A2Zzz Volume 14 Number 3

PUBLICATION OF THE APT ASSOCIATION OF POLYSOMNOGRAPHIC TECHNOLOGISTS 2005 YEAR END ISSUE • VOLUME 14 • NUMBER 3

Accreditation

Health Professions Network Examines Workforce Issues

What’s in it for the Techs?

Negotiating Managed Care Contracts Key Points for Sleep Disorder Centers

CPAP Desensitization in the Sleep Lab Sleep Apnea and Pregnancy High School Athletics and the Sleepy Teen Athlete

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

THE A2ZZZ MAGAZINE, EDITORIAL BOARD THERESA SHUMARD, EDITOR-IN-CHIEF ASSISTANT EDITOR ROBERT LINDSEY, MS, RPSGT APT BOARD OF DIRECTORS LIAISON CYNTHIA MATTICE, MA, RPSGT CARTOONIST BARBARA LUDWIG CULL, RPSGT CORRESPONDENTS IAIN BOYLE, RPSGT, CANADA PAMELA JOHNSON, RPSGT, AUSTRALIA/NEW ZEALAND WAYNE PEACOCK, RPSGT, UNITED KINGDOM ROGERIO SANTOS DA SILVA, BRAZIL

ASSOCIATE EDITORS JOSEPH ANDERSON, RPSGT, RPFT, CRTT KIM BURNS, RPSGT EDWIN CINTRON, RPSGT JOSHUA COLE, RPSGT WILLIAM ECKHARDT, BS, RPSGT REG HACKSHAW, RPSGT JOANNE HEBDING, RPSGT REGINA PATRICK, RPSGT KIMBERLY TROTTER, RPSGT, MA SPECIAL PROJECTS JAYME MATCHINSKI, ESQ. TRACY NASCA MARY JONES-PARKER, RRT, RPFT, RPSGT ADVERTISING SCOTT COLE, RPSGT LAURA LINLEY, RCP, RPSGT

MISSION STATEMENT: A medium to provide progressive technical information and an avenue of communication for members, presented in a professional and constructive manner, to further the goals of, and promote unity in the Association of Polysomnographic Technologists.

In This Issue…

Editorial ..................................................................6 President’s Message ................................................7 CPAP Desensitization in the Sleep Lab ........................8 High School Athletics and the Sleepy Teen Athlete ........9 Accreditation: What’s in it for the Techs? ..................12 Answers to your Questions about AASM Accreditation..............................................13 Health Professions Network Examines Workforce Issues ................................................14 Negotiating Managed Care Contracts: Key Points for Sleep Disorder Centers ....................15 Crossword Puzzle....................................................16 Scenes from the 2005 APT Fall Review Course......18-19 A2Zzz Technical Corner ..........................................21 APT Standing Committee Roster 2005-2006 ............22

ADVERTISING POLICY As a service to our membership, The A2Zzz Magazine prints information on educational programs and products. It is not intended to imply that the programs and products are approved by the Association of Polysomnographic Technologists (APT) or the Board of Registered Polysomnographic Technologists (BRPT), or that they are endorsed as a method of preparation for the BRPT examination. Professional products and services are subject to approval by The A2Zzz Magazine Editor-in-Chief. Ad inquiries may be directed by fax to 781/823-4787 or by e-mail to aptads@aptweb.org.

For advertising billing questions, call 708-492-0796.

APT Directory ........................................................22 NewZzz Briefs....................................................24-26 Classified Ads ........................................................28 Product Order Form ..........................................29-30 Membership Form ..................................................31

Advertising rates, specs and info: www.aptweb.org/advertising.asp ARTICLE SUBMISSIONS GUIDELINES Research, feature and news manuscript submission guidelines, word limits and e-mail submission instructions may be obtained from the Editor-inChief. All articles subject to standard, blind peer review. Article queries should be mailed directly to: Theresa Shumard, Editor-in-Chief • APT Communications Office PO Box 70 • Mohnton, PA 19540 Phone: 610/796-0788 • Fax: 781/823-4787 E-Mail: sleepeditor@aol.com Copyright © 2005 by the Association of Polysomnographic Technologists. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy or recording, or any information and retrieval system, without permission in writing from: APT National Office, One Westbrook Corporate Center, Suite 920, Westchester, IL 60154. Opinions expressed in The A2Zzz Magazine are not necessarily those of the APT Board of Directors.

SleepLand Calendar ................................................32

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Editorial Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Editorial

BY THERESA SHUMARD ave you ever noticed how many songs relate to sleep, dreams, or nighttime? There are thousands. Songs containing slumbering subject matter run the full gamut from pop music to classical and everything in between. Quite often, this music is prone to lament the restless nights of the lovelorn, chronicle the dreamier elements of nature, or wonder about the secret mysteries in the ceaseless ponderings of the night. For the discriminating sleep song collector, the music industry landscape is a virtual candy store for the “somnus aficionado.” Some tunes popular, and others very obscure and not often part of the mainstream, many of these songs you will easily recognize whose themes are often embodied in terms of motifs that serve as modes of expression.

Challenge your memory to see if you recognize the following:

H

All You Want (Dido) I’d like to watch you sleep at night To hear you breathe by my side And though sleep leaves me behind There’s nowhere I’d rather be Lady D’arbanville (Elton John) My lady D’arbanville Why do you sleep so still I’ll wake you tomorrow... ...Why does it grieve me so But your heart seems so silent Why do you breathe so low, why do you breathe so low

Or these… Enter Sandman (Metallica); Golden Slumbers (Beatles); Try For Sleep (Van Morrison); Do You Sleep? (Lisa Loeb); Talking in His Sleep (Toni Braxton); Insomnia (Megadeth); Something to Sleep To (Michelle Branch); Nocturnal (Eve 6); Sleeping Bag (ZZ Top); How Do You Sleep (John Lennon); Rodeo Moon (Toby Keith); Sleep City Sleep (Armoury Show); Sleep (Imogen Heap); Before the Dawn (Judas Priest); I Couldn’t Sleep a Wink Last Night (Frank Sinatra); I Drove All Night (Celine Dion); And Dream of Sleep (Kate Bush); Nightwalker (Gino Theresa Shumard Vanelli); Sleep (Unsung Zeros); Sleep Now in the Fire (Rage Against the Machine); The Sidewinder Sleeps Tonight (R.E.M.); Fall Into Your Dreams (Cyndi Lauper); Dream On (Aerosmith); Where Did You Sleep Last Night (Nirvana); These Dreams (Heart); I Can Sleep (Gin Blossoms); Dream Walkin’ (Toby Keith); Moondance (Van Morrison); The Sleep (Pantera); Blue Moon of Kentucky (Bill Monroe); Sleep To Dream Her (Dave Matthews Band); Pray Nightfall (Paradise Lost); A Night to Remember (Foreigner); It’s Only a Paper Moon (Arlen, Harburg and Rose); Sleep’s Dark & Silent Gate (Jackson Browne); Sleep On (Alison Krauss); Wake Me When It’s Over (Andy Williams); Dream (Bobby Darin); Lullaby (Shawn Mullins); Moon Over Bourbon Street (Sting); Night (J.D. Souther); Do You Dream of Me? (Michael W. Smith); Just a Dream (Madonna); Shine Like Stars (Primal Scream); Narcolepsy (Crackjaw); Who Needs Sleep? (Barenaked Ladies); Dancin’ in the Moonlight (King Harvest); Dream a Little Dream of Me (Mamas & Papas); Talking in Your Sleep (The Romantics); Harvest Moon (Neil Young); Moon (Sun); and Moon River (Henry Mancini and Andy Williams).

There are plenty of bands whose names conjure up celestial posture — to name a few, Dream Theater, Celestial Vibrations, The Moonglows, Andrew Brel & Celestial 7, A Static Lullaby, Midnight Oil, Nightwatchers, and last, but not least, R.E.M.

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It would be great hearing from you about some sleep music that you may know. Just drop a line to apt@aptweb.org. I wish you happy holidays and remember...

Sing in the rain, dance in the sun, and dream by the light of the moon.

APT NewZzz Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

President’s Message

BY CYNTHIA MATTICE, MA, RPSGT s this year comes to a close, it is a great time to reflect on all that the Association of Polysomnographic Technologists (APT) has accomplished to meet the needs of our members and to look to the future of our profession.

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A Successful 2005 Because of You The APT continues to provide the sleep technology profession with a unified voice that represents more than 2,900 polysomnographic technologists in the United States. This is possible because of the support from each of you as APT members, the leadership of your Board of Directors, and the valuable work of committee members. A heartfelt “thank you” to each member for the countless hours you dedicated to the APT and the valuable contributions you made to the organization.

Highlights of Our Year The APT is committed to providing polysomnographic technologists with educational programs that broaden our knowledge, advocating on behalf of its members to protect the profession and creating professional standards that ensure quality care. However, as our profession evolves, we are continually engaging in new initiatives that promote sleep technology as a separate and distinct profession, and increase recognition and support from educational institutions, medical associations, state legislative bodies and state regulatory agencies.

The APT is working with the Board of Registered Polysomnographic Technologists (BRPT) and the American Academy of Sleep Medicine (AASM) to advance sleep technology as an allied health profession by ensuring that there are enough well-trained technologists to meet current and expected needs of the field of sleep medicine. These efforts are being realized through the development of national educational standards for our profession and will be implemented though formal educational programs, on-going training and certification.

Additionally, in an effort to promote and advance consistency within our profession, the APT has developed eight core competencies and a Policy and Procedure Manual for Sleep Disorder Centers. The APT is also evaluating the need to promote and expand the Continuing Education Credits (CEC’s) program to meet the needs of our advancing profession.

These individual initiatives may seem like small parts, but, as a whole, these efforts have allowed us to turn back attempts to deny you the ability to work in your profession and to defend our profession against new threats in various state legislatures and state regulatory agencies. With your ongoing support, the APT will continue to champion this protection and advancement of our profession.

2005 Legislative Roundup The 2005 legislative session witnessed the introduction of several pieces of legislation affecting the practice of sleep medicine. By far this has been the most politically active year for polysomnographic technology issues. The APT has tracked, monitored, and issued opinions on many legislative initiatives.

Polysomnographic licensure acts were presented in Louisiana, New Jersey and Maryland. Louisiana, in June of 2005, became the first state

to pass a full licensure law for the profession of polysomnographic technology and in December New Jersey became the second state in the nation to license the profession when Acting Governor Richard Codey signed the Polysomnographic Licensure Act into law Other legislation concerning the profession of polysomnographic technology Cynthia Mattice has included exemption language for the profession. Illinois, North Dakota, Colorado and New Mexico all debated exemption language for polysomnographic technology within respiratory therapy licensure laws. The Illinois and Colorado exemption bills were both passed and signed into law during the 2005 legislative session.

Several regulatory actions concerning polysomnographic were debated by numerous respiratory care and medical boards in a number of states. North Carolina's Respiratory Care Board and South Carolina's Board of Medical Examiners have both issued declaratory rulings regarding the practice of sleep technology within their state. Montana has also been looking into drafting legislation that will affect polysomnography in 2007. The New York State Board for Respiratory Care has also threatened to issue cease and desist orders to polysomnographic technologists for practicing respiratory care without a license, but has also indicated it will support the introduction of legislation that will license polysomnographic technology as a separate and distinct profession.

Momentum garnered from the 2005 legislative session will be helpful in 2006 as it appears that a continued flow of legislation and regulatory actions regarding the profession will progress and become more numerous.

The Value of APT Membership Whether you have been an active volunteer member of the APT for many years or have recently joined the APT, we all share a passion for improving the quality of sleep and wakefulness in all people through the sound practice of sleep technology and realize the value of investing in our career through membership with the APT. Our profession is unique because of the multidisciplinary nature of a polysomnographic technologist; it is this diverse membership that makes us a strong, vital professional membership association.

In order for the APT to continue providing a level of service that keeps pace with these growing and changing needs, a modest increase in dues is necessary. Membership will now cost $100 per year, but for less than $10 per month you, as an APT member, are investing in your professional development and the future of your career as well as ensuring the vitality of polysomnographic technology.

You also receive several tools and resources that advance professional development. These benefits include A2Zzz Magazine, an important resource for your career development; Online Forum, an avenue for members to ask questions, exchange ideas and discuss issues facing our profession; and important e-mail updates on issues and trends that affect our professional environment. Members also benefit from educational programs that keep you abreast of new trends and practices in continued on page 32 7

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

CPAP Desensitization in the Sleep Lab A Sensitive Subject!

KIMBERLY TROTTER, M.A., RPSGT, ASSOCIATE EDITOR e all have them — patients who can’t tolerate Continuous Positive Airway Pressure (CPAP) whether the complaint be the mask, pressure of air, claustrophobia, or anxiety.

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The night technologist may be the “first line of defense” in working with CPAP-intolerant patients. This can be a challenge to the technologist because they have so much more to do. They are usually responsible for not one, but two patients, plus documenting the studies and troubleshooting the waveforms. There are a few things the night technologist can do to help patients non-compliant or non-tolerant of CPAP. The first introduction of CPAP to the patient can make all the difference in adherence. Holding the mask without the headgear can give the patient more control. Instruction on breathing, “don’t feel that you have to breathe in all the air,” and purposeful exhalations can be helpful, too.

You can do other things as a technologist working with non-compliant patients at night such as trying bilevel PAP therapy, ramping technology, or using therapies that provide pressure relief during early exhalation.

Trying different types of masks — nasal interfaces and nasal masks, oral masks, or full face masks — can also help, however, sometimes patients need more than what can be offered at night during the sleep study.

CPAP desensitization programs are gaining in popularity and although few and far between, they and are out there in different degrees.

Accuhealth Sleep Disorders Center has such a program. William O’Connell, President/CEO developed a comprehensive CPAP desensitization program in Oklahoma City, Oklahoma.

If a patient goes in for a split-night study, and does not tolerate CPAP during the titration portion of the test, the Kimberly Trotter patient is then referred to the desensitization program. Patients that have difficulty using CPAP at home can also be referred to the program, as are those that have a diagnostic study and need CPAP but are unable to use it.

The program, which is free to patients, involves using an autotitrating CPAP for seven nights to allow the patient to get used to wearing a CPAP mask and experiencing the stream of air. Depending on patients’ actual complaints, the program also involves using a stan-

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

dard CPAP machine at home at a low pressure, and raising the pressure incrementally over time until the optimal pressure is reached.

Visits in the lab are also made by the patient to try different masks.

“These are excellent tools to help the patient become more compliant,” said O’Connell. The program also tracks their patients with an autotitrating CPAP questionnaire. Some of the questions asked in the questionnaire include: • • • • • •

Did you feel rested in the morning after using the machine?

Did you have more energy during the day?

Did you take naps during the day after using the machine?

Did you experience any problems with the mask?

Did you have any nasal dryness?

Would you use CPAP at home?

Set up date and mask brand used are also included in the questionnaire. When asked why Accuhealth has the program available, and at no charge to patients, O’Connell responded, “Not only is it good practice, but it’s good marketing, too, because it sets you apart from the other sleep labs.”

Loyola University Medical Center for Sleep Disorders, Maywood, IL, offers a CPAP clinic where patients can make an appointment to learn about different kinds of machines (CPAP, bilevel, auto-PAP etc.) and different types of masks (nasal masks, nasal pillows, full face masks etc.).

The clinic is able to help patients with mask fitting, calibration of machine pressure settings, monitoring of CPAP compliance, and CPAP desensitization. The clinic offers audio-visual aids for patient education, and has trained staff available for individualized instruction and coaching.

St. Alexius Medical Center Sleep Center, Bismarck, ND, has a program similar to Accuhealth, where a patient who cannot tolerate the CPAP or bilevel PAP during the sleep study goes home for two to four weeks on a CPAP unit. The patient is instructed to slowly put the mask on with low pressures night by night, in the comfort of their own home, to get used to the sensation of CPAP or bilevel PAP. Once the patient has adjusted to the pressure and mask, they are then brought back to the lab for a titration study to get the optimal pressure.

The Mid-West Center for Sleep Disorders has a very good Web site (www.mwcsd.com/education.htm) instructing patients having trouble tolerating CPAP on desensitization: Follow the following steps if you are unable to tolerate CPAP: 1. Wear the CPAP mask at home while awake for one hour each day.

2. Attach the mask to the CPAP device, and switch the unit “on”.

Practice breathing through the mask for one hour while watching television, reading or performing some other sedentary activity.

3. Use the CPAP during scheduled one-hour naps at home.

4. Use CPAP during initial 3-4 hours of nocturnal sleep.

5. Use CPAP through an entire night of sleep.

Advance by one step after each five days, once the first step can be carried out without anxiety.”

In the New England area, The Sleep HealthCenters affiliates has a comprehensive program on CPAP management. They are a group of sleep disorders centers that include Brigham and Women’s Hospital, continued on page 23

High School Athletics and the Sleepy Teen Athlete

BY BRENDAN DUFFY, RPSGT here have been many avenues that have been explored with the goal of giving school athletes the competitive edge. Some schools have brought in the latest and greatest cardio fitness workout equipment that money can buy. Others have started training more often and longer than in years past. But it appears that these schools and coaches may have “dropped the ball” when it comes to taking a look at the sleep needs of their young bench warriors.

T

Brendan Duffy

Teens typically need about 9 hours of sleep and are faced with a host of problems in obtaining an adequate amount of sleep. The list of problems includes a change in their circadian rhythm, which causes them to not feel ready for bed until late in the evening, as well as homework, socializing, and perhaps part-time job responsibilities. The problem for athletes is exacerbated by late and/or early practices that lead to a sleep deprived athlete performing at a subpar level.

Student athletes frequently forgo their needed sleep amount to attend (in body anyway!) an early morning practice BEFORE their school day starts. We are all familiar with the stories of ice skaters or gymnasts that start their day at 5am or earlier High School athletes also are faced with some games or events that are a distance away from their school and require returning to their home at a late hour. Because they have just finished participating in a competitive event, they are still often “wound up” over the game they have just finished and not relaxed enough to fall asleep. They also have increased their body temperature and will find it hard to get ready to sleep for a while.

On many occasions there is still homework to be done, or tests that need to be studied for. For others there is a long phone call or chat with a girlfriend or boyfriend to discuss the day’s events or weekend plans.

The cumulative effect of all of this lost shut-eye may make the athlete less ready for competition both physically and mentally. Loss of continued on page 27 9

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Sleep Apnea and Pregnancy

BY REGINA PATRICK, RPSGT any women develop sleep-disordered breathing during pregnancy which then resolves after delivery. The health consequences of sleep-disordered breathing during pregnancy have not been thoroughly investigated although scientists have long noted that untreated sleep-disordered breathing can negatively impact one’s health. As scientists now study this, it is increasingly becoming clear that sleep-disordered breathing can negatively affect a pregnant woman’s health as well as the health of her baby.

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Sleep-disordered breathing (e.g., obstructive sleep apnea [OSA], hypopnea) that begins during pregnancy may have a hormonal basis.

One possibility1 may be the effect of hormonal changes on the respiratory drive. The hormones progesterone and estrogen increase dramatically during pregnancy. Increased levels of these two hormones alter the function of chemoreceptors on the medulla which control respiration.

The receptors become more sensitive to decreases in carbon dioxide levels which in turn causes the receptors to perceive more quickly that a person is “hypocapnic.” Perceived hypocapnia triggers a person to breathe rapidly and increases diaphragmatic effort. Sleep-disordered breathing may then occur when diaphragmatic pressures culminate in inspiratory pressures strong enough to cause upper airway collapse. A second possibility2 may be the effect of hormones on airway tissues.

Increased levels of estrogen during pregnancy result in hypersecretion of fluids, edema of the mucous membranes lining the airway, and hyperemia (tissue engorgement due to an excess volume of blood) of the mucous membranes lining the airway. These three processes narrow the upper airway passages and can allow the upper airway to close more easily during inspirations.

A recently discovered breathing pattern is causing scientists to develop new ideas on the genesis of sleep-disordered breathing during preg-

nancy. In 2000, Australian researchers Natalie Edwards et al.3 introduced the term low frequency inspiratory flow limitation (LFIFL) to describe a breathing pattern noted in pregnant patients who appeared to have normal oxygen saturation (SaO2) and no apparent OSA or hypopnea. They noted that the oral/nasal channel on the polysomnogram showed evidence of airflow restriction which was occurring dur- Regina Patrick ing inspirations only. The airflow restriction manifested as short-lasting fluctuations of one to five cycles per second.

They named the fluctuations low frequency inspiratory flow limitation.

Edwards et al. are not clear why LFIFL occurs but suggest that the restriction may result from circulating relaxant factors which allow airway tissues to be drawn together more easily.

Pregnant women with OSA, hypopnea, or LFIFL have an increased risk of developing a potentially fatal complication of pregnancy called preeclampsia. Pre-eclampsia is characterized by hypertension, edema, and proteinuria (presence of protein in the urine). If left untreated, hypertension may result in hypertensive encephalopathy or ruptured blood vessels in the brain. Other symptoms that can occur with untreated preeclampsia are: headache, visual disturbances, confusion, abdominal pain, impaired liver function with elevated liver enzyme levels, diminished urine output, pulmonary edema, microangiopathic hemolytic anemia (anemia resulting from the destruction of red blood cells within the small blood vessels), and a low blood platelet count. In pre-eclampsia, the systolic pressure is greater than 140 mm Hg and the diastolic is greater than 90 mm Hg. Typically, symptoms of pre-eclampsia begin during the third trimester of pregnancy and may last up to two days after delivery.

If symptoms of pre-eclampsia can not be alleviated by less aggressive therapy such as bedrest or anti-hypertensive drugs, a physician can immediately stop the progression of symptoms by inducing labor and delivering a baby before full-term.

Pre-eclampsia develops into eclampsia when seizure or coma occurs. During an eclamptic seizure, uterine muscular activity is increased and vasospasms occur in placental vessels reducing placental blood flow. A potentially life-threatening consequence of an eclamptic seizure for both mother and infant is premature detachment of the placenta. Placenta is normally expelled (i.e., detaches from the uterus) only after the birth of an infant. Fetal death can occur if the placenta detaches before birth (i.e., prematurely) since the fetus’ only source of nutrients and gas exchange is through the placenta. Premature placental detachment can result in maternal death due to uncontrolled bleeding. Placental vessel vasospasms during a seizure can result

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

in fetal death due to hypoxia. Eclampsia occurs anywhere from around the 20th week of pregnancy to up to three weeks after a woman has delivered her baby. The hypertensive criterion for eclampsia is a systolic pressure greater than 160 mm Hg and diastolic pressure greater than 110 mm Hg. Infants born to women with sleep-disordered breathing often have intrauterine growth restriction (IUGR). That is, an infant is smaller-thannormal for his gestational age as a result of an in utero problem that affects gas exchange and delivery of nutrients through the placenta during pregnancy. Disruptions in gas exchange and delivery of nutrients through the placenta is called placental insufficiency.

Placental insufficiency can result from maternal health problems and maternal lifestyle or habits. For example, smoking and cyanotic heart disease in the mother can lower the amount of oxygen available to placental blood; diabetes, hypertension, or other vascular disease in the mother can hinder gas exchange across the placenta; and maternal malnutrition or anemia can damage the placental tissue itself and thereby disrupt gas exchange and nutrient delivery. Scientists now believe that the repeated maternal hypoxia that occurs in sleep-disordered breathing can result in insufficient placental delivery by disrupting proper gas exchange.

Scientists are not clear why placental insufficiency causes IUGR but animal studies4 are pointing to a possible cause: placental insufficiency apparently reduces the amount of growth factors needed in the uterus to promote fetal growth. Consequently, a developing fetus has a smaller size.

The consequences of placental insufficiency may continue throughout an offspring’s life. In various ovine studies, researcher Richard Harding5,6,7 found that several weeks after birth IUGR lambs (i.e., lambs born of mothers in which placental insufficiency had been induced) have increased blood levels of CO2 during both sleep and wake and the lambs have a decreased response to hypoxia but maintain a normal response to hypercapnia. This suggests that placental insufficiency may either affect the development of the brainstem chemoreceptors controlling respiration or the development of other respiratory chemoreceptors in a developing fetus. Additionally, Harding found that the structure of the lungs of the IUGR lambs is altered (e.g., decreased amount of alveoli, thickened interalveolar septa, and a thickened basement membrane) and the lungs have a decreased ability to inflate. This suggests that placental insufficiency may alter the structure of lung tissue or may alter the mechanics of lung tissue. The consequences of these changes on chemoreceptors and lung structure may result in lifelong problems in maintaining proper ventilation.

Continuous positive airway pressure (CPAP) treatment appears to benefit women who have sleep-disordered breathing during pregnancy.

In pre-eclamptic women, CPAP treatment causes an immediate reduction in blood pressure1,2,3. Additionally, CPAP treatment prevents intrauterine growth restriction of a fetus. Edwards et al.1 reviewed several cases in which women with OSA who were treated early during their pregnancies (within the first trimester) delivered normal-sized infants.

Jennifer R. Santiago et al.2 reviewed several studies involving sleep-disordered breathing during pregnancy and noted four studies in which women received treatment for their sleep-disordered; three of these four delivered normal-sized infants.

Although more studies are needed, findings such as these are encouraging. More studies are needed to determine how best to use

treatment (e.g., CPAP) for sleep-disordered breathing during pregnancy.

If correctly used, treatment may prevent the development of pre-eclampsia (or other pregnancy complications such as pulmonary hypertension) and may delay the need or prevent the need to induce labor and delivery in an effort to stop the progression of symptoms to eclampsia. For a fetus, treatment may prevent the consequences of placental insufficiency (e.g., IUGR, alterations in lung physiology, alterations in chemoreceptor development). After birth, treatment may prevent an infant from suffering possible lifelong consequences (e.g., impaired gas exchange) of placental insufficiency. H References 1. Edwards N, Middleton PG, Byton DM, Sullivan CE, “Sleep disordered breathing and pregnancy,” Thorax, 57:555-558, 2002.

2. Santiago JR, Nolledo MS, Kinzler W, Santiago TV, “Sleep and sleep disorders in pregnancy,” Annals of Internal Medicine, 134:396-408, 2001.

3. Edwards N, Blyton DM, Kirjavainen T, et al., “Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia,” American Journal of Respiratory and Critical Care Medicine, 162(1):252-257, July 2000.

4. Wlodek ME, Westcott KT, O’Dowd R, et al., “Uteroplacental restriction in the rat impairs fetal growth in association with alterations in placental growth factors including PTHrP,” American Journal of Physiology — Regulatory, Integrative, and Comparative Physiology, 288:R1620-R1627, Jan 20, 2005.

5. Harding R, Tester ML, Moss TJ, et al., “Effects of intra-uterine growth restriction on the control of breathing and lung development after birth,” Clinical and Experimental Pharmacology & Physiology, 27(1-2):114-119, Jan-Feb 2000.

6. Maritz GS, Cock ML, Louey S, et al., “Effects of fetal growth restriction on lung development before and after birth: a morphometric analysis,” Pediatric Pulmonology, 32(3):201210, Sep 2001.

7. Harding R, Tester ML, Moss TJ, et al., “The compromised intra-uterine environment: implications for future lung health,”, Clinical and Experimental Pharmacology & Physiology, 27(12):965-974, Dec 2000.

What’s in Salt Lake City, Utah?

Plan to attend the APT 28th Annual Meeting June 18-21, 2006, and see...

• The Wasatch Mountain Range • Host of the 2002 Winter Games • Home of the worldwide headquarters of the Church of Jesus Christ of Latter Day Saints • The Mormon Tabernacle Choir • The Utah Symphony • Ballet West

• The Utah Opera • Ririe-Woodbury & Repertory Dance troupes • The Delta Center, home of the NBA’s Utah Jazz and hosts numerous national concert tours • Great family attractions ...and so much more!

And remember, flights to Salt Lake City are some of the most inexpensive in the country. For tourism details, visit: www.visitsaltlake.com/home.shtml For conference details, visit: www.apss.org and www.aptweb.org

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Accreditation: What’s in it for the Techs? ince its founding, the AASM has dedicated itself to the advancement of sleep medicine and the promotion of related research. Through their pursuit of optimal patient care standards, their promotion of education and public awareness, and their emphasis on quality control, they have helped legitimize and define the study of Polysomnography. AASM Sleep Disorders Center Accreditation is the gold standard by which all sleep programs are measured.

The distinction of accreditation ensures that an accurate study will be performed in a well-maintained, sufficiently-staffed facility of a certain quality guaranteeing patient comfort and privacy. In fact, many states require a sleep study be performed at an accredited center for reimbursement. AASM accreditation presents countless benefits to the industry as a whole, and it also presents benefits for techs.

What are the incentives or advantages for technicians who work at accredited centers?

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environment in which the technician and patient are comfortable and confident in the study and its precision.

Technicians who work at accredited centers may overlook all that is afforded them, and do not realize that the many accreditation standards benefit the technicians indirectly. Perhaps the greatest advantage for technologists stems from the measures taken during the intake process to properly screen and process patients.

The Accreditation Standard requires that written criteria for patient acceptance are put in place and that the medical director or a staff physician reviews patient charts and approves each ordered test.

Complete charts are made available to the technicians and generally include full histories and physical reports, questionnaires, assessments and evaluations along with any associated practitioner reports. This information is extremely valuable to technicians and makes for a reasonably predictable night.

Each accredited sleep disorders center must maintain a staff of trained technicians who are monitored and evaluated for quality assurance. The technicians must exercise proficiency when performing the duties outlined in their respective job descriptions.

Continuing education is another benefit that can be easily overlooked by technicians. The AASM requires accredited sleep centers to guarantee that the technicians skills and knowledge of sleep medicine is current and in line with existing industry standards.

Centers must document 10 CME’s/equivalent per year over a period of 3 years for each technician.

As outlined in the Accreditation Standards, accredited centers strive for a 2 to 1 patient to technician ratio and provide policies and procedures for each technical process. Accreditation standards also require the sleep center to maintain accessible emergency equipment and to create emergency plans that delineate the responsibilities of and the actions to be taken by personnel during specific situations. Technicians working at these centers also enjoy both patient and control rooms of more than sufficient size designed for uninhibited job function. These standards create an

Accredited centers ultimately become a primary source of information and education for other medical professionals, patients and the general public. For technicians, the benefits are invaluable; accredited sleep centers reinforce the technicians’ value to the industry, provide continued education, and create comfortable and safe working environments. Clearly, AASM accreditation creates a mutually beneficial relationship between the sleep center and the technician that is paramount to the success of sleep medicine. H

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Answers to your Questions about AASM Accreditation

1. The sleep center that I work at is applying for accreditation from the AASM, and we just received the application materials. Who should complete the application?

The AASM standards for accreditation strongly recommend that a clinical sleep medicine specialist fill out or at the very least carefully review the entire application when it is complete. The center director and medical director are ultimately responsible for the accuracy of the application. To avoid any delays, the AASM recommends that the center director and medical director, with the assistance of staff, review the application in detail to make sure every question is fully answered and to make sure all supporting material is included.

2. Is there a requirement for the number of technicians at an accredited sleep center?

The AASM position statement on polysomnographic technology requires no more than two patients per each technician. Typically, technicians work 40 hours per week. Most programs schedule their technicians for either three 12-hour shifts with some daytime work to reach

40 hours or four 10-hour shifts. This works out to eight patients per technician per week.

3. If I work at a sleep center accredited by the AASM, do I need to be certified by the Board of Registered Polysomnographic Technologists?

No. However, the AASM strongly recommends that at least one RPSGT be present in each program. Moreover, the AASM encourages all technicians to sit for the BRPT examination and strive toward certification. Passing the examination shows a commitment and shows a level of expertise necessary to perform polysomnography testing and Multiple Sleep Latency Testing. Also, RPSGTs frequently act as training resources for the program.

4. An AASM site visitor is coming to our office for the on-site evaluation. Does a technician need to be present?

According to the AASM standards for accreditation, the technical director (or laboratory supervisor) and at least one other technician must be present at the time of the site visit. The clinical director, medical director, all staff sleep physicians and all PhD-level staff must be present during the site visit. The medical director should be available during the entire visit to speak with the site visitor, answer questions and provide requested information. The office manager or supervisor and upper administration should also be present for and available during the site visit. Two physicians that commonly refer patients to the program continued on page 27

MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG • MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG • 2005 SLEEP CATALOG • MVAP MEDICAL SUPPLIES

MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG • 2005 SLEEP CATALOG • MVAP MEDICAL SUPPLIES

s a technician at a sleep center, you may have questions about American Academy of Sleep Medicine accreditation, including the accreditation standards, the application process and the site visit. Below are some question frequently asked by technicians and comprehensive responses provided by the AASM. If you are interested in learning more about AASM accreditation, visit www.aasmnet.org/ProgramOver.aspx.

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MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG • MVAP MEDICAL SUPPLIES • 2005 SLEEP CATALOG

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Health Professions Network Examines Workforce Issues Allied health leaders in meet in Louisville for 10th Anniversary epresenting the Association of Polysomnographic Technologists (APT) in the Health Professions Network (HPN), APT President Cynthia Mattice and Theresa Shumard, Director-at-Large, met with other allied health leaders recently for a look at issues related to the health care workforce shortages in Louisville, Kentucky. Information from topics addressing approaches to allied health employee recruitment, retention and educational needs, as well as generational differences between the existing workforce are valuable resources participants take back to their respective associations. Mattice is a member of the HPN Media Team and Shumard is HPN’s Media Team Leader, and on the group’s Coordinating Team.

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Helping raise awareness of allied health among policymakers and the public and urging increased federal funding for allied health education is the goal of the Health Professions Network (HPN). This nationwide collaborative group of nearly 200 organizations represents leading allied health professional associations, accrediting agencies, and educational institutions as well as federal and state workforce analysts and licensing/certification bodies.

In what seems like most appropriate timing, HPN’s tenth anniversary this year encroached upon the timing of another event — Allied Health Professions Week which was celebrated in November.

In 1995, as the Clinton Administration health care reform movement was unfolding, allied health by name and definition was noticeably absent from the documents that were being produced. Additionally, representatives from the various allied health professions, including those representing a large proportion of the health care human resources, were not included in policy-making discussions.

Realizing the importance of inclusion and recognition of allied health professions during this critical time in the nation’s history, a few visionary leaders convened the first gathering of allied health professions for the sole purpose of discussion and collaboration. An over-arching conclusion resulted from that initial coalition of leaders: that allied health professionals, who comprise the majority of the health care workforce, would remain under-represented unless they began to work together and build networks to achieve common goals. Only then could allied health collectively gain recognition from policy makers and national leaders in health care.

The allied health coalition recognized that individual professional groups lack the impact of a collaborative network, and all participants wanted to contribute to an effort that would inform policy makers of the value that allied health professions add to the nation’s health care system. This was a significant turning point for allied health professions.

Collaboration was needed to ensure continued support and funding for professions that, if gone unrecognized, could be in jeopardy. If allied health professions were not considered as appropriate for reimbursable services or federal funding, allied health education programs could be eliminated and professions could become obsolete.

The political and economic climate in health care at this time was primed for spending less money on multi-skilled providers if specialized allied health professionals were no longer available. Non-credentialed personnel with minimal, if any, formal specialized training were being prepared to perform procedures that previously had been reserved for more educated and credentialed individuals. Extensive preparation and commensurate licensure or certification verifying skill level were leveraged against providing care for less cost. continued on page 23

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Negotiating Managed Care Contracts: Key Points for Sleep Disorder Centers

BY JAYME R. MATCHINSKI, ESQ. here are several traps that sleep disorder centers may encounter and fall into during the negotiation, execution, and renewal of managed care contracts. Historically, managed care contracts were adhesion contracts that were provided to sleep disorder centers by a managed care organization (MCO) for signature with little, if any, discussion or negotiation prior to the execution of such contracts.

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Emerging state and federal managed care legislation and patient rights initiatives have had a tremendous impact on managed care contracts and sleep disorder center’s involvement in such agreements.

Sleep disorder centers should pay close attention to the following provisions in their managed care contracts to ensure that the center is signing a contract which specifically defines its relationship with the MCO and eliminates the potential for unwarily becoming trapped after the contract has been signed.

Reimbursement for Services Managed care contracts provide a full range of reimbursement methodologies including: fee-for-service; per diem and case rates; capitation; capitation with “Bill Aboves” for specific services, and other risk arrangements. Some states require that reimbursement issues be addressed in written agreements with providers.

While reimbursement is an obvious contract term to review, managed care contracts often conceal the reimbursement scheme in incomplete or over-simplified schedules. Managed care contracts sometimes are silent on specific terms for reimbursement. When your lab is contracting to provide services in exchange for traditional fee-for-service, per diem rates, per case rates, capitation, percentage of premium or some other combination, make sure that the managed care contract specifically delineates each type of service entitled to reimbursement and the rate of reimbursement for each service.

Undefined Provider Responsibilities/ Delegation of Duties Sleep disorder centers often do not realize that a managed care contract might require additional responsibilities Jayme R. Matchinski, Esq. during the course of treating patients which include extensive involvement in utilization management, medical management, member relations, credentialing, and compliance with specific accreditation standards. A MCO typically will delegate certain administrative duties to the sleep disorder center which is sharing the risk with the MCO (e.g. capitation agreements or risk pool arrangements). Make sure that any responsibilities and duties which the sleep lab is expected to perform under the contract and are contingent upon the lab’s receipt of payment are clearly identified and defined within the parameters of the contract and any attached exhibits.

Prompt Payment and Balance Billing The sleep disorder center should specifically review the prompt payment provisions in any managed care contract as related to the state law that governs the contract and recent court decisions and legislative trends. The contract most likely will require the sleep lab to submit a “completed claim” as a condition to receiving payment. Make sure that “completed claim” is specifically defined within the contract or an attached exhibit. A defined term will enable the parties to reach a consensus on what will be deemed a “completed claim” for coordination of benefits and the timing and recovery of payments. A sample “completed claim” definition might include the following language: “Completed Claim” is an industry billing form (UB-92, HCFA 1500 or any successor form) which: provides the Beneficiary’s name and identification number, claim date, date of birth, Group name and number; Provider’s name and identification number; dates and location of services, description of procedures, diagnosis code (ICD-9-CM), secondary diagnosis code (ICD-9-CM), most current ICD version, procedure codes (CPT-4), DRG, units, modifiers and amount billed for each procedure, where applicable, and includes itemized claim statements and/or Beneficiaries’ medical records if requested by Payor within twenty (20) calendar days after Payor’s receipt of a claim described in Section __ of this Agreement.”

You should note that some state statutes set forth detailed provisions relating to completed claims and balance billing, which may modify the contract and impact the other definitions and terms set forth in the contract. Most states have statutes which address MCOs, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and third part administrators (TPAs). It is important that the sleep disorder center and its attorney understand all applicable state requirements regarding mandatory language for managed care contracts. continued on page 26 15

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Sleep Crossword Puzzle

BY SANTA CLAUDE Down

1. REM [Blank] 4. Respiratory Inductance [Blank] 5. Happens when falling asleep 6. Sleep neurotranmitter 9. Sleep Talking 10. Annoying Breathing sounds 11. Sleep Walking 12. New term for Auto-titrating PAP 13. New term for Bi-Level PAP 14. Sleep Display Across

2. [Blank] Sharp wave 3. Cyclic Alternating Pattern 7. To cause sleep 8. Grandfather of Sleep 14. Happens when awakening from sleep 15. Term for Continuous Positive Airway Pressure 16. Snoring surgery 17. Father of UAR 18. Father of Sleep Medicine Solution on page 32.

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Whether studying for the board exam or training new technicians, APT Registry Exam Flashcards are a great resource, and an excellent way to study.

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Allows student to not only use the questions as a study guide but also as a reference for further review.

Includes examples of sleep stages and event recognition, definitions for cardiac events, and artifact, complete with the information on how to fix these types of artifacts. Excellent tool for technologists to use for study or to enhance skills on troubleshooting and artifact elimination.

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Go to page 29 for ordering instructions & prices.

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Scenes from the 2005 APT Fall Review Course hese photos depict scenes at the APT Fall Review Course held in Dallas, Texas, October 25-25, 2005. There were 188 registrants, 19 vendors and three sponsors including Tyco Health Care, Nihon Kohden America and SensorMedics at the conference. The APT would like to give special thanks to its Supporter Members: Protech Services and Cadwell Laboratories.

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The APT wishes to thank the following vendors for exhibiting at the conference:

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• Bio-Logic Systems Corporation • The Board of Registered Polysomnographic Technologists • Braebon • Cadwell Laboratories • Compumedics USA • Fisher & Paykel Healthcare • Grass Telefactor, An Astro-Med Inc. Product Group • Lippincott, Williams & Wilkins • MVAP Medical Supplies, Inc. • Nihon Kohden America

• • • • • • • • • • • •

Pro-Tech Services ResMed Respironics, Inc Rochester Electro-Medical, Inc. SensorMedics SleepMate SleepNet Sleep Healers SLP, Inc. Syntech Solutions Tyco Healthcare XLTEK

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

T-SHIRTS BENEFIT HURRICANE KATRINA VICTIMS These front and back views of a t-shirt, designed by Karen Allen, RPSGT, of Billings, Montana, went on sale at the Montana Regional Sleep Conference, held this fall at the St. Vincent Health Care System. Proceeds are being donated to members of the Sleep Community impacted by Hurricane Katrina. Allen is a longtime APT member and coordinator of the Billings conference annually, slated for its tenth anniversary in 2006.

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Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

W E T E A C H Y O U F I R S T. Our innovative, web-based learning series is coming to a classroom near you. With extensive video and hands-on demonstrations designed to benefit new and experienced sleep professionals, these classes will definitely not put you to sleep. Continuing education – another facet of our Customer First initiative.

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Go to page 29 for ordering instructions & prices.

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Technical Corner Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

A2Zzzz Technical Corner

BY MARY JONES-PARKER, RRT, RPFT, RPSGT Question: You wrote an article a few years back about why patients with COPD tolerate BiPAP better than CPAP, and I can’t seem to find it. Would you reprint the piece as I am training a new technologist and I wanted to share it with her?

Answer: The vast majority of adults with obstructive lung disease have chronic disease in the lower airways that we call “COPD” which is the acronym for Chronic Obstructive Pulmonary Disease. The main obstructive diseases of the lower airways include bronchial asthma, chronic bronchitis, and emphysema. To answer your question, let’s review what physiological processes occur in Chronic Obstructive Pulmonary Disease. It should be noted that the majority of patients with moderate to severe chronic bronchitis have some overlapping degree of emphysema. In fact, these two diseases often coexist.

Committee on Accreditation for Polysomnographic Technology Education (CoA PSG) Is your Polysomnographic Technology Training Program accredited? The CoA PSG is now accepting applications for accreditation from allied health education programs.

CoA PSG accreditation is the gold standard for sleep technology educational programs and has several benefits: • Access to formal and standardized educational resources • Recognition of your program’s quality curriculum and instruction • Recognition by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) • Prepares your students for the national credentialing examination • Recognition by professional societies, including the American Academy of Sleep Medicine, Association of Polysomnographic Technologists and Board of Registered Polysomnographic Technologists Visit www.caahep.org/accredit.aspx?ID=obtainCredit for information on the accreditation standards and guidelines or contact Dr. Richard Rosenberg at (708) 492-0930 for more information.

In chronic bronchitis, the most characteristic feature is an increase in the size and numbers of sub-mucous glands in the large bronchi. The presence of secretions can cause considerable obstruction and narrowing of the airway lumen. The primary pathologies in asthma are smooth muscle spasm around the airways, swelling of the mucosa, and thick secretions.

Emphysema, in contrast to bronchitis and asthma, occurs at the alveolar level.

The primary pathologic processes associ- Mary Jones-Parker ated with emphysema include: loss of lung elasticity, lung hyperinflation (the lung does not recoil to its normal resting position during expiration), airway collapse, and air trapping. With lung hyperinflation intra-pleural pressures remain in more positive (in pulmonary medicine this is called automatic positive end expiratory pressure or Auto-PEEP, which is, in essence, an intrinsic positive airway pressure of the airways very similar to mechanical CPAP) and greater muscular effort is necessary to exhale completely.

The common characteristic in all three diseases is impaired expiration: due either to airway narrowing or secretions. CPAP increases the resistance to exhalation, and in individuals who already have a compromised expiratory flow, this may not be tolerated. In addition CPAP increases the functional residual capacity (FRC) and as we already have learned, because of airway collapse, the FRC is usually elevated to begin with.

In an article published in the American Journal of Respiratory Care and Critical Care Medicine in January 1999, the authors noted that in patients with chronic lung disease, the major cause of nocturnal desaturation was a reduction in tidal volume.CPAP cannot increase tidal volume, but bi-level can as long as there is a large enough gradient between the inspiratory and expiratory pressure to overcome the dynamic airway collapse. Because of the muscle fatigue associated with chronic obstructive lung disease, the increase in tidal volume generated by bi-level positive airway pressure will rest the chest wall muscles. In summary, patients with COPD are less likely to tolerate CPAP when compared to bi-level for three reasons: CPAP creates a resistance to expiratory flow, it does not increase tidal volume, and it increases FRC. H “For what seemed ages piled on ages, I lay there, frozen with the most awful fears, not daring to drag away my hand; yet ever thinking that if I could but stir it one single inch, the horrid spell would be broken. I knew not how this consciousness at last glided away from me; but waking in the morning, I shudderingly remembered it all, and for days and weeks and months afterwards I lost myself in confounding attempts to explain the mystery.”

—Moby Dick, Chapter IV

by Herman Melville, 1851 21

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

APT Standing Committee Roster 2005-2006 Communications Committee Kimberly Burns, Chair Kenneth Chapman Joshua Cole Scott Cole J.L. Magee Erby Williams Joanne Hebding, Board Liaison Education Committee Melinda Trimble, Chair Jeanette Robins Vice Chair Educational Programs Shirley Hodges Laura Linley Mary Jones Parker Crintz Scott James Shigley Kim Trotter Katrina Warren Michael Delayo, Vice-Chair Educational Products Terrence Malloy Quentin Worthen, Vice-Chair Continuing Education Credits W. Michael Chris Steven Lenik Theresa Shumard, Board Liaison Membership Committee Debbie Akers, Chair Jeffrey Smith, Vice-Chair Michael Adams Joseph Anderson Iain Boyle Laree Fordyce Jane Hodges Robert Monroe David Gregory, Board Liaison Regional Activities Committee Mary Kay Hobby, Chair Shawn Cole, Vice-Chair Robert Evelyn Charlotte Fromer Jennie Hall Angela Neal Marilyn Swick, Board Liaison Standards & Guidelines Committee Tina Jenkins, Chair Elise Franko, Vice-Chair Frank Walther William Eckhardt, Board Liaison

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APT Directory President Cynthia Mattice, MS, RPSGT Past President Rose Ann Zumstein, RPSGT Secretary Cindy Kistner, RPSGT Treasurer Bill Rivers, RPSGT

Directors at Large Jon Atkinson, RPSGT David Gregory, RPSGT Joanne Hebding, RPSGT Theresa Shumard, BA Todd Smeltzer, RPSGT Marilyn Swick, RPSGT

Contact Us

If you have questions about any of the following, please contact the APT National Office: Membership, Advertising, Billing, Publications’ Circulation, Mailing Labels, Products, Orders and General Questions.

APT National Office Christopher Waring APT Coordinator One Westbrook Corporate Center Suite 920 Westchester, IL 60154 Phone 708-492-0796 Fax 708-273-9344 cwaring@aptweb.org

Billing Questions Phone (708) 492-0796 APTWeb Website/Technical Issues E-Mail support@aptweb.org

Editorial Questions

If you have editorial questions, please contact: A2Zzz Magazine Editorial Office 25 Madison St. Shillington, PA 19607 Phone 610-796-0788 Fax 781-823-4787 Sleep-Related Organizations American Academy of Sleep Medicine One Westbrook Corporate Center, Suite 920 Westchester, IL 60154 Phone 708-492-0930, Fax 708-492-0943 webmaster@aasmnet.org BRPT Management Office 8201 Greensboro Drive, Suite 300 McLean, VA 22102 Phone 703-610-9020, Fax 703-610-9005 brpt@amg-inc.com, www.brpt.org Committee on Accreditation for Polysomnographic Technology Education (CoA PSG) Visit www.caahep.org/accredit.aspx?ID=obtainCredit for information on the accreditation standards and guidelines, or contact Dr. Richard Rosenberg at (708) 492-0930.

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Health Professions Network Examines Workforce Issues

CPAP Desensitization in the Sleep Lab

continued from page 14

continued from page 9

In the face of these many challenges, the allied health leadership recognized the need not only for cohesiveness but also for communication. A network of professional organizations could collectively keep informed more efficiently and effectively than any one individual organization. Also, individual groups could stay on the lookout for any changes affecting another profession or the allied health community, in general. Most importantly, a network would allow for a single, strong voice to advocate for allied health.

Beth Israel Deaconess Medical Center, Faulkner Hospital, Hallmark Health, and McLean Hospital, all located in Massachusetts. The Sleep HealthCenters Management program involves intensive patient counseling and education as well as monitoring for problems and compliance and follow up for a full year. This is done by qualified “CPAP counselors” through clinic visits and phone calls. Charting on the patient is sent to the physicians to keep them informed.

The result of this discussion was a loosely structured “organization of organizations” intended to promote recognition of the value and importance of the allied health professions and communicate collaboratively to advocate for allied health as a whole. Thus, the Health Professions Network was formed.

Because many labs don’t necessarily have the full time staff to cover such a program, they may perhaps consider starting off slow, by opening an afternoon per week as a drop in clinic for patients struggling with CPAP. The daytime technologist can be trained to deal with these patient issues, and find a solution for them in changing the mask, trying a different mode of CPAP, or giving them desensitization instructions.

Participants attended the following sessions at the HPN’s fall meeting, sponsored by the Louisville Convention and Visitors Bureau: Organizational Behavior Meets Generation X and Y — A Practical Approach. Richard A. Lewis, CRA, Director of Operations, Florida Radiology Imaging.

Panel: What Federal Agencies Are Doing Regarding HealthCare Workforce Development and Other Initiatives Gina N. King, Business Relations Group, US Department of Labor, Washington, DC; and Young Song, MS, MPH, RD, Health Resources and Services Administration, Rockville, MD. Are We Graduating Enough Health Care Providers to Meet Current and Future Needs? Pat Munzer, MS, RRT, Chair, Allied Health Department, Washburn University, Topeka, KS. Employee Retention: Got Them? Keep Them. Hazel Hacker, Edison Imaging Associates, Edison, NJ. How Mapping Can Support Allied Health Professionals. Ann Peton, RUPRI’s Community Information Resources Center (CIRC), Columbia, MO.

Outcomes and follow up is key, otherwise, you’d never know if your hard work is paying off for the patients. It’s important to document, especially if you are not able to bill for these services. The administrator of the lab will want data to convince her/him that the program is working, and as a bonus, there may even be referrals back to the lab for studies as a result of the program.

For those sleep labs interested in starting a desensitization program, but not knowing where to turn, there are a number of references and resource articles available through the Internet. The American Sleep Apnea Association (ASAA) has an article on CPAP compliance and desensitization at: www.sleepapnea.org/info/practitioner/cpappatient.html. The sleep centers mentioned above also have Web sites that describe their programs.

Either way, it should be an important part of our jobs as technologists, to not only titrate patients and send them on their way, but to make sure they have the resources to continue therapy. H

For more information about the HPN, please visit www.healthpronet.org H

Answers to your Questions about AASM Accreditation continued from page 13

Sleep Disorders Technologists UNIVERSITY

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S.E. PA - Del Regional Centers

and two physicians who are consultants to the program will be asked to meet with the site visitor. Since each program’s operation varies, however, the clinical director and medical director should determine which additional members of the staff should be present during the site visit in order to provide a good overview of the day-to-day operations.

5. Who can read sleep studies?

The AASM accreditation standards do not set qualifications to read sleep studies. Generally, doctoral-level professionals read and interpret sleep studies, and a D, ABSM then reviews and signs-off on the study.

Qualifications and privileges that outline eligibility for reading sleep studies are usually determined by each faculty and then approved by the medical director. However, these qualifications and privileges must be clearly stated in the policies and procedures manual and followed at the center. H

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Multiple locations, good working environment, competitive pay.

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NewZzz Briefs Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Pro-Tech Wins National Institutes of Health Contract for Web-Enabled PSG Information Sharing Platform SBIR Phase I Project to be based on SleepXML platform Mukilteo, WA — Pro-Tech Services, Inc. (www.pro-tech.com), a leader in diagnostic sleep instrumentation, has won a Phase 1 Small Business Innovation Research (SBIR) award for $400,000 from the National Institutes of Health (NIH). The project, entitled Peer-to-Peer Knowledge Integration Platform for Heterogeneous Data in PSG, is for the development of web-centric methods and tools for distributing and sharing integrated polysomnographic data. This work is to be completed over a 24-month period beginning August 1, 2005.

There has been an enormous increase in the number of clinical and research Nocturnal Polysomnography (NPSG) studies being performed in the past decade. These studies represent a valuable investment of research effort and dollars, but their interchange among researchers is limited by both the proprietary and non-standardized format in which the data are stored, and the absence of software tools for data sharing and exchange. There are several standards existing for PSG data interchange that adequately deals with raw data, the most well known is EDF — European Data Format. However, the processed PSG data (e.g., sleep stage scores, respiratory scores and other events, as well as reports) are not addressed by these existing standards. All these processed data are necessary for a complete description of a polysomnogram, but no common language existed for such data exchange. There are a variety of PSG events, score and report definitions, all of which are in some proprietary vendor formats.

To address this problem, Pro-Tech Services plans to develop Internet-centric methods and software tools for the rapid handling of PSG information using an XML dialect. This dialect, named SleepXML (www.SleepXML.org), was recently developed by Pro-Tech and allows for describing PSG Data. SleepXML aims to provide a flexible, extensible, non-proprietary, open electronic language capable of describing polysomnographic data and presents tools that could be used for the data transformation, archiving and exchange.

“We are pleased to announce our first grant from the National Institutes of Health,” said Jim Johnson, CEO and President of Pro-Tech Services Inc. “What makes this competitive award significant is the selection of Pro-Tech Services by a peer review process. The selection criteria were heavily weighted on the technical expertise of our Software Development department and our position as a market leader in diagnostic sleep instrumentation. We want to emphasize the fact that SleepXML is not a new format to describe PSG events and other data; it is a common XML-based language that allows different labs or research groups to have different definitions of their data and still to be able to understand each other and exchange the data.”

About SBIR Grants The U.S. National Institutes of Health SBIR program is a highly competitive program that encourages small business to explore their tech24

nological potential and provides the incentive to profit from its commercialization. By including qualified small businesses in the nation’s research and development arena, high-tech innovation is stimulated and the United States gains entrepreneurial spirit as it meets its specific research and development needs. Since its enactment in 1982, as part of the Small Business Innovation Development Act, the SBIR program has helped businesses compete for federal research and development awards. The contributions of these small businesses have advanced health care, protected our environment, and improved our ability to manage information and manipulate data.

The Phase I SBIR award is intended to establish project feasibility and leads to a Phase II SBIR project for full implementation.

About Pro-Tech Services, Inc. Since 1987 Pro-Tech Services, Inc. has been specializing in the field of sleep disorders medicine and is uniquely situated as a manufacturer of sleep diagnostic equipment. Pro-Tech is the leading developer, manufacturer, and supplier of diagnostic sensors to the sleep medicine field. As a supplier of quality sleep sensors, it works closely with all of the manufacturers of equipment used in the diagnosis of sleep related breathing disorders.

Addressing the needs of its customer base, in 2003 Pro-Tech established the Software Development department and invited Vladimir G. Ivanov, Ph.D. to head it as a Chief Software Architect. During the past 12 years Dr. Ivanov was the Principal Investigator for a number of NIH-funded SBIR projects and worked on biomedical applications related to computerized PSG, EEG and evoked potential data acquisition and analysis systems. Dr. Ivanov will lead the SleepXML SBIR project as Principal Investigator.

For additional information please contact Jim Johnson, CEO and President, e-mail jimj@protech.com, phone 800-919-3900; or Vladimir Ivanov, Principal Investigator, e-mail vladimiri@pro-tech.com, phone (425) 609-4542.

Coffee and High Blood Pressure Two long-running studies of more than 150,000 female nurses showed that drinking coffee did not seem to cause long-term high blood pressure. In fact, there was some evidence that women who drank four or more daily cups of regular or decaffeinated coffee had a slightly lower risk of developing high blood pressure than those who drank little or none. A possible explanation is that coffee has a lot of antioxidants, substances that are believed to help protect the heart and reduce the risk of cancer. Researchers cautioned that the study was not conclusive.

Circadian Commentary Coffee drinkers, and their employers, will be happy to hear the results of this study. After all, a well-timed cup of coffee can help workers stay alert on the job and be productive. This is probably why more than eighty percent of extended hours employees drink coffee on a daily basis. Just be aware that the effect of caffeine in coffee produces varies considerably from person to person. People who are very sensitive to caffeine may find that drinking even a little bit of coffee can disrupt their sleep. For most people it is generally wise to avoid caffeine three to four hours before sleep and refrain from drinking more than 3-4 cups per day (if that much).

Source: Andrew Moore-Ede, ame@circadian.com, Circadian Technologies Business Insider

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NewZzz Briefs Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Obstructive Sleep Apnea Facts • It is estimated that about 5% of the US population suffers from Obstructive Sleep Apnea (OSA).

• Only 10% of the affected individuals have the condition diagnosed and treated.

• Survey results suggest that 26% of Americans show risk factors for being at high risk for OSA. Source: Circadian Technologies Business Insider

Survey Reveals Older Americans’ Attitudes Toward Sleep, Healthy Aging NEWSWISE — According to results of a new Gallup survey by the International Longevity Center-USA (ILC), almost half (46 percent) of older adults receive fewer than seven hours of sleep each night, and a quarter (25 percent) believe they have a “sleep problem.” Furthermore, older adults have concerns about taking prescription sleep medications including addiction, next-day grogginess and long-term side effects.

Although most older adults (80 percent) recognize the importance of sleep to their health, many who experience trouble sleeping remain untreated. According to the survey, 53 percent of adults who have spoken with their healthcare providers about a sleep problem are not receiving treatment.

“The importance of sleep to healthy aging is often overlooked in the medical community, but it’s becoming increasingly apparent that good sleep could be a new vital sign,” said Robert N. Butler, M.D., president and chief executive officer of the ILC. “Poor sleep is a condition that needs to be addressed, diagnosed and treated — it could be as important as nutrition, exercise and social engagement to the health of older adults.”

The Gallup survey also showed that 77 percent of older adults expressed concerns about the long-term effects of prescription sleep aids and nearly seven in ten (68 percent) are concerned about becoming addicted to them. Fewer than one in ten respondents (9 percent) deemed prescription sleep aids as “very safe.”

Caregiver Worries Why are older adults suffering from sleepless nights? Worry is a common factor that interferes with nearly 40 percent of older adults’ ability to fall asleep — a trend that is especially common among primary caregivers. According to the survey, half of caregivers (50 percent) report that worrying has interfered with their ability to fall asleep.

“As the population continues to age, many older Americans are assuming the role of primary caregiver for a parent or relative — a position often accompanied by high levels of anxiety,” said Dr. Butler. “It is no surprise that this stress and the need for round-the-clock care often interfere with getting a good night’s sleep.”

About the Survey and Consensus Conference Findings of the survey were presented at the ILC’s Sleep and Healthy Aging Scientific Consensus Conference being held November 2-4 in New York City. The nation’s top medical experts are convening at the confer-

ence to discuss a range of topics including the challenges caregivers face in getting good sleep, the relationship between exercise and sleep, and the unique effects of sleep on older adults’ quality of life. Additional survey results include the following: • Respondents ranked good sleep quality as the fourth most important factor to a healthy lifestyle, following good nutrition, mental sharpness and regular exercise.

• Older men are more likely than older women (38 percent vs. 27 percent) to say they get a good night’s sleep seven days a week.

• The 46 percent of adults who describe their health as excellent are the most likely group to say they get a good night’s sleep every night of the week.

• Forty-five percent of older adults feel they need more sleep today than when they were young.

The random telephone survey of 1,003 adults 50 years of age or older was conducted by The Gallup Organization for ILC to examine older adults’ knowledge of the importance of sleep, their sleep behaviors and their attitudes toward sleep and aging. The results have been statistically adjusted to be nationally representative of all adults age 50 and older. Additional information about the survey can be found at www.ilcusa.org.

The International Longevity Center-USA is a research policy organization in New York City and has sister centers in Europe, Asia, Latin America and Africa. Led by Dr. Robert N. Butler, a world renowned physician specializing in geriatrics, the Center is a non-for-profit, non-partisan organization with a staff of economists, medical and health researchers, demographers and others who study the impact of population aging on society. The ILC-USA focuses on combating ageism, healthy aging, productive engagement and the financing of old age. The ILC-USA is an independent affiliate of Mount Sinai School of Medicine and is incorporated as a tax-exempt 501(c)(3) entity.

The Gallup survey and the Sleep and Healthy Aging Scientific Consensus Conference are supported by an unrestricted educational grant from Takeda Pharmaceuticals North America, Inc.

Help Just a Phone Call Away for Individuals Affected by Memory Loss NEWSWISE — When it comes to Alzheimer’s, you are not alone. That is the message the Alzheimer’s Association is sending out to people with Alzheimer’s, their families and caregivers in a nationwide campaign during National Alzheimer’s Disease Month (NADM) which is held in November and was established by former president Ronald Reagan in 1983.

The Alzheimer’s Association’s has launched the “Make the First Call” campaign, a nationwide public education initiative to educate the public about the Association’s Helpline which provides 24-hour assistance, 7 days a week at 1.800.272.3900.

The Helpline is a confidential service, staffed by master’s level clinicians who provide callers with information about understanding dementia, Alzheimer’s diagnosis, treatment options, caregiving information and crisis assistance. Through the Helpline, callers can also be connected to continued on page 26 25

NewZzz Briefs Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

NewZzz Briefs continued from page 25

local Association chapters which are the premier local resource for help with memory loss. In 2004, the Association received more than 240,000 calls.

Since the first National Alzheimer’s Disease Month in 1983, the number of people with Alzheimer’s has increased from 2 million to 4.5 million.

“Alzheimer’s is a devastating and overwhelming disease and people often feel ashamed by it or don’t know where to turn for help. We want people to know that the Alzheimer’s Association is there to help,” said Kathleen O’Brien, senior vice president, program and community services, Alzheimer’s Association. “One simple call to the Alzheimer’s Association can be the first step to helping individuals and families regain control and confidence over this disease. Our Helpline is staffed by trained and knowledgeable individuals who are there to listen with a sympathetic ear. Each caller’s questions or concerns are important to us.”

The Alzheimer’s Association, the world leader in Alzheimer research and support, is the first and largest voluntary health organization dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer’s. For nearly 25 years, the donor-supported, not-for-profit Alzheimer’s Association has provided reliable information and care consultation; created supportive services for families; increased funding for dementia research; and influenced public policy changes.

The Alzheimer’s Association’s vision is a world without Alzheimer’s and its dual mission is to eliminate Alzheimer’s disease through the advancement of research and to enhance care and support for individuals, their families and caregivers. For more information, visit http://www.alz.org or call 800-272-3900.

News from the ASAA Plans are underway for Sleep Apnea Awareness Day 2006. It will be held on March 30, 2006. We will have available for distribution the Snore Score flyers. The flyers were very popular last year for use at health fairs and open houses.

This year the ASAA is launching a public awareness campaign using a public service announcement for television and perhaps radio. The 30second spots will begin airing in January on some broadcast and cable channels around the country. We are planning to have copies of the PSAs available for use on public access channels.

There will be another lecture in Washington. We have not finalized the speaker yet, but if you will be DC on March 30th, please make plans to attend the event.

The ASAA online support group — Apnea Support Forum (www.apneasupport.org) continues to increase in registered members. Started in June of 2005, the forum now has over 1,200 registered members. In addition to the message board there is a weekly scheduled chat. The chat is so popular; you can usual find patients talking most evening. The forum has sections reserved for sleep professionals and A.W.A.K.E. coordinators. They are visible only usergroup members.

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We are glad to make this service available to sleep apnea patients with questions and looking for encouragement with treatment.

There are still SLEEP — A.W.A.K.E. wristbands available. We are using the wristbands as a fundraising tool for sleep apnea research. To date we have sold over 1500 wristbands. They make great stocking stuffers. H

Negotiating Managed Care Contracts: Key Points for Sleep Disorder Centers continued from page 15

Dispute Resolution An alternative dispute resolution (ADR) should be included in the sleep lab’s managed care contract so that the parties have a mechanism to resolve disputes when they arise. The sleep disorder center should consider including one of the following ADR methods in its contract: an internal administrative determination or appeal as a prerequisite to any further process, nonbinding, conciliatory dispute resolution processes, such as mediation, and binding adjudicatory alternatives to litigation, such as arbitration. Any one of these ADR methods would probably avoid the cost, delay and unpredictability of litigation. The sleep lab should check its state law regarding any limitation on the use of arbitration because some states have placed limitations on the use of arbitration when the dispute involves professional liability. An internal administrative process or mediation may give the center greater control over the identity and qualifications of the decision-maker.

The ADR provision should include specific language identifying the ADR method, how the mediator is chosen, and minimum qualifications of the mediator. The managed care contract should also identify the allocation of cost for ADR between the parties and the location of the ADR. The best time to agree to an ADR process is before a dispute occurs.

Renewal Provisions Remember to include a provision within the contract which states that fees will be negotiated separate and apart from the renewal terms of the contract. Usually, the contract will automatically renew for additional one-year terms unless one party provides written notice. An MCO often ties the sleep lab’s ability to renegotiate fees received under the contract to the renewal provisions which is automatic unless either party provides notice. Therefore, the sleep disorder center should make sure that fees can be renegotiated on a more frequent basis than the renewal provision of your contract.

To avoid potential pitfalls, sleep disorder centers should carefully review the proposed terms of its managed care contract including all provisions related to reimbursement for services, delegation of duties, prompt payment and balance billing, dispute resolution, and renewal terms. H About the Author Jayme R. Matchinski, a partner with the law firm of Harris Kessler & Goldstein LLC, in Chicago, concentrates on health care law and has counseled sleep disorder centers, physicians, and health care providers nationally. She can be reached at (312) 280-0111 and jmatchinski@hkgold.com.

Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

High School Athletics and the Sleepy Teen Athlete

nicotine, alcohol, and other agents. This would also be a good time to point out the dangers of driving while you are drowsy.

continued from page 9

The athlete for their part is able to control some of the pieces that will enable them to perform at an optimal level. They should try and maintain a regular sleep schedule even on the weekends. They must refrain from extended naps during the daytime that will make it difficult to be sleepy at night. Coffee and caffeine-containing products should be kept to a minimum or eliminated after lunchtime. Their exercise workouts should be done several hours before bedtime. They should have an uncluttered room with a cool temperature and low lighting in order to set the stage for a good night’s rest. They also need to stay away from stimulating, or scary TV shows or movies before bed. Some other behaviors that reduce distractions include turning off the cell phone, music, television, earphones etc when settling in to bed for the night.

sleep time for teens has been shown to cause them to have difficulty in concentrating, becoming moody, or depressed. In schools with early start times, teens have been described as “walking zombies” and mood and behavior has been less than desired. If the athlete is trying to stay awake via caffeine, or the latest craze, high caffeine sports drinks; the inevitable sleep debt will have to be reckoned with at some perhaps inopportune point. When the game is on the line, what coach or teammate wants to have a sleep deprived quarterback trying to process his available options in a matter of seconds? What coach wants a player to “fly off the handle” at the smallest provocation when they are finally worn out for the want of a good night’s sleep? Neither of these scenarios will bring about the desired result of all the early morning or late evening training sessions.

So, what should the coaches be doing about all this?

For one thing, they should be aware of the relevance of sleep to their team’s performance and take the time to discuss proper sleep and its importance in conditioning and competition. They also should be aware that the early practices they plan might be of no more benefit to the team than the first-period math class that teens sleep through in schools because the students are not really “awake”. They should warn against the many substances that can affect a teen’s sleep. These warnings should include discussing the harm done via the use of caffeine,

A good night’s rest may be just the answer to replacing the old adage that states, “If you snooze, you lose” to a more realistic one for the teen athletes which is “If you don’t snooze, you may lose”. H About the Author Brendan Duffy is a longtime APT member and lives in Port Jefferson, NY. He is the Sleep Department Coordinator at St Charles Hospital in Port Jefferson. He has coached little league and travel baseball teams and covers high school athletics as a sports writer for a hometown Web-based newspaper.

Policy and Procedure Manual for Sleep Disorders Centers APT is proud to present a Policy and Procedure Manual for Sleep Disorders Centers. At the request of the APT Board of Directors, the Standards and Guidelines Committee created a reference manual to assist sleep disorders center personnel in the development of their own policy and procedure manual. This manual provides sample forms and policies, job descriptions and core competencies for the Sleep Technology profession. The manual is intended to provide a standardized guideline in the development of a policy and procedure manual to quantify service and performance that ultimately delivers quality patient care.

Order form page 29

Watch for APT Committee 2006-2007 Call for Volunteers To participate, members in good standing may find the necessary forms on www.APTweb.org under Important Downloads: APT Conflict of Interest Disclosure Form APT Committee Interest Form APT Conflict of Interest Policy For more information contact: Christopher Waring, APT Coordinator Phone 708-492-0796 • Fax 708-273-9344 cwaring@aptweb.org 27

Classified Ads Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Please direct resume and information requests to: Michael Nielson, RPSGT, Clinical Director California Center for Sleep Disorders miken@sleepdx.com 510-834-8333 ext. 20

POLYSOMNOGRAPHIC TECHNOLOGIST NORTH CENTRAL IOWA Mercy Medical Center — North Iowa, a 346-bed regional referral center located in North Central Iowa, is currently seeking a Polysomnographic Technologist to work full-time in our sleep lab.

This permanent opportunity in Mason City, IA requires candidates to be a graduate of an educational program for EEG technology or respiratory therapy. 1-3 years experience working in a sleep disorders setting preferred. Must be registered, or registry eligible, within one year in position.

Competitive wages and excellent benefit package await the right candidate. Apply today at www.mercynorthiowa.com under requisition number 05-357.

Mercy Medical Center North Iowa 1000 4th Street SW Mason City, IA 50401 Mercy Medical Center — North Iowa is an Equal Opportunity Employer.

SWING SHIFT AND NIGHT SHIFT POSITIONS SAN FRANCISCO BAY AREA The California Center for Sleep Disorders (CCSD) is looking for experienced sleep technologists for clinical and research testing. Full-time, part-time, swing shift and night shift positions available. Our organization has five satellite laboratories (two AASM accredited) in the San Francisco Bay area.

CCSD has been serving the SF Bay area for over 20 years. We are a progressive, free-standing sleep center with a positive work environment and exciting programs such as pharmaceutical research, home testing, DME services, oral appliance therapy, monthly technologist training sessions and extensive community outreach to medical professionals and the general public.

Ideal candidates will have 2+ years experience as a technologist and proficient scoring skills. RPSGT credential is preferred. Extra points for computer skills and training experience. An excellent benefit package includes, 410K, profit sharing, healthcare, etc. Salary commensurate with experience.

CCSD is headquartered in Oakland, California. The San Francisco Bay area is one of the most beautiful metropolitan areas in the world featuring a diverse population and tremendous educational, recreational and cultural opportunities.

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BOCA RATON SLEEP DISORDERS CENTER Boca Raton Sleep Disorders Center located in sunny South Florida has two immediate night technologists’ positions available. Work the same schedule each week and earn a competitive salary. The Boca Raton Sleep Disorders Center provides a unique opportunity to advance your career experience in a comprehensive patient care environment. The Boca Raton Sleep Disorders Center offers a wide range of testing services as a freestanding state-of-the-art facility accredited since 1992. We offer a competitive salary with benefit packages and a guaranteed work schedule!

We invite experienced Polysomnographic Technologists to join our dedicated team. These positions require knowledge and competency in all aspects of polysomnographic testing procedures and scoring. RPSGT registry preferred.

This is an excellent opportunity to join our dedicated team. Immediate opportunity. Interested candidates please fax your resume to (561) 7509644. Mail confidential resumes to 660 Glades Road, Suite 220, Boca Raton, FL 33431.

POLYSOMNOGRAPHIC TECHNICIAN The Sleep Research Center at McLean Hospital is seeking a qualified polysomnographic technician for a full time position in our lab. Position involves mostly nights but may involve daytime hours instead of nights (e.g. during weeks when subjects are not scheduled). Candidate must be mature, detail-oriented, flexible and able to work independently.

Responsibilities include: • Preparation and monitoring of equipment and research subjects for several industry-sponsored clinical trials and a NIH funded study.

• Ability to run standard digital polysomnographic recordings.

• Administration of questionnaires, complete cognitive testing with subjects, maintenance of subject charts, data entry & analysis.

Job Requirements: • Bachelor’s degree.

• Experience in polysomnography preferred.

• RPSGT preferred but not required.

• Must be detail-oriented and able to interact easily with research subjects and other laboratory personnel.

• Background in a research setting is helpful.

Ideal position for experienced sleep technician who is ready to move away from CPAP titrations into a more creative, independent position.

Salary depends on experience. Please forward resume to: McLean Hospital, Sleep Research Lab, 115 Mill Street, Belmont, MA 02478 Fax: 617-855-3784.

ADVERTISING INFORMATION The APT offers a full range of advertising services.

See the advertising page on APTWEB, fax 781-823-4787, or e-mail APTads@aptweb.org for details.

Product Order Form Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

Educational/Technical Order Form APT National Office One Westbrook Corporate Center, Suite 920 Westchester, IL 60154 Phone (708) 492-0796, Fax (708) 273-9344

Educational Resources

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1003

$325.00

$360.00

1004

$895.00

$895.00

1020

$65.00

$85.00

1021

$40.00

$55.00

TOTAL

APT Review Course — 2nd Edition (Individual) Intense review preparing for the registry exam. Realtime video alongside an electronic presentation.

Includes CD, booklet and review test to complete and return for 14 CEC credits.

APT Review Course — 2nd Edition (Institutional) Intense review preparing for the registry exam. Realtime video alongside an electronic presentation.

Includes CD, booklet and five review tests to complete and return for 14 CEC credits per test.

Normal and Abnormal Record Flashcards Registry Exam Flashcards

Technical References

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$85.00

1130

$60.00

$75.00

1131

$25.00

$35.00

1132

$60.00

$75.00

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APT Policy and Procedure Manual A reference tool designed to assist sleep disorders center personnel in the development of their policy and procedure manual. This manual provides sample forms and policies, job descriptions and core competencies for the Sleep Technology profession.

Current Concepts The first textbook any PSG technologist should own. Covers normal sleep, diagnosis approaches, sleep disorders classifications and waveform graphics depicting the stages of sleep.

Filter Settings and Calibrations Technical article written by Edwin Cintron, RPSGT.

2003 Demographic, Salary & Educational Needs Survey Identifies PSG technologist practice environments, technologist characteristics, compensation, and education.

R&K Scoring Manual Technical Manual Written by A. Rechtschaffen and A. Kales. Includes standardized terminology, techniques and a scoring system for sleep stages

Artifact & Troubleshooting Guide “Sleeping on the Job” Answers basic questions on site location, design, setup, staffing and more. Offers resources for locating equipment and supplies and is highlighted by a sample Policy and Procedure manual

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Product Order Form Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

APT Promotional Item Order Form APT National Office One Westbrook Corporate Center, Suite 920 Westchester, IL 60154 Phone (708) 492-0796, Fax (708) 273-9344

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2021

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Sleep Disorders Awareness Pin Show you care! Makes a great PSG Technologist Appreciation Week gift.

“Celestial Delectables” Cookbook Silver Anniversary cookbook.

“Guardian Sleep” Print (Signed) Limited edition series of 500 color prints (certificate included).

The original painting was rendered in oil and mixed media.

“Guardian Sleep” Print (Unsigned) “Sentries of the Night” Print Color print, measures approximately 8-1/2” x 11”.

APT Santa Flag Display holiday spirit in your sleep lab! Measures 24” X 36”, vibrant colors. While supplies last!

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APT Denim Shirt High-quality denim shirt featuring the APT logo. Available sizes: S / M / L / XL / XXL / XXXL

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APT T-Shirt High-quality t-shirt featuring the APT logo. Available sizes: S / M / L / XL / XXL / XXXL

APT Sweatshirt High-quality sweatshirt featuring the APT logo. Available sizes: S / M / L / XL / XXL

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*Please note that the APT does not accept purchase orders or orders over the phone. Shipping and handling charges for orders over six items will be charged based on cost. Orders may be expedited via UPS 2-Day (where available) based on cost. International shipping is available through the United States Postal Service and charged based on cost. The APT accepts no responsibility for loss of product.

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SleepLand Calendar Publication of the Association of Polysomnographic Technologists • 2005 Year End Issue • www.aptweb.org

WASHINGTON REGIONAL SLEEP DISORDERS CENTER SPRING SLEEP SEMINAR 2006, March 11-13, 2006, Hot Springs National Park, Arkansas, Arlington Resort Hotel & Spa. For hotel and transportation information call 800-643-1502. For meeting information call Bill Rivers or Melinda Trimble at: 479-713-1272 or fax 479-713-1190.

NORTH EAST SLEEP SOCIETY (NESS) 2006, March 17-18, 2006 at the Crowne Plaza Hotel in Warwick, RI, just south of Providence.

More details will follow in September.

THE NATIONAL FIBROMYALGIA ASSOCIATION (NFA) will host a three-day conference in Anaheim, CA, March 17-19, 2006.

International physicians and fibromyalgia researchers will present the latest information on the treatment and diagnosis of fibromyalgia and chronic pain. The event will include over 60 presentations for patients and health care professionals. Visit fmawareorg0.web120.discountasp.net/events/2006/fame/fame.asp for more information.

NATIONAL SLEEP AWARENESS WEEK, March 27-April 2, 2006.

Visit www.sleepfoundation.org for more details.

Crossword Puzzle Solution

SLEEP APNEA AWARENESS DAY, March 30, 2006.

2006 APT POLYSOMNOGRAPHIC TECHNOLOGIST RECOGNITION WEEK, April 3-9, 2006. For more information, visit www.aptweb.org.

President’s Message continued from page 7

APT SPRING REVIEW COURSE, April 10-11, 2006, St. Louis, Missouri. St. Louis Pavilion Hotel Downtown. For registration & hotel information, visit www.aptweb.org. For questions about the course, contact the Meeting Department at (708) 492-0796.

SLEEP 2006 20TH ANNIVERSARY MEETING OF THE ASSOCIATED PROFESSIONAL SLEEP SOCIETIES, June 17-22, 2006, Salt Lake City, Utah. More information available in upcoming issues of A2Zzz Magazine.

8TH WORLD CONGRESS — SLEEP APNEA 2006 September 27October 1, 2006, Montreal, QC, Canada, www.wcsa2006.com.

MONTANA REGIONAL SLEEP SEMINAR 2006, October 12-14, 2006, Mansfield Health Education Center, Billings, Montana. Topics and speakers to be announced at a later date. For more information, contact Karen Allen at karen.allen@svh-mt.org or call toll-free (800) 4SNORES.

the field and educational products that enhance your knowledge of sleep technology — all at discounted prices.

Grow Your Profession by Giving Back As your career grows, I challenge you to think of ways to broaden your involvement in the APT. As a member, you can volunteer to serve as a committee member and be part of a team that provides input and recommendations to advance our profession. The diversity of committee members is integral in providing fresh perspectives to fulfilling the mandate of the committee and contributing to the overall strength of the APT. If you are interested in participating as a committee member, look for information in this issue about the 2006 Call for Volunteers.

Volunteer membership organizations rely on commitments of time and expertise from its members for success. In recognition of these vital efforts, the APT recognizes individual efforts through several honored awards. I encourage you to recognize accomplishments of your peers by nominating them for an award. Additional information on the 2006 APT Award Nominations will be available on www.aptweb.org in January 2006.

18TH CONGRESS OF THE EUROPEAN SLEEP RESEARCH SOCIETY Innsbruck, Austria, 2006, www.esrs.org.

In this issue of A2Zzz Magazine you will find several interesting and beneficial articles I know you will enjoy reading it from cover to cover as I do. I learn something new with every issue. If you would like to submit an article for consideration for A2Zzz Magazine, or have a topic for an article, please send it to cwaring@aptweb.org.

WORLD FEDERATION OF SLEEP RESEARCH SOCIETIES WORLD CONGRESS 2007 September 1-8, 2007, Cairns, QLD, Australia, www.wfsrs.org.

The APT board welcomes input from its members. If you have questions or ideas that you would like to propose, please submit them to aptaction@aptweb.org.

19TH CONGRESS OF THE EUROPEAN SLEEP RESEARCH SOCIETY Glasgow, Scotland, 2008, www.esrs.org.

I firmly believe that the APT is moving in a direction that you, as members, will benefit. Join with me in furthering the future of the polysomnographic technology profession through your APT membership and volunteer efforts. H

EUROPEAN SLEEP RESEARCH SOCIETY 2006 meeting is scheduled in Innsbruck, Austria. Please visit ww.esrs.org.

32

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