Volume 25, Number 3 by American Association of Sleep Technologists

September 2016 | Volume 25 | Number 3

Restless Legs Syndrome and Diabetes The Credential Exam: Don’t Sweat It … Nail It! Waking up to a Major But Necessary Decision: An Open Letter to Local School Board Don't Overlook the Value of State and Regional Sleep Societies Improving Safety in Sleep Disorders Centers: A Primer For Using Root Cause Analysis Should Sleep Technologists Be Reading Clinical Research Studies? A Publication of the American Association of Sleep Technologists

FROM THE EDITOR

SEPTEMBER 2016 | VOLUME 25 NUMBER 3

Rita Brooks, MED, RST, RPSGT, REEG/EPT he American Association of Sleep Technologists (AAST) board recently met to begin work on a new strategic plan that focuses on what is best for our profession. I want to thank all of our members for their continued support and for trusting us to advance the field of sleep technology to where it needs to be.

As usual, this issue of A2Zzz contains some great articles on a variety of topics. Regina Patrick discusses the possible relationship between diabetes and restless legs syndrome (RLS). Terrence Malloy reviews a strategy for preparing for and taking a credentialing examination. Brendan Duffy addresses the issue of school start times. Tamara Sellman penned two articles, one on how state sleep societies help keep us connected to ideas, skills and each other and another on the benefits of reading clinical studies. Christopher Hope contributed a piece on performing root cause analysis, which is a new mandate in the 2016 standards for American Academy of Sleep Medicine (AASM) accredited sleep centers and programs. I hope you will take the opportunity to learn from these contributions and earn some CECs! Many of the articles in this issue are relevant to anyone attending the AAST’s fall course: Technologist Fundamentals Course. The course will be held October 7-8, 2016, at the Wyndham Playhouse Square in Cleveland, Ohio. The speakers the AAST has lined up for this course are superb and include Robert Pamenter, who will speak about 10-20 measurements and calculations; Byron Jamerson, who will speak about filters and amplifiers, and sleep related breathing disorders; Laree Fordyce, who will speak about procedures and PAP titration, management and adherence; Joel Porquez, who will speak about pediatrics; Laura Linley, who will speak about respiratory physiology, artifact recognition and troubleshooting, and safety and infection control in the sleep lab; Jon Atkinson, who will speak about cardiac events; Terrence Malloy, who will speak about interpreting hypnograms and preparing for a taking the credentialing examination and Elise Maher, who will speak about record management and documentation. I myself will be speaking on normal sleep and medications, adult and pediatric stage scoring; PLM and arousal scoring and epilepsy and parasomnias. I hope to see you all in Cleveland in October!

TABLE OF CONTENTS From the President............................................................6 Continuing Education Credit Offering..........................7 An Interview with Robert Turner............................... 8-9 Pennsylvania State Sleep Society: An Interview with Mathew Anastasi.............................10 Restless Legs Syndrome and Diabetes....................11-13 The Credential Exam: Don't Sweat It ... Nail It!...........................................14-15 Waking up to a Major But Necessary Decision: An Open Letter to Local School Board.................16-17 Don't Overlook the Value of State and Regional Sleep Societies............................................18-20 Improving Safety in Sleep Disorders Centers: A Primer For Using Root Cause Analysis..............21-23 Should Sleep Technologists Be Reading Clinical Research Studies?.........................................24-26 The Basics of Charting: Best Practices in Patient Care...................................27-28 In the Moonlight..............................................................29 Certification Update (BRPT).........................................30

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A2 Zzz 25.3 | September 2016

Submit an original article for publication in A2Zzz. See page 4 for details.

OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF SLEEP TECHNOLOGISTS (AAST)

ABOUT A2Zzz

A2Zzz is published quarterly by the American Association of Sleep Technologists (AAST), 2510 North Frontage Road, Darien, IL 60561. Learning Objectives: Readers of A2Zzz should be able to do the following:

not of the American Association of Sleep Technologists (AAST); the American Academy of Sleep Medicine (AASM), which provides management services for the AAST; or of either organization’s officers, regents, members or employees. The appearance of products and services, and statements contained in advertisements, are the • Analyze articles for information that improves their under- sole responsibility of the advertisers, including any descriptions of standing of sleep, sleep disorders, sleep studies and treatment effectiveness, quality or safety. The Editor; Managing Editor; AAST; AASM; and each organization’s officers, regents, members and options employees disclaim all responsibility for any injury to persons or • Interpret this information to determine how it relates to the property resulting from any ideas, products or services referred to in practice of sleep technology articles or advertisements in this magazine. • Decide how this information can improve the techniques and procedures that are used to evaluate sleep disorders patients and treatments • Apply this knowledge in the practice of sleep technology

Mission: The American Association of Sleep Technologists (AAST) promotes sleep wellness and leads the sleep technology profession through education, resources, and advocacy.

Submissions: Original articles submitted by AAST members and Vision: The American Association of Sleep Technologists (AAST) will play a key role in setting the standard for professional excellence by invited authors will be considered for publication. Published in the evolving practice of sleep healthcare. articles become the permanent property of the AAST. Permission to Use and Reproduce: A2Zzz is published quarterly by the AAST, all rights reserved. Permission to copy or republish A2Zzz material is limited by restrictions. Visit www.aastweb.org to view the full A2Zzz permissions and use policy.

Purpose: To provide a voice for the professionals who ensure the safe and accurate assessment and treatment of sleep disorders.

2510 North Frontage Road Darien, IL 60561 Advertising: Advertising is available in A2Zzz. Please contact the Phone: (630) 737-9704 AAST national office for information concerning A2Zzz rates and Fax: (630) 737-9788 E-mail: A2Zzz@aastweb.org | Web: policies, or find more details online at www.aastweb.org. http://www.aastweb.org Disclaimer: The statements and opinions contained in articles and editorials in this magazine are solely those of the authors thereof and © 2016 American Association of Sleep Technologists

SUBMIT AN ARTICLE TO A2Zzz Share your expertise with colleagues in the profession of sleep technology by submitting an original article to A2Zzz. Read the A2Zzz Writer’s Guidelines at http://www.aastweb.org/publication-info. To propose an article topic or to get more information, send an e-mail to A2Zzz@aastweb.org.

CONTRIBUTORS EDITOR

Rita Brooks, MED, RST, RPSGT, REEG/EPT

MANAGING EDITOR Lynn Celmer

SENIOR WRITERS

Regina Patrick, RST, RPSGT

CONTRIBUTING WRITERS

Lisa Bond, RST, RPSGT Rita Brooks, MED, RST, RPSGT, REEG/EPT Brendan Duffy, RST, RPSGT Yoona Ha Christopher Hope, MD, MHA Terrance Malloy, RPSGT, RST Tamara Kaye Sellman, RPSGT, CCSH Penni Smith, RPSGT, RST, CCSH

A2Zzz publishes articles that relate to the profession of sleep technology and informs members about recent and upcoming activities of the American Association of Sleep Technologists (AAST).

A2 Zzz 25.3 | September 2016

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FROM THE PRESIDENT

By Laura Linley, CRT, RST, RPSGT would like to take this opportunity to thank all of the American Association of Sleep Technologists (AAST) members who contributed to the success of the AAST’s 38th annual meeting held in June in Denver. The AAST Program Committee once again put together a fantastic annual meeting. This year’s AAST PRESIDENT meeting also provided almost 500 LAURA LINLEY, CRT, attendees with many new features to RST, RPSGT enhance their experience, such as a new audience engagement platform, a dual track of sessions on Sunday afternoon and designated time to explore the SLEEP 2016 exhibit hall.

If you haven’t claimed your continuing education credits (CECs) from the annual meeting yet, you have until October 1, 2016 at 4:00 p.m. CDT to do so. Visit go.aastweb.org/credits/ to complete the online credit claim form and claim your CECs. I look forward to seeing you all at the 39th annual meeting in Boston on June 4-6, 2017. In addition to the annual meeting, the AAST holds courses throughout the year to help meet the educational needs of our more than 4,200 members. To that effect, the AAST is offering a Technologist Fundamentals Course on October 7-8, 2016, at the Wyndham Playhouse Square in Cleveland, Ohio. This course is perfect for brushing up on the fundamentals. During this two-day course an expert faculty will present a comprehensive review of the basics of polysomnography, including a review of sleep stages and sleep related events, recording procedures and instrumentation, appropriate therapeutic interventions, and strategies for exam success. Discounted registration is only available until September 9th, so make sure you register today! Click to view the course program. If you are not able to make it to the fall course, we will offer online learning modules at a future date.

by Robert Turner; Internal Audits: Regulatory and Legislative Advisory Committee by Kathryn Hansen and Life Safety by Michael Zachek. The AAST also had teamed up with the Southern Sleep Society (SSS) to host an advanced clinical course in April in Asheville, N.C. The April 7, 2016 technologist course preceded the SSS’s 38th annual meeting. The 8-hour course that was titled “Essential Skills in Sleep Education—Tools for Career Advancement” was designed for allied health professionals who are focused toward education in clinical sleep health. There are 9 presentations available from the course including Health Literacy for Patient Education by Marietta Bibbs; Education : Teaching for Your Community by Janice East; Sleep Disorders in Various Age Groups and The Evolving Role of the Sleep Technologist by myself; How Common Medications Can Affect Sleep by Shalanda Mitchell; Educational Coding: What You Can Bill? by Becky Appenzeller; Distinguishing Medical vs Behavioral Disorders in Pediatric Patients by Joel Porquez; Improving Acceptance and Adherence to PAP Therapy - What the Biggest Losers Taught Me by Pamela Minkley and Managing Therapy to Enhance Compliance by Carolyn Campo. Also make sure to check out the AAST 2016 Salary and Benefits survey. The AAST commissioned an independent consulting firm, McKinley Advisers, to conduct a current assessment of salary and compensation for sleep technologists. The American Association of Sleep Technologists 2016 Salary and Benefits Survey was released in May. The survey compares current findings with the AAST’s previous salary and compensation surveys from 2007 and 2010. An online survey was sent to 5,144 members and non-members, as well as to sleep center email addresses and the response rate was 16 percent, representing 832 respondents. I hope you will find this to be a useful tool in your sleep center and as a reference for your human resources department. I look forward to seeing you in Cleveland for our fall course!

The AAST has just added a total of 15 new online learning modules to the online store. For those who were unable to attend the AAST’s spring course on Risk Management in the Sleep Center held March 11-12, 2016, in Louisville, Ky., we have six presentations from the course available as online learning modules. Topics covered include Patient Acceptance Criteria by Kathryn Hansen; Documenting and Charting by Rita Brooks; Infection Control by myself; HIPAA and Patient Confidentiality

A2 Zzz 25.3 | September 2016

CONTINUING EDUCATION CREDIT OFFERING INSTRUCTIONS FOR EARNING CREDIT

AAST members who read A2Zzz and claim their credits online by the deadline can earn 2.00 AAST Continuing Education Credits (CECs) per issue – for up to 8.00 AAST CECs per year. AAST CECs are accepted by the American Board of Sleep Medicine (ABSM) and the Board of Registered Polysomnographic Technologists (BRPT). To earn AAST CECs, carefully read four of the designated CEC articles from the list below and claim your credits online. You must go online to claim your credits by the deadline of December 6, 2016. After the successful completion of this educational activity, a confirmation letter acknowledging that you have earned 2.00 AAST CECs will be sent to the email address that you have on file with the AAST.

COST

The A2Zzz continuing education credit offering is an exclusive learning opportunity for AAST members only and is a free benefit of membership.

CLAIM CEC CREDITS FOR A2Zzz ONLINE

Claiming continuing education credits (CECs) by reading A2Zzz is now easier than ever: AAST Members can claim credits online through the AAST website – no need to mail, email or fax your completed evaluation form! Visit the AAST website and claim your CECs today!

STATEMENT OF APPROVAL

This activity has been planned and implemented by the AAST Board of Directors to meet the educational needs of sleep technologists. AAST CECs are accepted by the American Board of Sleep Medicine (ABSM) and the Board of Registered Polysomnographic Technologists (BRPT). Individuals should only claim credit for the articles that they actually read and evaluate for this educational activity.

STATEMENT OF EDUCATIONAL PURPOSE/OVERALL EDUCATIONAL OBJECTIVES

A2Zzz provides current sleep-related information that is relevant to sleep technologists. The magazine also informs readers about recent and upcoming activities of the AAST. CEC articles should benefit readers in their practice of sleep technology or in their management and administration of a sleep disorders center. Readers of A2Zzz should be able to do the following: • Analyze articles for information that improves their understanding of sleep, sleep disorders, sleep studies and treatment options • Interpret this information to determine how it relates to the practice of sleep technology • Decide how this information can improve the techniques and procedures that are used to evaluate sleep disorders patients and treatments • Apply this knowledge in the practice of sleep technology You must go online to claim your CECs by the deadline of December 6, 2016. Read and evaluate four of the following articles to earn 2.0 AAST CECs: Page # Restless Legs Syndrome and Diebetes............................................................................................................................... 11-13 Objective: Be aware that the prevalence of restless legs syndrome (RLS) is greater in patients with diabetes than in people without diabetes. The Credential Exam: Don't Sweat it ... Nail it! ................................................................................................................. 14-15 Objective: Learn techniques for how to best prepare to take the credential examination. Waking up to a Major But Necessary Decision: An Open Letter to Local School Board Members........................................ 16-17 Objective: Learn how school start times can have an impact on the health and well-being of students. Don't Overlook the Value of State and Regional Sleep Societies......................................................................................... 18-20 Objective: Learn how state and regional sleep societies help keep us connected to ideas, skills and each other. Improving Safety in Sleep Disorders Centers: A Primer for Using Root Cause Analysis....................................................... 21-23 Objective: Become familiar with the use and limitations of root cause analysis for any significant adverse events in the facility. Should Sleep Technologists Be Reading Clinical Research Studies?................................................................................... 24-26 Objective: Learn how to stay up to date on research without overstepping our clinical limits as lab technicians.

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AN INTERVIEW WITH ROBERT TURNER, RPSGT, RRT By Yoona Ha & Rita Brooks, MED, RST, RPSGT, REEG/EPT

obert told us that he started as a sleep technologist many years ago in 1984. His hospital wanted to start a sleep laboratory, and he was picked to be the person who would learn how to do all of this stuff (polysomnography). He obtained his training in polysomnography in a couple of different places; initially at the Cleveland Clinic and then at Stanford University. At that time there were few people who were getting into sleep medicine. In those days it was difficult to find places to learn more about sleep medicine and to learn more about the job of a sleep technologist, and that was Robert’s reason for joining the American Association of Sleep Technologists (AAST).

a community back then. So it was easy to pick up the phone and talk to people all over the country to check on each other and ask questions like “Oh, so how did you score this and, how did you do that?” Our profession was built on the community mentality; we were small and we helped each other out as we learned and improved our skills. We helped each other out in the most fundamental sense and also helped each other to accomplish what we wanted to be as sleep technologists. That meant advocating for our profession and teaching each other how to better do our jobs! “I have to tell you, I became fast and good friends with many people in sleep medicine over these years.”

The AAST, then the Association of Polysomnographic Technologists (APT), was a resource for people getting into sleep medicine and technology, like myself. I don’t remember the exact year I became a member but it would have been 1984 or 1985. At that time the APT was comprised of a small group of technologists, and back then you would know everybody in the field. At some point a few people in the organization came up to me and asked that I should become president. A few years before I became president I was actually the APT treasurer, so becoming president seemed natural in a way.

A big challenge for the APT was to make sure that we were meeting the needs of sleep technologists and growing our organization. As the organization grew we were no longer the small group of people that called each other across the country; our profession was growing rapidly at that time.

Even back then, when Robert was President of the APT, there were a lot of people performing the various tasks that all technologists do now. As the APT leaders, the main concern for them was to understand and implement the responsibilities of a technologist consistently to standardize and build sleep technology as a profession.

During the first part of Robert’s presidency, the BRPT was actually a part of the APT (an APT committee) and not a separate entity. It was during his presidency that the BRPT became a separate entity. Robert remembers that as a huge decision at the time; mostly because the role and purpose of the BRPT was a large part of what the APT was and did at that time. The challenge for APT was to figure out how to become a unique and separate organization, apart from the BRPT. The APT had to redefine the organizational goals and move toward providing technologist education. A major initiative was undertaken to differentiate the organization as an educational entity and a huge effort went into improving the APT educational courses.

A lot of the dialogue back then centered on how to score these studies (recorded on paper) in the most efficient manner possible. It was a learning experience for all of us, and we learned together and tried to standardize how things were done. The profession then consisted of a small group of people; it really was

One of the unique challenges that the profession faced during my presidency was legitimizing the RPSGT credential. It was during this time that the APT decided to make the Board of Registered Polysomnographic Technologists (BRPT) a separate entity.

YOONA HA SELLMAN RPSGT, CCSH BY TAMARA Yoona Ha is a graduate of Northwestern University’s Medill School of Journalism and Weinberg College of Arts and Sciences.

A2 Zzz 25.3 | September 2016

RITA BROOKS MED, RST, RPSGT, REEG/EPT Rita Brooks MED, RST, RPSGT, REEG/EPT is the President of the American Association of Sleep Technologists. She is the Director of Diagnostic Services for Capital Health in Trenton, N.J.

9 Revamping the educational course efforts and developing newsletters that contained our new focus and the new message to our members was a top priority at the time. “A huge part of my presidency, and what we did together as a board, was to redefine ourselves as a professional society that brought the utmost value to our members.” One significant change following Robert’s presidency was the issue of licensure. Following his presidency Robert traveled a lot to provide information about the profession to state licensure boards. At that time there were few states that had licensure, but that has changed, and continues to change and add legitimacy to our profession. Other changes that he sees that have occurred since his presidency include the changes in how information is disseminated. These changes include the widespread use of the internet and websites to share information, and the use of social media.

Other significant changes that the organization has seen include a more solid understanding of a corporate pathway in terms of finances and how to run an organization, a meeting or a course. “As early leaders we didn’t have as much support, or at least I felt that way when I was president.” This has been a positive change for the profession and the organization. There is a wonderful opportunity now to represent and be in contact with all the great people is the field, and that has become easier. I became friends with the past presidents who I looked up to and relied upon, and became close to a lot of people from who I was able to get advice over the years, including from Sharon Keenan, Peter McGregor and Pam Minkley, as well as many others. As leaders we have all become great friends and we continue to support the growth of our young profession. 

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A2 Zzz 25.3 | September 2016

PENNSYLVANIA STATE SLEEP SOCIETY: AN INTERVIEW WITH MATTHEW ANASTASI By Yoona Ha and Rita Brooks, MED, RST, RPSGT, REEG/EPT

attend the annual meeting for $75 instead of the usual $100, so the membership is designed to pay for itself the first day. Our membership is diverse and our educational meeting attracts attendees from a variety of professional backgrounds. Approximately 55 percent of our members and meeting attendees are sleep technologists; 10 percent identify as respiratory therapists; 15 percent are physicians; and dentists, psychologists and nurses comprise about 5 percent each. We provide approved continuing education unit (CEU) accreditation for sleep technologists and respiratory therapists for our educational meetings as well as continuing medical education (CME) for physicians and dentists. Pennsylvania does not currently require licensure for sleep technologists. This is unique in the area because all of the surrounding states require licensure or are in the process of trying to obtain licensure. Society leaders have been speaking with representatives from the American Association of Sleep Technologists (AAST) Regulatory and Legislative Advisory Committee and gaining insight on strategies for obtaining licensure during the annual national meetings. The society The biggest challenge for our organization is that everything has built a legislative infrastructure at the state level and is has to get done in one year. As President, I would only have well-positioned to have a seat at the table for the inevitable a year to prepare and would have to start everything anew: political discussions toward state sleep technologist licensure. engaging with a new board, planning a new conference, with The outcome will clearly affect the scope of practice of the sleep new speakers, topics and a new set of sponsors and vendors. It is really a challenge to cover the basic educational requirements and technology profession. Requiring licensure to practice provides also determine the current and most cutting edge topics of interest in certain protections for sleep technologists. It certainly does formalize the profession, yet we, as a state society, do not have an sleep medicine. The priority is always to make sure we provide official position at present. If we did move forward toward educational opportunities that are most relevant to our members. licensure for sleep technologists in Pennsylvania, we would need to ensure we have input in any drafting of legislation that draws a The Pennsylvania Sleep Society has a membership of approxdistinctive line between the role of a respiratory therapist and the imately 150, and had 128 attendees at last year’s meeting. Membership fees are an affordable $25, and membership comes role of a sleep technologist, particularly since the role of the sleep technologist is expanding so rapidly today.  with a discount for annual meeting registration. Members e discussed the Pennsylvania Sleep Society with Matthew Anastai, BS, RST, RPSGT, Manager of the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital and Mercy Hospital Sleep Centers and, at the time of this interview, President of the Pennsylvania Sleep Society. The Pennsylvania Sleep Society is an organization representing sleep research and sleep medicine professionals within the Commonwealth of Pennsylvania. Our mission was developed based on the vibrant sleep research community that exists in Pennsylvania. With that in mind, we wrote our mission statement with a diverse objective to promote excellence in sleep research and education and serve as a network for sleep professionals that encourages collaboration. The PA Sleep Society holds an annual educational meeting, usually in April or May. The society leadership spends the entire year planning the annual spring meeting, which is centrally located at the state capital of downtown Harrisburg, Pa.

YOONA HA SELLMAN RPSGT, CCSH BY TAMARA Yoona Ha is a graduate of Northwestern University’s Medill School of Journalism and Weinberg College of Arts and Sciences.

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RITA BROOKS BY TAMARA SELLMAN RPSGT, CCSH MED, RST, RPSGT, REEG/EPT Rita Brooks MED, RST, RPSGT, REEG/EPT is the President of the American Association of Sleep Technologists. She is the Director of Diagnostic Services for Capital Health in Trenton, N.J.

RESTLESS LEGS SYNDROME AND DIABETES Regina Patrick, RST, RPSGT

in the sleep field for more than 20 years and works as a sleep technologist at the Wolverine Sleep Disorders Center in Tecumseh, Mich.

Small fiber sensory nerves innervate the skin. Problems in these nerves may be experienced as uncomfortable sensations of pinsand-needles, pricks, tingling and numbness, brief intermittent

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 Continued on Page 12

or weakness in the limbs. How diabetic neuropathy occurs is unclear. estless legs syndrome (RLS) affects an estimated 7–10 percent 1 Some pathological processes that have been suggested include: of the general population. The prevalence of RLS is greater 1-3 in patients with diabetes than in people without diabetes. Diabetic 1. Loss of nerve growth factors. Some research indicates that neuropathy (i.e., pathological changes in the peripheral nerves) has nerve growth factor and related proteins such as the neubeen implicated as a risk factor for RLS in diabetic patients. To what rotrophins are decreased in people with diabetic neuropaextent and how diabetic neuropathy contributes to RLS is unclear. thy.4 Damage to the nerves normally triggers biochemical Recent investigations into the relationship between RLS and processes that are involved in axonal regeneration, remyediabetes have revealed some interesting findings. lination, and synaptogenesis. However, if factors involved in neuronal growth and repair are insufficient to restore neuronal function, cell death can occur. Restless legs syndrome is a sleep disorder in which a person feels unpleasant sensations in the legs that are most noted in the 2. Hyperglycemia. Hyperglycemia (i.e., increased blood evening soon before bedtime when a person is winding down glucose levels) increases the amount of glucose within for the day. In an attempt to relieve the sensations, a person feels the nerve cells, where the excess glucose is enzymatically converted to the molecules sorbitol (a sugar alcohol) and compelled to move the legs by walking, massaging them, rubbing fructose (a sugar molecule). The intracellular accumulation them against bedsheets, etc. These actions only give temporary of these molecules interferes with the transport of ions relief. The sensations ultimately disappear just before sleep onset, such as sodium and potassium across the axonal membrane. and a person is finally able to go to sleep. If the person awakens A consequence is the impaired conduction of neuronal during the night, the sensations may return, and the person once signals4 and osmotic damage to nerve cells.5,6 again goes through the attempts to relieve them. 3. Production of advanced glycation end products. The interaction between excess glucose and proteins and lipids Diabetes mellitus (often simply called “diabetes”) is a disorder results in the production of advanced glycation end prodcaused by the insufficient production of insulin (i.e., insulin ucts (i.e., proteins or lipids bonded to a sugar molecule). deficiency) or impaired utilization of insulin (i.e., insulin These products get incorporated in myelin (i.e., a substance resistance). The hormone insulin aids in the absorption of glucose containing protein and lipids that encases the nerve fibers) and other peripheral nerve proteins. Once incorporated, from blood into the body’s tissues (e.g., fat, liver, and skeletal advanced glycation end products disrupt neuronal integrity muscles). Insufficient amounts of insulin, or inability to fully and interfere with repair processes, thereby leading to the utilize it, contribute to disturbances in carbohydrate, protein, and loss of nerve fibers.7 fat metabolism. A person with diabetes has difficulty maintaining 4. Oxidative stress. Increased production of free radicals proper blood glucose levels; therefore, a primary goal of treatment (i.e., molecules that have lost an electron pair) may directis to maintain proper glucose levels. A person with diabetes may ly damage the blood vessels (e.g., vessel occlusion) and require insulin injections to maintain proper glucose levels (i.e., consequently damage the nerves.5,8 A free radical is highly insulin-dependent diabetes) or may be able to maintain proper reactive: it quickly “steals” an electron pair from another glucose levels with medication and lifestyle and dietary changes nearby molecule, which quickly destabilizes the nearby (i.e., noninsulin-dependent diabetes). molecule. Such destabilization interferes with the biochemical processes within nerves and can result in nerve damage. Even with proper treatment to control glucose levels, a A nerve fiber is classified by thickness as “small fiber” (<5 µm) complication of diabetes is peripheral neuropathy (i.e., nerve or “large fiber” (≥5 µm). Small fibers relay signals resulting from damage), which may manifest as numbness, pain in the hands or feet, exposure to pain and itch and hot and cold. These fibers are not enveloped in myelin. Large fibers relay signals to muscles that are involved in movement and they receive and relay signals that REGINA PATRICK, RST, RPSGT are involved in touch, vibration, and balance. Large fibers are Regina Patrick, RST, RPSGT, has been encased in myelin.

ď&#x192;&#x160; Continued from Page 11

12 electric shock-like sensations, burning pain, or coldness. Symptoms of small fiber sensory nerve loss are typically noted initially in the feet. As the loss of small sensory fiber nerves progresses, symptoms travel upward and may affect the hands or face.

They found that RLS was approximately three times more prevalent among the diabetic patients (17.7 percent) than among the control patients (5.5 percent). Statistical tests further revealed that RLS was independently and significantly associated with type 2 diabetes.

Problems in large fiber sensory nerves may be experienced as decreased sensation, especially in the hands and feet (e.g., a person may complain of having a sense of wearing gloves or socks). A person with large fiber sensory nerve problems may have decreased reflexes, which may contribute to balance problems.

Other researchers have similarly corroborated an association between diabetes and RLS. For example, Zobeiri and Shokoohi1,9 found that the prevalence of RLS was approximately four times higher among the diabetic patients (28.6 percent) than among the control (i.e., nondiabetic) patients (7.1 percent), and that this difference was significant.

Small fiber neuropathy and RLS share many risk factors (for example, diabetes is a risk factor in both disorders) and both disorders involve sensory symptoms, circadian changes in symptoms, and a length-dependent pattern of symptoms (i.e., the symptoms are initially noted in the feet and lower legs). In addition, patients with small fiber neuropathy tend to complain of RLS symptoms. With this in mind, Polydefkis9 and colleagues at Johns Hopkins University (Baltimore, MD) investigated whether different forms of peripheral neuropathy exist among patients with RLS. The researchers evaluated 22 nondiabetic patients with RLS for large fiber neuropathy (LFN) and small sensory fiber loss (SSFL). Nerve conduction tests and sensory threshold tests for cooling and vibration were conducted to assess patients for LFN, and punch skin biopsies of the thigh and lower legs were performed to assess patients for SSFL. Eight (36 percent) patients had neuropathy. Among these eight patients, three patients had LFN alone, two patients had mixture of LFN and SSFL, and three patients had SSFL alone. The researchers divided the patients into the late-onset group (i.e., the RLS symptoms began after age 45 years) and the early-onset group (i.e., the RLS symptoms began before age 45 years). They noted that the SSFL group had a later onset of RLS, and were more likely to report pain in their feet with their RLS symptoms. By contrast, the RLS symptoms in patients with LFN was not correlated with age at onset and they did not report pain with their symptoms. Based on these findings, Polydefkis proposed that two forms of RLS may exist: one form that is triggered by painful sensations associated with SSFL and has a later onset; and a second form that does not involve the small sensory fibers, has an earlier onset age, and has no pain with the RLS symptoms. In 2007, Italian researcher Giovanni Merlino2 and colleagues were the first investigators to demonstrate an association between RLS and type 2 diabetes and demonstrate that peripheral neuropathy is a primary risk factor for RLS in diabetic patients. They compared the prevalence of RLS among diabetic outpatients versus among nondiabetic controls who were diagnosed with other endocrine diseases. They also assessed the diabetic patients for peripheral neuropathy to determine whether it was a risk factor for RLS.

Sabic3 and colleagues also noted an association between diabetes and RLS, but with an interesting finding. They examined the frequency of RLS among patients with hypertension and among diabetic patients with and without hypertension versus its frequency among healthy (i.e., nondiabetic nonhypertensive) controls. There was a greater frequency of RLS among patients with hypertension (30 percent) and among diabetic patients with (30 percent) or without hypertension (21 percent), compared to the controls (12 percent). However, the difference in RLS prevalence between the hypertensive diabetic patients and the controls and between the hypertension-only patients and the controls was significant, whereas the difference in RLS prevalence between nonhypertensive diabetic patients and the controls was insignificant. They concluded that a link existed between hypertension, RLS, and diabetes. Hypertension may be a greater risk factor for RLS than diabetes since the prevalence of RLS was statistically more significant in patients with hypertension only and in patients with hypertension and diabetes, but not in patients with diabetes alone. Restless legs syndrome can be problematic if attempts to relieve uncomfortable leg sensations substantially delay sleep onset, and thereby impair daytime function. Neuropathy can become debilitating as it progresses. For example, neuropathy-related sensations such pain and burning can delay sleep onset or may disrupt sleep, numbness in the feet can make it impossible to drive, and decreased reflexes may create balance problems. Because of the increased prevalence of RLS among diabetic patients, clinicians may need to consider asking diabetic patients about symptoms of RLS and symptoms of peripheral neuropathy such as pain or a sense of burning or â&#x20AC;&#x153;electric shockâ&#x20AC;? sensations (i.e., short fiber neuropathy) or decreased sensation in the feet or balance problems (i.e., LFN). Treating neuropathy may help to slow the progression of the disease and may be helpful in improving RLS symptoms. Polydefkis9 speculates that RLS symptoms in diabetic patients with SSFL may respond better to neuropathic pain medications, compared to diabetic patients with LFN. However, studies are needed to determine the impact of neuropathic pain medications on RLS associated with SSFL versus RLS associated with LFN.

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13 Future studies may determine how RLS and neuropathy in diabetics are related and determine whether different treatment approaches for RLS are needed, based on the presence of large

fiber or small fiber neuropathy. Clarifying these issues could ultimately improve treatment for neuropathy, as well as for RLS, in people with diabetes.

REFERENCES 1. Zobeiri M, Shokoohi A. Restless leg syndrome in diabetics compared with normal controls. Sleep Disorders. 2014: doi: 10.1155/2014/871751.

6. Kitada M, Zhang Z, Mima A, et al. Molecular mechanisms of diabetic vascular complications. Journal of Diabetes Investigation. 2010;1:77-89.

2. Merlino G, Fratticci L, Valente M, et al. Association of restless legs syndrome in type 2 diabetes: A case-control study. Sleep. 2007;30:866-871.

7. Ryle C, Donaghy M. Non-enzymatic glycation of peripheral nerve proteins in human diabetics. Journal of the Neurological Sciences. 1995;129:62-68.

3. Sabic A, Sinanovic O, Sabic D, et al. Restless legs syndrome in patients with hypertension and diabetes mellitus. Medical Archives. 2016;70:116-118.

8. Stirban A. Microvascular dysfunction in the context of diabetic neuropathy. Current Diabetes Reports. 2014;14:541-549.

4. Pittenger G, Vinik A. Nerve growth factor and diabetic neuropathy. Experimental Diabesity Research. 2003;4:271-285.

9. Polydefkis M, Allen RP, Hauer P, et al. Subclinical sensory neuropathy in late-onset restless legs syndrome. Neurology. 2000;55:1115-1121. ď ś

5. Ullah A KA, Khan I. Diabetes mellitus and oxidative stressâ&#x20AC;&#x201D;a concise review. Saudi Pharmaceutical Journal 2015: doi: http://dx.doi.org/10.1016/j.jsps.2015.1003.1013.

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A2 Zzz 25.3 | September 2016

THE CREDENTIAL EXAM: DON’T SWEAT IT … NAIL IT! By Terrance Malloy, RPSGT, RST

“A goal without a plan is a wish” — Antoine de Saint-Exupery

sleep technologist credential, whether registered polysomnographic technologist (RPSGT) or registered sleep technologist (RST), is a validation of knowledge, experience and professional judgment; often a requirement for employment and certainly for advancing your profession. Whether you are anticipating taking the exam for the first time, retaking it after coming up short on your score or to maintain your existing credential, or are in a senior position with newer technicians looking to you for guidance, an exam preparation plan is the key to success. “Exams don’t always test a person’s true knowledge, because some people with equivalent levels of knowledge can perform differently on the same test. Some people are good ‘test takers’, and could easily pass an exam without the same knowledge as someone who has worked hard and studied hard to pass the exam. To become a better test-taker, familiarize yourself with the exam, develop a written study plan and utilize study guides and practice exams,” says Marietta B. Bibbs, BA, RPSGT, CCSH, current American Association of Sleep Technologists (AAST) board director, past president of the BRPT and past chair of the Board of Registered Polysomnographic Technologists (BRPT) Exam Development Committee.

The exam blueprint will help you to understand the broad content areas and their percentage emphasis on the exam. Don’t be frustrated by what may appear to be vague descriptions of the content; take it as an overview and let the percentage emphasis help to guide your study plan. Consider whether an area has a relatively small or large percentage emphasis and reflect on your knowledge and experience with that content area. Plan more study time for those areas in the exam blueprint that cover the largest percentage of the test. Think about exam content areas that cover procedures that are not part of your regular work, such as Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Test (MWT), Home Sleep Apnea Testing (HSAT), polysomnogram (PSG) report calculations and sleep stage and event graphic summary interpretations. There may be sections that list terms/abbreviations that you should be familiar with. Begin reviewing these lists and checking off terms that you know and highlighting for study the ones you don’t.

Gather your study resources. Your sleep center or colleagues may have textbooks or review materials. Consider the purchase of the board study guide as a wise addition to the handbook review. Give preference to the references listed in the exam handbook and consider study of American Academy of Sleep Medicine PREPARATION (AASM) and AAST guidelines a must. Focus on the AASM The importance of learning about the exam content cannot be Practice Parameters and the Clinical Guidelines that cover overstated. Colleagues can tell you about their exam experience technical procedures and positive airway pressure (PAP) titration. and what they remember of the content, but a careful and Titration protocols and practices vary between even accredited thorough reading about the exam and review of the content outline from the examining board should be considered a first step sleep centers and the exam will be based on these guidelines — not your sleep center protocol. to success. Candidate handbooks and board study guides exist to help you succeed. They include an exam overview, eligibility requirements and application procedures. Carefully read the section about scheduling, rescheduling, and cancellation requirements. Just as carefully, read the section regarding the day of the exam. TERRENCE MALLOY, RPSGT, RST Terrence Malloy, RPSGT, RST is currently a Sleep Technologist at Children’s Hospital of Wisconsin. He has over 30 years of experience in sleep medicine and technology and has training technologists and physicians for more than 15 years.

TIME MANAGEMENT

This is a critical part of your planning and requires a realistic examination of your daily/weekly schedule. At this point in your life, you likely have many demands on your time. Work, family, exercise and of course … sleep. Make a realistic goal date for taking the exam and plan each week up to that date. Help your family and friends understand your goal and plan. When and where you study should match testing time of day and conditions. If necessary, make appointments to meet your mind in a study location for a specific period of time. Treat it as a work meeting. If you’re easily drawn to your smartphone, leave it out of the study session. Schedule time away from other distractions; family, TV and work.

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MENTAL CONDITIONING

Unless you’re taking the exam right after completing a formal education course, you’ve probably got some mental conditioning to do. If your daily exercise consists of walking the stairs at work or even a 45 minute workout, you wouldn’t expect to be able to do well on a 10 K run or an intense bootcamp workout. The exam requires 3-4 hours of concentration. The last 50 questions are no easier than the previous 150. Part of your plan should include gradually increasing the time of each study session.

If you didn’t pass the exam, you’re in good company. Since the BRPT credential was first awarded in 1979, thousands of now-RPSGTs failed to pass the exam on their first attempt. Take a brief step away and then mentally review the process, taking notes to guide your next attempt. Decide on a realistic date for retesting and review the first part of this article. What can you improve on? Did you have a written plan or just a goal? Did you rely on one reference book because it worked for your co-worker? Did you carefully study the AASM/AAST guidelines?

THE DAY OF THE EXAM

“The first time I took the exam, I was sure I would pass because I felt I had prepared well. There were questions that I never expected Carefully review the information in the handbook about the day and to my shock, I failed. I had depended on my experience and of the exam. It should be obvious that you shouldn’t schedule the exam for the morning after you work. Get a good night’s sleep, eat lab protocols. I learned that there are procedures and published a healthy breakfast, limit or avoid caffeine and be sure to hydrate. guidelines, not used in my lab. I focused on them, retook the exam and passed easily,” says Raafat Kashlan, RPSGT, Milwaukee, Wis. Food and drink won’t be allowed, but you may be able to take in some chewing gum. Bathroom breaks are permitted and can help Obtaining the RPSGT or RST credential is a necessary and you mentally refresh after an hour or two. important goal and a very significant achievement. Planning carefully for your exam and focusing on your plan will greatly SO… WHAT IF YOU DIDN’T “NAIL IT”? increase your chances of saying “I nailed it!”  “Failure is the condiment that gives success its flavor” - Truman Capote

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WAKING UP TO A MAJOR BUT NECESSARY DECISION: AN OPEN LETTER TO LOCAL SCHOOL BOARD MEMBERS By Brendan Duffy, RST, RPSGT Dear School Board Members:

How does your school fit with that start time?

Another summer winds down and we prepare for another school year filled with many discussions and many important and possibly life altering decisions to be made.

The lead author of the policy statement, Judith Owens MD, FAAP, said “Chronic sleep loss in children and adolescents is one of the most common — and easily fixable — public health issues in the U.S. today.”

First of all, thank you for your service in your community school district. Your time and talent is greatly appreciated by the many parents and community members that you serve. You are entrusted each year to do your very best for the students and schools that you serve. I have something important to discuss with you with regard to an important decision that must be made. For some students, the decision you make can literally be life saving. Their health and well-being depend on you taking a look at one critical factor that is often overlooked. Or, it is discussed briefly, but the logistics involved in making a change are waved away as being “too cumbersome” or “too much trouble” for a school board member to get involved with. So the topic becomes the elephant in the room that board members avoid. But how much trouble is too much trouble when we are talking about preventing teen car crashes, reducing disciplinary incidents and improving student grades? If I had a presentation that would bring about all of the positive results noted above, as in less crashes, less disciplinary incidents, great student performance, more focus, and better student attitudes many of you would be happy to have me present this valuable information to your school community. Many would ask me to explain my premise so you could reduce accidents, improve student focus, show better student performance on the athletic field and reduce athletic injuries. I am going to give you the answer and it is up to you to implement this as it is you that holds the key. The answer is later school start times. The American Academy of Pediatrics (AAP) has recommended that middle and high schools delay the start of school until at least 8:30 a.m. BRENDAN DUFFY, RST, RPSGT Brendan Duffy, RST, RPSGT is the Coordinator/ Manager of a six bed AASM accredited sleep disorders center at St. Charles Hospital in Port Jefferson, N.Y. With almost 20 years of sleep medicine experience, he enjoys speaking and writing on various sleep topics especially sleep as it relates to athletic competition and performance.

Students not getting enough sleep have an increased risk for being overweight or for suffering from depression. And those that get more sleep are less likely to be involved in automobile accidents, have better grades and achieve higher standardized test scores. Let’s just look at a few examples. In a study in 2014 from Old Dominion University, auto crashes were compared over two years for two counties and a correlation was made between crashes involving teen drivers and early school start times. The two central Virginia counties in the study began classes about an hour and a half apart. Chesterfield County, which started high school classes at 7:20 a.m., had a significantly higher rate of crashes among teens than their neighboring county, Henrico, which started classes at 8:45 a.m. This difference between the counties was only applicable to teen drivers, not adults, which suggests the early start time could be a preventable contributor. It is fairly obvious that young drivers, with little driving experience, and even less knowledge of the dangers of microsleep or driving sleep deprived, are put in precarious situations that they are ill prepared to handle. The other take away from the study was that there were significantly more instances where the teen driver “ran off the road to the right — a common finding in crashes where inadequate sleep is suspected.” In 2013, the Rock Bridge High School Board in Columbia Mo., after much debate, voted to change the start time from 7:20 a.m. to 8:55 a.m. The result? It was reported that students seemed to be more awake and more eager to learn. In addition, the out of school suspensions since 2012 have dropped by 1,000! And graduation rates went from 82.7 percent to over 90 percent. Whether you look at the clock to improve the life, health, and well-being of your students, or perhaps you become the brave board member that rolled up their sleeves on behalf of making a simple, yet vital change a reality in your district, you truly can be a lifesaver.

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17 Please don’t “kick the can” down the hall for the next board member to address. Be the one that “puts the brakes” on those cars full of young people that we all too often hear about that just “ran off the road.” Be the one that helps stem the mood disorders, the ever-growing obesity problem, and the disciplinary distractions and risky behaviors that are seen too often in sleep-deprived students. Be the one that refused to be told it could not be done because of bus schedules or sports schedules etc. Other board members nationwide have navigated this change and met those challenges head on. They are enjoying the satisfaction of knowing they have truly changed the lives and the health of the students they represent. Make this school year the year you make the time to move the time!

REFERENCES 1. www.odu.edu/news/2014/11/teen_drivers 2. https://www.aap.org/en-us/about-the-aap/aap-press-room/ pages/let-them-sleep-aap-recommends-delaying-start-timesof-middle-and-high-schools-to-combat-teen-sleep-deprivation. aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-0 00000000000&nfstatusdescription=ERROR:+No+local+token 3. A ‘Start School Later’ Success Story in Missouri: Higher Graduation Rates, Fewer Suspensions http://bit.ly/1ObEAqe 

Have a great school year! Sleep Well - Live Better!

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DON’T OVERLOOK THE VALUE OF STATE AND REGIONAL SLEEP SOCIETIES By Tamara Kaye Sellman, RPSGT, CCSH

leep technologists commonly (though not always) become members of peer organizations, such as the American Association for Sleep Technologists (AAST) or the Board of Registered Polysomnographic Technologists (BRPT). They join because they know the inherent value in being part of the professional community. Beyond easy access to continuing education credits (CECs), they are interested in: • Networking with other sleep health professionals • Enjoying discounts on conference registrations and merchandise • Taking pride in their profession • Meeting employer requirements for attending annual conferences National organizations certainly meet many critical needs for sleep technology professionals, but sometimes, it’s support and involvement at the local level that cements a technologist’s place in the community.

WHAT IS A STATE SLEEP SOCIETY?

Like those organizations at the national level, these are typically nonprofit organizations led by volunteers who work in the field. They come together chiefly to provide an annual meeting that sleep professionals in the region can attend to acquire their annual TAMARA KAYE SELLMAN, RPSGT, CCSH Tamara Kaye Sellman RPSGT, CCSH is a science journalist and sleep health activist. She is currently writing a book on sleep hygiene for mainstream audiences which she hopes to launch in 2016. She is Chief Content Officer for InboundMed and curates the sleep health information clearinghouse, SleepyHeadCENTRAL.

CECs. Usually these meetings are open to all professionals within the scope of sleep health, such as physicians, dentists, patient educators, nurses, DME providers, and, of course, technologists. Sometimes meetings are scheduled for every other year and some, like the Washington State Sleep Society, skipped offering a conference in 2015, as the national SLEEP meeting was held in Seattle that same year.

However they function, state sleep societies can be the perfect umbrella for organizing sleep activists who wish to meet more regularly to discuss trending topics, review legislation that impacts their livelihood, or organize lobbies for sleep health measures at the state level. Occasionally, technologists will form a state sleep society as a state requirement for licensure, as well. How active these societies remain after they attain licensure can vary widely. Occasionally a state sleep society website will be several years out of date with no events planned for the near future. Others will post resources and information but never have live meetings to offer. As Yoona Ha reported last June for the AAST blog, “Some of these inactive sleep websites were originally set up as an information hub to obtain state licensure information for polysomnography. Once the goal of state licensing was accomplished, it appears that some sites are relatively quiescent. This appears to be the case, for instance, with the New York State Society of Sleep Medicine website.” However, while some societies seem to be in hibernation, others are alive and well and in need of volunteers to keep their numbers growing and their conferences active and relevant to the needs of their members. These organizations offer open-ended opportunities for sleep technologists and educators who are interested in networking, lobbying, participating in important research efforts or stimulating new public health outreach efforts at all levels. Which state and regional sleep society’s are closest to you? Are you a member?

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INDIVIDUAL STATES WITH ACTIVE SLEEP SOCIETIES Arizona: Arizona Sleep Society next meeting Oct 8, 2016 Arkansas: Sleep Professionals of Arkansas most recent meeting Apr 2016 California: California Sleep Society next meeting Sept 30, 2016 Colorado: Colorado Sleep Society most recent meeting June 2016 Delaware: Delaware Sleep Society next meeting Oct 21, 2016 Florida: Florida Association of Sleep Techologists next meeting Nov 11, 2016 Georgia: Georgia Association of Sleep Professionals next meeting Sept 24, 2016 Illinois: Illinois Sleep Society next meeting Oct 1, 2016 Iowa: Iowa Sleep Society next meeting Sept 16, 2016 Kansas: Kansas Association of Sleep Professionals next meeting Nov 3, 2016

Kentucky: Kentucky Sleep Society next meeting Oct 14, 2016 Louisiana: Louisiana Academy of Sleep Medicine next meeting Oct 7, 2016 Maine: Maine Sleep Society most recent meeting Mar 2016 Maryland: Maryland Sleep Society next meeting Apr 27, 2017 Massachusetts: Massachusetts Sleep Society see Maine Sleep Society Michigan: Michigan Academy of Sleep Medicine next meeting Oct 7, 2016 Minnesota: Minnesota Sleep Society next meeting Oct 15, 2016 Mississippi: Mississippi Sleep Society most recent meeting Aug 2016 Missouri: Missouri Sleep Society most recent meeting Apr 2016 Montana: Montana Sleep Society next meeting Sept 29, 2016

REGIONAL SLEEP SOCIETIES

These organizations serve multiple states in a single region (and can often alternate host locations within these regions). They serve at least half of the states in the union and, in some cases, international members:

• The Southern Sleep Society (http://www.southernsleepsociety.org/) serves the states of Alabama, Arkansas,

• The North East Sleep Society (http://www.northeastsleep. org/index.php) serves the states of Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. They offer a meeting every other year and have been active since 1985. Their most recent meeting was held in March 2015 and they do not have a meeting slated for 2016. • The Washington State Sleep Society (http://www.wasleep. org) serves Alaska, Hawaii, Idaho, Montana, Oregon, Washington and southwestern Canada. The previously active Pacific Northwest Sleep Association, which typically served scores of Oregon-based sleep technologists, went defunct in 2016, making the WSSS and Montana Sleep Society meetings the only Northwest regional events available. Their next meeting is slated for Oct 21, 2016.

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 Continued on Page 20

Florida, Georgia, Louisiana, North Carolina, South Carolina, Texas and Virginia. It is the oldest regional sleep society in the country and its host location changes from year to year. Physician educational credits are provided during this 4-day event, which includes an 8-hour comprehensive technologist course (in collaboration with the AAST) providing comprehensive training, education, and CECs for sleep technologists. Their most recent meeting was held in Apr 2016.

New Jersey: New Jersey Sleep Society next meeting Nov 5, 2016 North Carolina: North Carolina Academy of Sleep Medicine next meeting Oct 29, 2016 South Carolina: Carolina Sleep Society most recent meeting May 2016 Tennessee: Tennessee Sleep Society most recent meeting Apr 21016 Texas: Texas Society of Sleep Professionals next meeting Oct 7 2016 Virginia: Virginia Academy of Sleep Medicine next meeting Nov 3, 2016 Washington: Washington State Sleep Society next meeting Oct 21, 2016 West Virginia: West Virginia Sleep Society next meeting Sept 23, 2016 Wisconsin: Wisconsin Sleep Society next meeting Sept 23, 2016

 Continued from Page 19

20 • The Network of Asia Pacific Sleep Specialists (https://napss.org/) uniquely serves sleep specialists who live across the Pacific Rim. This includes Hawaii, Malaysia, The Philippines, Thailand, China, Singapore, South Korea, Hong Kong and others. Their next meeting is slated for Oct 15, 2016 in Manila, The Philippines. • The Tri-State Sleep Society (http://nwosemsleep.org/) serves Indiana, Michigan, and Ohio and launched their first annual educational meeting in Perrysburg, Ohio last May.

way they do two things at once: get their annual CECs and keep up with the networks of other sleep professionals they’ve built as the result of attending. Join a board as an executive: Most state sleep societies are nonprofits ruled by requirements that include a functioning board. Check your local society to see if they are looking for new executive board members (president, vice president, secretary, treasurer). If you have administrative experience, they will surely appreciate and welcome it.

HOW TO GET INVOLVED

Volunteer: There is no such thing as too many volunteers in a If you’re ready to move beyond your job in the sleep center to meet nonprofit environment. Lend a hand with registration, help a society other sleep technologists, become a sleep activist, or widen your with their website or sit on a committee. There’s a task for every educational horizons, here are some ways you can get the ball rolling. interest and the most active sleep societies rely on a large volunteer basis to get things done. This is a great way to enlarge your inner Go to a conference: Find the one nearest you, register and circle of sleep professional contacts and learn more about the attend. For some sleep technologists, this annual event is the functions of the board without having to be an executive.

EXPLORE NEW CAREER OPPORTUNITIES by browsing through the AAST Job Board!

www.aastweb.org/Jobboard.aspx A2 Zzz 25.3 | September 2016

IMPROVING SAFETY IN SLEEP DISORDERS CENTERS: A PRIMER FOR USING ROOT CAUSE ANALYSIS By Christopher Hope, MD, MHA

n June 2016, the American Academy of Sleep Medicine (AASM) released revised standards for the accreditation of sleep facilities, which includes new standards focusing on improving the safety of patients undergoing sleep testing. Specifically, standard K-5 requires that facilities define serious adverse events (see table 1) and document their occurrence, while standard K-6 requires that a root cause analysis (RCA) be performed and documented for each serious adverse event which has occurred. Since compliance with the new standards is required by July 2017, staff of accredited facilities should be familiar with the use and limitations of RCA. RCA is a structured method used to analyze a serious adverse event after it has occurred, and was initially developed to analyze industrial accidents. The central tenet of RCA is that adverse events occur, in part, because of how systems of care are designed, and that by looking at how those systems are set up and functioning (or malfunctioning), we can obtain a better understanding about how to change those systems to make another adverse event less likely. This process involves organizing the team that will perform the analysis of the adverse event, reconstructing the event and identifying the factors that contributed to the occurrence of the event, and then developing an action plan to change those factors.

STEP 1: ORGANIZE THE RCA TEAM

Sleep facilities accredited by the AASM vary widely in their organization, from small, independent testing facilities to large academic hospital-based centers that perform studies on specific populations such as children. As such, the human resources available to perform a RCA may vary widely.

• Facility Director

• Risk Manager/Legal

• Medical Director

• Technical Director

• Staff Physician

• Sleep Technologist

• Sleep Medicine Fellow

• Nurse

• Patient Safety/Quality Improvement Professional

• Office Staff • Patient Representative

It is recommended that a core RCA team be 4-6 members with additional members added as needed based on the circumstances of the particular adverse event. For example, if the adverse event involves an equipment failure, then a representative from the biomedical department could be invited. If available, a team member with experience with performing RCA should lead the team, and a member should be designated a scribe to document the work of the team and draft the analysis and recommendations.

STEP 2: RECONSTRUCT THE ADVERSE EVENT AND PERFORM THE RCA

Once the team is assembled, the goal of the RCA should be made explicit by the team leader — to generate knowledge about the system of care that our patients interact with in anticipation of improving that system and improving patient safety. It is not to assign blame on any individuals.

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 Continued on Page 22

The first step is to reconstruct the events that preceded the adverse event, taken from the events documented in the medical record, review of polysomnographic data and video recordings if appropriate, and supplemented by interviews with staff that The goal of assembling the RCA team is to have representatives had direct experience with the patient and processes involved in from enough disciplines that a variety of perspectives are available, the adverse event. The goal of this reconstruction is to generate while also balancing the size of the group so as not to become too a timeline of events that can then be analyzed for factors that large and unwieldy to efficiently complete the RCA in a timely contributed to the adverse event. manner. Possible RCA team members include the following: The second step of the analysis is to review the timeline of events for factors that may have contributed to the adverse event. Table 2 lists types of factors that contribute to adverse events in healthcare CHRISTOPHER HOPE, MD, MHA settings. As an example, after a patient fall with injury, the analysis Dr. Christopher Hope has been in the sleep may reveal that the involved person has congestive heart failure and field for over 15 years, originally working as chronic obstructive pulmonary disease which limits her ability to a registered polysomnographic technologist ambulate without assistance (patient specific factor). The office staff and clinical researcher. He is currently doesn't routinely let patients know that technologists are available a psychiatrist and sleep specialist with to assist with a wheelchair (staffing factor), so the patient attempted Baptist Medical Center in Montgomery, Ala. to walk unassisted and fell while attempting to enter the facility.

 Continued from Page 21

STEP 3: DEVELOP AN ACTION PLAN

Once the RCA is completed and a list of factors that contributed to the adverse event is completed, the work of the team has not finished. The final step of the improvement process is to feed the results into the quality improvement processes that the facility should be developing in parallel using a measurable action plan. For example, if the RCA into an adverse event of delayed recognition and appropriate response to a dangerous cardiac arrhythmia identified a factor of poor knowledge of arrhythmias by the technical staff, the team could develop an arrhythmia course and make an arrhythmia the focus of the annual safety drill.

SUMMARY, LIMITATIONS AND RECOMMENDATIONS

RCA is one of the most widely-used tools to improve patient safety; however there is a limited amount of data that supports

its effectiveness. Part of this may be due to the considerable heterogeneity of how these methods are performed and how the knowledge developed is utilized in action plans afterward. Despite this, regulatory bodies are requiring the use of RCA after adverse events, and they represent a potentially useful tool in decreasing the frequency of adverse events in our patients. The use of RCA will pose a challenge to facilities that are not familiar with their use. Finally, there are opportunities to share knowledge generated by RCA and other improvement processes with others in the sleep field, although venues are not readily available currently. Sharing the processes and results of improvement efforts with peers locally, and at state and national meetings, has the potential to increase the quality and safety of sleep medicine for our patients.

TABLE 1: SAFETY-RELATED AASM STANDARDS FOR THE ACCREDITATION OF SLEEP FACILITIES

Standard K-5: Patient Safety Related Significant Adverse Events

Description Within the facility, the facility director must document the occurrence of significant adverse events for its patient population. At a minimum, the following events must be considered significant adverse events: • Patient or staff death • Permanent loss of function or of a body part by a patient or staff • An event that leads to the hospitalization of a patient or staff • An event that requires activation of an emergency medical response • Sexual or physical assault of a patient or staff or allegations thereof • Release of a minor or a patient lacking capacity or competency to an unauthorized individual • Elopement of a patient • Complications arising from the effects of hypnotics used for the purpose of sleep testing • Any event required by the applicable jurisdiction to be reported to a government agency

K-6: Analysis of Significant Adverse Events

The facility must create a policy and procedure for performing a root cause analysis of any significant adverse events. Consistent with the policy, the facility must conduct an investigation of all significant adverse events that occur.

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23 TABLE 2: FACTORS CONTRIBUTING TO ADVERSE EVENTS

Factor

Description

Patient Characteristics

medical condition, language/cultural issues, social issues

Task-related

specific aspects of the procedure that may make harm more likely

Staffing

knowledge, skills, attitudes and motivation

Team Environment

communication style, hierarchies, supervisors, and team culture

Work Environment

staffing levels, workload acuity, nightshift, equipment-specific limitations

Organizational/Management

culture of safety, patient-centeredness

Institutional/Regulatory

state & national factors, accreditation

REFERENCES

1. American Academy of Sleep Medicine (2016). Standards for Accreditation, updated June 2016. Available at http:// www.aasmnet.org/resources/pdf/accreditationstandards-2016.pdf

JOIN AAST

TODAY

2. Patient Safety Network (2016). Patient safety primer – Root cause analysis. Available at https://psnet.ahrq.gov/ primers/primer/10/root-cause-analysis 

Invest in yourself, your career and your profession by becoming a member of the American Association of Sleep Technologists. Join today and receive membership benefits including: •

Free CECs each month

•

Discounts on a multitude of educational resources including AAST products, courses, annual meeting registration and more

•

E-mail notifications about the latest news and developments affecting the field...from legislative updates to information concerning certification

•

Career resources and CEC transcript

•

And more!

AAST members will receive FREE access to two new online learning modules per month, a $960 value. Both modules are intended to sharpen the skills and advance the knowledge of experienced technologists. To join, visit the AAST website at www.aastweb.org Questions? Contact the AAST Membership Department at (630) 737-9704 or AASTmembership@aastweb.org.

A2 Zzz 25.3 | September 2016

SHOULD SLEEP TECHNOLOGISTS BE READING CLINICAL RESEARCH STUDIES? By Tamara Kaye Sellman, RPSGT, CCSH

t’s such a relief when you pass those boards and get your credentials, isn’t it? No more homework, no more thinking about the biology of the brain, the half-life metabolism of drugs, the special needs of pediatric patients you may never see…

so their ability to distinguish legitimate medical information from bogus clickbait is questionable. Fear-based articles based on nameless “studies” pushing questionable alternatives with no scientific backing do not help matters.

Except that this isn’t the reality for people who work in the healthcare field. We all know this. It’s called continuing education, and we need to capture those annual credits through webinars, conferences and other forms of homework in order to keep our jobs.

The popular media also has a bias and tends toward headlines that ask questions their articles never really answer, knowing full well that many will never read past those headlines. But it’s not all bad. These same patients may also access quality information online. What they do with it, however, can be problematic:

Is it enough to just maintain our credentials? There are some pretty compelling reasons to work beyond the minimum requirements in order to maintain your credential. Most of these reasons are tied into the availability of information on the internet, our need to be more educated than our patients on topics even beyond sleep and a growing call for workers in our field to become active advocates for sleep health in our communities. In every case, these efforts begin with mastering the interpretation of clinical research studies.

WHY WE SHOULD BE READING (AND UNDERSTANDING) CLINICAL RESEARCH STUDIES Our patients are doing it. For good reasons or not, more than 2/3 of patients will go to “Dr. Google” first for answers to their healthcare questions. Often, this can be disastrous. Americans aren’t particularly media literate,

TAMARA KAYE SELLMAN, RPSGT, CCSH Tamara Kaye Sellman RPSGT, CCSH is a science journalist and sleep health activist. She is currently writing a book on sleep hygiene for mainstream audiences which she hopes to launch in 2016. She is Chief Content Officer for InboundMed and curates the sleep health information clearinghouse, SleepyHeadCENTRAL.

• As a healthcare professional, you know, first hand, how challenging it can be to interpret a clinical research study’s results. There are lots of features to a published study that require attention before one can make any assumptions about the validity of its tests or results. • Meanwhile, medical writers can’t be trusted to be on top of this. They sometimes write “conclusive” articles derived from clinical research that only observes results from a handful of participants or is funded by a pharmaceutical sponsor. If medical writers can’t see through the holes or the spin, how are average citizens of average literacy going to do it? Another relatively new trend that probably isn’t going away any time soon: Patients now bring copies of these studies to their appointments to assert some claim they want to make about their own health (“Here is proof I don’t snore,” or “I am certain that I have narcolepsy; can you just give me Provigil?”). It’s a sad fact that perceptions about the healthcare field in 2016 (as recently detailed in a Gallup Poll) have plummeted to all-time lows; patients do not trust the medical profession like they used to. The outcome is “research” often conducted by people with very little to no biology education. This is where your skill in interpreting clinical research studies can really come in handy. By spending a few minutes to help them understand what they are reading, you are doing your job as a patient educator, as well as improving the level of trust your patient has with your clinic.

A2 Zzz 25.3 | September 2016

25 But you must already know how to interpret clinical research studies in order to do this. How sharp are your skills? Where can you improve?

HOW TO INTERPRET CLINICAL RESEARCH STUDIES

We need to be able to answer questions that exceed our basic knowledge of sleep health in order to inspire patient confidence. Taking things one step further … as sleep technologists and patient educators, we already know how complex the sleep process is, and that it intertwines with nearly every system in the body. We really do need to know more than our patients, not only about sleep (and, by default, pulmonology or respiratory health), but also about cardiology, vascular disease, metabolic syndrome, neurological conditions, mood disorders, brain and blood chemistry, neuropathy, drug addiction, cranial physiology, even basic eye health.

the skills necessary to parse a 15-page clinical research

This is not because we are allowed to diagnose anything, because we absolutely aren’t. But our patients spend more time with us than with nearly any other medical professional they will encounter in their continuum of care with regard to a sleep complaint. The odds are much higher that they will ask you questions that might be better addressed to their physicians, based entirely on proximity. You still need to be able to provide cogent, educated responses to patient’s questions, nonetheless.

it so that you can share what it says to patients, who most

Keep in mind patients don’t know how protocols in our field work. If you have scrubs on, they think you could be a technologist, a doctor, a nurse or some other specialist. They do not know the chain of command, they only know they aren’t feeling well and you are someone who should know how to help them. If you encounter lots of patients with cardiac issues, then it behooves you to learn all you can about cardiology: arrhythmias, procedures, electrocardiogram (EKG) anomalies, drugs that impact heart health and so forth. If you encounter veterans, then you are best advised to keep up on all things related to post-traumatic stress disorder (PTSD), which is a very fluid arena of inquiry at present, given the vast numbers of soldiers returning home from the Middle East with major sleep and behavioral problems. If most of your patients are African American, you should really stay on top of research focused on the full range of African American health issues (and not just sleep issues). Your effort at becoming an expert in your field may never be reimbursed (although you are probably able to at least get free access to PubMed or other subscription-only research resources through your employer). This should not be the reason why you read above and beyond what your day-to-day job requires, anyway; you should be thinking about ways to be the resource that your patients need you to be, and that may mean doing

 Continued on Page 26

Let’s face it, not all of us in the sleep technology field have study. It’s nothing to be ashamed of; this research is written for an audience of physicians who have read countless studies and written a few themselves. Also, even if you have been in the field for longer than credentialing programs have existed, you may never have encountered clinical research studies except to pass (or renew) your boards. It can't hurt to learn the skill now. Here are some great resources for learning how to break down a research study to more effectively understand and interpret likely do not have this skill set. • University of California San Francisco Medical Center: “Evaluating Health Information” — This patient-focused guide can benefit sleep techs, too. • American Nursing Association: “Framework for how to read and critique a research study” — This is an amazing resource from Louise Kaplan, PhD, Senior Policy Fellow for the ANA. • The Crohnology Blog: “How To Read Medical Research” — Some of the best resources for learning how to interpret clinical research studies come from chronic illness advocates. This is a good starting point for not only understanding the format and information provided, but for practicing critical thinking. Similarly ... from the Lewy Body Dementia Association: “Increasing Knowledge — How to Read a Research Paper”. • Susan G. Komen: “How to read a research table” — If we are to be smarter than our patients, we need to have better health literacy than they do, and that means beginning with how we interpret data presentations. • The BMJ: “How to read a paper” — This article breaks down the different kinds of clinical research studies, an important distinction when talking with patients, who do not always understand that research has many faces and can take many years to complete. • Journal of Oral and Maxillofacial Pathology: “Art of reading a journal article: Methodically and effectively” — Also, consult the links in the References section at the end.

A2 Zzz 25.3 | September 2016

 Sidebar continued on Page 26

 Continued from Page 25

26 more homework even in the absence of “credits.” It’s the same in every career path … those who do the extra work will generally reap the extra “credit” with job promotions, raises and more visibility. Sleep activism requires it. The sleep field has long been in need of advocacy, and with the wide range of media outlets available to us now — and a growing army of sleep health educators with CCSH credentials out there looking to put their new knowledge to use — sleep activism is beginning to have both a presence and an impact. Bolstering your knowledge of sleep through mastery of current research trends is one way to establish yourself as an expert. The best activists succeed because they are perceived as having expertise. Here are some ways you put yours to use: • Media outlets like the Huffington Post are obvious targets for advocacy efforts, but there are all kinds of great publishers of web and print content looking for sleep health information and advocacy. • The American Academy of Sleep Medicine (AASM) always needs volunteers to help with lobbying, such as with the most recent discussions about requiring transportation operators (drivers, pilots, captains, etc.) to undergo sleep health evaluations periodically to help reduce the risks for drowsy driving. • Local school boards need our help in convincing districts to switch to later school start times for teenagers as a way to stem the tide of sleep deprivation among America’s young adults, who accrue sleep debt at a much higher rate than nearly any other population. • Big business is becoming more friendly to the concept of the employee nap and flex hours, as statistics continue to show

a bottom-line deficit when it comes to the effects of sleep deprivation in the workplace. An activist can mine this (quite lucratively) by providing sleep health presentations to CEOs, employee unions and the human resource departments of small businesses most impacted by sleep deprivation. • Hospital systems across the country are working hard to eliminate sudden infant death syndrome (SIDS) among their populations, and this means constant public education about what constitutes healthy sleeping conditions. Your expertise with pediatric sleep makes you a perfect spokesperson. • Speaking of healthy sleeping conditions, there are “right to sleep” campaigns cropping up all over these days, for divergent populations including the homeless and emergency room doctors. Sleep educators can make serious headway as advocates in this space. 

 Sidebar continued from Page 25 LOCATING AND ACCESSING CLINICAL RESEARCH STUDIES This can be challenging because many study publishers only offer an abstract, with a members-only paywall barricading readers from access to the actual data. However, there are ways around this (including taking advantage of your hospital PubMed subscription). Scientist and writer Tanner Helland of Mythbusters fame offers “How to Access Science and Medical Research without Paying an Arm and a Leg for It,” a useful article about accessing legitimate research through open sources.

A2 Zzz 25.3 | September 2016

THE BASICS OF CHARTING: BEST PRACTICES IN PATIENT CARE By Lisa Bond, RST, RPSGT

harting is one of the most basic and important aspects of patient care. Unfortunately charting is also one of the most often slighted duties by sleep technologists. By slighted I mean that it is frequently deemed as unimportant and therefore overlooked, done sloppily, at too minimal a level, inaccurately or, sadly, even not done at all. Charting is a very vital and important part of any healthcare provider’s job, including that of the sleep technologist.

proof. So if you are not charting regularly on a patient throughout the collection, then as far as anyone is concerned, you did not actually monitor that patient. The accuracy of your charting shows not only that you are good at your job, but also that you were actually paying attention. So if you chart that the patient is sleeping, and they are actually awake according to the recording, that is a problem.

Charting says a lot about the patient, true, but it also says a lot about you as a technologist when content, depth and accuracy are assessed. A professional will work to make sure that their charting is accurate and complete as they know their charting is a reflection of themselves as a professional, as well as good patient care.

There should be a policy in your sleep center about how often to chart during the recording and what to chart. If your policy is not comprehensive don’t do just the bare minimum but don’t go overboard either. Maintain an appropriate balance. Lengthy notes do not always mean relevant notes. Keep things brief, to the point and document facts.

So let’s talk about charting. What is it? Charting is documentation in a legal medical record that communicates crucial information to other members of the healthcare team so that they can make accurate and informed decisions about the patient’s medical treatment. Think about that definition, don’t just skim past it but actually think about that definition and what it implies. Your charting is a LEGAL document that can be used in a court of law. Your charting impacts the decisions that will be made about the patient’s healthcare trajectory. Charting is important, vitally important. You are the eyes and ears of the physician who is not physically present during the study and therefore you must provide the information they need. Not everything can be garnered from the signals you record and maintain. Those signals are important, but so is charting. The first thing any medical professional is taught about charting is that if it is not documented, you didn’t do it. This sounds pretty basic but let’s think about that for a moment. Your job is to monitor the patient. If you do not chart regularly on that patient what means do you have to prove you actually did monitor them? Remember this is a legal document. If you are summoned to court what means do you have to prove you were monitoring the patient? Your word and your co-worker’s word will not be sufficient. The law wants facts and supporting documentation;

Lisa M. Bond RST, RPSGT, has been in the healthcare field since the late 1980s and the sleep field since the early 1990s. She is a Clinical Manager for Advanced Sleep Medicine and Chair of the AAST Membership & Communications Committee.

During the study, regardless of the type, you should be routinely charting the patient’s current sleep stage, heart rate (HR), respiratory rate (RR), SpO2 and body position along with a general observation since your last charting. When you do this you are providing facts that prove you are observing the patient. You are also providing a back up to the signals that are being recorded. If you say that patient is supine but the signal derivation states left lateral, then you know you need to correct that signal so that the record is a true reflection of what is actually going on with the patient. If you are performing a diagnostic study, you should also make comments about snoring intensity and frequency, as well as if the patient qualifies for a split-night study or not and why. If you are performing a titration study then you should also be making comments about the pressure the patient is on and if this pressure is controlling respiratory events and snoring. General comments should include basic factual information about how the patient has done since your last charting.

A2 Zzz 25.3 | September 2016

 Continued on Page 28

LISA M. BOND, RST, RPSGT

So what should you chart during the study collection as compared to after? During the study, you are charting what is going on right now with the patient. If you notice that the patient is talking in their sleep, that needs to be documented as it is happening, so that later it can be determined if it is important to the patient’s diagnosis. Did this occur when the patient was in rapid eye movement (REM) or non-rapid eye movement (NREM) sleep? Before an arousal or after an arousal? Remember that you are the eyes and ears of the physician, providing important information that supplements and enhances the signals recorded. Information like this is time-sensitive and should be charted as it happens.

 Continued from Page 27

28 Have they had respiratory events and are they increasing or decreasing? If there is an artifact, you should be documenting the type of artifact seen and how you have or are going to correct it. For example; maybe you note that the patient has a sweat artifact. You could document that sweat artifact is present and that at the patient’s next arousal you will go in to flip the patient’s pillow or turn down the temperature. However, you also need to follow through and actually do that at the patient’s next arousal, and then chart that you were in the room and doing just that right after the intervention. As always, if you don’t document it, you did not do it! Chart facts, not guesses. You will note that what I have been listing are simple facts. A guess leaves you open to looking unprofessional and possibly incompetent. Make sure what you are charting is pertinent to the study and appropriate. Be specific and objective; avoid generalizations and subjective statements. What does that mean? If you chart that the patient appears upset that would be subjective. Upset can mean many different things and doesn’t say about what. An objective observation states facts and includes signs, symptoms and timing. An example would be to chart that at 22:15 the patient was crying, breathing rapidly and made a specific statement indicating a fear of sleeping tonight without the continuous positive airway pressure (CPAP) they have been using for the past 10 years.

the patient’s care. There is also the potential to simply check off standard information without actually observing the patient. If you use this type of a system you will always need to supplement these chart notes with your pertinent observations. Your assessment is integral to your patient’s care. Check boxes cannot cover everything. It is never appropriate to pre-fill this type of charting note because if things change there is the potential that your charting will not reflect what is actually happening with the patient. Summarizing the night is another type of charting that you need to do. You cannot rely solely on charting during the study and you also cannot rely solely on summaries. Your summary gives those following after you, the scoring technologist and clinician, a brief overview of what is inside all those detailed individual notes and your general observations. This will assist them to quickly determine pertinent information that can impact the patient’s care and outcome.

Summary notes are often templates that help to reduce the charting workload and provide some consistency. Be very careful that you are completing that template accurately and correctly and are not simply copying and pasting or leaving inaccurate or incorrect information in the summary. A prime example is a template statement that indicates: “The respiratory events were noted to be worse when sleeping supine.” If this particular patient We also need to talk a bit about inappropriate charting. Nothing either did not, or was unable to, sleep supine at all during the you chart should be of a personal nature about the patient. Your study this would be an inappropriate and inaccurate statement. patient may be mean, rude, smell badly, and be a curmudgeon, but Another example would be to find the final charting including that is inappropriate to chart. It is also inappropriate to chart that an unedited statement like: “This is a XX-year-old male/female the patient is sweet, pretty/handsome, wears nice perfume/cologne patient that presented for a diagnostic/split/CPAP titration/ or is adorable. Nor should your charting ever include anything Bi-level titration/ASV study.” Templates can be helpful but they about your feelings, or any excuses or departmental problems. can lead to the dangerous practice of simply copying and pasting Examples of what NOT to chart include: and being incomplete and inaccurate.

• “The patient refuses to put down her stupid tablet and is still As a professional, you need to take responsibility for your playing Candy Crush.” charting. It is an integral part of the care you provide for your • “The patient’s blasted phone rang AGAIN.” patient. You must realize that the patient chart, when it is accurate • “I have asked management three times to get me a new belt and well done, is a lifeline to better care, and a badly done chart because this one is malfunctioning but they have not done it is not just detrimental to the patient, but also potentially to you professionally. yet therefore I am unable to fix this artifact.” • “I am so bored right now, the patient doesn’t even snore; why they are here is beyond me.”

Many systems have preset charting notes that pop up for you to check off during the recording. Be very careful when using this type of charting system. These systems provide basic static charting notes that reduces your work, but they lack individuality and you can easily miss pertinent information that may impact

A final thought for you about charting. When you chart, you are documenting not just what happened with the patient, but you are also charting all that you do as a sleep professional. You work hard to take good care of your patients, why not get the appropriate credit for doing that by making sure your charting reflects your accuracy, and the care and attention you have given to the patients while they were in your care. 

A2 Zzz 25.3 | September 2016

In the Moonlight

In the Moonlight: Q&A with Penni Smith, RPSGT, RST, CCSH

In the Moonlight” puts an American Association of Sleep Technologists (AAST) member in the spotlight, giving readers an opportunity to get to know one of their colleagues. This month A2Zzz asked Penni Smith, RPSGT, RST, CCSH, to complete the following statements. She started in sleep technology as a trainee at Capital Health in 1996. She achieved her RPSGT credential in 1998 and has proven herself as a skilled night technologist, scoring technologist and clinical sleep educator. She was involved in the legislative initiative for licensure in New Jersey and served on the NJ Polysomnography Licensing Board from 2007 to 2014. “I am proud to say she has worked for me her entire career!” said Rita Brooks, AAST President Elect. When I was young I wanted to grow up to be…I didn’t know what I wanted to be. I just knew I wanted to do something that was different from what everyone else was doing. I decided to become a sleep technologist because…I find it interesting to learn about what happens while people are asleep and the effects it can have on their life. I got my first job in sleep technology at…Capital Health. I have worked at the same place for my entire career. I work with such a great group of people, I wouldn’t dream of working anywhere else.

The thing I like most about my profession is…having a patient come in and say that you have changed their life. The food I’m most likely to snack on while working is…I try to eat as many fruits and veggies I can, so more than likely you will see me eating some kind of fruit. For fun on days off from work I like to…in the summer I spend most of my free time down the shore. My favorite TV show is…The Middle and Last Man Standing. My favorite singer or musical group is…I can’t say that I have a favorite, I love all music. You just never know what will be playing on my headphones as I am scoring a sleep study. The website I visit most often is…Pinterest. There I said it, I am addicted. The person I would most like to meet is…Ben Franklin. The biggest change I have seen in the profession since I started is…that insurance companies think an HSAT is the same as an in lab test.

Words of advice I have for people who are new to the I became an AAST member because…this organization is dedicated to making a good technologist into a great technologist. profession are…if you only work nights, try the day position even if it’s only for a couple of weeks. Try and learn all aspects of The person who has had the greatest influence on my career is… being a technologist. Rita Brooks, I wouldn't be the technologist I am today without her help. My professional goals for the next five years are…to continue to grow with the field as it changes. The most challenging part of Sleep is…the best meditation — Dalai Lama my profession is…this is also one of my favorite parts, getting (I got that from Pinterest). a patient who is having trouble tolerating CPAP, to not only tolerate it but also to see the Would you like to appear benefits of using it every night. “In the Moonlight”? Send an e-mail to A2Zzz@aastweb.org. September

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A2 Zzz 25.3 | September 2016

CERTIFICATION UPDATE: FROM THE BOARD OF REGISTERED POLYSOMNOGRAPHIC TECHNOLOGISTS BRPT Celebrates 10th Annual Symposium Come to the Symposium and celebrate our 10th annual event – three days packed with professional development, networking and fun. Register today for the 2016 BRPT Symposium www. brpt-gasp2016.com in Atlanta, GA September 22-24.

The Symposium offers a CCSH exam prep course: this is an excellent opportunity to participate in a live event and to get ready for the CCSH exam. The CCSH Temporary Pathway deadline is available until September 30, 2016. This CCSH Temporary Pathway is for candidates with a BRPT-issued Clinical Sleep Educator Certificate and a current healthcare credential or license. CCSH exam candidates using this temporary pathway will receive a discounted exam fee.

For those of you interested in earning the CSE certificate, and using this temporary eligibility pathway, you may take the online CSE course. With a packed agenda delivered by nationally renowned speakers, the online program focuses on obstructive sleep apnea syndrome and other common sleep

disorders, their treatments, comorbidities, and communication to empower healthcare professionals to educate, coach and provide resources to patients, their families, and the community. For more on the online course, go to: https://training.brpt.org Speaker Spotlight – Dr. Nancy Collop Dr. Collop will present new scientific findings in sleep on Friday, September 23rd.

Dr. Collop is an AASM Past President and is currently the Director of the Emory University Sleep Center. She has served the field of sleep medicine in a variety of capacities, from founding the Maryland Sleep Society to serving on a number of AASM/ABIM/ABMS boards. She is currently the editor of the Journal of Clinical Sleep Medicine. She has advocated for quality sleep care standards with Medicare and was the lead author in guidelines for home sleep apnea testing (HSAT). Dr. Collop is truly one of the top experts and advocates in sleep medicine, providing a unique perspective as editor of a major journal for the profession. To view the agenda and speaker line up, go to: https://paecanada.eventsair.com/QuickEventWebsitePortal/ 2016-brpt-symposium/brpt2016/Agenda 

A2 Zzz 25.3 | September 2016