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By: Kent Caylor, RPSGT on March 13th, 2020

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The Changing Face of Sleep Technology, Part 4

Sleep technology

This is the fourth article in a series on the changing face of sleep technology. The past three articles focused on technology and the economy. This article focuses on how all these changes could directly impact the future sleep technologist.

Technology is advancing at an incredible rate, and with home sleep apnea tests on the rise, the role of the sleep technologist will continue to evolve. I use the word “evolve” because I don’t think this position will be phased out any time soon. In fact, I see just the opposite happening.

But, won’t home sleep apnea tests (HSATs) and auto-titrations ultimately eliminate the acquisition technologist? And what about the regulatory and economic pressures that are changing the way sleep-disordered patients are being diagnosed and treated? These are excellent questions; those issues could definitely cause the financial viability of future   sleep centers to become an issue. So, yes, this would lead to a reduction in the in lab technologist workforce.

However, the end is nowhere in sight. In fact, the technologist of the future will be taking on an even greater role in the sleep field. This is because technology is creating other positions within sleep medicine — positions just waiting for a versatile sleep technologist to fill. Thus, our scope of practice could actually be more extensive than it is today.

Let’s take a look at just how this might work.

The Expanded Role of the Sleep Technologist

The sleep technologist of tomorrow will need to do more than just acquire sleep studies. As sleep technology continues to evolve, core competencies will no longer be sufficient.  We must become more proficient in all aspects of sleep medicine and be able to be cross- trained in other facets of sleep. These advances in diagnostic and therapeutic devices will require not only greater technical skills, but clinical skills, as well. Tomorrow’s sleep technologist will not only be taking on greater roles in the overall management of those sleep centers that remain; they will also play an integral part in overall patient care.

Other disciplines require higher degrees, but, presently, the highest degree most sleep technologists have achieved is an associate’s degree. An advanced degree would greatly benefit the field of sleep technology. And, actually, tomorrow’s technologist will be part of a   patient’s whole interdisciplinary team. They will be taking a more active role in the overall care of the patient beyond the acquisition phase. Thus, there will be a need to remain diligent in keeping up with research, as new findings further advance this vital field.

Let’s look at another way technology is creating new opportunities for the future sleep technologist.

Telemedicine

People often confuse the terms telemedicine and telehealth. They are technically different. Telehealth involves various technologies in providing patient care, while telemedicine is a sub-group of telehealth and is strictly involved in clinical care. In this article, we will be more focused on telemedicine as it relates to sleep medicine.

In essence, telemedicine is the use of various ways to communicate electronically, such as visiting with your doctor via the internet from the comfort  of your own home. Video conferencing among healthcare professionals would be another example.

Considering that the future sleep technologist will play a more active role in the patient’s interdisciplinary team, there are a number of possible roles for them to fill. And with the increasing use of telemedicine, one of the many things the future sleep technologist might be involved in is that of telepresenter. According to the American Telemedicine Association, the role of the telepresenter “is to support and facilitate communication of both the patient and evaluating provider throughout the tele- encounter process”.

Telepresenters need to  be  proficient  in both clinical and technical aspects of sleep medicine. For more information, you can read the AASM position on the use of telemedicine for diagnosing and treating sleep disorders. Also, there are currently courses at some colleges offering certification as a telemedicine presenter, although these aren’t specifically for sleep technologists just yet.

Besides telepresenters, the sleep technologist of the future will be involved in every aspect of patient care.

 

The Future Sleep Technologists’ Scope of Practice

The scope of practice of tomorrow’s sleep technologist will also encompass patient care from pre-test evaluation to long-term care. In fact, the Journal of Clinical Sleep Medicine defines the following five major categories of care as:

  1. Pre-Test Evaluation — Examples of this would include pulmonary function tests, pre-test screening and patient education. The technologist will need to be proficient in clinical evaluation and accurate documentation.
  1. Diagnostic Testing — This would include home sleep apnea testing (HSAT), actigraphy and CO2 For this area, the technologist will need to be proficient in age-appropriate  care,  as well as have a thorough understanding of comorbidities.                                                                                                       
  2. Provision of Treatment — Under this category are advanced PAP treatment and appropriate use of O2. Here, the technologist will need to be proficient in critical care, basic physiology and alternative therapies.                                                                                                                      
  3. Follow-up — This includes monitoring treatment adherence. Here, the technologist will need a good understanding of the various treatment modalities, as well as be proficient in patient education.                                                                                                                                                                           
  4. Long-Term Care — The sleep technologist will monitor equipment and patient compliance and will need to be proficient in coding and billing.

Also, at present, the number of sleep technologist educators is on the decline, just as the need for more education is needed. So, this is definitely another critical role needing to be filled.

Additionally, reimbursements for HSATs are lower than for in-lab studies, which translates to more HSATs being ordered. However, there will most likely continue to be patients who are too severe for home studies, such as those with comorbidities. These patients will need in-lab studies; thus, those sleep technologists will be seeing more complex patients. It will be to their benefit if they are more highly skilled and have  more advanced degrees than today’s sleep technologists. Also, obesity is on the rise, so it’s highly likely that more people will be diagnosed with OSA in the coming years.

Besides the increased opportunities for future sleep technologists, there are also health benefits to be gained by more day shift work.

Health Risks of Shift Work

If you work the night shift, you know it can be stressful. But stress isn’t just hard to deal with emotionally; chronic stress can cause physical damage, as well. That’s because stress releases a chemical called cortisol. In the short term, cortisol is part of the fight-or- flight response and is a good thing. However, elevated levels of cortisol over an extended period actually cause more harm than good.

For instance, chronic elevations in cortisol lead to insulin resistance, which is the main component of type 2 diabetes. Insulin resistance has also been shown to increase risk of cardiovascular disease.

Even more critically, consistently working the night shift causes our circadian rhythm to get out of sync, also known as circadian rhythm misalignment. This results in a number of health hazards. Let’s do a little review and see how this happens.

There are a group of neurons located in the hypothalamus called the suprachiasmatic nucleus, or SCN. The SCN is our “master clock” and drives biological functions that fluctuate on a roughly 24-hour basis, known as our circadian rhythm. And while there are both internal and external factors that influence the circadian rhythm, the one that has the most effect is exposure to light through the eyes.

A hormone known as melatonin is secreted by the pineal gland, and although driven by the circadian rhythm, its secretion is greatly influenced by light. This hormone is involved in our sleepiness drive with levels usually peaking around 3-4 a.m. However, if you are a chronic night shift worker, melatonin production is suppressed. But melatonin does more than just make us sleepy; it has been shown to actually inhibit tumor growth, as well as help regulate the inflammatory process. There is also a greater risk of heart disease as well as a higher mortality rate (See “Working on Atypical Schedules”).

However, working nights isn’t just hard on our bodies. This is because sleep and   our circadian rhythm help regulate not only our physical health, but our mental  health as well. Studies have shown that circadian clock dysfunction is actually a common risk factor for various psychiatric disorders. And while mood disorders  such as nervousness, anxiety and irritability can cloud our judgement and affect our decision making, circadian clock dysfunction also results in deficits in both thinking and memory.

Conclusion

This article wraps up a series on the changing face of sleep technology. We’ve looked at the past, present and future of the sleep field. We’ve also explored how technology and economic pressures might impact the sleep technologist of the future and how these changes will actually create other, more diverse roles for tomorrow’s sleep technologists.

But to be a part of this change, we need to stay ahead of the game. We need to plan ahead and position ourselves for the coming change. We will need to increase our value as members of an integrated healthcare team and see these opportunities as more than just a job. We will need to adapt to new technology. Technical, clinical   and communication skills will be a must. So, although we can’t be certain about the future, one thing is sure: Our role as sleep technologists is evolving and will continue to evolve.

Also, the more closely we look at something, and the more time we spend thinking things through, the greater our understanding becomes. It appears that our knowledge of sleep medicine is not complete, so as your position becomes more diversified, remain diligent; you might just observe something others have missed and help advance the field of sleep medicine.