The Polysomnographic Technologist performs a vital role in the diagnosis and treatment of sleep disorders.
Already an integral part of clinical and research settings, some polysomnographic technologists have broadened their scopes to include management and marketing of sleep centers, product support and sales, public and patient education regarding sleep hygiene and relaxation counseling, increasing public awareness about sleep disorders and working to shape public policy through advocacy. The field has shown significant growth due to obvious increased public awareness of sleep disorders worldwide. With this growth has come the need for accessible educational opportunities for technologists. Sleep technologists obtain certification through board examination to acquire the credential of Registered Polysomnographic Technologist (RPSGT).
Trends
Since the early 1970s, polysomnographic technologists have been the technical group specially trained to perform polysomnograms (PSG) for the diagnosis and treatment of sleep/arousal disorders, including the management of nasal positive airway pressure (nPAP) titration for obstructive sleep apnea syndrome (OSAS). 1 These individuals function independently to safely operate sophisticated medical equipment to record sleep/wake physiology. 2 They work under the direct supervision of a physician who practices sleep disorders medicine. The physician develops the protocols technologists follow in performing PSG studies, including utilization of PSG for nPAP titration.
Technologists who perform PSG-related procedures must: be well-versed in instrumentation used in a sleep laboratory and have a command of the sleep-induced physiological changes in various body systems including, but not limited to, the neurological, musculoskeletal, cardiac, and respiratory systems; have a working knowledge of the physiological and behavioral alterations associated with sleep/wake pathology; be capable of interpretation of electroencephalographic, electrooculographic, electromyographic, electrocardiographic, and respiratory tracings so as to be able to intervene appropriately during a study. They also are familiar with the integration of PSG and nPAP equipment to titrate positive pressure against respiratory events and arousals; and have recognition of and appropriate response to critical events that can occur in sleep, such as cardiac arrhythmias, seizure disorders, and other medical emergencies. Physicians utilize the observations of technologists to assist in the identification of dysfunction in sleep/wake cycles, to diagnose breathing disorders during sleep, and to evaluate treatment of these disorders. The specific parameters selected for a given polysomnographic study (the "montage") are determined by the nature of the patient's presenting complaints and the differential diagnosis. 1
Polysomnographic technologists titrate nPAP for OSAS. This is an application of nPAP different from its traditional therapeutic use in intubated, ventilator-dependent patients. 1 In nPAP titration for OSAS, pressure is delivered non-invasively through the nose (or nose and mouth) to evaluate whether it can prevent collapse of the upper airway at the level of the palate, tonsils and tongue. The correct nPAP pressure eliminates pharyngeal collapse and arousals from sleep resulting from increased upper airway resistance. Determination of this optimal level of pressure is accomplished in the sleeping patient by titrating pressures against respiratory events and arousals from sleep.
Patient and Public Education
The technologist is directly involved in patient education concerning nPAP and sleep disorders, and takes this one step further when making an outreach to the public or community in sleep awareness events. In regard to marketing and public education, many American sleep laboratories have entered into partnerships with the National Sleep Foundation (NSF) in Washington, DC for a program known as Community Sleep Awareness Partners (CSAP). Annual events surrounding National Sleep Awareness Week (NSAW) are highly publicized in the larger market media.
Nationwide activities in the United States during NSAW range from numerous media events to grassroots involvement, with sleep specialists, technologists, government leaders, corporations, volunteers and sleep laboratories and centers working together to host special awareness activities and encourage Americans to make healthy, quality sleep a priority. 3 On April 2, 2002, at the National Press Club in Washington, DC, the NSF is scheduled to release the results of its nationwide "Sleep in America 2002" omnibus survey on Americans and sleep. Among other important statistics, this poll will highlight specifically how seriously fatigue affects our productivity at work, at school, and at home.
Another initiative for the year includes National Drowsy Driving Week, with staggering figured expected.
Polysomnographic Technologists are members of the task force stemming from a recent NSF convocation of health and transportation experts titled: "Morbidity and mortality associated with inadequate sleep." The task force is charged with the tracking system for injury and fatality related accidents due to inadequate sleep. The results are expected to aid in the development of public education programs targeting the perils of inadequate sleep.
The collective habits and practices of everyday living that promote good sleep and optimal daytime functioning have been called sleep hygiene. 4 Although not practicing counselors or licensed psychologists, the polysomnographic technologist has ample opportunity during PSG hookup time to remind patients of good sleep hygiene. Many times, reading material is suggested to patients by technologists to help them gain better understanding of good habits at bedtime. Regarding insomniacs, technologists frequently describe the induction of the relaxation response by controlling mental activity and muscle tone. They suggest peaceful thoughts while telling the patient to consciously relaxing the muscles of the trunk, neck and limbs so the reduction of the excitatory drive occurs. 5
Regarding patient education, the technologist that spends time to introduce simple relaxation techniques to the patient prior to nPAP titration proves it is an integral component of nPAP compliancy. The use of visual aids especially those of upper airway physiology of the sleeping patient are beneficial in creating the well-informed and hopefully more compliant nPAP patient during the study, and upon the patient's return home with nPAP.
Education
In the United States, currently there is one technologist educational program that offers a stand-alone sleep program. Several electroneurodiagnostic schools offer sleep technology within their programs, and a few respiratory care practitioner programs provide orientation into sleep technology as well. At this time, one program is known of in The Netherlands. Several programs are in development at this time, and Internet-based accredited programs are forming. The Association of Polysomnographic Technologists (APT) Professional Development Committee developed curriculum guidelines for accredited educational programs for polysomnographic technologists and other projects that strengthen core competencies 3 expected for release in early 2002.
Certification/Registry
The polysomnographic technologist is credentialed though a comprehensive registry examination. Candidates must complete a minimum of 18 months of experience in clinical or human research where duties performed are primarily polysomnography, or complete a minimum of 12 months of experience in clinical or human research if proof of credentialing in a health-related field accepted by the Board of Registered Polysomnographic Technologists is provided (e.g., nursing, respiratory therapy, etc). Applicants for the comprehensive registry examination must be currently certified in Basic Cardiac Life Support (BCLS), Cardiopulmonary Resuscitation (CPR) or its equivalent. 6
It would be beneficial to the field of polysomnographic technology to be able to accurately determine how many individuals perform polysomnograms worldwide. In some countries besides the United States, medical residents and nurses sometimes work in the field and perform the role of polysomnography. The total number of individuals performing polysomnograms is unknown, as is the number of clinical and research laboratories worldwide. This is primarily due to more and more sleep labs opening at a fast pace, and until the labs' accreditation processes are completed, it is difficult to track the number of technologists working in the field. A newly formed organization of freestanding sleep labs hopes to aid in tracking these figures. According to the executive summary of the 1999 APT Demographics, Salary and Educational Needs (DSEN) survey that 1,680 APT members and 1,300 laboratories served by one equipment manufacturer received surveys.
Additionally, respondents of the DSEN survey across all technologist job titles reported an average salary of $1508 for a two-week period, which is a 9% increase over the typical salary in 1996, and technologist laboratory supervisors by 13.4% for an average of $1774 for a two-week period. 7
References
- Role and Qualifications of Technologists Performing Polysomnography, Position Paper by the American Sleep Disorders Association. (1998).
- Polysomnographic Technologist Position Description, document formulated from the national job analysis study by the Association of Polysomnographic Technologists. (1989)
- Minkley, P. (2000). Curriculum Development Committee Report. The A2Zzz. Association of Polysomnographic Technologists. 8(1), 5.
- Chokroverty, S. (1999). Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects Second edition. Boston: Butterworth.
- Hobson JA: (1989) Sleep. New York: W.H. Freeman and Company
- BRPT Candidate Handbook for the Comprehensive Registry Examination for Polysomnographic Technologists: New York: Professional Examination Service 2000
- Executive Summary (2000). Association of Polysomnographic Technologists 1999 Demographic Salary and Education Needs Survey. The A2Zzz. 8 (1), 3
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Last updated: January 2002