polysomnography tech

Amber Allen, BA, AAS, RPSGT, RST, CCSH

• Director of Polysomnographic Technology at Collin College, McKinney, Texas

• President of the Board of Registered Polysomnographic Technologists

• Started career in 1970s, transitioned into sleep technology from the music industry.

Career Journey:

• Background:
  Amber Allen began with a BA at 19 and worked in the music industry for 8 years but shifted to polysomnography due to the instability in the industry.
  Her mother was a respiratory therapist and worked at a private sleep lab, which inspired Amber to transition to sleep technology.
  She received modular training in the sleep lab and was ready for certification by 2010.
  Worked at Cleveland Clinic and treated patients ranging from 5 months to 92 years old.
  Moved to Texas to build the program at Collin College, converted an office to a sleep lab, and began recruiting students.

• Leadership Roles:
  Elected as President of the Board of Registered Polysomnographic Technologists in January 2017, started a 2-year term as President last year.
  Recognized as a speaker at conferences, including in Shanghai, China, and Balmantone, Italy.

The Sleep Technology Field:

• Growing Demand:
  There is a massive shortage of sleep technologists worldwide, with only 16,000 technologists globally and 1,000+ sleep labs in the U.S.
  As of now, there are only 38 accredited sleep programs in the U.S., 16 of which offer associates degrees.
  Some hospitals offer sign-on bonuses up to $25,000 for sleep techs, and many can earn six-figure salaries.

• Historical Background:
  Over the past 60 years, we've learned more about sleep than in the previous 6,000 years. However, we still don't fully understand all the benefits of sleep.

• Polysomnography:
  The term polysomnography refers to the technical, clinical care, and management involved in diagnosing and treating sleep disorders.
  Technologists work to obtain diagnostic data and determine the course of treatment. There are more than 30 different sleep disorders identified today.

Types of Sleep Disorders:

• Insomnia:
  The most common sleep disorder but often doesn't provide much diagnostic data in sleep labs.

• Sleep Apnea:
  Affects about 30 million people in the U.S. and is one of the most common conditions studied in sleep labs.
  The U.S. population with sleep disorders is around 60 million.

• Technologist Shortage:
  There's a huge shortage of sleep technologists, with only 16,000 technologists worldwide and 1,000+ sleep labs across the nation.

Historical Views of Sleep:

• In ancient cultures, sleep was often seen as a state where people "died and came back to life," and gods of sleep like Hypnos and Somnas were worshipped.

• Opium was historically used for sleep disorders, but it is now recognized as a major cause of sleep disruption.

• Sleep in Art and Literature:
  Sleep has been depicted throughout history, often symbolizing vulnerability and peace.

  • Shakespeare’s "Hamlet" and Charles Dickens’ "Pickwick Papers" explore sleep themes.

  • John Keats wrote extensively about sleep in his poetry.

Evolution of Polysomnography:

• Early Research:

  • In the 1930s, Nathaniel Kleitman laid the foundation for sleep research.

  • In 1950s, researchers began studying REM sleep and how to record sleep data accurately.

  • In 1970, William Dement founded the first sleep lab at Stanford University, and is considered the Father of Sleep Medicine.

• The 1970s and Beyond:

  • Polysomnography became a formal term in 1974.

  • The first RPSGT exam (Registered Polysomnographic Technologist) was administered in 1979.

  • Manual scoring of sleep was done on analog systems until digital systems were introduced in the 1990s.

Modern-Day Sleep Studies:

• Technological Advancements:

  1. Transitioned from analog pen-and-paper systems to digital systems that are more compact and efficient.

  2. Devices have become smaller, allowing for home sleep testing with wireless technology.

  3. In-lab sleep studies are still common but now allow for greater movement during testing to gather better data.

• Sleep Study Process:

  1. Initial Evaluation:
     The process begins when someone (often a loved one) identifies a sleep problem (e.g., snoring).
     A doctor evaluates risk factors like tonsils, neck size, and body fat that may predispose someone to sleep disorders.

  2. Overnight Sleep Study:
     If sleep apnea is suspected, patients undergo overnight testing. This typically requires insurance approval.
     The results are digitally scored, but human oversight is still essential for accuracy.

  3. Treatment:
     Once diagnosed, treatment options are discussed. A common treatment for sleep apnea is the use of CPAP (Continuous Positive Airway Pressure) to keep the airway open during sleep.

     • Follow-up is crucial for long-term management. Treatments may include re-titration of CPAP settings or other interventions.

Sleep Disorder Categories:

1. SRBD (Sleep-Related Breathing Disorders)

   • Sleep Apnea

2. Hypersomnias

   • Excessive daytime sleepiness due to insufficient nighttime sleep.

3. Circadian Rhythm Disorders

   • Jet lag or the inability to sleep at conventional times (night owls).

4. Parasomnias

   • Sleepwalking, sleep terrors, and actions like grinding teeth.

5. SRMD (Sleep-Related Movement Disorders)

   • Restless Leg Syndrome and leg jerks during sleep.

Physiological Parameters in Polysomnography:

• EEG (Electroencephalogram): Measures brain waves to assess sleep stages (awake, NREM, REM).

• EOG (Electrooculogram): Measures eye movements, crucial for detecting REM sleep.

• Oronasal Airflow: Monitors breathing to detect apnea.

• Chin EMG: Records muscle activity, helping to distinguish sleep stages.

• Position Sensors: Helps identify if certain positions cause sleep problems.

• ECG (Electrocardiogram): Monitors heart rhythms, identifies issues like atrial fibrillation.

• Pulse Oximetry: Monitors oxygen levels during sleep.

• Limb Leads: Detects leg movements like kicking.

Sleep Phases and Their Importance:

1. NREM Sleep (Non-Rapid Eye Movement):

   • 75% of total sleep.

   • Includes N1 (light sleep), N2 (steady sleep), and N3 (deep sleep), the latter is crucial for restoration and growth.

2. REM Sleep:

   • 20-25% of total sleep, key for memory consolidation and brain restoration.

   • Sleep cycles last 90-110 minutes, with REM periods becoming longer throughout the night.

3. Sleep Deprivation:

   • Lack of sleep leads to decreased cognitive function, mood swings, and impaired physical health.

   • After 24 hours of no sleep, the effects are similar to a 0.125% BAC (blood alcohol content), impairing motor skills and decision-making.

Treatment Options for Sleep Apnea and Other Disorders:

1. CPAP (invented in 1985) is the primary treatment for sleep apnea.

2. Oral Appliance Therapy: An alternative for those who cannot tolerate CPAP, it moves the jaw forward to keep the airway open.

3. Surgery: Procedures like Inspire (an implanted stimulator) help by moving the tongue forward during sleep.

4. Sleep Hygiene: For behavioral disorders, educating patients on sleep habits can improve outcomes.

Sleep Technologist’s Role:

• Responsibilities include performing polysomnographic studies, scoring data, and working with patients to optimize their sleep.

• They must have knowledge of neuroanatomy, cardiopulmonary physiology, EEG principles, and sleep disorders.

Career Opportunities:

• Roles: Night techs, day techs, scoring techs, clinical educators, research, management, and more.

• Median Salary: Around $64,393.

• Shift Hours: Night shifts (typically 10-13 hours, 3-4 nights a week) are common but daytime positions are growing.

• Training & Certifications:

  • Requires at least a certificate.

  • Credentials: CPSGT, RPSGT, CCSH.

  • Continuing education: Requires 50 CECs every 5 years to maintain credentials.

Tips for Optimizing Sleep:

• Best Sleep Environment: Dark, cool, quiet, and comfy.

• Sleep Position: The back with a slightly elevated head and neck is ideal.

Naps: Keep naps under 20 minutes to avoid disrupting nighttime sleep.