Bridging the Gap between the Sleep Lab & DME – A Sleep Educator’s Role
Having been in health care for nearly 35 years now, I feel like I have worked all aspects of patient care. I did bedside care for patients as a respiratory therapist, and overnight sleep studies/daytime studies/scoring as an RPSGT. I have set patients up on PAP therapy and resolved their problems with therapy as a durable medical equipment (DME) clinician.
I am also a continuous positive airway pressure (CPAP) user. Every role I have performed has taught me the importance of education of/for the patient in their disease process and therapeutic treatment. It led me to my current role as a sleep educator.
How many times have you asked a patient as they arrive for their sleep study, “What brings you here tonight?” Only to be told, “My doctor says I have to,” or “My spouse says I snore and have to do this.” Most patients just know they are tired, they snore and they have no idea what that means. They do not know why they stop breathing or what happens to their body/brain during an apneic event.
Most patients do not truly understand why they need CPAP or what CPAP will do for them. They do not know the severity of their apnea or all of the other health issues causing it. Therefore, it is not surprising that CPAP compliance is low because most patients don’t understand the importance of sleep disordered breathing (SDB) and its treatment. Getting used to CPAP, monitoring your progress, maintaining your equipment and bringing it with you wherever you travel can be challenging if you do not understand why you’re doing it.
I am fortunate to work in a hospital-based sleep lab that also has a hospital-based DME. It makes it much easier for the sleep lab and DME to work as a team in providing the best possible care. Our sleep lab does incredible work to be sure all necessary information is gathered for each patient, both before and after the study is completed. Besides being sure the proper study is being done for the patient, they obtain face-to-face physician visit office notes and all other necessary medical records and information.
My portion—patient education—occurs at a few different points. Generally, when patients have a home sleep apnea test (HSAT), they are told they have obstructive sleep apnea (OSA) and are set up on auto CPAP. In our lab, patients have an HSAT and the results are sent to the ordering physician with a recommendation for a PAP titration and patient education.
When the sleep lab receives the order, the sleep schedulers set up the patient education and the DME starts the insurance process for their equipment set up. So now the process is: HSAT, patient education, auto CPAP set up. Or PSG/HSAT, patient education, PAP titration, PAP setup.
How has this helped bridge the gap and helped our patients? When the patient comes in for education, I go over their study with them and explain SDB and their type of SBD, go over the causes of OSA, what happens in their body every time they stop breathing, the comorbid conditions and how OSA causes or contributes to these disorders.
I then relate all of this to their current health history using physician office notes, patient questionnaires and sleep studies. I show them their hypnogram so they can see the sleep fragmentation on the PSG and the many arousals. Even on an HSAT, they can see the oxygen level dropping and the heart rate increasing. I explain the consequences of untreated OSA and the path the disease will follow if left untreated. Then I inform how PAP therapy works to treat OSA. I describe to them their many mask options. I also tell them how simple the machines are to use, and how they will be able to follow their own progress on an app on their phone—or directly from the machine.
They leave understanding their disease process and the importance of treating it. Most patients are eager to get started. I have educated people who were previously on therapy and quit using it and now they are trying to requalify. They generally are extremely tired, have hypertension, coronary artery disease, and/or diabetes and do not know where to turn. These people always tell me, “No one ever explained this all to me. I had no idea. I would not have quit using it if I had known.”
This is also a big help for our DME. Patient education provided at their set up can now focus more on the machine itself, mask interface and follow up. The clinician can focus more on how the patient is responding to PAP and spend their time acclimating the patient to therapy.
In our sleep lab, the educator role bridges the gap between diagnosis and therapy. It helps patients easily navigate through the often confusing time from testing to treatment. Their newfound knowledge helps them stay compliant with therapy.