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Sleep Medicine

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Cherryl Allard

on 22 October 2014

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Transcript of Sleep Medicine

A Little History
Sleep Medicine arose out of the discovery of REM sleep and Chronobiology in the 1950's and 60's respectively.
The current classification groupings of sleep disorders follows that of the 1939 book
Sleep And Wakefullness
by the father of sleep research, Nathaniel Kleitman.
Sleep Disorder Classifications
Circadian Rhythm Sleep Disorders

Sleep Walking
Bed Wetting

Medical or Psychiatric Sleep Disorders
Let's Compare Wages
Respiratory Therapist $27.83 $24.10

Health Technologist (Sleep Tech) $21.62 $16.78

First Line Supervisor (Patient Coordinator) $25.81 $21.94

Medical and Health Service Manager $48.72 $40.82

* Utah does not have a Certification or Licensure requirement for Sleep Technologists
Obstructive Sleep Apnea - most common type of sleep apnea caused by obstruction of the upper airway, characterized by repetitive pauses in breathing during sleep, despite the effort to breathe. Usually associated with a reduction in blood oxygen saturation. Apneas typically last 20 to 40 seconds.
Symptoms: Snoring, excessive daytime sleepiness, inability to concentrate, irritability, depression, forgetfulness, headaches, increased heart rate and/or BP.
Diagnosis: Patient History, Home oxymetry study, Polysomnography
Treatment: CPAP, VPAP (BiPAP), Dental Appliance, Neurostimulation, Surgery
Central Sleep Apnea - the central respiratory drive is impaired or absent, and the brain does not respond to changing blood levels of oxygen and CO2. No respiratory effort is given.
What Careers Are Available For CRTs or RRTs In Sleep Medicine?

Sleep Care Manager
Can supervise: Polysomnographic Students, Trainees or Technicians

Patient Coordinator (Firstline Supervisor)

Registered Polysomnography Technologist
Some things you need to know to be a Sleep Disorder Specialist
Requirements to take the SDS or the RST Examinations
NBRC SDS Credential:
CRT 6 months full time (21 hours/week) or RRT 3 months full time clinical experience in a sleep lab under doctor supervision qualifies you to take the SDS exam.

AASM RST Certification:
CRT or RRT, complete 25 overnight sleep studies with 10 CPAPs and minimum of one Multiple Sleep Latency Test within 3 months to 2 years, plus successful completion of ABSM sleep scoring proficiency exam or a 2 month sleep center inter-scorer reliability program at an AASM accredited sleep center. This qualifies you to take the RST exam.
Sleep Medicine
Just Ahead

National Mean Hourly Wage Utah Mean Hourly Wage
There are two ways to get a Sleep Disorder Credential:
Sleep Stages and How to identify them on an EEG. REM (when we dream), 3 stages of NREM = N1 - falling asleep (1-7 min);
N2 - memory organization (10-25 min); N3 - deep sleep (20-40 min)

What is Hypopnea?
episodes of overly shallow breathing or an abnormally low respiratory rate.
not considered to be clinically significant unless there is a 30% (or greater) reduction in flow lasting for 10 seconds or longer and an associated 4% (or greater) desaturation in the person's O2 levels

What is AHI?
Apnea Hypopnea Index is used to indicate the severity of sleep apnea:
calculated by dividing the number of apnea events by the number of hours of sleep:
Normal: 0-4
Mild Sleep Apnea: 5-14
Moderate Sleep Apnea: 15-29
Severe Sleep Apnea: 30 or more

What is RDI?
Respiratory Disturbance Index is like the AHI but also includes respiratory-effort related arousals. RERAs are arousals from sleep that do not technically meet the definitions of apneas or hypopneas. They are abrupt transitions from a deeper stage of sleep to a shallower one. (The time it takes to transition from one sleep stage to another is called latency)
how to calculate RDI = (RERAs + Hypopneas + apneas) X 60 / TST (in minutes)

Extensive knowledge in ECG interpretation.

How to interpret and score a polysomnography test.

The use and titration of Positive Airway Pressure equipment and supplemental oxygen.

Full transcript