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Adventures in Sleep

At Long Last: Spring!
April 10, 2014 9:54 AM by Penny Mehaffey

Spring is trying so hard to manifest here in Augusta. I keep hoping it will happen any day now. The past couple of days have been so pretty, sunny and warmish-cool. My assistant Brittany texted me this morning to say that she thinks we should have a day set aside when we are allowed to call off "because it's just too pretty to work." I second that! 

Here in our area it's very warm in the sun but also very cool in the shade, maintaining a need for jackets. Our flowers are late blooming, so the "garden city" is not quite living up to it's name yet. The Master's golf tournament is underway and that, of course, is the main event in town. I guess the weather is pretty good for golfing right now. 

My son Noah, is trying to get out of Turkey and return home to start his civilian life after spending the last six years in the U.S. Air Force. He has been met with delays all along the way, and now is becoming frustrated. He's stuck in "transition limbo." I am very excited that he will be home this Saturday night.  Woohoo!! That is my main event. My birthday is next week and I could not ask for a better gift than to have my son back. I have missed him.

I hope spring comes forth for all of us very soon. We've endured the winter storms and are now ready for the renewal that is springtime. Don't give up hope, it will surely happen.
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Election Time
April 3, 2014 12:04 PM by Amy Reavis

I am excited to see the elections this year. There are many new people on the ballot and the desire to bring new blood into the AAST and for more people to be involved is very exciting. I have also seen more people volunteering for committees. This again is exciting as our field grows and changes. 

Why am I so excited? Well, it came on the heels of an experience my dean had when he visited a hospital. It appears there are still many people who believe that the field of sleep is going away. A program director at a local hospital told him that the field is dead and that there is no hope of a future. Of course I do not believe it. I believe that our field is growing and changing and that there isindeed a future. It is this belief that others also have that leads them to volunteer for the association. 

Are there labs closing? Absolutely -- labs that were not designed to be successful but instead were designed to diagnose sleep apnea only or test a patient and never follow up. I also know labs that are growing. They are labs that understand that sleep education and follow-up is part of the role of the technologist. They understand that the new credential is going to be a necessary part of the field. They understand that support groups and clinics are the best way to grow a lab. 

The labs that are growing need to share their success. The labs that are struggling need to be open to new ideas. I think that lack of being open is going to go away (just like those who were in respiratory therapy and refused to sit for their certification no longer work in the field). And those who are not getting their registry will have difficulty gaining employment in the future. It is about looking to the future and growing rather than looking at the present and the past and saying I am good enough as-is. 

Whether working in the field of sleep or in respiratory, it is essential that we grow and volunteer and continue to look toward the future. It is why you need to vote in the elections and volunteer for committees. And I hope to talk to you during one of the teleconferences soon.
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Review, Review, Review!
March 20, 2014 8:33 AM by Amy Reavis

The one thing I can tell you as I teach is how much reviewing the rules is important. I have recently taught scoring and titration. As I am going through the curriculum it is always helpful to remember that reviewing the rules makes me a stronger technologist. 

Titration is the heart and soul of our profession. As we were reviewing proper titration I was reminded how important educating our patients is. Anatomy and physiology of sleep apnea and why CPAP works helps to make a patient more compliant. Finding the right mask and trialing more than one mask may not make our nights easier, but it will make the patient compliant over the long term; the real reason we do sleep studies. 

Using proper titration, minimal pressures, pressure relief and ramp helps make the night more successful. We also need to remember how long between increases in pressure and that according to the AASM the pressure should be increased by only 1cm with a wait of at least 5 minutes between titrations. 

Scoring is a little more difficult to teach. The rules are black and white, but the studies are never quite so clear. This is as much an art as it is a science. We look at sleep onset and discuss epochs. Then the thought is shared, maybe one or two epochs in the grand scheme of a study is not enough to make us crazy. It became more a discussion of what do each of us think and ultimately a consensus of what is right. The bigger challenge is when there is differences between EEG and sleep and the questiond arise as to how we are able to tell what is alpha and do we have time to count waves when we will be scoring 5-8 studies a day or score on the fly. 

What I learn doing this teaching is how much I gain from my students when I review the rules and review studies with them. I remember that I gain so much more skill from them and am able to be a better technologist for my patients.
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Asleep During 'The Week'
March 13, 2014 12:26 PM by Penny Mehaffey

We just concluded Sleep Awareness week 2014.  I am ashamed to say that I completely forgot about it this year. This year I was too distracted and was not even aware until the last day. But I will make up for it next week by hosting a belated event.  After all, it is spreading the word and awareness for sleep apnea that is important --  not a specific date that matters.

Normally I take this time to host an open house in the lab. We have assorted refreshments and invite the hospital staff to drop in throughout the day. It creates awareness of who we are and what we do. It also provides a good opportunity to talk to a variety of folks about sleep apnea. 

We give a tour of the lab and have little goodie packets that include sleep quizzes, OSA pamphlets and details for how to make an appointment.  

 Hopefully I was the only one who suffered amnesia (smile). How did everyone else observe the week?

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Alternatives to CPAP
March 6, 2014 4:49 PM by Penny Mehaffey

All of my experience in sleep having come from the sleep lab, I do not have any hands-on experience with oral appliances. I have done a few sleep studies with appliances in place but that is the extent of my exposure. 

I am comfortable supporting the oral appliance in theory. I think it is an excellent option and/or alternative. Thinking of the patients who just cannot tolerate CPAP -- what do we do? Do we tell them in no uncertain terms that CPAP is what they need and they need to try harder to use it? I don't think that's realistic and it's very not very user-friendly. 

I think we should embrace new therapies and try to have several options to present to patients. Is a little CPAP better than no CPAP at all?  Is an oral appliance better than no intervention ever? Yes! 

And can we also concede that while CPAP is the gold standard of treatment for sleep apnea, it is not always practical? Why not have the appliance available for times when CPAP is not practical or convenient, such as when travelling or flying (the oral appliance fits in your pocket) and when camping (no power or water is needed). If a patient has difficulty acclimating to traditional CPAP but really needs intervention should they not be given an option?  I think most practitioners would say yes. But I see very little actual implementation of alternatives. I wonder, what are other techs seeing?

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Community Service Is Necessary
February 27, 2014 9:20 AM by Amy Reavis

We are all in fields that need a little more representation. We are not nurses, doctors or x-ray technologists. Our fields are often misunderstood by those outside our field. As a program director for a neurodiagnostic technology program I have learned that almost no one knows what that is and that the word polysomnography is nothing more than a tongue twister. So how do we change the lack of knowledge of the fields? Volunteer in your community!

I have gathered a team to participate in the Epilepsy Association of Central Florida walk. During that time my team will be wearing our college logo and we will be there to answer questions. I have similarly volunteered with my students as well. It is always nice to educate people about our field of study. I am also involved with my respiratory therapy department where we are also doing a walk for the Lung Association. 

In addition, we are doing a community health fair at our school. This chance to give services to people who many not have the opportunity or the chance to be educated about health conditions will not just help the people who visit but will also help to educate the community about our fields of study. The goodwill goes a long way in the community when residents may need our services due to health issues. It is important that they know what an EEG tech, sleep tech and respiratory therapist does and how much education we have. And the best part is maybe one of the children will see what we do and decide that might be a good opportunity for the future.
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Mother Nature Keeping Us Awake
February 20, 2014 10:31 AM by Penny Mehaffey

I missed my blog deadline last week due to the crazy weather.

We are accustomed to weird weather phenomena in the garden city. Augusta, Ga., seems to have her own personal climate system at work. Last week we prepared for winter storm Pax to cross us. He did and apparently was bitter about it.  

On Wednesday and Thursday we had wind and ice which brought down numerous trees and left much of the state without any utilities. A pine tree fell on my mother's home splitting it in half. Thank God no one was hurt. Friday was gray, gloomy and cold. Saturday came with a warm, sunny 60 degree temp. It was heaven. 

Oh by the way, did I mention that we had an earthquake on Friday night?  Yep, a 4.2 with the epicenter about 45 miles from my home. Sunday was even more beautiful and warm with a light breeze. Ollie, my little shihtzababy, and I sat on the patio trying to recover from the craziness of the week and then in the afternoon we had an aftershock that was a 2.1. Really? You kind of have to laugh because it's so bizarre.   

On sadder note from the Augusta National, the Eisenhower Tree has been lost due to the damage it suffered during the storm. The Eisenhower Tree is a famous landmark at the 17th hole.  t was believed to be 100 to 120 years old. The former president was known for hitting into the tree and at one point proposed having it cut down. He was voted down and the tree had continued to guard the fourth par until now.

As a native Augustan I feel I can honestly say "only in Augusta"... ice storms and blooming camellias with earthquakes and falling trees all in the same week. Is there no end to Mother Nature ‘s frivolity?

 

 

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Elections and Volunteers
February 13, 2014 10:15 AM by Amy Reavis

This is that time of year when our associations are looking for us to step up to the plate. It is the time for us to have an influence on our field and those we chose to represent us. This is the time of year when I see so many complaints and so little action that I want to scream. 

I have volunteered for several years on the AAST communications and membership committee. I have been the president of the Florida Association of Sleep Technologists and I am working with ASET on their social media. Why do I spend so much time doing all this free, and unrecognized work? Because I believe in our field and because if we do not put ourselves out there and let the world know how valuable we are then HST and autopaps are going to take over. 

The fact is that it is our responsibility to work with our organizations and to vote for the officers. If we do not participate then we have no right to complain about our profession. If we do not join our professional organizations then we do not have a voice. If you do not like how it is run then run yourself or volunteer or, like me, write about your issues. Once I stated my issue with the black hole that was volunteering things changed. 

I may even decide one day to run for an office. But for now I back those who do and I vote in every election. I read the biographies and I check the people out on Linkedin. I am a person who is proud of my profession and I will continue to back those who feel as I do, even if I do not agree with them on every issue. They are stepping up and volunteering their time. I am proud to be part of the BRPT, AAST, AARC and ASET because they represent the fields I work in and that I am so devoted to.

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Do As I Say, Not As I Do
February 6, 2014 10:38 AM by Amy Reavis

I do not know about you but I used to hear, "Do as I say, not as I do," all the time from my parents.  I know that as sleep techs we are not perfect, but we really should follow our own advice. I have worked in labs, I have sent students out to labs and I chat with my fellow techs all the time. It amazes me how bad our sleep hygiene is.

With all the current research on night shift work and the effect it has on our health, it is more important than ever to try to be a model for our patients. Night shift is known for packing on the pounds, causing us to be sleep deprived and decreasing our immunity. But if we tried to do things to help us work optimally, we might feel a little better and we might also convince our patients how important the hygiene part of their therapy is.

Current research has shown that some of the issues have to do with genetics and the fact that when we change our circadian rhythm our cells are not able to adapt to those changes. We cannot change that fact, but we can limit the light we are exposed to by wearing sun glasses for the drive home.  We could use a light therapy light for part of the night while we are at work. We could cut down on the caffeine and snack on healthier foods such as almond and fruit during the night rather than chips or cookies. 

It is not that I think any change is easy or that working nights is easy. I raised my two children while working nights and now I watch my son work night shift. I also know there is the likelihood that I will do night shift again someday as I miss working with my patients. But if I do, I now know that in order for my health to be optimal I have to do the things I dislike most -- such as exercise and eat healthy -- as I consider my health and my being an example as part of my job.
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When It's Icy in Georgia
January 30, 2014 11:37 AM by Penny Mehaffey

I'm blogging today about the weather.  It is the big story here in the Garden City where I am. The lab closed Tuesday and Wednesday nights due to snow and ice. 

We had originally planned to remain open for testing but as the weather worsened Tuesday afternoon, our patients started calling to cancel. When the census dropped to one, we gave up and closed. The situation was the same on Wednesday. Patients actually began calling Tuesday afternoon to cancel their Wednesday night sleep studies.

I know other areas of the country were more hard hit, but we are not at all prepared for this type of weather in Georgia. I cannot imagine having to cope with it on a routine basis. In the best of times, we have some of the worst drivers in our town. I am happy to stay off the roads and out of their way during snow storms. 

A friend of ours was one of the teachers stuck at school with her kids in Atlanta. It was very dramatic. I am thankful that we all made it through with no major impacts. I was happy to have had a snow day but I am looking forward to Frosty's departure.

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Sleep Defeat
January 16, 2014 9:34 AM by Penny Mehaffey

What do you say? Should we ever admit defeat with sleep patients?  Is it just me or does it seem that men in their 80s are particularly harder to coach and titrate? They tend to fight CPAP and usually come with a library of reasons they can't or won't use it.

My most recent example was in the lab just this weekend. The techs worked with a patient for four hours with mask fittings and acclimation time to no avail. He insisted he could not wear it and would pass out and faint if they "made" him do it. Dutifully the techs had marched in, one after another, hoping to find a way with a mask that would not suck the life out of the aged subject. 

Women in this age bracket with the same sort of issues seem to be more willing to be "honest" about their feelings and say "I'm just not going to do it. I don't want it and I don't like it. I've gotten along fine without it all this time, I'll take my chances." Younger men react a little more aggressively. Those who "fail to acclimate" seem to be more high-strung and get angry and frustrated with the process. 

It becomes difficult to get them to relax and try the therapy. I had a guy just this week stop in the lab asking if I had any tips to help him use his CPAP. I was thrilled and did. Sadly though, he came to me out of frustration from another sleep professional across town, who told him that he would just have to do it out of sheer determination and will, no other help. 

Strangely, I have not had many of these types of experiences with women in the 20-60s range. They arrive ready and willing to do whatever we say as long as more -- or better -- sleep is part of the deal. 

What are we to do? In the end patients have to comply in order for any of our "tricks" to work. They do have the right not to accept therapy. When do you say, "It's OK, you can't fix everybody," and admit defeat? Hopefully before they pass out.

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Another Opportunity for Sleep Field Growth
January 9, 2014 10:09 AM by Amy Reavis

I read an interesting article about how the Affordable Care Act will be covering weight loss coaching as part of the mandatory coverage starting in 2014. The article goes on to talk about the fact that physicians will not be able to do this counseling due to their current work load. They are instead turning to health and wellness coaches to do this counseling. 

What might that have to do with being a sleep technologist?  A great deal, if you are considering getting your sleep educator credential. Right now health and wellness coaches are not licensed.  They generally get their training from online fitness or coaching programs. They may or may not have credentials. With the education we have and the education we have the opportunity to work as part of a team to help people lose weight fits. We know sleep deprivation and sleep disorders contribute to diabetes and other conditions associated with obesity. Sleep education should be part of the weight loss program. 

The idea of working as part of a team is going to be essential to the growth of our field. We must understand and react to the fact that the ongoing change in healthcare is going to require multi-disciplinary teams to care for patients as a shortage of workers and an increase in uninsured and underinsured grow. New forms of care, such as group physician visits, wellness education and preventative care such as CPAP therapy for UAR and snoring, are going to grow to help reduce cost of care. We just need to make sure healthcare understands how valuable we are as professionals.
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Resolve to Improve Sleep Field
January 2, 2014 10:47 AM by Penny Mehaffey

It's a cold rainy day here in Georgia. In fact it's downright dreary. Yet I must confess that I love this weather. It's perfect for self reflection, studying and making resolutions. I make several new resolutions every year, or more accurately I update my resolution list. I do manage to accomplish maybe one thing and the others remain works in progress. 

For instance, this year I resolve to be on time with my blogs. I have not been doing so well as of late.  My last deadline was missed even after I checked with my editor to make sure it was my turn and she confirmed. So Val, this one is for you. As for the rest of the list it consists of the usual suspects: lose weight, exercise more, get healthier, etc. You may be familiar with that list yourself. 

I have one more, and it's important: I have resolved to be more active or proactive in our field as it relates to my abilities and my state. I was inspired after reading the article about Rita Brooks in the October edition of Sleep Review. It was indeed food for thought and I can certainly see areas where not only I -- but all of us -- can do more. And by more, I mean at least one thing. We can write a letter, make a phone call or on our day off drop in to our local rep's office for a few minutes. I am fortunate that in my area our officials are fairly accessible. 

Given how far behind I am with my reading I should probably make at least one more resolution.  Happy New Year!

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The Best Blogs Make You Think
December 26, 2013 9:20 AM by Amy Reavis

Those who read my blog know I am an avid reader. I read books and I read articles but the best things I read are blogs by other people I admire.  Why do I do this?  One, they are short -- usually between 300 and 500 words. Two, they give me something that makes me think. So I am going to share some of the ones I enjoy reading and some of the best ideas they have given me. 

Seth Godin is someone who writes short blogs of about 100-150 words once to three times a day. I do not read all of them but I do save the emails for when I need some inspiration. His suggestion for holiday gifts was probably one of the best I have ever heard. He suggested that you should give three life changing books to three people who have influenced you this year. It can be anyone -- your children, your spouse, a teacher, a student, a coworker, your boss or maybe your pastor. He did not suggest which books, just said they should be books that have influenced you. For me it would be Stephen Covey's 7 Habits of Highly Effective People, John Maxwell's 15 Indisputable Laws of Growth, and Sark's Wild Succulent Women for a female and The Richest Man in Babylon for a man. I also love the book Imagineering from the engineers at Disney. Each of these books has taught me something to move to the next level. 

Next, the blog CoachMD by Charles Glassman looks at healthcare from a holistic approach. His is one of several blogs I read about holistic medicine. When you start looking at your lifestyle as the true path to wellness instead of healthcare as simply a cure for symptoms it helps you to explain to your patients why sleep hygiene and sleep apnea needs to be treated. 

Dr. Daniel Amen and his TED talk really made me look at the true workings of the brain. So which would I read?  I would watch at least 1 TED talk a week and I would read Dr. Amen's blog because his work is truly cutting edge research on how your life and your diet affect your brain and the hormones it creates. 

Please share here what you read.  Do you read blogs about healthcare? Or about exercise? Or maybe about diet?  Do you read business blogs?  Whatever you are doing to grow please share because we all want to grow as technologists this next year and together we can change our field to the next hot profession.
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Why a Sleep Study?
December 12, 2013 10:01 AM by Amy Reavis

We need to encourage our patients. This is especially true this time of year when holidays are foremost in people's minds. So why do we need to treat sleep apnea? There are so many reasons, but most people do not realize they have symptoms -- they just think this is what normal is.

One of the men I work with is a typical example. He is a middle-age many who is overweight and has an 18+ inch neck. He looks tired and tells me he wakes up every two hours during the night but that is just because he has a stressful job. He does not need a sleep study because he does not have high blood pressure or any health issues.

So how do you convince someone like this to talk to his doctor about sleep apnea? Well if he is a truck driver or a pilot his work now requires that he have a study. If he does not have health issues then maybe you need to look at some of the reasons outside of blood pressure, MI and stroke because everyone believes it will happen to someone else. Then there is the vanity issue and the fact that people look healthier and have fewer wrinkles if they treat their sleep apnea. There is also the correlation between glaucoma, colon cancer and memory and sleep deprivation. 

There are issues specific to women and sleep as well. The fact that women have some protection from the effects of sleep apnea when they are young changes as they become premenopausal and menopausal. That protection not only goes away, but women actually become more symptomatic at lower apnea levels. Women also need to know that snoring and sleep apnea do not go hand-in-hand --with central apnea and hypopnea there is no snoring or very mild snoring. 

It is up to us to educate our patients when we are scheduling their appointments. It is essential that we educate the public because there are those out on the web who will tell people that sleep apnea is nothing but a money-making scheme. There are those who say that a 50% compliance rate proves that we do not have to treat sleep apnea. (I will talk about his fallacy of compliance rates and us being hung out to dry about it  in mynext blog.) What we need to do is share our knowledge and passion and I need more sleep geeks out there sharing the love. 

Have a great holiday and I hope you do not get snowed in.

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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