Sleep tech and New member

Two opinions from me:

1. Good techs are the unsung heroes of the industry when they represent it well by making people comfortable and by treating them with dignity during their creepy overnight alien abduction. Some great docs have lousy social skills. A good tech, on the other hand, MUST have good people skills in sensing how to be friendly without being overly- friendly to people in a vulnerable circumstance according to each person's culture and expectation--beyond being good with the technical aspects of testing. I have had great respect for the techs I've dealt with.

2. I think the AASM is wisely slow and conservative while gradually adapting to new technologies and approaches and does a good job overall, from where I sit. I get it that some docs don't like all the approaches. But as a general rule, when both the conservative traditionalists and the cutting-edge radicals are equally mad at you, you must be doing a good job at finding the solid middle ground. Unlike some other bodies, they don't have much of a history of embarrassing themselves with corrections and retractions and reversals. I give them nine out of ten stars and consider myself a fan. I think some docs just enjoy bad-mouthing consensus organizations as a way to deflect personal blame and to express pet peeves as a hobby.

Hi and welcome,

My titration study was a nightmare. The guy who did my study was nice..at first. Things quickly went downhill. He was friendly enough when I arrived, asking me questions about my sleep habits. I told him straight up I had been sleeping in a recliner for 3 years because I cant breathe laying down. I also mouth breathe due to my sinus issues. So he fits me with a nasal mask and Tells me to read or whatever until i get sleepy. All is going pretty well until he pops in at 9:30 to turn off the lights. Im not allowed to sleep in the recliner, not even allowed to use two pillows to prop up my head a little.

At 2:30 he brought me a full face mask. At 4:00 he stomped in the room and slid the recliner over by the bed after I asked him was it more important that I get sleep, or that I sleep in the bed. I got 38 minutes of sleep total for the study.

I will never have another sleep study.

I have had a total of five sleep studies. The first was around 1997. The only mask they had available for me to use was a nasal mask. I am a mouth breather when sleeping. At that time, I had a very badly deviated septum which prevented me from breathing through my nose. I could not sleep with the mask on. Every time I would doze off, air would blow out between my lips making an odd sound. My second study was in 2014. When I was in the hospital for a knee replacement, the nurses noted my blood oxygen was dropping very low when I slept. They told the doctor who did the morning rounds, and he scheduled me for a sleep study. This was my sleep study from hell. The technician had a very heavy eastern European accent, and kept calling me "dahling". When she put the mask on me, she used a full face mask and pulled it too tight. I told her it was too tight, but she insisted it had to be that tight in order to work properly. When the doctor's office called me and said I needed to do another study, I told then there was no way I would ever do another sleep study. After seeing the doctor, I agreed to do the titration study, but insisted it be done at a different lab. The people there were very good. When the doctor wrote the script for my machine, it could not be filled. Medicare refused to pay for the machine. The doctor had not documented a face to face meeting before he scheduled my first sleep study. His office would not return my phone calls, so I found a new sleep doctor and lab to redo my tests. This place was really good. The techs were all very friendly and competent. After almost ten months, I finally got my machine.

Ariseal wrote: ↑

Fri Jul 20, 2018 9:20 pm

So my first question for everyone who has gone through a sleep study here. If you could sit down with the tech you had or various techs you have had, what would you ask them about now or ask them to do different next time. I would like to see if their is anything I am currently not doing that I should be.

Well, in my split lab study I'd like to know why they didn't show me the mask and try it on for fit **before** I started the study? Instead I felt like I was awakened by a drill sergeant tumbling people out of bed in the middle of the night, fitted with a mask I'd never seen before to an unfamiliar device. And I'm wondering whether they should have done something when my apneas got as long as 1 min 48 seconds while they were trying to manually titrate - mean I'm fine, but I now I associate lab titration with suffocation.

I like explanations and being told in advance what is going to happen. I think in my case, there was a lot of room for improvement on the tech side.

It may be uncomfortable to not have great 'treatment' while titrating, but it's important for the labs to get a baseline 'worst scenario', to find out the extremes of your apnea so they can better present them to the docs for pressure setting scripts. But because of how labs are set up, even if you feel things are 'extreme', they won't let you die, suffocate, etc. to find the extremes - they will address any problems before they get out of hand.

During one sleep study, by oxygen level dropped to 63% and they put me on supplemental oxygen to complete the test.

Ok so first of all thank you everyone for your replies . Ok lots of things to address and I am typing from a phone so this should be fun and I apologize in advance for errors.

Ok so first of all JNK you bring up a valid point about the AASM. They haven’t had a lot of retractions
And corrections that I know about. Now I haven’t been in the industry really long so I will take your word for it on this one. My problem is more with the insurance companies and their attempt to deprive patients of good care in the name of saving money. The AASM is an organization and does have things it has to answer too so I can understand why they have buckled to insurance and Medicare policies and desires.
Can you though make a good argument of why patients should ever be scored on a 4% desat scale instead of a 3% for hypopneas.

As for personal skills as a tech. You are complete right about the need for good social skills and rapport with patients. Something I will admit I have had trouble with sometimes. Specifically the not being overly friendly part. I have some mild autism stuff and have trouble reading people at times so I try to rely on my analytical skills to present the best behavior and methods to treat people as a whole but everyone is different and that does not always work out well.

Typing this from phone so I will post and make edits addressing the other replies one at time.

1rst edit addressing Barbee

I am sorry your study was a nightmare and that you will never have another study again. I urge you to reconsider as study experiences can vary greatly from location to location and even from night to night.

As for the recliners it is not uncommon to see Apnic suffers especially the untreated ones to sleep in a recliner as that is the only way they feel they can breathe. The back is the worst position for Apnea as it places gravity entirely working against you at that point. Concerning your tech depending on the Dr. he may not have been allowed to let you sleep in a recliner and many labs do not have access to one at all. Often times Doctors will ask tech to make patients sleep on their back for at least 2 hours of recording time so that they can see the apnea at its worst and also will not allow techs to give more than 1 pillow for elevation. Now I am not trying to make excuses for your tech, just letting you know he may have had orders you didn’t know about. However I have come to appreciate more the school of thought of let patients sleep how they sleep at home. Also one of the goals of cpap is to treat the apnea well enough that you can sleep in a more natural position laying down. Which cant be achieved if the patient never lays down with the mask.

2nd edit addressing Okie Bipap

So I am glad despite your troubles you finally got your machine and mask and that it has helped you. Only thing for me to add not covered already for your experience is this. All providers are presented with one of two cost options when doing cpap therapy. Either to clean the mask or to give them away to patients. If cleaning then they have to pay the cleaning cost for the chemicals and the service if a hospital is doing it. If the later then they only want the patient to take home one mask and hose at the end of the study, and if others where used then they have to be cleaned. For this reason Techs are told often flat out not to used to many different mask on a single patient. Unfortunately the only real way I know to combat this is for a tech to be able to judge a patients face size and type upon first visual inspection. That is highly dependent on experience, and newer techs just don't have the experience to do that. The best you can do is do a detailed verbal explanation of the mask types and try to see if the patient can determine what they both want and need.

Ok so oxygen protocols. Doctors want to prevent putting any patient on oxygen unless they absolutely need it. Beside the medical aspects of the effects on O2 on people oxygen can cover up apnea desats. Apnea is graded based on oxygen level drops at the start and end of an event. So even patients that come in on O2 doctors will tell techs to try to start the patient off oxygen for a study. All labs have their own O2 protocols. Generally they go along the lines that if a patient drops below 88% O2 and stays below 88 for a period of 15minutes without fluctuations then put them on O2 after calling the Dr. for conformation. Even if a patient has very low oxygen drops from apnea as long as their oxygen comes back up the tech will not interfere. All techs are required to maintain their Basic life support and AED certifications in case a patient codes.

I cannot contribute much to this discussion except a different experience. I requested a lab sleep study since I suspected I had apnea.

My doctor approved the lab study, but my insurance would only pay for a home study. I when to the lab to pick up the equipment after a short meeting one evening and returned it the next morning. Later I had an appointment with a sleep doctor who basically just referred me to a DME to get a CPAP.

The DME (Lincare) technician was not very helpful. He was going to keep the SD Card for my Resmed machine until I insisted the sleep Doctor wanted me to bring the card. He decided I should get a P10 pillow mask. The first thing he did after opening the fit pack was toss the small & large pillows in a drawer, insisting insurance would only pay for one pillow. I really had to insist I get a heated hose. He said insurance never covers them even though I showed him a copy of the insurance pre-authorization sent to Lincare approving it.

Definitely listen to your patients. I think you already know that though. I have been on CPAP for about 18 months but likely would have given up if not for this forum.

Overall, my experience was positive except for one guy. He was inattentive. That is he did not respond to my call for quite some time, meaning that my toilet needs became urgent by the time he did.

My problem with the very first one is that when I summoned him, he turned off the pressure first instead of last. Even on initial titration, the cessation of pressure was bothersome (that's probably an unusual complaint, at least for a first timer). This was back when there were not remote controls on the lab CPAPs. The machine was outside the room and there was a hole in the wall and a long hose that went through it.

The other thing that I would have preferred on initial titration would have been putting on the mask myself. This way, there would be no question that I would be able to do it myself at home, and any problem that arose in that area could have been addressed immediately. Also, the standard answer to leaks was to tighten the straps. Sometimes, they're too tight and need to be loosened. Also, more attention needs to be paid to the evenness of the mask and the relative tightness of the upper and lower straps. If nothing works well, they should consider a different mask, possibly a different mask type. This should be addressed at initial titration. If the attitude is to address these matters later, the patient will have a bead experience and just give up; you'll never see him (her) agian.

Oh Prodigy don't even get me started on home sleep studies. So the idea behind home sleep studies is not a bad one if it were used that way. A home study should be used to identify more people with Apnea and get them the care they need. However the reality is that most insurance companies use Home Studies as an excuse to weed people out and prevent them from getting an in lab study. Personally I think home studies are shit and no substitute for an in-lab. With no EEG they can't even tell if the patient is asleep or not. They have no leg electrodes for PLM detection and no chin electrodes to detect Bruxism aka teeth grinding.

D.H. the only thing I can say extra regarding your desire to place the mask on is that if a patient is not careful during the study when placing the mask on (and this is only if the electrodes are already on) then they can knock off electrodes which will mess up the study and cause the tech to have to replace the fallen electrodes. Now this can happen anyway but adding to it dosen't help especially if a patient manages to knock off multiple electrodes at once. Now if the tech already placed the mask on and the patient wants to adjust the straps then any tech should allow that. As for the straps and leak fixing that just comes down to Tech experience. There is not adequate training or schooling given to techs on mask fitting and they generally have to just figure it out through trial and error.

"Sweat artifact" does make sense; but controlling room humidity along with temperature
might allow for a dry, but COMFORTABLE patient.
Can't assess sleep when the subject is too chilly to sleep.
I can tolerate much higher temperatures if the humidity is reasonable.
We discovered this when our AC died, and we ran the dehumidifier to make things bearable.
It felt much cooler than the thermometer said it was.

Oh I agree humidifiers in each room would be wonderful to have. Now to just get the higher ups to pay for it sigh.

Ariseal wrote: ↑

Sat Jul 21, 2018 9:25 pm

Oh I agree humidifiers in each room would be wonderful to have. Now to just get the higher ups to pay for it sigh.

Humidifiers AND dehumidifiers!
High ambient humidity causes sweat to REMAIN on the skin.
Lower the humidity, and the body's natural cooling mechanisms cool the body and keep the skin dry.
No need to freeze the poor victim. Studies are miserable enough without hypothermia.

Yea meant to say dehumidifier

Ariseal wrote: ↑

Sun Jul 22, 2018 12:07 pm

Yea meant to say dehumidifier

I assumed you were one to torture your patients.
I am sure if you hang around here we will torture your patience.