Nicholas Charles, RPSGT

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Dina Elliott
5 years ago
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1 Nicholas Charles, RPSGT

Worked as a data collection tech in sleep labs since 2006 and have been credentialed as RPSGT

2 First Things Are First I am *not* a respiratory therapist! This is my son, Nick. He s a RBXNT er, Arby s BLT, um sleep tech! Worked as a data collection tech in sleep labs since 2006 and have been credentialed as RPSGT through the Board of Registered Polysomnographic Technologists since Poly = Many, Somno = Related To Sleep & Graph = Recordings Polysomnograph Many Sleep Recordings!

accredited). One such lab in the surrounding area is located at PVCH.

All sleep study acquisition, PAP titrations, scoring of data, etc is done

3 Where Do Sleep Techs Work? Sleep Technicians work in diagnostic sleep labs (preferably those that are AASM accredited). One such lab in the surrounding area is located at PVCH. Two bed lab that presently runs up to 10 patients/week. All sleep study acquisition, PAP titrations, scoring of data, etc is done in-house by credentialed staff. Rapid turn around times for referring doctors to receive results as interpreted by board certified medical director, Son V. Truong, MD. FULL DISCLOSURE!

4 One (of many!) Distinct Differences... between non-accredited sleep diagnostics centers and those that ARE AASM accredited is the mandate to engage our community of patients in specialtyrelated education! One way we are doing this at PVCH is through our monthly CPAP Compliance Clinic.

5 Visual Representations Of Apnea OTC Sleep Aids For PAP Compliant Patients Sleep Disorders In The Bible??? Why these three topics, though???

7 First Some Vocabulary Basics When we are talking about the most commonly diagnosed types of apnea it s usually a matter of physiologically induced apnea vs. neurologically induced apnea. Obstructive Sleep Apnea Central Sleep Apnea

How Does The Sleep Tech Know If He/She Is Looking @ Obstructive

Respiratory Effort Belts: During sleep study, the patient wears

With each breath, 2 waves are created Nasal Pressure Cannula:

8 How Does The Sleep Tech Know If He/She Is Obstructive Sleep Apnea or Central Sleep Apnea? Respiratory Effort Belts: During sleep study, the patient wears one across the chest & one across the abdomen. With each breath, 2 waves are created Nasal Pressure Cannula: Patient wears on face and it creates waveform based on temperature! CHEST BELT ABDOMEN BELT It s all about WAVES!

9 When It All Comes Together NASAL CHEST ABDOMEN NORMAL BREATHING OVER THE COURSE OF 30 SECONDS

10 Sleep Tech Humor: Typically, phone apps and other at home electronics will only measure Actigraphy Actigraphy is a noninvasive method of monitoring human activity cycles.

11 So what does apneic breathing look like??? NASAL CHEST ABDOMEN THIS PERSON TRIED TO TAKE 9 BREATHS BUT ONLY TOOK 7! 30 seconds OBSTRUCTIVE SLEEP APNEA

12 The Respiratory Therapist Reacts To Low SPO2 *much* differently than the Sleep Technician Does Sustained Low SPO2 Vs Intermittently Low SPO2

our readings indicate that these SPO2 values remain low *without* the presence of apnea, we may introduce supplemental

13 Add Oximeter Readings Into The Mix! If this trend continues for 10 minutes or more and our readings indicate that these SPO2 values remain low *without* the presence of apnea, we may introduce supplemental oxygen. In this instance, we would NOT want to introduce supplemental oxygen These are apneas with associated desaturations that should be factored into our count to determine eligibility for PAP therapy.

14 4/12/18 Sleep Study For Patient Brown, Charlie NASAL CHEST ABDOMEN 5 min. NASAL CHEST ABDOME N Video Surveillance 5 min. THIS REPRESENTS 10 MINUTES OF BREATHING TOTAL FOR CHARLIE BROWN

15 Questions The Tech Needs To Answer Re: How many apneas did Charlie have over 10 minutes? If Charlie repeats this 10 minute pattern 6x, he will have 1 hour of data if Charlie repeats this EXACT 10 minute pattern 6x in a row, how many apneas will Charlie have had in an hour? Charlie s Sleep Will Charlie s insurance rep be ok with the tech implementing PAP for 42 apneas in an hour? Will Charlie s doctor be ok with the tech implementing PAP for 42 apneas in an hour? Needed > 20 apneas Diagnose apnea > 5/hour

Here s Where 90% of Disconnect Happens in Post Study Followup Care 1.) Your tech performed your test incorrectly. 2.) Your tech was probably on Facebook instead of paying attention to your study. 3.

16 Here s Where 90% of Disconnect Happens in Post Study Followup Care 1.) Your tech performed your test incorrectly. 2.) Your tech was probably on Facebook instead of paying attention to your study. 3.) Your tech probably fell asleep during your study. Thanks for following up after your PSG, Mr. Smith! Your results show you are positive for apnea and need CPAP! You had an AHI of 14! Why didn t that idiot sleep tech put me on CPAP while I was in the lab??? Now I probably have to go back and do another test! That tech is dead meat! He s wasted a lot of my time and money! *Grrrrr!*

17 More Questions How many of Charlie s apneas were obstructive? OBSTRUCTIVE APNEAS LOOK LIKE THIS: How many of Charlie s apneas were central (neurologically induced)? CENTRAL APNEAS LOOK LIKE THIS: Did Charlie Brown have more obstructives or centrals??? Given all your central apnea, Charlie Brown, can you recall a time when you might have hit your head?

18 Might this be THE REASON FOR CHARLIE BROWN S HIGH OCCURRENCE OF CENTRAL SLEEP APNEA?

20 I m using my CPAP but I m still tired! Is there anything else that may be wrong?

21 If compliant CPAP use is verified and insufficient sleep quality is still an issue Ask, Does using my CPAP make me too nervous to fall asleep? (common in newly diagnosed apnea patients) Ask, Does my nightly regimen of activity prior to bedtime promote successful use of my CPAP therapy?

Does wearing CPAP all night rob me of sleep due to

IF SO, YOU AREN T ALONE *** But what if I don t

sleep aids like Zolpidem (Ambien) to assist newly

22 Does wearing CPAP all night rob me of sleep due to nervousness? IF SO, YOU AREN T ALONE *** But what if I don t want to ask my doctor about a prescription strength sleep aid??? - Some physicians have even taken to prescribing sleep aids like Zolpidem (Ambien) to assist newly diagnosed apnea patients with learning to incorporate their CPAP therapy into their nightly sleep routine. What other remedies can I try?

The truth of the matter is Many of us have many good reasons to

of daily medications we may already be taking These reasons

Not wanting to incur additional pharmaceutical expenses Unknown

23 The truth of the matter is Many of us have many good reasons to NOT want to implement a new prescription drug into the long list of daily medications we may already be taking These reasons include So what OTC options may help? Not wanting to incur additional pharmaceutical expenses Unknown Side Effects Not wanting to commit to a prescription drug for a problem that is likely only temporary

24 Let s talk about 3 DISCLAIMER: Even nonprescribed OTC insomnia remedies require a conversation with your doctor in order to insure they can be implemented safely and effectively.

The $120 million dollar leader in sales Diphenhydramine This sleep aid

FDA & has gone on to average the aforementioned $120 million dollars in OTC sales

25 The $120 million dollar leader in sales Diphenhydramine This sleep aid (discovered in 1943 by George Rieveschl, a former professor at the University of Cincinnati) became regulated in It became the first prescription antihistamine approved by the U.S. FDA & has gone on to average the aforementioned $120 million dollars in OTC sales annually! Most popular for its use as an antihistamine, the drug is better known by it s nongeneric name All Advertise As Being Non- Habit Forming Rx Rx

26 There s no way I ll be able to sleep unless I have ALL of this stuff!! There s no way you ll be able to sleep BECAUSE of all that stuff! What Does The Tech Understand About The Patient s Body Mechanics That Perhaps The Patient Does Not???

28 Before We Begin For many does not always equal a palatable combo! And yet Quotes Are From the AMA Journal of Ethics; May 2015, Vol. 17, Number 5 Incorporating Spirituality Into Patient Care

Case Study I - Sleep Lab Notes: Young man < 30 years old, sensation of falling upon achieving sleep onset, wakes up suddenly to a jerking sensation Chaplain s Notes In the Sleep Center, we often hear

29 Case Study I - Sleep Lab Notes: Young man < 30 years old, sensation of falling upon achieving sleep onset, wakes up suddenly to a jerking sensation Chaplain s Notes In the Sleep Center, we often hear of a condition that is known as myoclonic jerks ( sleep starts ). The sleep tech would probably remember that this condition is highlighted by the brain s perception that the body is falling from a great height as muscles achieve complete relaxation at the start of sleep*. Story of Eutychus (Acts 20:7-12) * Vetrugno, R, Montagna, P. Sleep To Wake Transition Movement Disorders. Sleep Med. 2011; 12 (Suppl 2): S11-6. [PubMed]

Case Study II - Sleep Lab Notes: Middle aged man excessively tired during normal waking hours and experiencing sudden onset of sleep during boat trip with friends

People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime.

30 Case Study II - Sleep Lab Notes: Middle aged man excessively tired during normal waking hours and experiencing sudden onset of sleep during boat trip with friends Did not rouse even when exposed to extreme stimuli. Chaplain s Notes: Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day.* Story of Jesus & Disciples (Mark4:35-41) *

Case Study III - Sleep Lab Notes: Male subject with higher than normal body mass index falling deeply asleep on his stomach and does not rouse even when touched.

His build is such that his airways likely have trouble staying open underneath the weight of heavy muscle when it relaxes during sleep.

31 Case Study III - Sleep Lab Notes: Male subject with higher than normal body mass index falling deeply asleep on his stomach and does not rouse even when touched. Chaplain s Notes: Technician would note that this patient is demonstrating symptoms consistent with Obstructive Sleep Apnea. His build is such that his airways likely have trouble staying open underneath the weight of heavy muscle when it relaxes during sleep. He has likely taught himself to sleep on his stomach to keep problematic heavy tissue from collapsing his airways. He likely does not rouse easily due to exhaustion caused by sleep apnea. Story of Samson & Delilah (Judges 16)

32 There are so many areas of sleep medicine that my care team can help me stay educated about! For followup information or to schedule Nick to speak to your group, - nick.charles@haysmed. com

Traumatic Brain Injury and Sleep

Traumatic Brain Injury and Sleep Javier has a hard time falling asleep and his lack of sleep made his anxiety worse. He Also became fatigued and irritable easily, It really made our lives harder. Sleep