Evolving Roles of Sleep Technologists

Hello NC Sleep Community,

We are hoping to add more editorial consent to the NCASM site, just to keep everyone informed of current developments, and the work that we are doing to promote sleep medicine within NC. As I started to think about adding editorials, it seemed important to reflect on where the field of sleep technology seems to be moving.

We face a rapidly evolving marketplace within the world of sleep medicine, and some of the policy changes implemented by insurers are moving in a direction that lab-based sleep studies will be increasingly reserved for more complicated patients. There are only two A-STEP providers remaining in NC, of which our practice is one. We have retained A-STEP accreditation because it has been a great benefit to some of the employees within our practice, but have also found lately that we have received several great, experienced candidates when we have openings for sleep technologists within our program. The trend for sleep technologists is movement away from a complete reliance on night, lab studies, and movement into new roles within the sleep center. When we started our sleep program, we had almost no day staff, and now we have sleep technologists filling several key roles within our sleep center. In annual reviews, I often will encourage techs to work toward diversity and specialization. Diversity is achieved by experience with a broad group of patients and technologies, whereas specialization is achieved by expanding knowledge within areas of the sleep center. For example, an excellent career move for a computer-oriented sleep technologist would be to gain additional skills in coding reports and programming sleep software. As home sleep testing programs develop within sleep labs, it is beneficial to have sleep technologists who can take leadership roles within program development. Some of our techs have taken an interest in working closely with our PAP clinics, and have moved into roles with provision of DME. There are a few psychologists out there, like myself, who completed their doctoral work while working nights as sleep techs and now work as behavioral sleep specialists. Our workload and roles are ever evolving.

As we debate the value of lab testing, one element that still feels essential to the lab experience is the patient care brought by the sleep technologist. Although some studies may show that auto-titrating devices are associated with appropriate treatment and patient adherence, there can be very valuable added experiences with a sleep technologist. It is often the sleep technologist who can work to fight mask leaks, recognize positional challenges with specific masks, and gently coach the less willing patient to trying PAP pressure. Some of the essential skills that sleep technologists can add to PAP adherence are as follows:

1.  Appropriate mask selection. Everyone usually has a favorite mask, but the favorite mask may not be the best for each patient. I had a few experiences in the past months where I was working with PAP desensitization for claustrophobia, and found that the smallest mask was not the answer- full-face was! Our lab policy is that at least three masks should be tried, although I think that a conversation about mask preferences also can go a long way.

2.  Adherence coaching. Most of the PAP manufacturers offer some way to monitor compliance, but we still need people to follow up with these patients and encourage them to wear their masks. I had a patient who was doing well call me recently, simply because they wanted to hear my "cheerleader" encouragement. Most people struggle with adapting to PAP pressure, and the skill set of the sleep technologist makes them a natural fit to coaching patients toward compliance.

3.  PAP clinic appointments. We have walk-in PAP clinic days at our practice and these clinics are staffed by sleep technologists. These techs offer a friendly face and depth of knowledge that help ease our patients through some of the challenges with PAP therapy.

4.  DME set-ups and program evaluation. The new wave of healthcare includes attention to quality assurance measures, and a smart DME program should be monitoring patient adherence and outcomes not only with their PAP therapy, but co-morbid conditions and quality of life.

I hope that these leaves you feeling excited about some of the innovation in our field. As I look back on where we have come, I feel exhilarated to imagine where we will go.

Kristin Daley, PhD

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