The 2023 Q4 issue of A₂Zzz is here! The use of the Internet of things (IoT) in the sleep field is showing promise in improving the diagnosis and management of sleep disorders, primarily obstructive sleep apnea (OSA). But are the drawbacks of IoT enough to prevent it from being fully utilized by sleep professionals?  

Explore additional articles, including:

• Revenge Bedtime Procrastination
• SPONSORED: Is the Apnea-hypopnea Index the Best Metric for Evaluating Obstructive Sleep Apnea
•  Sleep Scoring Among Different Types of Scorers: Thoughts on Getting to 100% Agreement

Updates to Claiming CECs From A2Zzz

AAST members looking to claim their free AAST continuing education credits (CECs) from reading the latest issue of A2Zzz will now need to complete a knowledge assessment in the Learning Center. Upon completion of the knowledge assessment, AAST members will be awarded their two free AAST CECs. For additional information on this change, please view the instructions for earning credits from A2Zzz.

The 2023 Q3 issue of A₂Zzz is here! This issue's cover story offers advice for sleep-care professionals treating sleep problems in patients with long COVID. 

Explore additional articles, including:

• The Impact of Sound on Sleep
  
• Sleep Hygiene: Practicing What You Preach 
• The Impact of Halloween on Sleep Hygiene

Updates to Claiming CECs From A2Zzz

AAST members looking to claim their free AAST continuing education credits (CECs) from reading the latest issue of A2Zzz will now need to complete a knowledge assessment in the Learning Center. Upon completion of the knowledge assessment, AAST members will be awarded their two free AAST CECs. For additional information on this change, please view the instructions for earning credits from A2Zzz.

The 2023 Q2 issue of A₂Zzz is here! This issue's cover story examines the latest developments in wireless sleep technology being used to screen for obstructive sleep apnea (OSA).

Explore additional articles, including:

• Potential Up-and-Coming Developments in Wireless Sleep Technology
• Optimizing Patient Outcomes Requires More Than Single-Night Testing for Sleep Apnea
• A Proactive Approach to Reimbursement
• The Reluctant Patient: Simplified Motivational Enhancement Therapy to Improve CPAP Adherence

Updates to Claiming CECs From A2Zzz

AAST members looking to claim their free AAST continuing education credits (CECs) from reading the latest issue of A2Zzz will now need to complete a knowledge assessment in the Learning Center. Upon completion of the knowledge assessment, AAST members will be awarded their two free AAST CECs. For additional information on this change, please view the instructions for earning credits from A2Zzz.

Description: People living within “the spectrum” of autism are known to struggle with sleep. Chiefly it’s insomnia, but circadian rhythm disorders, movement disorders of sleep, parasomnias, and other sleep issues are also common in both children and adults who have autism spectrum disorder (ASD). What is it about neurodivergence that leads to sleep problems? Or is it the other way around? YAMADA et al tries to dig more deeply to answer the question, looking more closely at two key theories about ASD which may reveal sleep as a kind of missing link that needs more control in future research. This month’s journal club seeks to demystify the puzzle of autism. We’ll shine a spotlight on sleep disorders that frequently occur in this patient population, then review YAMADA et al’s findings. Finally, sleep technologists will take a look at some strategies into best care practices and tools to inform how we work with patients, both pediatric and adult, who live on the spectrum.

Recorded: 6/26/2023

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: With all the attention focusing on open source chatGPT these days (a popular interactive form of artificial intelligence, or AI), it seems necessary to discuss how aspects of AI—especially machine learning—impact our work in sleep technology. Specifically, new research has set out to find new, more efficient and accurate ways to identify patients with sleep apnea, determine its severity, and even decide on more personalized treatment pathways. This month’s Journal Club address AI and OSA by first examining just what machine learning is, then exploring the history of AI in the healthcare industry, looking even more closely at how it has served the field of sleep medicine and technology. Then we’ll review the Maniaci, et al (2023) study, which takes a closer look at how certain algorithms might help sleep medicine practitioners to better help identify and treat those patients with more severe sleep breathing disorders.

Recorded: 4/27/2023

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

The 2023 Q1 issue of A₂Zzz is here! This issue's cover story examines the research surrounding home sleep testing devices for long-term follow-up of patients treated for obstructive sleep apnea.

Explore additional articles, including:

• Case Study: Implementing an Apprentice Program at the Sleep Lab
• Everything You Wanted to Know About the SDS Credential
• President's Message
• From AAST

Updates to Claiming CECs From A2Zzz

AAST members looking to claim their free AAST continuing education credits (CECs) from reading the latest issue of A2Zzz will now need to complete a knowledge assessment in the Learning Center. Upon completion of the knowledge assessment, AAST members will be awarded their two free AAST CECs. For additional information on this change, please view the instructions for earning credits from A2Zzz.

Discussion of a 46-year-old patient with loud snoring and witnessed apnea. Criteria for “high risk” for OSA are reviewed as well as the use of the STOP-Bang evaluation. The patient’s recording is discussed with an emphasis on event criteria and severity estimation. The ICSD-3 criteria are used to determine if the patient can be diagnosed with OSA syndrome. Recommendations for a conversation at the end of the test are made.

Presenter: Richard S. Rosenberg, PhD

Recorded: 5/25/2017

CEC Credit(s): 1.0

Ms. Brooks reviews regulatory and accreditation requirements for sleep centers. Legal issues are discussed as well as OSHA workplace guidelines with an emphasis on areas of importance to sleep programs. AASM accreditation standards are described and changes to standards in the most recent update are highlighted.

Presenter: Rita Brooks, RPSGT, RST, M Ed

Recorded: 6/7/17

CEC Credit(s): 0.5

Ms. Weaver reviews cardiac abnormalities associated with sleep apnea. A focus of the discussion is the identification of arrhythmias and which are associated with a need for urgent intervention. Electrical conduction through the heart is reviewed. The consequences of untreated sleep apnea and the benefits of treatment are discussed in the context of heart failure, stroke, and hypertension.

Presenter: Kristina Weaver, RPSGT, NREMT-P

Recorded: 6/7/17

CEC Credit(s): 1.0

Ms. Head reviews the legal requirements for maintaining confidentiality of patient health information. She notes that there are strict regulations at the federal and state levels and harsh penalties are possible for breaches of confidentiality. She provides a review of who, what, and when information can be disclosed to family members and medical professionals.

Presenter: Erin Head, MBA, RHIA, CHDA, CHTS-TR

Recorded: 6/5/17

CEC Credit(s): 0.5

Laura Linley provides an extensive discussion of infection control guidelines, ranging from hand washing to flu vaccines. General requirements include universal precautions and use of protective gear. Ms. Linley also discusses critical elements more specific to the sleep center such as cleaning of reusable supplies and PAP equipment.

Presenter: Laura Linley, CRTT, RPSGT, RST, FAAST

Recorded: 8/22/16

CEC Credit(s): 1.0

Ms. Bibbs provides a review of life safety, which includes all elements of sleep center function that might have an impact on the well-being of the patient during their time in the center. The focus of the discussion is on regulatory issues and methods for meeting requirements and passing inspections. During the last portion of the talk Ms. Bibbs shares her own checklists and forms for insuring that all requirements are met. 

Presenter: Marietta Bibbs

Recorded: 6/1/17

CEC Credit(s): 1.0

Marietta Bibbs describes an often-overlooked source of patients and revenue for sleep centers: corporate sleep wellness programs. She reviews strategies for preparing a wellness program, provides specific suggestions for marketing and gives insights into her own functioning program. By the end of the talk you will be convinced that a corporate sleep wellness program is cost-effective, smart, and the right thing to do for employees.

Presenter: Marietta Bibbs, BA, RPSGT, CCSH

Recorded: 4/19/17

CEC Credit(s): 0.5

Mr. Gaden reviews the pressures and constraints on providing sleep therapy and advocates for a role of sleep professionals in the DME process. After a review of fiscal assumptions, he shows significant return on investment when registered sleep technologists are added to the DME program. He discusses several intangibles that sleep technologists bring to the position. The module lays out the case a registered sleep technologist can make when applying for a position in a DME company.

Presenter: Brian Gaden, BSRT, RRT, RPSGT

Recorded: 4/19/17

CEC Credit(s): 1.0

Cheryl May describes her approach to motivating patients to use their CPAP treatment following a diagnosis of OSA. She provides suggestions for communicating essential elements of CPAP adherence, putting the focus on the patient and establishing rapport. She highlights barriers to treatment and outlines a plan for overcoming them. A focus of the presentation is on frequent assessment of the patient and responding to patient needs.

Presenter: Cheryl May, CRT

Recorded: 4/19/17

CEC Credit(s): 0.5

Ms. Allen is the program coordinator for polysomnographic technology at Collin College, McKinney, Texas. She shares her experience in developing, marketing and accrediting a training program. Issues to be addressed during development include finding a sponsor, deciding whether to have a college affiliation, staffing, and preparation for accreditation. Marketing includes deciding on level of education and target audience, with suggestions for separating your program from other options. The module also covers referrals and retention, as well as a financial strategy to keep your program active and vibrant.

Presenter: Amber Allen, RPSGT

Recorded: 4/19/17

CEC Credit(s): 0.5

Steps in Implementing A Successful Patient Education Program and Getting Paid To Educate 

Dr. Al-Himyary relates his experience with the institution of a sleep educator program.

Motivating Sleep Patients to Utilize PAP Therapy and Other Treatment Options

Cheryl May describes her approach to motivating patients to use their CPAP treatment following a diagnosis of OSA and provides suggestions for communicating essential elements of CPAP adherence, putting the focus on the patient and establishing rapport.

Developing A Thriving Polysomnography Program: Strategies For Marketing And Maintaining Successful Students

Ms. Allen is the program coordinator for polysomnographic technology at Collin College, McKinney, Texas shares her experience in developing, marketing and accrediting a training program. Issues to be addressed during development include finding a sponsor, deciding whether to have a college affiliation, staffing, and preparation for accreditation.

Corporate Sleep Health: A Different Revenue Stream 

Marietta Bibbs describes an often-overlooked source of patients and revenue for sleep centers: corporate sleep wellness programs and reviews strategies for preparing a wellness program, provides specific suggestions for marketing and gives insights into her own functioning program.

Adding a Sleep Professional to the DME Team 

Mr. Gaden reviews the pressures and constraints on providing sleep therapy and advocates for a role of sleep professionals in the DME process. He shows significant return on investment when registered sleep technologists are added to the DME program.

Each of the modules in this bundle have been designed to meet the following overall objectives: Define current educational issues, trends and models; Identify links to grow sleep education programs; Evaluate innovative tools for successful sleep center growth; and Describe methods to leverage knowledge through collaboration

Dr. Al-Himyary relates his experience with the institution of a sleep educator program. His successful and growing education program grew out of a need to maximize the use of physician time as his patient load increased. He encountered push back from doubtful referring physicians and training educators in tasks that they had not encountered as night technologists. He provides insight into solutions to these problems and addresses the business issues associated with his program. He provides suggestions for billing codes to use and ways to optimize communication using electronic medical records.

Author: Ali Al-Himyary, MD, MPH

Recorded: 4/19/17

CEC Credit(s): 0.5

Description: Sleep health has taken a big hit globally in the wake of the pandemic. This isn’t news, nor is it surprising to learn that our healthcare peers on the COVID-19 frontline are suffering from long-term sleep and mental health problems. One particular population of medical professionals, registered nurses, are the target for recent research suggesting an alarming mental health impact on those working the frontlines. In this month’s Journal Club, we’ll review how sleep, or lack of sleep, or poor sleep, can affect psychological health in general and consider sleep health among healthcare workers prior to the pandemic. Then we’ll break down the NORFUL et al study into two separate sections, the first one examining the foundation of the study specifically tuned to psychological health concerns, and the second section focused on the sleep health implications of the study as well as insights into how this might impact us on the job in sleep clinics and research laboratories.

Recorded: 2/27/2023

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: Pediatric restless legs syndrome

Presenter: Richard S. Rosenberg, PhD

Recorded: 9/15/2018

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: 1 hour, 5 quiz questions

Description: Is there a new pediatric sleep disorder on the horizon? This month we'll review the work of sleep physician and researcher Dr. Lourdes DelRosso to learn more about the distinction between Restless Sleep Disorder (RSD) and Restless Legs Syndrome (RLS) and what might be done about it.

Presenter: Tamara Sellman, RPSGT CCSH 

Recorded: 4/19/19 

CEC Credit(s): 1.0 

Target Audience: Sleep technologists seeking a background in the science of sleep. 

Expected Completion Time: 1 Hour 

Description: A patient with moderate hypopnea has a split night study using a variety of PAP platforms.

Presenter: Richard S. Rosenberg, PhD

Recorded: 7/12/2019

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Description: A variety of cases are used to review CPAP titration for OSA, beginning with patient interaction, mask fitting, and establishing a relationship for collection of outcomes. A simple flow chart for titration is presented and complexities are explored. Rules for identifying respiratory events and using events to determine PAP pressure increases are listed. The perils of over-titration are assessed and rules for down-titration are discussed. What does the technologist add to the titration process? A comparison of human and auto-titration methodologies provides the answer.

Presenter: Richard S. Rosenberg, PhD

Recorded: 7/12/2017

CEC Credit(s): 1.0

Target Audience: Sleep technologists seeking a background in PAP titration for obstructive sleep apnea.

Length: 45 minutes

Review of the PAP titration portion of a split night study in a 47-year-old woman. Criteria for increasing and decreasing pressure settings are reviewed. Differences between adequate, good, and optimal titrations are provided. The case is used as a springboard for a comparison of laboratory and home (APAP) titration results.

Presenter: Richard S. Rosenberg, PhD

Recorded: 11/13/2016

CEC Credit(s): 1.0

Target Audience: Sleep technologists seeking a background in the science of sleep.

Length: 52 minutes

Description: Discussion of the sleep recording of a 66 year old woman with snoring and daytime sleepiness. The record shows prolonged sleep onset, fragmented sleep, and no REM sleep. This presentation uses this record to review the incidence of the comorbidity of apnea and insomnia, and treatment options are discussed. 

Presenter: Richard S. Rosenberg, PhD

Recorded: 11/24/14

CEC Credit(s): 1.0

Target Audience: Sleep technologists and sleep center managers

Length: 43 minutes

Recognizing and reducing artifacts and the impact of artifacts on scoring. Discussion of a patient with a variety of artifacts in the recording. This presentation reviews methods for reducing artifact and the impact of the artifact on scoring.

Presenter: Richard S. Rosenberg, PhD

Recorded: 12/16/13

CEC Credit(s): 1.0

Target Audience: Sleep technologists and sleep center managers

Length: 55 minutes

Description: A patient with COPD has a diagnostic portion with OSA and has a split night study using a variety of PAP platforms.

Presenter: Richard S. Rosenberg, PhD

Recorded: 7/12/2019

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Description: A patient with Cheyne-Stokes Breathing pattern receives a diagnosis and treatment.

Presenter: Richard S. Rosenberg, PhD

Recorded: 7/12/2019

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Description: The diagnostic portion of a sleep study shows severe OSA. But how do we know it's severe? The debate between AHI and other markers of apnea severity is reviewed, including the positions of Drs. Rapaport and Punjabi. The treatment portion of the recording makes it clear that the AHI is inadequate as the technologist attempts to normalize the patient's breathing during sleep.

Presenter: Richard S. Rosenberg, PhD

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Description: Alpha-Delta Sleep. Does it exist? Is it "alpha intrusion" instead? We explore frequency analysis of two patients to attempt to explain why one is tagged with this finding and the other is not.

Presenter: Richard S. Rosenberg, PhD

CEC Credit(s): 1.0

Target Audience: Sleep technologists and other allied health professionals.

Estimated Time to Completion: Approximately one hour

Description: There are various types of headache that show different kinds of impacts on the continuum of the sleep-wake cycle. It's no surprise, as sleep disorders and headaches share multiple pain-perception structures in the brain. Many sleep technologists study patients who complain of headache. The AASM considers headache associated with sleep as one of the most common complaints of sleep disorder patients. KORABELNIKOVA et al seeks to "connect the dots" related to headaches as a comorbidity of sleep disorders, and sleep disorders as a comorbidity of headaches.  

Recorded: 12/13/2021

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: While we may or may not always encounter patients with rare genetic disorders, this doesn't mean we shouldn't have at least a cursory idea of what these conditions are and how sleep for these patients may be affected. The genetics of sleep itself, meanwhile, continues to grow as a subject matter in the literature, so it's not a bad idea to better understand these basics, too. This month, we'll take a look at a recent survey of the molecular genetics of human sleep (Zhang & Fu, 2020) for a basic foundation, then we'll become familiar with some rare genetic disorders before reviewing this month's Journal Club study by AGAR et al, which gives a sweeping view of the prevalence and profiles of sleep disorders among those living with these conditions. 

Recorded: 2/13/2022

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: Since the advent of social media, a wide range of new behaviors has emerged, with many having a negative impact on sleep health. This month, we'll look at some of those behaviors to understand how they impact sleep, then we'll identify sleep hygiene best practices that should be part of our regular discussions with patients. Then, we'll review DHIR et al, which offers up what they discovered when they examined specific social media use behaviors and their impact on both sleep health and sleep hygiene.

Recorded: 4/11/2022

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: Up until now, sleep specialists have only presumed that childhood OSA could be linked to adult health concerns, such as cardiovascular issues and metabolic syndrome. In 2022, researchers followed up on a cohort of patients diagnosed with OSA two decades ago as children. NOSETTI, et al sought to identify any patterns in outcomes as well as potentially determine whether AHI in childhood for those with OSA—especially severe OSA—might accurately predict health problems for them in adulthood. This small study cracks open a lot of big questions about sleep apnea as a lifelong illness. It also reveals some interesting and unexpected findings that emerged during research conducted in a hotspot during the earlier part of the pandemic. It deserves a sidebar discussion on the global challenges that researchers now face as a result of performing studies in the shadow of COVID-19, especially among patient cohorts facing sleep-disrupting conditions worldwide.

Recorded: 6/15/2022

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: It seems obvious that noise disrupts sleep, but do you know the What, the How, and the Why? And even more importantly, what can be done for patients who need relief from sleep-disrupting noise? In this month's Journal Club, we'll take a look at noise from the source, both inside and out. First, we'll review the intersection between noise and sleep through physiology and neurology. Then, from the "inside," we'll look at the particulars of tinnitus (or ringing ears) and how this can impact sleep, through research from MILINSKI, et al (2022). Following that, we'll examine the "outside" through noisy environments and their effects on both sleep and overall health, as discussed in BASNER (2022). And finally, we'll review what you can do to help your patients sleep better in a noisy world.

Recorded: 8/15/2022

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Description: Fifty years ago, three doctors at Stanford identified patients with a specific overlap of two sleep disorders: insomnia and sleep apnea. Today, there's a name for that specific condition, COMISA, as well as new understanding about its prevalence and impact on overall health and well being. In this month's Journal Club, we'll break down what COMISA looks like, then review recent findings from the LECHAT et al study, which draws its observations from samples of the Wisconsin Sleep Cohort to address all-cause mortality for people who have COMISA. Finally, we'll take a look at how a greater understanding of COMISA can inform our work as sleep technologists in the lab environment. 

Recorded: 12/21/2022

CEC Credit(s): 1.0

Target Audience: Sleep technologists

Length: 1-hour

Sleep Center Essentials: Life Safety

Ms. Bibbs provides a review of life safety, which includes all elements of sleep center function that might have an impact on the well-being of the patient during their time in the center. The focus of the discussion is on regulatory issues and methods for meeting requirements and passing inspections.

Sleep Center Essentials: Risk Management Infection Control in the Sleep Center

Laura Linley provides an extensive discussion of infection control guidelines, ranging from hand washing to flu vaccines. General requirements include universal precautions and use of protective gear. 

Sleep Center Essentials: HIPAA and Patient Confidentiality

Ms. Erin Head reviews the legal requirements for maintaining confidentiality of patient health information. She notes that there are strict regulations at the federal and state levels and harsh penalties are possible for breaches of confidentiality.

Sleep Center Essentials: Cardiac Abnormalities: Patient Based Learning (PBL) Format

Kristina Weaver reviews cardiac abnormalities associated with sleep apnea. A focus of the discussion is the identification of arrhythmias and which are associated with a need for urgent intervention. Electrical conduction through the heart is reviewed.

Sleep Center Essentials: Internal Audits Regulatory and Accreditation Requirements

Rita Brooks reviews regulatory and accreditation requirements for sleep centers. Legal issues are discussed as well as OSHA workplace guidelines with an emphasis on areas of importance to sleep programs. AASM accreditation standards are described and changes to standards in the most recent update are highlighted.

Each of the modules in this bundle are designed for sleep technologists with less than 5 years of experience, this bundle will complement and strengthen your skills, and help you as you grow and evolve in your career.

The seventh module in the series provides an extensive overview of the numerous different types of medical disorders that may be seen in pediatric special populations. Each disorder is defined and provides information on how sleep is affected in infants and children with these medical disorders, including the anticipated PSG changes seen in these populations.  In pediatric sleep medicine, the ability to recognize these disorders is important in order to best care for these children during their night in the sleep lab. This module provides valuable information for any sleep technologist who works with pediatric patients.

By Kimberly Trotter, MA, RPSGT, FAAST

This sixth module of the series provides an excellent review of the parasomnias and hypersomnias that affect the pediatric population.  A review of the different types of primary and secondary excessive daytime somnolence (EDS) in the pediatric population that includes age specific signs and symptoms of hypersomnolence in the pediatric patient is provided. The review of parasomnias focuses on recognizing risk factors for and identifying common parasomnias in the pediatric population and discusses when to utilize polysomnography for evaluation of parasomnias. The causes of both pediatric hypersomnias and parasomnias and how the appropriate medical history and testing affect proper diagnosis and treatment are reviewed, and the importance of parental education and reassurance in the management of these disorders is discussed. This module provides an extensive overview of two of the more common pediatric sleep disorders.

By Laree Fordyce, RPSGT, RST, CCSH, CCRP

This fifth module in the series reviews insomnias and circadian rhythm sleep disorders in the pediatric population. The evolution, emergence, and prevalence of insomnia disorders, signs and symptoms of the primary pediatric insomnias and management and treatment options for these disorders are discussed.  Pediatric circadian rhythm sleep disorders including delayed sleep phase syndrome (DSPS) and its causes and symptoms are reviewed and differentiated from the insomnias in the pediatric population. A discussion of appropriate behavioral and environmental interventions for pediatric sleep disorders is also included.  This module provides an excellent overview of the primary insomnia and circadian rhythm sleep disorders that affect pediatric patients.

By Kimberly Trotter, MA, RPSGT, FAAST

In this fourth module of the series we define and describe the common modalities used to treat sleep disordered breathing in the pediatric patient. Indications, contraindications, and precautions for each modality of treatment are outlined, along with the appropriate interfaces for pediatric therapies.  Troubleshooting methods for mask leaks, excessive pressure on the face, and humidification are described, and tips for achieving successful therapy in the pediatric patient are provided. Treatment goals and patient follow-up guidelines for each type of therapy, as defined by best practices and the American Academy of Sleep Medicine Task Force, are also provided.  This module provides a thorough review of treatment options for sleep related breathing disorders in the pediatric patient.

By Debra Medin

This is the third module in the series which reviews the development of sleep in children from infancy through adolescence and provides an overview of a variety of sleep and sleep related breathing disorders in pediatric patients.  An assortment of case studies is provided that illuminate several sleep and breathing disorders that are seen in pediatrics and discusses treatment options and management of these various types of disorders.

By Julie DeWitte, RCP, RPSGT, RST, FAAST

This module is the second in the series and reviews the most recent AASM pediatric scoring rules, focusing on the specifics of the infant and child sleep staging and arousal scoring rules and respiratory event scoring in these age groups. Terminology describing infant age relevant to infant scoring is explained, along with the specific nomenclature used in infant and pediatric sleep staging. The specific respiratory event scoring differences that apply to the pediatric patient are reviewed, along with cardiac event scoring rules for pediatrics. The module provides and reviews pediatric sleep stage and event scoring examples throughout the module and provides rationale for the additional monitoring parameters essential in pediatric polysomnography. This module provides an in-depth review and explanation of how to utilize the pediatric scoring rules to evaluate sleep disorders in infants and children.  

By Laree Fordyce, RPSGT, RST, CCSH, CCRP

This module is the first in a series of Pediatric resources being developed for those new to pediatrics and pediatric sleep testing and therapy.  The module provides an overview of the specific knowledge and skills the sleep technologist performing pediatric testing requires.  A review of the development of sleep in infants and children, information on pediatric sleep evaluation and questionnaires, and indications for polysomnography in pediatric patients is provided.  Information regarding pediatric equipment requirements and testing considerations for the young and very young pediatric patient is provided.  Tips on communicating with pediatric patients and their parents and getting the leads on these young patients are included, along with testing set-up, instrumentation, recording and documentation requirements for pediatric polysomnography.  This module provides a useful introduction to pediatric polysomnography for the sleep technologist. 

By Rita Brooks, MEd., R. EEG/EP T., RPSGT, FAAST

This is the first module in the series which is an introduction to the Fundamentals of Virtual Patient Monitoring: Utilizing Connected Technologies to Improve Clinical Outcomes module series. This module includes discussing development of a virtual patient monitoring program, reviewing patient’s rights and responsibilities, and identifying best practices for patient interviewing and assessment.  Learners will also discuss medical ethics, developing communication skills, identifying useful policies and procedures, coding, billing, regulatory compliance, and business operations models.

 By Melinda Trimble, LRCP, RPSGT, RST, FAAST; Laura A Linley, CRT, RPSGT, FAAST; Amy Korn-Reavis, RRT, RPSGT, CCSH

In this third module, Case Studies are used to present multiple EKG abnormalities for review.  A systematic analysis is provided for each abnormality presented.

By Jon Atkinson, BS, RPSGT, CCSH, FAAST

Funding for this course was provided by Philips Home Healthcare Solutions.

Module 1 - Building a Remote Patient Monitoring Coaching Program 0.5 CEC

This module is an introduction to the Fundamentals of Virtual Patient Monitoring: Utilizing Connected Technologies to Improve Clinical Outcomes module series. This module includes discussing development of a virtual patient monitoring program, reviewing patient’s rights and responsibilities, and identifying best practices for patient interviewing and assessment.  Learners will also discuss medical ethics, developing communication skills, identifying useful policies and procedures, coding, billing, regulatory compliance, and business operations models.

Module 2 – Care Orchestrator Report Development Tools for Successful Patient and Program Management 1.0 CEC

This module will cover care orchestrator report development tools for successful patient and program management and the following course objectives: Introduce Care Orchestrator, which includes identifying supported devices and uploading data into Care Orchestrator; Review navigating the patient record and report generation and creating custom compliance reports; and Describe how to interpret reports, and utilizing tasks and reminders.

Module 3 – Data Management in Patients with Sleep Disordered Breathing 1.0 CEC

This module will cover data management in patients with sleep disordered breathing. The objectives for this module are to review report data for patients with classic OSA, review event detection and classification and describe the basic functions of the auto algorithm.  Learners will discuss report structure, learn how to generate reports in Care Orchestrator, and review report interpretation.

Module 4 - Remote Patient Monitoring - Case Studies 1.0 CEC

This module provides patient scenarios that incorporate the information provided in the earlier learning modules and provide an opportunity for practical application.  Learners will be asked to review each scenario, consider what information is important, and think about how they would respond in each situation. 

Funding for this course was provided by Philips Home Healthcare Solutions.

These modules are a comprehensive program designed to give you the skills you need to work virtually as a sleep health professional. The 4th module offers case study scenarios for knowledge assessment. Each module includes a glossary and a knowledge check section to reinforce learning. 

Module 1 - Pediatric Polysomnography 1.0 CEC

This module is the first in a series of Pediatric resources being developed for those new to pediatrics and pediatric sleep testing and therapy.  The module provides an overview of the specific knowledge and skills the sleep technologist performing pediatric testing requires.  A review of the development of sleep in infants and children, information on pediatric sleep evaluation and questionnaires, and indications for polysomnography in pediatric patients is provided.  Information regarding pediatric equipment requirements and testing considerations for the young and very young pediatric patient is provided.  Tips on communicating with pediatric patients and their parents and getting the leads on these young patients are included, along with testing set-up, instrumentation, recording and documentation requirements for pediatric polysomnography.  This module provides a useful introduction to pediatric polysomnography for the sleep technologist.

Module 2 - Pediatric Scoring 1.0 CEC

This module reviews the most recent AASM pediatric scoring rules, focusing on the specifics of the infant and child sleep staging and arousal scoring rules and respiratory event scoring in these age groups.  Terminology describing infant age relevant to infant scoring is explained, along with the specific nomenclature used in infant and pediatric sleep staging.  The specific respiratory event scoring differences that apply to the pediatric patient are reviewed, along with cardiac event scoring rules for pediatrics.  The module provides and reviews pediatric sleep stage and event scoring examples throughout the module and provides rationale for the additional monitoring parameters essential in pediatric polysomnography.  This module provides an in-depth review and explanation of how to utilize the pediatric scoring rules to evaluate sleep disorders in infants and children. 

Module 3 - Pediatric Sleep Development & Sleep Related Breathing Disorders 1.0 CEC

This module reviews the development of sleep in children from infancy through adolescence and provides an overview of a variety of sleep and sleep related breathing disorders in pediatric patients.  An assortment of case studies is provided that illuminate several sleep and breathing disorders that are seen in pediatrics and discusses treatment options and management of these various types of disorders.

Module 4 - Pediatric Treatment Options & Guidelines 1.0 CEC

In this module we define and describe the common modalities used to treat sleep disordered breathing in the pediatric patient.  Indications, contraindications, and precautions for each modality of treatment are outlined, along with the appropriate interfaces for pediatric therapies.  Troubleshooting methods for mask leaks, excessive pressure on the face, and humidification are described, and tips for achieving successful therapy in the pediatric patient are provided.  Treatment goals and patient follow-up guidelines for each type of therapy, as defined by best practices and the American Academy of Sleep Medicine Task Force, are also provided.  This module provides a thorough review of treatment options for sleep related breathing disorders in the pediatric patient.

Module 5 - Pediatric Insomnia & Circadian Rhythm Sleep Disorders 1.0 CEC

This module reviews insomnias and circadian rhythm sleep disorders in the pediatric population.  The evolution, emergence, and prevalence of insomnia disorders, signs and symptoms of the primary pediatric insomnias and management and treatment options for these disorders are discussed.  Pediatric circadian rhythm sleep disorders including delayed sleep phase syndrome (DSPS) and its causes and symptoms are reviewed and differentiated from the insomnias in the pediatric population.  A discussion of appropriate behavioral and environmental interventions for pediatric sleep disorders is also included.  This module provides an excellent overview of the primary insomnia and circadian rhythm sleep disorders that affect pediatric patients.

Module 6 - Pediatric Parasomnias & Hypersomnias 1.0 CEC

This module provides an excellent review of the parasomnias and hypersomnias that affect the pediatric population.  A review of the different types of primary and secondary excessive daytime somnolence (EDS) in the pediatric population that includes age specific signs and symptoms of hypersomnolence in the pediatric patient is provided.  The review of parasomnias focuses on recognizing risk factors for and identifying common parasomnias in the pediatric population and discusses when to utilize polysomnography for evaluation of parasomnias.  The causes of both pediatric hypersomnias and parasomnias and how the appropriate medical history and testing affect proper diagnosis and treatment are reviewed, and the importance of parental education and reassurance in the management of these disorders is discussed.  This module provides an extensive overview of two of the more common pediatric sleep disorders.

Module 7 - Sleep & Medical Disorders in Special Populations 1.0 CEC

This module provides an extensive overview of the numerous different types of medical disorders that may be seen in pediatric special populations.  Each disorder is defined and provides information on how sleep is affected in infants and children with these medical disorders, including the anticipated PSG changes seen in these populations.  In pediatric sleep medicine, the ability to recognize these disorders is important in order to best care for these children during their night in the sleep lab.  This module provides valuable information for any sleep technologist who works with pediatric patients.

Module 8 – Addendum

This module provides supplemental materials as additional learning and for reference on many of the topics covered in this course.  These materials include both technical guidelines developed and endorsed by the AAST and professional practice guidelines from the American Academy of Sleep Medicine (AASM) that set the standards for our work in sleep medicine and technology. These reference materials are provided as an enhancement to this course.  Please note that some of the materials provided are not pediatric specific, however all of these references contain information that is relevant in some manner to the care of pediatric sleep patients.  

These modules are a comprehensive program built to follow the BRPT's Pediatric Sleep Certificate Exam Blueprint and are designed to help students close knowledge gaps in pediatric sleep care before sitting for the certificate exam. Each module includes a glossary and a knowledge check section to reinforce learning. 

Funding for this course was provided by Philips Home Healthcare Solutions.

Module 1 - Anatomy & Physiology 1.0 CEC 

This module provides a review of the basic concepts of the cardiopulmonary system from the primary components of the respiratory system, ventilatory assessment and control, and the impact of common lung diseases to anatomical issues that impact management of sleep-disordered breathing. This module provides a basis for implementing problem-based therapy and the rationale for where to start and why.

Module 2 - CPAP & BPAP Titration Guidelines 1.0 CEC

This module outlines the indications for and goals of PAP therapy and reviews the CPAP and BPAP titration guidelines for adult and pediatric patients. Also covered is the importance of patient education regarding symptoms and health effects of sleep-disordered breathing, the therapy itself, and long-term management. This module concludes by addressing the rationale and methods for switching to bi-level therapy and titration protocols, based on when and how the switch occurs, along with a reminder of the importance of knowledge of physiology and disease in the titration process.

Module 3 - Adaptive Servo Ventilation (ASV) 1.0 CEC 

This module reviews the indications and contraindications for use of ASV therapy in patients with central sleep apnea, variable breathing patterns such as seen in Cheyne-Stokes respiration, or treatment emergent complex sleep apnea in OSA patients. This module includes a comprehensive overview of what ASV is, how it works, which patients benefit from ASV therapy, and the potential risks. The module concludes by addressing the pathophysiology of the disorders that require this type of therapy, principles of operation, and the titration protocol itself, thereby ensuring a thorough understanding of the appropriate use of this therapy.

Module 4 - Noninvasive Positive Pressure Ventilation (NPPV) 1.0 CEC

This module covers the use of noninvasive mechanical ventilation and Average Volume Assured Pressure Support or AVAPS to reduce work of breathing in patients with respiratory failure. The common disorders that affect patients who are appropriate for this therapy and the goals of therapy, along with detailed equipment settings and titration protocols, are provided. The benefits of therapy and adjustments to therapy related to comfort and disease progression are outlined. A case study that includes a demonstration of the changes in breathing pattern throughout the titration and rationale for the final settings is included so that students gain an understanding of how to appropriately apply this therapy.

Module 5 - Average Volume Assured Pressure Support AVAPS-Auto EPAP (AVAPS-AE) 1.0 CEC

This module provides an overview of AVAPS-AE technology and how and when to employ it.  AVAPS technology provides noninvasive ventilation for patients with chronic respiratory insufficiency, and in the AE mode also treats Obstructive Sleep Apnea (OSA) using auto EPAP. Moreover, this technology utilizes and adjusts pressure support to maintain a target tidal volume and can provide an adjustable backup rate when needed. Covered in this module are the disorders appropriate for this therapy, a thorough explanation of the device algorithm and operation, appropriate settings based on specific sleep-disordered breathing problems, and patient comfort settings information. Titration protocols are also provided that address appropriate titration settings based on the specific sleep-disordered breathing problems for which this therapy is appropriate. Contents of this module provide an excellent introduction to AVAPS-AE technology and its effectiveness in patients with advanced therapy needs.

Scenarios Module

Interactive Learner Case Studies 1-3

Funding for this course was provided by Philips Home Healthcare Solutions.

These modules are a comprehensive program built to improve your knowledge of basic cardiorespiratory anatomy and physiology and build your PAP titration skills. Developed specifically for the sleep technologist seeking to expand their knowledge and confidence using advanced titration platforms, each module builds on the next, taking you through the process of transitioning from CPAP to BPAP, and provides a practical knowledge base for technologists new to advanced titration methods. Advanced titration modules for Adaptive Servo Ventilation (ASV), Noninvasive Positive Pressure Ventilation (NPPV), and AVAPS-AE provide information about the technology, the patients and disorders for which each technology is appropriate, and details related to appropriate use of these technologies. Each module includes a glossary and a knowledge check section to reinforce learning. In addition to the learning modules there are three interactive titration scenarios that will allow you to practice your new titration skills. 

There are three pathways of eligibility for the BRPT CCSH exam:

• Pathway #1: for candidates who have 1,000 hours of clinical experience in sleep health and hold a Bachelor’s degree or above. 
• Pathway #2: for candidates who have an approved healthcare credential and hold an Associate degree or above. 
• Pathway #3: for the active RPSGT credential holder who has recertified at least once, completes a CCSH designated focused education program and attains an approved program certificate.

This program has been approved by the BRPT as a CCSH Designated Focused Education Program under Pathway #3. 

Participants seeking the CCSH credential through Pathway #3 that complete this designated focused education program, including successfully completing the accompanying course exam with a score of 70% or better, will receive a certificate of eligibility to sit for the CCSH exam via Pathway #3 at the end of the program. The program includes seven core speaker presentations, a case study presentation and discussion section, access to the individual PowerPoint presentations and the CCSH Workbook, and a CCSH Exam. You can access the program workbook and accompanying PPT presentations by clicking on the Handouts tab.

Program Sections:

1. Normal Sleep and Circadian Rhythms
2. Evaluation of Sleep Disorders
3. Clinical Evaluations – Part One
4. Incidence and Prevalence of Sleep Disorders
5. Clinical Evaluation and Management for the CCSH
6. Clinical Evaluations – Part Two
7. Patient Follow-Up and Management
8. CCSH Case Study Scenario Presentations/Discussions
9. AAST CCSH Post-Test Exam

This program has been approved by the BRPT as a CCSH Designated Focused Education Program.

Participants seeking the CCSH credential through Pathway #3 that complete this designated focused education program, including successfully completing the accompanying course exam with a score of 70% or better, will receive a certificate of eligibility to sit for the CCSH exam via Pathway #3 at the end of the program. 

The program includes seven core speaker presentations, a case study presentation and discussion section, access to the individual handout presentations, the CCSH Workbook, and the AAST Post-Test CCSH Exam.

Important Information Regarding The Post-Test:

• Candidates must provide proof to the BRPT that they passed the post-test with a greater than 70% score to receive a certificate of eligibility to apply. (BRPT also requires current BLS certification for eligibility.)
• This is an open-book exam. Users can access the program workbook, case study scenarios, and PowerPoint slides by clicking on the Resources tab in the course, or utilize the paper workbook that was provided. 
• There is no time limit for completing the exam once you begin, however, users will only receive two attempts. 
• Users may zoom in to view patient data images and examples by clicking on the magnifying glass icon in the course. 
• Users will receive a certificate upon successful completion of the exam. This is the certificate that will be used to verify pathway eligibility for the CCSH credentialing examination. 
• Access to the exam is limited to 120 days upon purchase of the course.