CleveMed Blogs

It was before I became an employee here, that I first used CleveMed’s Crystal PSG software. I was a sleep tech working third shift at the time, and had very little tolerance for device-software-malfunctions in the wee hours of the morning. Understandably so, right? I thought their wireless PSG hardware was pretty cool; allowing the patient to move quite a bit freer than anything else I had used, but what was in it for me, the sleep tech? This blog is my answer to that question.

Interestingly enough, sometime later I joined CleveMed as their sleep application specialist. My input (as a sleep tech and a former customer), was considered an integral part of product development. More importantly, the customers’ input is routinely considered and often taken right into development. For the sleep tech who has never used Crystal PSG software before, I offer a brief overview in this blog. I also want to highlight a few features in Crystal PSG that I particularly appreciate, (hope other techs might benefit from this as well).

The Crystal PSG software offers a complete and user-intuitive software package for managing patient sleep data with data acquisition, scoring, and reporting. I like that it has a quick and easy system setup, as well as simple (as in convenient) patient and study management. Crystal PSG can be used with any of CleveMed’s PSG systems or SleepScout portable sleep monitor, so the same program and database can be used for multiple products.

In addition to the wireless capability, here’s my list of "what’s in it (Crystal PSG) for me the sleep tech"

I want to hear what my fellow-sleep-techs (who are probably reading this with your 6th cup of coffee) think of this, so write me back!

For most of us, when we think of carbon dioxide (CO2), we think of words like waste, danger, toxic, poison; but in reality CO₂ is not only a natural part of our existence but an essential one. We know we need to breathe oxygen to live. So many of us naturally assume that when we hold our breath, that it is the lack of oxygen that our body is reacting to and forcing us to breathe again. . . wrong. In reality, it is the accumulation of CO₂ that our body is reacting to and forcing us to breathe again, trying to reduce and remove the CO₂ from our lungs (You say: Ah ha, see, CO₂ is bad! Our body is fighting to get rid of it). Well, yes, too much of anything is a bad thing, even oxygen (Oxygen toxicity or oxygen poisoning, causes disorientation, breathing problems, and even seizures, but that’s not the point of this article). Back to CO₂, the needed concentrations of carbon dioxide we are talking about are well below the toxic levels, and most importantly without CO₂, you don’t have as much drive to breathe.

There are tens of millions of people with sleep apnea (that is, the failure to breathe while you sleep). Sleep apnea is typically further broken down into obstructive sleep apnea (OSA), where by the patient is trying to breath but air can’t get in due to an obstruction or collapse in the airway, and central sleep apnea (CSA), where by the patient just stops trying to breathe for short periods of time. The most prominent and successful treatment of OSA is using a constant positive airway pressure (CPAP) device or a variation there of. However some of these OSA patients do not get better, do not tolerate the CPAP, or even get worse. One reason is that a portion of the OSA population actually has a complex sleep apnea (CSA) condition that is masked by the OSA. In these cases the CPAP will prevent the obstructions, but then it becomes apparent that the patient is exhibiting CSA characteristics as well. The complex sleep apnea symptoms are unmasked or amplified because of a lack of respiratory drive due to insufficient levels of CO₂. Normally when we sleep, our CO₂ levels increase just slightly. Think about it, you are sleeping in a relatively stationary position creating a slight cloud of CO₂ around you. A CPAP device, however, reverses that effect since it is drawing air from an area a few feet away and pumping it into your airway. To add to that, the increased pressure and flow also acts to ‘blow off’ more of the CO₂ that is normally inside your lungs, so it is very conceivable that the CO₂ levels on CPAP can be even lower than normal (as opposed to slightly elevated in normal sleep). So this complex sleep apnea (CSA) population would appear to have a CO₂ ‘critical threshold’ right at that point between the CO₂ levels experienced with and without CPAP. There are multiple studies that have now shown that adding just a small amount of CO₂ actually treats these patients.

So yes, these patients do say, “give me CO₂ or give me bad sleep!”

Poor quality of sleep tends to accompany common illnesses, and life stressors (including family and social structure changes); patients tend to visit their primary care physician (PCP) who has knowledge of these factors that are related with their sleep problems. Symptoms and complaints associated with Obstructive Sleep Apnea are often expressed at a higher frequency in the primary care practice setting.

Patients often go to a sleep lab for OSA diagnosis & evaluation. On many instances, the primary care physician looses direct contact with his/her patient’s sleep condition and overall care path. An alternative to sending patients to a sleep lab test is to begin the diagnosis and management process within the primary care setting, by utilizing newer technology that makes sleep diagnosis portable and more readily accessible.

CleveMed’s sleep study network connects the primary care physician to sleep technologists, and board certified sleep physicians, so that the primary doc is able to be involved in the patient’s continuum of care. Here’s how:

This way, the PCP can maintain management of his/her patients’ sleep apnea and associated conditions.

We spend a third of our lives asleep –that can be a long time of fitful rest for someone who experiences sleep problems. Disruptions in this state of rest can lead to a decline in one’s overall quality of life. Most patients with sleep problems first seek medical help from their primary care physician.

Sleep in the Primary Care Setting:

Poor quality of sleep tends to accompany common illnesses, and life stressors (including family and social structure changes); thus, patients tend to visit their primary care physician who has a complete knowledge of the factors that are related with their sleep problems. Obstructive Sleep Apnea occurs at a high frequency in the primary care practice setting. An estimated 18 million Americans suffer from OSA; yet, despite the volume of sleep complaints to the primary care physicians, they often go unaddressed.

Common OSA facts and its associated health risks

• OSA is more common in men, and those over the age of 40.
• Snoring (Sleep Disordered Breathing) can be a sign of sleep apnea.
• Adult OSA has a long-standing and unambiguous correlation with obesity and daytime sleepiness. The National Sleep Foundation Sleep in America poll found that 77% of obese adults report having sleep problems. ¹ Sleep specialists say that weight gain, especially in the trunk and neck area, increases the risk of sleep-disordered breathing due to compromised respiratory function.¹ Research shows that sleep problems, like sleep apnea, also result in weight gain which can lead to additional health problems.¹
• Epidemiologic studies have linked sleep apnea with potential, long-term cardiovascular risk.
• Other studies have noted the consistent and strong association between OSA and hypertension.

Diagnosis and Management of OSA

Patients normally go to a sleep lab for OSA diagnosis & evaluation. Often, this causes the primary care physician to loose direct view of his/her patient’s sleep condition. An alternative to sending patients to a sleep lab test is to begin the diagnosis and management process within the primary care setting, by utilizing newer technology that makes sleep diagnosis portable and more readily accessible. Today, diagnosis and therapy of OSA should be considered as part of the health plan to manage diabetes, hypertension, and congestive heart failure — which are all core aspects of primary care medicine.

In conclusion, with training in sleep and an understanding of appropriate testing procedures, primary care physicians can use current evidence based information in the field to provide high-quality sleep medicine in the primary care setting.