This is a reprint of a letter recently published at www.BRPT.org By Cindy Altman, RPSGT, R.EEG/EP T., President-Elect, BRPT .
What are your thoughts?:
Did the AAST have prior knowledge of the AASM/ABSM decision to develop a credentialing exam that by design is easier to pass? Did the AAST ask the AASM/ABSM to develope such an exam and credential?
Did/Are certain members of te AAST Board of Directors (present or past) participating in the development of such a credentialing process while serving on the AAST Board of Directors? If they are/did, are you OK with that?
Has sufficient information been released to the professional sleep community by either the AAST/AASM/ABSM to support the claims made about the pass rate of the RPSGT exam or the skills sets of the new RPSGT’s?
If you are an RPSGT, are you yourself planning on supporting the new credential by paying the ABSM $25 to be grandfathered in to the new credential?
Do you think that this is all meaningless and that an influx of newly credential sleeptechs will have no impact on your current salary or employment opportunites?
By Cindy Altman, RPSGT, R.EEG/EP T.
“I recently attended an American Board of Sleep Medicine (ABSM) technologist examination information
session at the American Association of Sleep Technologists (AAST) program in Minneapolis. Most
technologists went to lunch, but a hundred or so were present.
Dr. Richard Rosenberg gave the presentation. Dr. Nathaniel Watson was also there. He was introduced
as president of the ABSM and he sat next to Dr. Rosenberg on the stage but really didn’t say much.
Dr. Rosenberg is a full-time American Academy of Sleep Medicine (AASM) employee, and Dr. Watson
is on the AASM board of directors. How can the ABSM be “an independent, nonprofit, self-designated
board” separate from undue influence by the AASM? The relationship between the two groups is not
On several occasions Dr. Rosenberg let the audience know that he trained in sleep with Dr.
Rechtschaffen, and he serves on the Committee for Accreditation of Polysomnographic Technologists
Education (CoA PSG). He talked of all the good the AASM has done for sleep technologists and
education. He forgot to mention the role that the AAST and the Board of Registered Polysomnographic
Technologists (BRPT) played in advancing technologists’ professional status, or in the formation and
continued support of the CoA PSG.
Dr. Rosenberg said there was absolutely no financial motivation, as rumors implied, behind the
development of the new technologist exam. He said the ABSM simply wants to offer a technologist
examination that is relevant for all “stakeholders.” And they want a pass rate that is higher than the
RPSGT exam…for the good of the profession. In other words, for the good of the physicians who employ
the techs who are unable to pass the RPSGT exam. After all, he implies, the problem in passing the
RPSGT exam is with the exam itself, and not the individuals or educational pathways.
To them, it doesn’t matter that the BRPT works with a well-respected professional testing company,
or that the BRPT uses best practices for developing, maintaining, reviewing, delivering, and scoring
the RPSGT examination. Or that it uses a geographically and professionally diverse group of Subject
Matter Experts. Or that at every step along the way, the RPSGT examination is checked for validity
and relevance not only by the professionals in the field, but by professionals in the testing community.
What matters is that the ABSM believes it has produced a better technologist exam that will result in a
higher pass rate. After all, the ABSM knows “some psychometricians” who help with the exam. What
matters is that the ABSM will do what the AASM asks.
Dr. Rosenberg said the ABSM would apply for NCCA accreditation for the technologist examination.
He fumbled with the terms and relationship between the Institute for Credentialing Excellence
(ICE), the National Commission for Certifying Agencies (NCCA), and the National Organization for Competency Assurance (NOCA), which is now ICE. I hope he gets these organizations straight for his
Dr. Rosenberg blamed the RPSGT exam pass rate on “stifling” the development of formal sleep
technology education programs across the country. He based this on a conversation with a dean at a
school in the Chicago area. Dr. Rosenberg talked about the dissatisfaction physician’s have with the
RPSGT credential, yet he has no data to support that. The AASM is certainly capable of surveying a
large number of people and institutions to determine the extent of this dissatisfaction…if they were
Dr. Rosenberg repeatedly referred to outdated RPSGT exam pass rates and did not discuss the
difference in pass rates based on educational pathway or over time, or compare the pass rates of similar
examinations with multiple pathways. When program directors from two different schools challenged
the assertion that the exam was too difficult for CAAHEP students, Dr. Rosenberg indicated their schools
were the exception, not the norm.
Dr. Rosenberg told us that the RPSGT requirement for AASM sleep center accreditation would still stand.
Yet when asked if he would put that statement in writing, he let the audience know it wouldn’t have any
weight. When asked if the new examination should be viewed as a mid-level credential, with the CPSGT
on the lowest level and the RPSGT on the highest level, he made it clear that the new credential was to
be on equal terms with the RPSGT.
Dr. Rosenberg reminded the audience that the AAST supports the new exam. He let us know AAST’s
immediate past president and current president have been involved in the development of the ABSM
technologist exam. The audience was already aware of AAST’s position to support “all” technologist
examinations—even those not yet developed or evaluated—but it was surprising that AAST leaders
were actually assisting in the exam development. This was news to current AAST board members as
well. Did Dr. Rosenberg let the cat out of the bag?
When it was time for questions and comments at the end of the presentation, not one person stood
up to voice support for the new exam. However, many stood in line to question or comment on the
purpose of it. At times those in attendance clapped enthusiastically in support of the techs or physicians
who challenged the ABSM. Suffice it to say, the new ABSM technologist examination was not well
So why, exactly, is the ABSM getting involved in technologist credentialing? Could it be that the BRPT is
truly an independent organization adhering to best practices in credentialing, and the AASM does not
The RPSGT is the Gold Standard. Don’t let grandfathering into the new credential confuse you. While
it is “only $25” and you may think that you have nothing to lose, you do. You risk losing the professional
identity that technologists have worked for over 32 years to achieve. As technologists we can stand
united to keep the RPSGT credential strong. Don’t let the AASM divide and conquer. That is really what
this is all about.”
In May, 2011 the first course in polysomnography in the city of Bogotá was presented. It was hosted by Sleepvirtual & Priority Health Education. The course gathered the participation of more than 50 attendees, which included doctors and technicians interested in the field of polysomnography. The course had more than 50 attendees, which included doctors and technicians interested in the field of polysomnography.
There was four days of intensive theoretical training starting with the Basic Priciples of Polysomnography, AASM New Scoring Guidelines, Patient Hook-up and Preparation, Digital Polysomnography, Positive Pressure Titration an O2 Therapy, among other points of interest. The program was delivered in spanish.
The four day polysomnography course was awarded 50 continuing education credits, 25 each by the AARC and the AAST. This unpresidented event marked the first time in Colombia’s history that a polysomography course was offered with the approval of this many education credits from American Associations.
In the opinion of the attendees, the course was one of the best offered to sleep professionals in Colombia and has sparked their interest to pursue more educational events geared toward the field of sleep medicine and technology.
“Very good and complete, the course is very well designed and deals with all of theissues from the simple to the complex and helps all the technicians.” – Dr Rafael Lobelo, Pulmonologist
“The course was excellent for deep content & well suited for activities that are performed daily. I hope to go deeper on most issues of polysomnography, thank you very much and I hope to participate again on the next course offered.” – Sandra Rocio Morales, Technical Coordinator in Polysomnography
“It was very good, I learned a lot, I would like to undertake some more practical sesions.” – Jeimy Carolina Gomez, Polysomnographt Technician
Ed Faria, MBA, Sleep virtual’s CEO presents the faculty: Felipe Lerida, CPSGT, Candace Anderson, CPSGT, and Joseph Anderson, RPSGT, RPFT, CRT-NPS, RCP, the Directorof Education for www.PriorityHealthEducation.com
The organizers (from left to right): Laura Patino, Felipe Lerida, Paula Velasquez, Joseph Anderson, and Candace Anderson
Plans are currently underway to bring additional educaion throughout Latin America.
Even in the population-dense region of Southern California, sleep labs used to be rare. When compared to 2011, sleep apnea awareness in the 1980s significantly trailed other conditions.
Officials at Hoag Memorial Hospital Presbyterian in Orange County, Calif, recognized early on that there was a need for a specialized center to evaluate and treat sleep disorders. The Judy & Richard Voltmer Sleep Center, backed by the resources at Hoag, filled this void back in 1987 in Newport Beach, Calif. More recently, the center moved to gleaming new quarters in an effort to modernize and accommodate more patients.
With considerable resources, expertise, and referrals flowing from Hoag, the state-of-the-art 8-bed facility never lacks for patients. Paul Selecky, MD, FACP, FCCP, FAASM, long-time medical director of the Voltmer Sleep Center, has tirelessly spread the message of sleep health among his colleagues. The result is that clinicians from diverse specialties appreciate the value of healthy sleep, and they don’t hesitate to ask for help when they need it.
Under the umbrella of Hoag Neurosciences Institute, the Voltmer Sleep Center is seamlessly integrated within the continuum of care. Sleep is not an afterthought. Neurologists, ENTs, pulmonologists, endocrinologists, and primary care physicians all readily send patients to the center.
Colleagues on Board
The evidence for the sleep/health connection seems to build each year, with ever-more co-morbidities related to poor sleep. The more apt question these days is what is not affected by sleep.
When the American Society of Anesthesiology (ASA) came out with its 2006 guidelines on peri-operative management of patients with known or suspected sleep apnea, clinicians at Voltmer Sleep Center were ready. “Our anesthesiologists asked if we could help them develop a program to screen patients who were coming in for elective surgery,” says Selecky. “That protocol has now grown, and nearly every admission coming into Hoag is evaluated for the risk factors of sleep apnea.”
Hoag has taken a proactive approach, and patients who come in for other ailments benefit from the extra attention. “About 70% of stroke patients have sleep apnea,” says Selecky. “It’s a chicken-egg type of thing, but at least they get sent here to lower that risk. Others who come in for total knee, hip, chest pain—we ask them about sleep and the patient is educated about serious breathing problems.”
Not surprisingly, about 90% of all referrals to Voltmer Sleep Center come from Hoag, but outside referrals are growing. If a patient is referred by a Hoag neurologist for sleep problems related to that neurologic problem, a neurologist working on staff at Voltmer Sleep Center is the one to see that patient.
If COPD was the primary problem, a pulmonologist would visit with the patient. “This is not just an independent sleep center,” explains Trish Stiger, BBA, RPSGT, CRT, manager of the Voltmer Sleep Center. “It is part of Hoag, and they refer from the Diabetes Center, the Cardiovascular Institute, and more. Even obstetricians are reminded that a snoring pregnant woman should not be ignored as if she merely has nasal congestion, as this can lead to complications of pregnancy.”
In line with the large body of evidence linking sleep apnea and congestive heart failure, Voltmer Sleep Center clinicians provide information and education to all Hoag cardiologists. “A lot of them have gotten the message,” says Selecky. “They ask every congestive heart patient, ‘Do you snore?’ If the patient snores, and has other features of sleep apnea, he comes to us.” Cardiologists will also send patients whom they are treating for resistant hypertension, as is recommended by the American College of Cardiology and American Heart Association because of the link with untreated obstructive sleep apnea.
Much the same can be said for diabetes management. Endocrinologists who prescribe several different medications for diabetes have referred their patients to the Center, again because of the link between diabetes management and sleep apnea . “The first thing that should be done is to rule out sleep apnea,” says Selecky.
Education and Follow-up
Every physician takes patients to the lab bedrooms to explain the diagnostic tests and procedures, and these in-person consultations provide vital information. Despite all the media attention on sleep, Selecky admits that some convincing is often part of the job. “Sometimes there is too much negative information out there,” laments Selecky. “People come in and say, ‘I don’t want that breathing machine. I know somebody that hated it.’ It gets a bad rap, so we must provide a lot of education.”
When it comes time to dispensing the actual CPAP machine, Selecky and Stiger work closely with trusted durable medical equipment (DME) providers who are known for their good service. “If they don’t provide good service, we don’t refer to them—it’s that simple,” says Selecky. “That means excellent follow-up, because if patients don’t have a positive experience in the first few weeks of CPAP use, they are more likely to abandon it. Nationally, the average for CPAP users is that 50% drop it by the end of the first year. We have several of the DME RTs spend time in the Center so patients can try a dozen different masks. It’s like buying a pair of shoes. If it doesn’t fit well, you are not going to use it.”
In addition to the familiar sleep apnea/CPAP combination, officials at Voltmer are keen to address all sleep disorders and treatments. “Insomnia is not a huge percentage of our patient population at this point, but it’s significant enough and our physicians treat it,” says Stiger. “Patients may need extensive cognitive behavioral therapy, sometimes with the aid of psychologists.
In addition to CPAP for apnea, we embrace dental sleep medicine as a valid option. “Oral corrective devices have been used throughout our history with the help of local dentists who started treating some of our milder patients, or those who could not tolerate CPAP,” adds Selecky.
Unlike the 1980s, Selecky says it seems as though these days there is a sleep lab on every corner. Favorable demographic trends suggest that won’t change, despite the furor caused last year when Medicare approved home sleep studies—much to the chagrin of lab owners. “People said that might be the end of all sleep centers,” says Selecky. “But as time has gone on, that has not occurred at all. Part of it is that reimbursement for home sleep studies is low. However, it has made every lab consider whether it should be involved in home sleep studies. The answer is yes for certain populations.”
In 2011, Selecky believes the keys to success looks a lot like the keys of the past. Education, clinical excellence, follow-up, and compliance must be the driving forces. As understanding of sleep medicine grows and physicians know more about it, they will inevitably order more sleep studies.
Those who have worked to be a full service center will remain in the black as they gain the trust of physicians and patients alike. “There is a difference between establishing yourself as a sleep center vs a sleep lab,” adds Stiger. “A center deals with everything. You educate, go out and teach the community, and work with all the other specialties to care for patients—which should always be the number one goal.”
Tradition of Excellence
Hoag Memorial Hospital Presbyterian is accredited by the Joint Commission on Accreditations of Healthcare Organizations (JCAHO), and home to Centers of Excellence in cancer, heart, orthopedics and women’s health services. Orange County residents named Hoag the “Hospital of Choice” in a National Research Corporation poll, as well as the county’s top hospital in a a local newspaper survey.
The Voltmer Sleep Center is an accredited member of the American Academy of Sleep Medicine, and features a Web site (http://www.hoag.org/services/neurosciences-institute/voltmer-sleep-center) where potential patients can view online sleep assessments, photos of the sleep center, and information about the physicians. “Many people simply don’t realize that an adequate night’s sleep is needed to maintain good health and stay fully alert throughout the day,” says Selecky. “We are excited about the opportunity to use the Internet to educate the public and to let them know there is help nearby.”
The new Out of Center Sleep Testing (OCST) in Adult Patients AASM Accreditation requirements were recently released. Although it does contain some very practical requirements for an entity wishing to be an AASM Accredited provider of OCST, it also contains some requirements (or some say, lack of requirements) when it comes to who will be scoring these recordings.
Of concern to many RPSGT’s is the lack of reference to the RPSGT credential anywhere in the document. In B-9 it does specify that CPSGT’s and other “non-specified” board or sleep certifications are “appropriate” to score OCST recordings. Also mentioned are holders of the respiratory “SDS” endorsement. Perhaps omitting the “RPSGT” credential is just an oversight by the AASM?
Furthering the controversy is F-4 which provides a pathway to exclude all scoring techs, regardless of credential, from scoring OCST recordings.
Below are paragraphs from the newly released standards. WHAT ARE YOUR THOUGHTS? Post a comment here
Standards for Accreditation of
Out of Center Sleep Testing (OCST) in Adult Patients
Appropriate scoring technical personnel include sleep technicians, sleep technicians with the CPSGT certification or other board approved (non-specified boars) certifications, sleep technologists, respiratory therapists with the sleep disorders specialist (SDS) certification, or electroneurodiagnostic technicians with additional sleep certification.
If used, computer-assisted scoring of OCST recordings must be reviewed and edited for accuracy by a board certified sleep physician.
Here is the link to read the entire OCST Standards:http://www.aasmnet.org/resources/pdf/OCSTstandards.pdf
I know that there are many opinions about the validity of doing OCST recordings. This editorial does not focus on that controversy. We will leave that for another day. However, many of the sleep professionals that have contacted me are very concerned that there is no mention of the RPSGT credential in the acceditation requirements and the seemingling acceptance of auto scoring. Combine this with the recent announcement that there will soon be a fourth (RPSGT + CPSGT + Respiratory SDS + new ABSM) tech sleep credential and many RPSGT’s are feeling threatened by these recent events.
Many are asking “where is the AAST in all this?” I have begun to hear rumblings from many techs that feel they have wasted their $100 annual dues for representation they feel is not happening. I dont have an answer for you. Each RPSGT, CPSGT, and sleep professional needs to come to their own conclusions about the direction that our field is moving in. As an editorial writter I would very much like to hear from you.
In order to be properly represented you need to make your desires known. Staying silent whether against or in favor of any position does not send a clear message to those we pay to represent us.
No matter what your indivdual thoughts are, the industry deserves to hear from you. Let your thoughts be known to those that care to listen Join the discussion on the Sleep Scholar Linkedin site
If you have not seen the latest from the AASM that directly impacts working sleep techs, I have included the letter below. What are your thoughts about the AASM deciding the value of your RPSGT Credential, allowing Auto Scoring for Home Sleep Studies, and now supporting a routine 3:1 ratio of patients to tech?
Please post your opinion (agree or disagree). If you have no opinion then you should say nothing when the industry changes.
“Dear Accredited Sleep Disorders Center,
Over the past year, selected sleep disorders centers accredited by the American Academy of Sleep Medicine participated in an assessment of current laboratory procedures to identify areas for improved patient care and safety as well as efficiency. The report resulting from this year-long assessment has assisted the Board of Directors in making strategic decisions related to policy for the diagnosis and treatment of sleep disorders.
After reviewing the final report, the Board of Directors amended Standard B-7 of the Standards for Accreditation of Sleep Disorders Centers. To ensure the highest quality of care and patient safety the standard continues to recommend a patient-to-technologist ratio of 2:1 for attended polysomnography, and now allows for a maximum ratio of 3:1. The revised standard states:
|B-7 – Sleep Technicians and TechnologistsAASM accredited sleep facilities must maintain appropriately trained, supervised, and, where required by state law, licensed sleep technologists. Technologist staffing must be adequate to address the workload of the sleep facility and assure the safety of patients. This includes a recommended patient to technologist ratio of 2:1 and a maximum patient to technologist ratio of 3:1 under usual circumstances for attended polysomnography.|
A complete version of the current Standards for Accreditation of Sleep Disorders Centers may be downloaded at www.aasmnet.org/accreditation.aspx. “
Sleep affects how children feel and function. By helping your child to get the recommended amount of sleep, you can improve your child’s health, psychological well-being, and safety. Sleep is key to your child’s growth and development as well as his/her ability to learn.
The chart below provides general guidelines showing how your child’s need for sleep changes with age. There may be individual differences between children:
|Daily Sleep Need|
|Preschool aged children||10-12 hours|
|School-aged children||At least 9 hours|
|Adolescents (Teens)||9 hours|
Unlike preschoolers who may need naps, school-aged children usually get all of their sleep at night. Teens need more sleep than adults. In addition, adolescent body clocks shift to a later sleep-wake cycle, making it hard for most teens to either fall asleep or wake up as early as they once did, or as early as younger children and adults. This shift is due to changes in teen brains and bodies and is what makes it hard for many teens to fall asleep much before 11:00 p.m.
Why Is Sleep Important? What Happens During Sleep?
Adequate sleep is a central part of a healthy lifestyle. During sleep, your body and your brain actively work to support healthy brain and body function.
Sleep helps your child focus and remember what he or she has learned. Memory is improved with sleep. Sleeping seems to enhance learning as if it were extra practice,iv whether your child is learning an academic subject like algebra, new physical skills like playing a musical instrument, dance steps, plays in sports, or how to drive a car.
Sleep also is vital for your child’s physical health. As one example, sleeping well supports the immune system, which helps fight infections, and thus sleep may decrease your child’s risk of getting sick.
What Happens When My Child Doesn’t Get Enough Sleep?
Sleep loss appears in younger age groups but is more common in teens. One national study showed that teenagers, on average, obtain 1.5 hours less sleep each school night than the 9 hours they need to function best.
Even repeatedly losing an hour of sleep per night can be harmful to your child’s function. This is because such nightly sleep loss accumulates (adds up) and produces a sleep debt. Performance and function decrease with each added night of sleep lost. Your child may tell you that they are used to a lack of sleep—this feeling has little to do with reality in terms of true daytime ability.
Young people who do not get enough sleep may be overly active, misbehave, have problems paying attention, or suffer declines in school performance. Sleep deprivation is sometimes misdiagnosed as attention deficit hyperactivity disorder.ii Sleep-deprived young people may have difficulty getting along with others, may be angry and impulsive, or lack motivation. Shorter sleep durations in adolescents and later parental set bedtimes (after midnight) have been linked with depression and increased suicide ideation. There also may be a link between sleep loss and risk-taking behavior. Sleep loss is of particular concern in teens as they are already inexperienced drivers. Research has linked decreased sleep (even 25 minutes less on school nights) to lower grades in adolescents.
Sleep loss may lead to increased weight gain and obesity. One study of teenagers showed that, for each hour of sleep lost, the odds of becoming obese increased. Sleep helps maintain the healthy balance of a number of hormones, including the ones that control appetite. Thus, loss of sleep may lead to increased appetite, overeating, and unhealthy weight gain.
Sleep loss may have life and death consequences for your teen driver. Drowsy driving causes more than 100,000 crashes a year, resulting in 40,000 injuries and 1,550 deaths and these numbers are considered conservative for many reasons including under-reporting by police of sleep as a cause of crashes. More than half of all fall-asleep crashes involve young drivers between the ages of 16 and 25.
How Can You Help Your Child Develop Healthy Sleep Habits?
It is important for your child to understand that getting enough sleep is a vital part of a healthy lifestyle. Make sleep a top priority and help your child to set a schedule that allows enough time for sleep. Developing a relaxing bedtime routine may help. Your Guide to Healthy Sleep provides tips to build healthy sleep habits: http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf. As always, if you have a question about your child’s or teen’s sleep, a good place to start is with his/her primary doctor.
Remember, even children who have established healthy sleep habits can be sleep deprived when schedules limit time for sleep or the time available conflicts with a child’s natural sleep cycle.
Posted By The Viginia Academy of Sleep Medicine.
For complete references, please visit: www.vasleepmedicine.org
This years meeting is in New Orleans and is March 24-27. Come and support a regional sleep society that supports the sleep professional and has done so since 1978. Additional information and registration can be found at: http://www.southernsleepsociety.org/index2.asp
Beyond boil and bite – T. Shumard