Have a sleep lab type question?

[montana user]

Tonight (1-22) My girlfriend ( also a sleep tech, who just passed her boards for registry sleep tech) will be hanging out with me in my sleep lab tonight! So heres a great chance to pick the brains of two sleep techs, and ask that question you always wondered about. We will do our best within our knowledge to answer your questions. It can even be questions to my girlfriend on how she puts up with me and my CPAP, or if she has any suggestions for spouses/loved ones. We are open to anything..Lord knows I love to talk, and she is a brilliant sleep tech and love of my life!

Don't tell her but this is also my way of getting her hooked on this forum as much as I am...

I know we will probably learn something from you as well! I wasn't going to tell any one this because it is embarrassing, but I had no idea I could check my leak and AHI on my CPAP machine. I know, I know, I put the manual on a shelf and never looked at it. Why would I? I'm a sleep tech and know everything!!! Ha ha..right( maybe if I worked DME I would know how to run my machine). So it was on this forum that I learned how to read my report on my CPAP..there I said it. Now everyone who thought I was a know it all, can sit back and relax, because I am no where near knowing it all. Whew! that felt good.

[Slinky]

So have either or both of you done many bi-level and/or SV titrations? How do they differ from CPAP titrations?

I think it hilarious that a sleep tech would have so little interest in their therapy they weren't aware of the full capabilities of their CPAP and wouldn't at least glance thru the manual and notice the data capability.

Gads! I'm just a patient and knew before I even got a CPAP that I would ONLY ACCEPT a fully data capable CPAP. HOW could you have had so little interest in your own therapy until now??????

[montana user]

I will answer the first part of your question tonight when she is here with me, but since the second part is all about me I can do that one.

Here is my reasoning. We could change our machines( in the lab) from CPAP to Bi-level, and some of them to SV with a push of a button on the computer. All our data is right there on the screen. No one taught us what the machines could do at a home. Sounds stupid, I know, but we were on the clinic side of this. When I got my own CPAP, they (DME) assumed I knew everything about it because I worked in the lab. The only thing the R.T. showed me was how to raise and lower my pressure since I could not do it with a computor at my house. So I get it home, its all set, no need to mess with it. Thats what were told on the clinic side. Never have to mess with the machine! However, I did raise my pressure after my girlfriend told me I was snoring for a couple of nights.

I was taught that you find the optimal pressure on a patient, and that fixes them. If they start to get tired, take more naps, etc, then they come back for a re-titration. I can be honest and say not one pt. who came back for a re-titration study, said they looked at their data on their machine and their AHI was higher than normal. So do we have a huge education issue with the local DME company??? Did we have an education issue in the sleep lab?? YES!

I honestly think this is where allot of issues come from, and why so many people are dropped when they start CPAP. The sleep lab says "well we did our job..good luck!" DME says " well I gave you the machine, good luck". Doctor says" Cool, you had the sleep study, and now have the machine..Good luck". No one wants to do the follow up. Untill I left that sleep lab, started using my own CPAP, and started running this sleep lab, I used to be the "thanks for coming in...good luck" guy.

If didn'tnt like my mask, I didn't go to DME. I got one from the lab to try. Any questions...in-house sleep doctor at my disposal. I was spoiled. I didn't need to check my machine. My sleep tech found my optimal pressure. I'm good to go.( my education from lab side)

So even now it is hard for me to look at my data, as I feel great. If I start to feel tired again, and taking naps, then I will look at my data and see whats going on. It's just a different mind set that I have from the average person. So while you look at numbers, and fight your mask, I take 4 mask home and find one I like. I get a sleep study at a huge discount. I don't have the issues fighting doctors, and DME companies. So in my mind set, I was taking care of myself. I was treating my apnea the way I was taught how to.


So my answer is...I didn't have to know. Put on the CPAP, go to sleep.

Thats why this forum has been so HUGE for me. I have such a better understanding of what happens to people after they get their CPAP. I now understand why people get mad at DME, sleep labs, doctors! I now know that I have to take a stand, and change things in my area! I have to change the way I think about CPAP treatment. I can not just hook up wires and say "sleep!" I have to educate my patients, assure them they are doing the right thing for seeking treatment for apnea. I have to take the time to explain procedures to them, answer their questions, make them feel comfortable!

Well I got off the topic a bit, but I am so dedicated to this field and changing peoples lives, that a simple question of "how did you not know" makes me realize I had my head in the sand for so long. I didn't care what happened to people after they left the lab. I wasn't trained to. We were trained to run as many people through as we could.

And that my friends, is where you have all helped me- well.... PULL MY HEAD OUT OF MY ASS!

THANK YOU!

[drewherndon]

montana user,
Thanks for starting this thread. I am sure that some good questions will be put in front of you. I do have a question, but it revolves around how you became involved/employed in the sleep industry. I am so amazed at the difference that CPAP has made in my life that I am considering a career change. What is the process to become a sleep lab technician?

Thanks!

[Slinky]

Thanks, Montana. It still tickled my funny bone tho! How DID you decide on sleep for a career? It isn't something we usually even think about unless we can't sleep.

[montana user]

montana user,
Thanks for starting this thread. I am sure that some good questions will be put in front of you. I do have a question, but it revolves around how you became involved/employed in the sleep industry. I am so amazed at the difference that CPAP has made in my life that I am considering a career change. What is the process to become a sleep lab technician?

Thanks!

That is a great question! you will probably not like my answer at first. I had applied at several different jobs and the sleep lab was one of them because they paid fairly well. Did I want to stay up all night, hell no! I figured I would apply and if I got the job I would do it untill I found a better one. I figured I had an inn, since my mom was on CPAP and when they asked that question "why do you want to work here" I would give them my kiss ass answer of " well you fixed my mom with CPAP and I would like to give back to the company who helped her" Total B.S! Well I was hired immediately after my interview. So now starts the training and mind set, 6 months and i'm gone!

Fast forward 6 months. I am amazed at what I see in peoples sleep! I am amazed how the treatment is working for people! I can look at a bunch of squiggly lines and tell what sleep stage it is. I can tell the difference between obstructive apnea, hypopnea, central apnea, mixed apnea....I love this job!!! ( please see earlier post, where I did have a bit of attitude and not caring once the Patient left the lab) Fast forward another year. I get my own sleep study and start CPAP. I totally understand how apnea makes a persons life hell, I totally understand how CPAP changes lives!!

So sleep medicine is NOT something I went looking for, but after a while I did fall in love with the challenge of titrating people and fixing apnea. And now running this lab, I love the fact I can help educate people, help with compliance, let them know there are people who care about them after they start CPAP. I tell every single patient of this web site, and I show them the site on my computer before they leave the lab.


To work at most sleep labs, at least here in Montana, you have to have some type of medical background. EMT,Nurse, Respiratory,etc. Then you do anywhere from 3-6 weeks of on the job training. Our lab would also have monthly meetings with the sleep doctor to go over the new procedures, anything new and upcoming in the sleep field, and we would pick several patients that we had a hard time titrating or maybe saw something we had not seen before. We also go yearly to a Sleep Conference.

It is a very rewarding job. We stay up all night and lose some sleep ourselves, so we can make someone elses sleep much better! It is not a job for everyone! We lost dozens of techs every year, and usually within 3 weeks of them starting. Your heart really has to be in this.

Well I hope this answers your question. If not please let me know. It is almost 430 am, I've been up all night and my brain does tend to shut down around this time...lol

[tomjax2]

How much time is spent grading a sleep study and does this vary with different labs?

How much does the average referring doc understand a sleep study?

Do the docs simply rely on the brief summary or actually make an attempt to come to their own didgnosis and recommendation?

What percent of docs ask questions to better inform themselves?

[Wulfman]

We could change our machines( in the lab) from CPAP to Bi-level, and some of them to SV with a push of a button on the computer.

I'd be interested in knowing what brands/models of machines are used in sleep labs. Also, something about the software and hardware used on and in conjunction with the computers.
The sleep "tech" (I seriously doubt that she had any accreditations) who monitored my sleep study allowed me to see some of my recorded sleep (from the digital capture) and I found that kind of interesting.


Den

[Snore_question]

I wanted to know what sleep labs are doing to make sure they don't have bedbugs. Hotels are very prone to bedbugs since new guests are sleeping there every night--but sleep labs do, too. GOOD MORNING AMERICA talked about the presence of bedbugs in hotels this morning. Someone I know believes he got bedbugs in a sleep lab since it was the only place away from home he had stayed in the months before he got them.

[Tielman]

I wanted to know what sleep labs are doing to make sure they don't have bedbugs. Hotels are very prone to bedbugs since new guests are sleeping there every night--but sleep labs do, too. GOOD MORNING AMERICA talked about the presence of bedbugs in hotels this morning. Someone I know believes he got bedbugs in a sleep lab since it was the only place away from home he had stayed in the months before he got them.

Don't know about any other sleep labs, but mine was done in a Hospital, with bed sheets that are sent out daily and washed in high temp.

Oh, and the machine was a Respironics Model 2 (old style with the humidifier in the front). They told me they use tap water as the disinfect the humidifier containers each day.

[montana user]

How much time is spent grading a sleep study and does this vary with different labs?

How much does the average referring doc understand a sleep study?

Do the docs simply rely on the brief summary or actually make an attempt to come to their own didgnosis and recommendation?

What percent of docs ask questions to better inform themselves?

The average sleep study time depends on how bad the apnea is. If you take a person with no apnea it takes about 30 min. to score. Now you take a severe person and it can take up to 3 hours. When you score you start by marking the sleep stages. then you go back to the beginning of the study and manually have to highlight each apnea and title it ( hypopnea, central, etc) at the same time you are marking every arousal and every leg movement. This is very time consuming!

The referring doc depends. They all have a different degree of knowledge on sleep studies. We have one doctor who just graduated last year and he is the most up on it, but still asks a lot of questions regarding the results. So we are sorry we can not give a good average.

Again every doc is different. At first our doctors were going strictly off the sleep doctor report. Now they look at the report in depth, the graphs, the patient questionnaires, etc and makes a decision.


I can only speak of the doctors and P.A.'s we work. Almost every night I get a question from one of them regarding a sleep study procedure, or a symptom they saw.

Sorry we cant be more specific on the last 3 questions. It is hard to speak on behalf of hundreds of doctors out there. I can tell you that sleep apnea is rolling off the tongues of more doctors every day. One P.A. told me last week that she now incorporates sleep apnea questions into every patient she sees. so they are getting better and wanting to educate themselves.

[montana user]

So have either or both of you done many bi-level and/or SV titrations? How do they differ from CPAP titrations?

I think it hilarious that a sleep tech would have so little interest in their therapy they weren't aware of the full capabilities of their CPAP and wouldn't at least glance thru the manual and notice the data capability.

Gads! I'm just a patient and knew before I even got a CPAP that I would ONLY ACCEPT a fully data capable CPAP. HOW could you have had so little interest in your own therapy until now??????

Bi-level provides a duel pressure for support. The pressure upon inspiration is at a minimum of 4 cmH2O higher than the expiration pressure.This can be used as a mere comfort to the pt and other times for the obstructive apnea. The SV units can have a higher difference in the duel pressure, it can function as a cpap also. I have had the SV with as much as a 20 cmH2O difference. SV machines memorizes the breathing pattern of the pt and adjusts the pressure as needed. Bi level has a constant pressure settting.
The main difference between the 2 is that the sv unit will automatically increase the pressure and pushes the air to,in essence, force the pt to take a breath.

[montana user]

We could change our machines( in the lab) from CPAP to Bi-level, and some of them to SV with a push of a button on the computer.

I'd be interested in knowing what brands/models of machines are used in sleep labs. Also, something about the software and hardware used on and in conjunction with the computers.
The sleep "tech" (I seriously doubt that she had any accreditations) who monitored my sleep study allowed me to see some of my recorded sleep (from the digital capture) and I found that kind of interesting.


Den

We use the Resmed M series. They are not the typical CPAP machines as we can make them do all 3 settings(CPAP,Bi-level, SV). The software we use is called PC direct. This is wired to the CPAP machines so we can change all settings needed on the computor and do not have to go in the pt. room to make adjustments. As far as software that collect the data, there are numerous ones. Alice 5, Somnologic, Sandman, to just name a few. They all record the exact same data, but each program has a few functions that are different. ( the way you type your tech notes, to the way the program starts).

What makes you think your tech had no accreditations? We also like to hear what other techs are doing "wrong" so we can measure ourselves against them.

[Muse-Inc]

OK, I have a question-thought-issue-concern...a something anyway . In my split-night PSG, my titration was 10 for my hypops (no apneas). No mention of centrals, no SWS or REM, little sleep overall just enough to bill insurance , severe OSA, desats, lotta respiratory arousals, nothing else to note. Sleep doc recommended we set my CPAP at 11. OK, almost 2 yrs go by, I am recovering slowly then have a backslide into OSA symptoms, enter APAP loaner and wow, I slept amazingly better! Months go by and I get an AutoSet II, now, what to set it all...based on loaner data, I decide 6 is good and upper should be maybe 12 (loaner data ranged from 95thcentile at 6.9 to max at 12)...doc & I discuss and set 6-15 so if I need it it's there. I ask about centrals emerging if APAP goes to higher pressure; because I showed no evidence during titration portion, he is not concerned. I only have the PSG summary. During titration studies, do you typically go to higher pressures than the one that eliminates events, at least for simple OSA? Could they have possible gone to higher pressures to see if centrals emerged? Seems to me that would be a good thing to check during a PSG for subsequent setting of auto pressure ranges...that way everyone would know that at the time of that PSG (given airways change over time) centrals did or did not emerge and what pressures induced them. Just curious.

[Guest]

OK, I have a question-thought-issue-concern...a something anyway . In my split-night PSG, my titration was 10 for my hypops (no apneas). No mention of centrals, no SWS or REM, little sleep overall just enough to bill insurance , severe OSA, desats, lotta respiratory arousals, nothing else to note. Sleep doc recommended we set my CPAP at 11. OK, almost 2 yrs go by, I am recovering slowly then have a backslide into OSA symptoms, enter APAP loaner and wow, I slept amazingly better! Months go by and I get an AutoSet II, now, what to set it all...based on loaner data, I decide 6 is good and upper should be maybe 12 (loaner data ranged from 95thcentile at 6.9 to max at 12)...doc & I discuss and set 6-15 so if I need it it's there. I ask about centrals emerging if APAP goes to higher pressure; because I showed no evidence during titration portion, he is not concerned. I only have the PSG summary. During titration studies, do you typically go to higher pressures than the one that eliminates events, at least for simple OSA? Could they have possible gone to higher pressures to see if centrals emerged? Seems to me that would be a good thing to check during a PSG for subsequent setting of auto pressure ranges...that way everyone would know that at the time of that PSG (given airways change over time) centrals did or did not emerge and what pressures induced them. Just curious.

Good question! The answer is yes, we do. We find the pressure that appears to fix the apnea then go 2 maybe 3 higher to see if they tolerate it. This way if they come back in a few months, and are tired again, taking naps, etc. the doctor knows he can raise the pressure safely. Now two years ago our policy was to fix the apnea then stop. Now doctors are learning that its better to go a few higher so they have this info on file and don't have to bring the patient back for a titration study. Of course, not all labs follow this procedure.