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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.

CleveMed’s DreamPort^™ was recently launched at Sleep 2009 in Seattle, WA:

DreamPort expands the reach of your sleep lab by allowing remotely attended sleep studies to be done from anywhere using a bedside system controlled by sleep lab technologists miles away - over the internet!

CleveMed showcased this innovative product with a Live Remotely Attended Sleep Study! A patient located in Cleveland, Ohio was hooked up to a Sapphire PSG^™ which wirelessly transmitted the real time data to the DreamPort located in the patient’s room. Using the camera and broadband technology that the DreamPort provides, the patient’s full PSG data was viewed live by sleep technicians in Seattle, Washington at Sleep 2009!

DreamPort Benefits:

DreamPort is especially ideal for those who are unable to make it into the sleep lab, such as pediatric patients, cross country truckers, the elderly, those with chronic pain and hospital inpatients. In addition, this system gives clinicians and researchers greater flexibility to conduct sleep studies in anyplace. DreamPort is suitable for clinical trials as it allows for cost effective research studies to be conducted in the patient’s home while adding an additional element of home care. Moreover, DreamPort is easy to use. The small, portable and single-button design simplifies the overall process and deployment.

DreamPort’s Easy Process:

Step 1: Patient is hooked up with Sapphire PSG
Step 2: Patient pushes power button on DreamPort
Step 3: Sleep tech remotely starts study from sleep lab
Step 4: Sleep tech controls video and full PSG data remotely

Broadband technology combined with a camera is used to transmit the patient’s full PSG data and video to technologists in real-time, allowing studies to be conducted anywhere the patient is.

As the market changes it is rapidly becoming important to offer flexible solutions for collecting sleep studies at varied locations. With the entrance of Wireless Polysomnography, sleep study setups outside of the lab become more feasible. A comprehensive sleep diagnostic service can now come to the patient instead of the patient having to come to the lab for a PSG. Wireless PSG also brings several benefits to the traditional in-lab setting. Here’s a quick introduction to the traditional and new & upcoming, non-traditional settings for a polysomnography.

Traditional Setting:

In-lab sleep facilities offer onsite sleep techs, medical equipment, and a full bedroom set. This is an expensive set-up, but wireless PSG completely eliminates the cost of running cables throughout the facility with its ability to transmit data through multiple walls. Also, there are typically fewer components with wireless devices and lower risk of individual component failure. Sleep labs will also benefit from expanding their sleep services to include non-traditional off-site testing. Sleep labs volume will not diminish but their patient mix will differ. Typically overcrowded labs will only have deal with those who strictly require in-lab testing, and they can service a larger total volume of patients (since they do not all need to be onsite). Each patient population can then receive a faster diagnosis and therefore faster treatment initiation, cutting out the need for long waits or investing in additional beds for the lab.

Non Traditional Settings:

Home Sleep Test: While some extreme conditions strictly require in-lab sleep testing, many patient populations are well suited for home sleep diagnostic testing, like those tested for occupational reasons, or the home-bound suffering from chronic pain. Home Sleep Testing (HST) allows patients the comfort of home and a familiar environment. It is also increases affordability by cutting out the facility costs of the sleep lab, and the costs involved in moving a patient to the sleep lab which can be expensive in some cases.

Hospital Inpatient PSG: Hospital networks, wireless or intranets are used to transfer sleep studies from the bedside to the sleep lab. Technicians can monitor and respond to problems, yet the patient is still under the immediate supervision of skilled nurses. Since Sleep Disorders Breathing is a complicating factor in many surgeries, the ability to conveniently conduct a sleep study in those settings may avoid complications intraoperatively and postoperatively (particularly for bariatric and cardiac surgery patients)

Hotels: Sometimes sleep labs use hotel rooms to conduct sleep studies because of reduced costs. Some patients are better able to relax in this more familiar setting, and benefit from a reduced first-night-effect.

CleveMed offers the technologies that can expand the reach of sleep services with its wireless systems that are suitable for both HST, follow-up and in-lab sleep studies. This post draws on the experience of several experts at CleveMed and the following web page: www.clevemed.com/PSGAnywhere

As sleep techs, we analyze the sleep of our patients to ultimately help guide them to improved overall quality of sleep throughout their life both in and out of the sleep center. In order to accomplish this, I have listed a few tips that the sleep tech should keep in mind:

1. Being Considerate of Patient’s Needs

This means accommodating the patients’ own sleep schedules as much as possible, using a bundling of wires that makes them feel as comfortable as possible, assisting when needed, to give them an utmost sense of ease during the study. It is ideal for the Tech to control the environment but allow the patient a measure of his/her own sense of control.

2. Determining the Use of “Tools”

The prudent tech recognizes that no matter what comforts are offered, the patient is still outside their natural sleeping environment, fitted with electrodes and wires, and hence may not as comfortable as they wish to be. It helps to remember that beyond the basic amenities, every comfort offered to the patient during a study is a tool. It is better to not offer the patient every tool all at once, because in doing so, it leaves the tech with fewer tools to work with if things go bad. For example, automatically starting all patients with humidity might not be the best approach. It is better to talk with the patients first to feel what their comfort levels are. Another example of this could be Respironics’ C-flex feature. If the tech uses it without needing to, and the patient still has a difficult time, it is one less tool the tech can offer. It is best to use the minimum number of tools until deemed necessary.

3. Knowing Expectations

Know the expectations of your facility, doctors, and supervisors. Having worked in a wide variety of centers myself (Hospital, IDTF, Physician Owned, Privately Owned, PRN, FT, Nights, Days, Management) it is apparent that expectations vary by site. In order to provide the best patient care, there needs to be excellent communication and delivery of expectations. This goes both ways, so let your supervisors know what you expect from them, keeping an open working relationship.

4. Continuing Learning

It is most important to recognize that the field of sleep is rapidly changing, and the only way to keep up with these changes is through ongoing education. If you do not receive this from your current center/lab, take it upon yourself to seek out education whenever & wherever possible. Some good sources for this are binarysleep.com, aastweb.org, brpt.org (from the sleep tech’s perspective), and cpaptalk.com (from the patient’s perspective). Push yourself to new experiences. The more knowledge and experience you have, the more bargaining power you have. For example, many techs don’t like to score studies at night. Not only does this make you more valuable as a tech, but it makes you more aware of the patient condition and the sleep study in its entirety. If you offer to help out more, you could find yourself learning something along the way as well as perfecting your skills.

Sleep techs, you are welcome to add to this article with your comments.