Sleep Tech In Training

Week Theme: Patient Hook-Up

2011-02-07T13:00:00.000-08:00

Each week I'll be tackling one section in the Principles of Polysomnography book (I have the second edition). Since there are six sections it will give me another week or two to do general study before I take the test by the end of March.

Week One: Patient Hook-Up

Monitoring Devices
Performing a Full Patient Hook-Up
Electrode Application
Waveform Characteristics and Montages
The Role of the Sleep Tech

In addition, I'll be brushing up on history of sleep medicine and EKG.

Time to get studying!

Weekend Vocabulary

2011-02-05T20:00:00.000-08:00

Atrioventricular (AV) Node
The point of the heart that is responsible for the conduction of the electrical impulses from the atria to the ventricles.

Bundle Branches
Three branches from the bundle of HIS in the heart that run along the interventricular septum.

Common Mode Rejection Reaction (CMRR)
A rating of the ability of differential amplifier to eliminate identical inputs.

Differential Amplifier
An amplifier used in polysomnography which works by comparing the difference between two incoming voltages and outputs a signal based on the difference.

End Tidal CO2
A reading of carbon dioxide levels in the blood as measured by expired air.

Frequency Response Curve Group
A graphical depiction of an amplifer's ability to filter unwanted signals at varying frequencies.

Glutamate
Excitatory amino acids that project to the cortex, forebrain, and brainstem.

Hyperoxemia
The state of having too much oxygen in the blood.

Internodal Pathways
The pathways which the electrical impulses of the heart follow, from the SA Node to the AV Node.

J

Klein-Levin Syndrome
A disorder that has recurrent hypersomnia as one of its symptoms.

Low Frequency Filter (LFF)
A tool or device on a polysomnograph which sets a limitation to the low frequency signals that are allowed to pass through the amplifier.

Mercury Strain Gauge
A device to detect respiratory effort by amplifying the change in resistance due to circuit elongation and narrowing with a wheatstone bridge box.

Noradrenaline
A chemical in the brain that maintains and enhances the activation of the cerebral cortex.

Oscillograph
A device that converts electrical signals into pen movements.

Purkinje Fibers
Specialized myocardial fibers that conduct electrical impulses that enable the heart to contract.

Q

Reticular Activating System (RAS)
A system in the brain causing wakefulness and alertness.

Sinoatrial (SA) Node
The point of the heart at which the electrical impulse begins. This is the pacemaker of the heart.

Tricyclic Antidepressants
A group of medications designed to treat depression. Most of these also reduce REM sleep and are sometimes used to treat certain disorders associated with REM sleep.

U

V waves (formerly known as Vertex waves or Vertex sharp waves)
Sharp negative deflections seen in an EEG channel. V Waves are characteristic of the later part of stage N1.

Water-filled Catheter
A device used to detect respiratory effort.

X

Y

Zeitgeber
External stimuli such as light, melatonin, and physical activity that entrain biological rhythms to certain levels of wakefulness or sleep.

These glossary terms are from The Sleep Technician's Flash Cards by Spriggs which you should definitely add to your wish list.

Studying for the BRPT...

2011-02-05T11:00:00.000-08:00

Even though there has been quite a bit of changes recently with the future of testing in the sleep field I'm still planning on taking the BRPT exam. See ABSM Creating New Sleep Technologist Certification Exam | News | Sleep Review or BRPT who posted links to responses from AASM and AAST.

I've been going to a study group and we're starting to get into a regular schedule now so finally I'll be posting bits and pieces of what I'm currently studying here.

I've yet to find a job, finding one in my area with no experience and not registered has been more difficult than I thought but that is just another reason for me to study hard and pass the exam.

In the meantime, I'll be stocking up on hot chocolate because it's cold out there!

Review for BRPT Exam

2010-07-23T22:00:00.000-07:00

Last minute I signed into a two day review hosted at NECC in Haverhill, MA. I got to see a few former classmates as well as meet many new faces, some traveling from New Jersey and Maine.

This review coupled with finding a huge online resource, Binary Sleep, will really help me get over summer time mentality and back into studying.

~~Break time is over so I'll add some links and pictures later.~~

The review covered AASM scoring guidelines and preparing for the newly restructured exam offered by the B.R.P.T. Respiratory therapists, Registered sleep technologists, recent graduates and former sleep tech's still in the sleep field received a binder full of information to study. For two days, about thirteen hours of lecturing, we listened to three professors discuss topics such as; pediatrics, cardiac evaluations, safety, and sleep disorders at length.

At the end we were awarded a certificate and members of AAST gained CEC credits. Sadly, I forgot to charge my camera so I was only able to take a few pictures today. Almost as sad is that I am so sleep deprived I'm having difficulty stringing together coherent sentences so take a gander at the few pictures below and get studying!

Chris Rowse

Lunch Time

Full study binders

Two of teachers

Worked super hard to keep our food and drinks flowing

More food!

John Murray, Forrest Broderick, & Christopher Rowse

Testing Quiz One

2010-05-19T12:22:00.001-07:00

Testing Quiz One
Hello, this is a test to see what it looks like...

Finals are over but studying isn't

2010-05-17T13:26:00.000-07:00

Getting ready for our scoring final!

Well, the idea that I would post on the blog during my last semester didn’t really work so well. Between work, clinical and studying I just couldn’t manage it.

Last week I took all five of my finals and this Saturday is graduation. Just because school is over though doesn’t mean that the learning has stopped. This Friday students from both the Hybrid and Day programs met with two of our teachers to take a review.

We all are eligible to take the RPSTG exam, which is in the process of a price increase and big overhaul, and now we really need to hit the books.

I’ll be posting here to help keep my studying organized, I’m still trying to find a good plugin for quizzes (so geeky but I can’t wait) and hopefully by the end of the summer I can say I’m a registered tech.

My next goal is getting a job!

Applied to Graduate!

2010-03-26T09:23:00.000-07:00

The deadline to submit the graduation application is days away so after my Bio Lab I meandered over to the offices at the Haverhill campus. It was not as complicated as I expected and in no time at all I was back on the road which happily was snow and rain free.

Last night I had my weekly clinical at SleepHealth Center and during a bit of down time I tested my knowledge using the Principles of Polysomnography Manual with practice questions. Eck! I did really, really bad. I'm not letting that get me down though. It was at three AM and now I see what my weak areas are. Plus, classes aren't done yet so hopefully it will help me to get a bit more organized. Hey that is what this blog is for right!

Any ways, on a blogging note, Blogger in Draft has added a new (and SICK) template designer. All those hacks I was so proud of doing to get my skinny sidebars and three column footer are superfluous. But I'm going to keep it like it is for now and resist playing with the new feature (on this blog at least).

Now here is a serious question- did you go to your college graduation ceremony?

NECC hosted an informational open house for the truck driving program

2010-03-12T14:00:00.000-08:00

Today as the Sleep Awareness Week winds down the Sleep Technology group over at NECC put together an informational Open House near the Haverhill Campus for the truck driving program today. Scheduled from 12:30 to 3:30 two groups of truck driving students came in to hear sleep technology students discuss sleep medicine and how it would effect them in particular.

Personally, I only made it in time for the second group. The crowd was friendly and inquisitive, surprising since I expected them to nod off after stopping at a local Chinese restaurant for lunch first. I attempted to take pictures but since I took them without a flash they are grainy but here are a few so you can get the idea.

Students briefly explained sleep apnea and how CPAP is one treatment. Guests asked questions or made statements about CPAP usage. Two concerns they expressed included how it would effect their intimacy with their bed partner and also comfort level for side but especially those that sleep on their stomach. These two points were made by CPAP users in the group; one who is compliant and one who has not been in the two months that they have had it.

Other questions were asked and the students covered a variety of topics while keeping it light, friendly, informative and interesting enough that no one fell asleep. Believe me as one student said, "she's a pit bull, she's waiting to get us' I was eagerly waiting for someone to nod off with my camera prepped.

A few of the topics covered:

Symptoms of sleep apnea

CPAP usage

Types of CPAP equipment

Alternative treatments- for example dental devices and surgery

Restless leg syndrome

The family history factor

One of the big topics in regards to truck drivers was drowsy driving. While the students speaking didn't get a chance to go to deeply into this, the phenomenon of micro sleep was discussed and there was even a first hand account from the truck driver students that was shared. State laws on drowsy driving in Massachusetts and New Hampshire and their possible changes that could effect truck drivers was an area of concern.

Students shared their personal sleep stories.

Overall, it was a great experience and one that hopefully will continue for the next round of students, in both the sleep technology and truck driving programs.

Some of the students from NECC's 2010 Sleep Program.

If you'd like to see more pictures from the event check out my set on Flickr.

Defined: L

2010-03-11T08:00:00.000-08:00

Low amplitude, mixed frequency activity:
An EEG pattern consisting of low amplitude, predominantly 4-7 Hz activity.

Low chin EMG tone:
Baseline EMG activity in the chin derivation no higher than in any other sleep stage and usually at the lowest level of the entire recording.

Defined: H

2010-03-11T07:00:00.000-08:00

Hypanagogic foot tremor:
Trains of EMG activity of the lower limb with a specified frequency,; not a defined disorder.

Hypopnea:
A specified reduction in airflow lasting at least 10 seconds in adults or the equivalent of 2 breaths in children.

8 Signs it is time to pull over

2010-03-09T23:00:00.000-08:00

Tips taken from Drowsy Driving

Heavy eyes, frequent blinking or difficulty focusing
Daydreaming, random thoughts
Gap driving, missing signs or exits
Excessive yawning or rubbing eyes
Nodding head
Drifting or hitting the rumble strip
Restless, irritable or slap happy
Erratic driving, tailgating

Even if some of these behaviors is how you normally drive-know your body and read its signs.

Define: G

2010-03-09T08:00:00.000-08:00

Guideline:
A recommendation based on level 2 evidence or a consensus of level 3 evidence.

Define: E

2010-03-09T07:00:00.000-08:00

Excessive fragmentary myoclonus:
Limb EMG activity of a specified frequency and duration often unassociated with visible movement; not a defined disorder.

Eye blinks:
EOG events consisting of conjugate vertical eye movements at a frequency of 0.5-2 Hz present in wakefulness with the eyes open or closed.

Sleep Awareness Week 2010: Post Roundup

2010-03-08T08:00:00.000-08:00

This is the first year I'm doing this but there are scores of others who have been sharing information about sleep and Sleep Awareness Week in particular. Here are a few posts from the week. I'll add more as the week goes on.

Sleep Awareness Week on the Recently On Around and About blog. It includes a podcast with Dr. Andrew Vernon, a sleep specialist in Chattanooga, TN.

Poll reveals sleep differences among ethnic groups from ScienceBlog discusses the Sleep in America poll that was released on March 8, 2010.

Sleep Disorder Symptoms for National Sleep Awareness Week at SleepEducation's blog.

National Sleep Awareness Week and Daylight Savings Time Arrive Together at Sleep Well and Live.

30 second commerical for Sleep Awareness Week 2010

2010-03-07T11:00:00.000-08:00

Create your own video slideshow at animoto.com.

Sleep Awareness Week is here! March 7-13, 2010

2010-03-07T09:00:00.000-08:00

The National Sleep Awareness Week in the United States is hosted by the National Sleep Foundation. Its purpose is to highlight the importance sleep factors into all of our lives. It is no coincidence that Daylight Savings Time marks the end of this week, since sadly the risk for sleep related accidents increase around this time.

Throughout the week I'll be adding videos, posts on sleep and sleep safety as well as pointing you towards other resources here online.

Events during Sleep Week

Sleep Health & Safety 2010: Convention in Washington, DC kicked off the week on March 5-6, 2010

Sleep Awareness Week Posts

Picture Credit: Amanda Truss on Flickr

EDS- What is it and why could it put your life in danger?

2010-03-05T10:00:00.000-08:00

EDS, or excessive daytime sleepiness, is not fatigue, which can be likened to sluggishness, rather those with EDS find it a challenge to stay awake throughout the day and their everyday activities. With less time spent on sleeping more and more are beginning to show signs of daytime sleepiness and are putting themselves and others at risk.

When the need to sleep begins to take over your day, it becomes hard to keep your eyes open, focus, even simple tasks may seen impossible to complete. Regardless of what country you reside studies report the need or urge to sleep during the day is a global issue. 40% of Americans report having daytime sleepiness at least several days a month (1).

EDS increases the risk for accidents. Recently, an incident where a commercial plane missed its scheduled stop is rumored to be caused by dozing pilots. More serious accidents include work related ones such as 1989's Exxon Valdez oil spill where between 500,000 and 750,000 animals were killed immediately after the accident and automobile crashes. With over 100,000 car accidents estimated per year, drowsy driving make excessive daytime sleepiness a community and not just an individual problem.

EDS can be a symptom of underlying conditions. Untreated sleep disorders have serious side effects and EDS is just one. If you find it hard to stay awake during the day on a regular basis contact your doctor to be screened.

Here are a few examples of Sleepiness Scales
The Epworth Sleepiness Scale
The Pediatric Daytime Sleepiness Scale

Check out this WedMd Quiz:
Sleep and Crazy Hours on the Job

Sources:
1. Fundamentals of Sleep Technology by Butkov & Lee-Chiong. 2007.

Formulas: % of Stages

2010-03-04T08:00:00.000-08:00

% of movement time
Minutes of MT / SPT (or TRT) x 100
Calculates minutes of movement time divided by sleep period time or total recording time and multiplying by 100 to get the total percentage.

% of Stage 1
Minutes of S1 / TST (or TRT or SPT) x 100
Calculates minutes in Stage 1 sleep by dividing by total sleep time or total recording time or sleep period time and multiplying by 100.

% of Stage 2
Minutes of S2 / TST (or TRT or SPT) x 100
Calculates minutes in Stage 2 sleep by dividing by total sleep time or total recording time or sleep period time and multiplying by 100.

% of Stage 3
Minutes of S3 / TST (or TRT or SPT) x 100
Calculates minutes in Stage 3 sleep by dividing by total sleep time or total recording time or sleep period time and multiplying by 100.

% of Stage REM
Minutes of REM / TST (or TRT or SPT) x 100
Calculates minutes in Stage REM sleep by dividing by total sleep time or total recording time or sleep period time and multiplying by 100.

Note:
These formulas are found in Fundamentals of Sleep Technology. Check out the Formulas page for more.

Defined: D

2010-02-26T07:00:00.000-08:00

Delta rhythm: An EEG rhythm consisting of 1-4 Hz activity.

Dominant posterior rhythm: An EEG pattern with frequency appropriate to age which is observed over the occipital regions during relaxed wakefulness with eyes closed and attenuates with eye opening or attention.

Dypnagogic hypersynchrony: An EEG pattern consisting of paroxysmal runs or bursts of diffuse high amplitude sinusoidal 75 to 350 u V 3-4.5 Hz waves which begin abruptly, are usually widely distributed but often maximal over the central, frontal, or frontocentral scalp regions.

Defined: C

2010-02-25T07:30:00.000-08:00

Chheyne Strokes breathing: A breathing rhythm with a specified crescendo and decrescendo change in breathing amplitude.

Consensus: A specified agreement of appropriateness amongst a minimum of 7 individuals using RAND/UCLA methods.

Defined: B

2010-02-24T07:00:00.000-08:00

Beta rhythm: An EEG rhythm consisting of 13-30 Hz activity.

Bradycardia: A sustained heart rate less than 40 beats per minute.

Bruxism: Grinding or clenching of the teeth during sleep that is often associated arousal.

Defined: A

2010-02-23T12:00:00.000-08:00

Apnea:
An interruption of airflow lasting at least 10 seconds in adults or the equivalent of 2 breaths in children.

Alpha rhythm:
An EEG pattern consisting of trains of sinusoidal 8-13 Hz activity recorded over the occipital region with eye closure and attenuating with eye opening.

Asystole:
An interruption of cardiac rhythm lasting more than 3 seconds.

Atrial fibrillation:
An irregularly irregular ventricular rhythm associated with replacement of consistent P waves by rapid electrical oscillations.

Follow Along My Last Semester and Beyond!

2010-02-20T07:00:00.000-08:00

Last summer when I threw myself rather recklessly into a 9 month certificate course in Polysomnography I thought, 'maybe I should start a blog'.

My saner self resisted, not only would I be in the middle of school and work but I was juggling two or so non-related blogs. Now, with one semester left and my other blogs lucky if I visit on a weekly basis I'm starting this one!

I'll share research, links, what to expect and events that relate to sleep medicine. Plus, I'll be asking many questions so don't hesitate to chime in!

Glossary

2010-02-01T12:00:00.000-08:00

Terms you may find useful. More added often.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Apnea:
An interruption of airflow lasting at least 10 seconds in adults or the equivalent of 2 breaths in children.

Alpha rhythm:
An EEG pattern consisting of trains of sinusoidal 8-13 Hz activity recorded over the occipital region with eye closure and attenuating with eye opening.

Asystole:
An interruption of cardiac rhythm lasting more than 3 seconds.

Atrial fibrillation:
An irregularly irregular ventricular rhythm associated with replacement of consistent P waves by rapid electrical oscillations.

B

Beta rhythm:
An EEG rhythm consisting of 13-30 Hz activity.

Bradycardia:
A sustained heart rate less than 40 beats per minute.

Bruxism:
Grinding or clenching of the teeth during sleep that is often associated arousal.

C

Cheyne-Stokes breathing:
A breathing rhythm with a specified crescendo and decrescendo change in breathing amplitude.

Consensus:
A specified agreement of appropriateness amongst a minimum of 7 individuals using RAND/UCLA methods.

D

Delta rhythm:
An EEG rhythm consisting of 1-4 Hz activity.

Dominant posterior rhythm:
An EEG pattern with frequency appropriate to age which is observed over the occipital regions during relaxed wakefulness with eyes closed and attenuates with eye opening or attention.

Dypnagogic hypersynchrony:
An EEG pattern consisting of paroxysmal runs or bursts of diffuse high amplitude sinusoidal 75 to 350 u V 3-4.5 Hz waves which begin abruptly, are usually widely distributed but often maximal over the central, frontal, or frontocentral scalp regions.

E

Excessive fragmentary myoclonus:
Limb EMG activity of a specified frequency and duration often unassociated with visible movement; not a defined disorder.

Eye blinks:
EOG events consisting of conjugate vertical eye movements at a frequency of 0.5-2 Hz present in wakefulness with the eyes open or closed.

F

G

Guideline:
A recommendation based on level 2 evidence or a consensus of level 3 evidence.

H
Hypanagogic foot tremor:
Trains of EMG activity of the lower limb with a specified frequency,; not a defined disorder.

Hypopnea:
A specified reduction in airflow lasting at least 10 seconds in adults or the equivalent of 2 breaths in children.

I
J

K
K complex:
An EEG event consisting of a well delineated negative sharp wave immediately followed by a positive component standing out from the background EEG with total duration >0.5 seconds, usually maximal in amplitude over the frontal regions.

Low amplitude, mixed frequency activity:
An EEG pattern consisting of low amplitude, predominantly 4-7 Hz activity.

Low chin EMG tone: Baseline EMG activity in the chin derivation no higher than in any other sleep stage and usually at the lowest level of the entire recording.

L

Formulas

2010-02-01T08:00:00.000-08:00

Looking for a formula to determine your patient's AHI? Or want to figure out Total Sleep Time? Over the next few weeks I'll be added these and many more formulas to the site and then compiling them all here. These formulas are found in Fundamentals of Sleep Technology.