device that triggers the neck muscles to tighten when the device detects that the airway is closing during sleep.
Narcolepsy

Narcolepsy is a chronic, neurological sleep disorder that affects the brain's ability to control sleep-wake cycles. Narcolepsy symptoms often start in younger people ages 7 to 25 but also later in life.

Symptoms

  • Excessive daytime sleepiness
  • Sleep attacks - Occur suddenly
  • Cataplexy - Sudden loss of muscle control or tone. It's often triggered by stress or emotion.
  • Sleep paralysis - A feeling of not being able to talk or move for a short time. It may occur when a person is falling asleep or waking up.
  • Hallucinations
  • Other symptoms, such as insomnia, fatigue, poor memory, and concentration, or depression

Rapid Eye Movement and Narcolepsy

REM (rapid eye movement) is the dreaming portion of sleep. REM sleep usually starts after the first 60 to 90 minutes. For people with narcolepsy, REM sleep starts much sooner, usually within 15 minutes of sleep. This can make dreaming so vivid, it seems real. 

Many symptoms of narcolepsy are caused by REM sleep intruding into wakefulness. During REM sleep, people are normally paralyzed. Waking out of REM sleep results in sleep paralysis. Cataplexy is a sudden loss of muscle tone, as would occur during REM sleep. Hallucinations may occur due to dreaming during REM sleep, which then continues when awake.

Dyssomnias

Disorders such as restless legs syndrome refer to an overwhelming urge to move the legs, usually associated with unpleasant sensations. The urge to move the legs is worse at rest and night and relieved by movement. It disturbs sleep and may include jerking and involuntary movements of the legs during sleep. When restless leg syndrome is not present, a condition called periodic limb movement disorder may be present.

Symptoms range from being barely noticeable and not requiring any treatment to those that make it hard to fall asleep. It also may not be limited to nighttime; it can also happen any time a person is sitting still, like in a car or movie theater.

A condition such as restless leg syndrome is different from the brief muscle twitches that occur during sleep, which are called “hypnic jerks.” The asleep study is unnecessary to diagnose this condition; the diagnosis is based on eliciting symptoms that patients experience through a clinical interview.

Treatment 

  • Pharmacologic therapies, including alpha-2-delta calcium channel ligands, dopaminergic agents, opioids, and benzodiazepine
  • Iron replacement, including through oral means or by IV
  • Behavioral changes, such as physical and mental exercises, reduced caffeine, massaging or soaking limbs, increasing the amount of sleep, avoiding certain medications, stretching before, bed, and staying hydrated
Insomnia

Insomnia is one of the most common sleep disorders and is characterized by the inability to fall asleep. Its occurrence can be influenced by multiple factors, including stress, caffeine use, pain, or medical issues that interrupt sleep. Identification of these factors is at the core of insomnia treatment. People with

Causes

Predisposing or precipitating factors – there may be events or comorbidities, including:

  • Pain
  • Nocturia
  • Shortness of breath
  • Sleep disorders other than insomnia, including obstructive sleep apnea or restless legs syndrome
  • Psychiatric disorders
  • History of childhood trauma or chaotic home environment at night

Medication side effects from such drugs as:

  • Antidepressants
  • Stimulants
  • Glucocorticoids
  • Opioids

Behavioral factors also may include:

  • Anxiety
  • Sleep time consistency
  • Mood and anxiety disorders
  • Posttraumatic stress disorder
  • Substance use disorders

Neurodegenerative brain disorders can also play a role

  • Dementia such as Alzheimer’s disease
  • Parkinson’s disease
  • Brain injury

Types of insomnia

  • Acute – Lasting less than one month and is most common
    • A sedative medication can be utilized, which may reduce the development of dysfunctional responses to sleeplessness that could otherwise increase the risk of more chronic insomnia. If the insomnia is persistent, evaluation and treatment with cognitive behavioral therapy for insomnia might be used.
  • Chronic – Long-lasting
    • Cognitive-behavioral therapy is a preferred approach to treatment as well as medication.

Management of insomnia requires a stepwise approach, beginning with attempts to eliminate or at least minimize contributing factors and comorbid illnesses that interfere with optimal sleep. Insomnia often responds only partially to the treatment of individual sleep-impairing influences, however, and many patients require medication directed towards sleep itself. Successful behavioral and pharmacologic approaches to insomnia can only be devised once all contributing factors are recognized and addressed.

For some people, simple tips known as sleep hygiene are enough to improve sleep. For others, however, the situation can be more complicated where they have such negative experiences with sleep that they get caught in a cycle where, each night, the idea of sleep causes stress, which makes it harder to sleep.

It is important to note that beliefs about what is “normal” sleep can impact whether a person seeks treatment, such as thinking it abnormal to awaken during the night or needing eight hours of sleep per night to be healthy. Individual needs vary greatly.

Parasomnias

Abnormal movements and behaviors during sleep are part of a larger group of nocturnal events that may occur during sleep, wake, or the transitions into or out of sleep. These nocturnal events are typically divided into simple behaviors, such as single movements or repetitive movements, or complex behaviors like sleep talking, sleepwalking, or sleep terrors. Sleep talking and sleepwalking mainly occur during non-REM (NREM) sleep.

Types

  • Simple and periodic movements
    • Teeth grinding or Bruxism
    • Hypnic jerks – Sudden or brief jerks of the body
    • Propriospinal myoclonus – Jerks of the abdomen, neck, or shoulders
    • Exploding head syndrome – Painless sensation of head exploding accompanied by fear
    • Epileptic myoclonus
    • Benign sleep myoclonus – Bilateral and symmetric jerks of the body
    • Leg cramps – Painful muscle contractions
    • Rhythmic movement disorder – Large muscle groups move
    • Hypnagogic foot tremor – Rapid movement of one foot
    • Periodic limb movements
  • Complex movements
    • Sleepwalking – Walking, sitting, talking, eyes open but with little to no memory of the event after and ability to interact with others during the event. Can be triggered by a stimulus such as a lack of sleep or stressors.
    • Sleep-related eating disorder – Involuntary eating during sleep where the memory of the event is minimal.
    • Sleep paralysis – Inability to move or make sounds and can be accompanied by hallucinations.
    • Nightmares or night terrors – usually involving disturbing or distressing dreams, these events could also lead to sudden wakefulness and screaming or movements.
    • Vocalization – Talking while sleeping
    • Sleep behavior disorder – The body moves in turn with a dream sequence.

Sleep behavior disorder is of particular significance as individuals who have the disorder may be at an increased risk for the development of neurodegenerative disorders such as Parkinson’s disease and dementia.

Risk factors

  • Poor sleep hygiene
  • Sleep deprivation
  • Circadian rhythm disturbances (i.e., jet lag)
  • Fever or other illnesses
  • Emotional stress
  • Medication use
  • Ingestion of alcohol or sedatives before sleep onset
  • Other medical conditions, such as obstructive pulmonary disease, and neurologic conditions

Diagnosis

An overnight polysomnography can help determine the reason for the events, along with patient history. The test would incorporate the following:

  • Complete respiratory monitoring
  • Time-synchronized high definition video monitoring
  • Electromyographic recording from all four limbs ("expanded EMG/RBD/parasomnia montage")
  • A complete 10-20 set of cephalic EEG electrodes
  • Ability to extensively review the electroencephalogram

Treatment

  • Medication
  • Behavior modification
Circadian Rhythm Disorders

Our internal “clock” is located in a small part of the brain called the suprachiasmatic nucleus (SCN). For most people, the clock runs on a cycle that is just slightly longer than 24 hours and is synchronized with the light-dark cycle. In fact, light detected by the eyes entrains the clock by sending signals to the SCN. However, for some people the clock does not synchronize properly, causing the person to feel sleepy before or after “normal” bedtimes.

In teenagers and young adults, the most common circadian rhythm disorder is called delayed phase (staying up late and then sleeping late the next morning), while in older adults the advanced phase pattern is more likely (early to bed, early to rise). These patterns can cause difficulty when the person’s social or work schedule is not compatible with the timing of the internal clock. Fortunately, the clock can be entrained to change – this happens when we cross time zones: the clock reacts to light as well as other clues (food, social activity, exercise).

Other Sleep Disorders

A common sleep disorder is hypopnea, which is both a symptom of other sleep disorders and also a common disorder in which 10 seconds or more of shallow breathing occurs where someone loses 30% to 90% of your normal airflow. Blood oxygen saturation drops by 3% to 4%.

Frequently Asked Questions

How long do I need to wear the home sleep testing device?
We ask that you wear your device for a minimum of 6 continuous hours. This ensures that a sufficient amount of data is recorded and we can provide you with the most accurate results.
Can I use the restroom during my sleep study?

Yes, the device is battery-operated and portable. We ask that you leave all equipment on for the duration of the test.

Can I sleep in my usual position?

Most people have apneas while lying on their back so this is the position we prefer for our patients in order to capture the event on the sleep recording. If this position prevents you from falling asleep or is painful, please assume a comfortable position and continue with the test.

What time do I have to go to bed?

Please try to go to bed at your regular bedtime. We only ask that the study be completed in time to return the device the next day.

How many nights do I have to use the home sleep study units?

We ask that you use the home sleep testing device for one night and return the next day.

What do the lights on the device mean?

If the light is green then everything has been attached correctly and you should get a good recording. If the light is yellow, something may be loose or not secured correctly. The lights may blink with movement but will return to green once movement has stopped. If the lights do not return to green after movement, please check all connections.

What if a sensor slips off during the night?

Movement often causes sensors to slip off and is not uncommon. Securing sensors with medical tape will prevent this from happening in most cases. If the sensor does slip, please place the sensor back in position and continue with the test. We will determine if sufficient data was collected once the study is downloaded.

What happens if I take off the device early?

We will try our best to work with the data that was recorded and submit a report to your referring physician. However, if the sleep lab physician deems the data was insufficient to determine a diagnosis, a repeat study may be necessary. If no data is collected or the device is unused, the study will be deemed invalid and no report will be generated.

What if another person or pets sleep in the same bed during the test?

We do not require you to sleep alone at home. Please document any disruptions such as dog barking, partner snoring, etc. that may have disturbed your sleep. 

Can I take my usual medications?

Yes, please take all medications at regular intervals unless otherwise directed by your physician. Do not discontinue any prescription medications without first talking to your doctor.

What if I don't fall asleep?

This occurs often and should not be a concern for our patients. Your study and paperwork will be reviewed and we will determine on a case by case basis how to proceed and obtain a better sleep study.

Do I have to wear a shirt or pajamas?

No, but if you do wear pajamas or a shirt, please ensure that it is not made of satin or other “slippery” material. This will prevent the belt from sliding out of position.

How do I start and stop the recording?

The home sleep testing unit will automatically start recording once the belt is securely fastened. At the end of the test, please remove the belt and the recording will stop. The lights may remain on at first but will shut off on their own. This will not affect the study. You do not need to press any buttons to start/stop recording.

What happens after the test?

Once the home testing device has returned to the sleep lab, the data will be downloaded and reviewed by a Registered Polysomnographic Technologist. A preliminary report will be generated and the study will be forwarded to a sleep lab physician who is Board Certified in Sleep Medicine for final review and final report. Your report will be auto-distributed to your referring physician. If there are additional physicians you’d like to receive a report from, please inform us during scheduling. Turnaround time will be dependent on how quickly we receive the testing units back.

Meet The Team

Tina Wagner, RPSGT

Sleep Lab Manager

Zulfi Alli, RPSGT

Lead Registered Polysomnographic Technologist

Christine Ruzzo, CRT, RPSGT

Registered Polysomnographic Technologist

Jenissa Swanson, RPSGT

Registered Polysomnographic Technologist

Cassie Tabares, RPSGT

Registered Polysomnographic Technologist

Zelia Vertentes, RPSGT

Registered Polysomnographic Technologist

Carol Messier

Administrative Staff

Cheryl Langlois

Administrative Staff