Tag Archives: sleep

Final Public Listening Session Today! Let Our Voices Be Heard!

truckaccident-300x240                                                                                                                                                    Today at 1:30PM- 3:30PM PST the third and final public listening session will be held at the Westin Bonaventure Hotel and Suites, 404 S. Figueroa St. in Los Angeles. On March 10, 2016 The Federal Motor Carrier Safety Administration and Federal Railroad Administration announced a notice of proposed rule making to receive feedback about any potential sleep apnea regulations. Information on the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and of its potential consequences for the safety of rail and highway transportation can be solicited at this hearing as well as be submitted online in the form of comments. The 90-day comment period will be ending June 8, 2016.

Through the listening session, interested parties will have one last opportunity to share their views and any data or analysis regarding sleep apnea with representatives of the FMCSA and FRA. As a contributor, you are asked to identify whether you are in the transportation industry or medical profession, but you can choose to remain anonymous. The Agencies will transcribe all comments and place the transcripts in the dockets FMCSA-2015-0419 and FRA-2015-0111.

Previous listening sessions took place May 12 in Washington, D.C., and May 17 in Chicago. Highly prioritized concerns during the sessions have included the cost of sleep studies for drivers and locomotive engineers, the failure of most safety-sensitive transportation employees with apnea to use their CPAP machines and ensuring that any apnea mandates consider safety benefits over costs and driver health.

As ASBA members, we need to provide input on how it is important to driver and public safety to be treated for OSA. For those who are unable to attend in person, the entire proceedings of today’s listening session will be available on the through a live webcast, which can be found here.

Alan Hickey

Alan Hickey

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

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Men’s Disconnect with Sleep and Health

Most people underestimate how long they can survive without food. Prisoners that have gone on hunger strikes live around 60 days before their demise. Although there is not a lot of data on how long humans can survive without sleep, researches agree that it is considerably less. In studies the longest lifespan of sleep deprived rats was only 11 days.

We know that men outnumber women when it comes to those that suffer sleep disorders. These disorders are killers. The challenge for those concerned for us is to get us to act on the lifesaving  treatments for these nighttime disorders. But should you deprive us men our dinners, you will most likely see us go into an immediate survival mode and take action to nourish our poor starving bodies. It would seem very unnatural to state that we will take care of this another day when it’s more convenient.

It’s no surprise that women in general are willing to admit when they are in poor health and less likely to die because of it. If you look at drugs that Big Pharma push in advertising to the male demographic, it would appear that the erectile disorder drugs are the big money makers over heart and hypertension drugs. Once again, showing that we men often lose focus on the one area that is most important, living.

So in an act to remind men of some of the dangers of sleep I will list some sleep disorder trivia

  • Humans can survive longer without food than without sleep
  •  Heart disease, diabetes, and obesity have been linked to chronic sleep loss
  •  Over 70 million Americans suffer from a sleep disorder
  • Those that have less sleep than the average person have shorter lives
  •  Sleep deprivation leads to higher inflammatory proteins in blood
  •  65% of Americans lose sleep because of stress
  •  A snoring person wakes their bed partner an average of 20 times per night with an average of 1 hour of sleep loss each night
  • Oh, did I mention that erectile dysfunction is often associated with sleep disorders?
Jeremy Andra, RPSGT, RST

Jeremy Andra, RPSGT, RST

Mr. Andra is well known throughout the western United States for bringing sleep programs from initial startup to full operational capabilities by opening approximately 100 sleep facilities. Mr. Andra has been involved in sleep medicine since 1990 when he started one of the first sleep labs using computerized digital systems and one of the earliest portable EEG services in the market. Later, he was involved in large drug research studies as well as evaluating and field testing various medical devices needing FDA approvals including auto technologies with major PAP companies. Mr. Andra then added the dental sleep medicine as a part of his focus. He developed a dental tool named the “Andra Gauge” that is now sold internationally. The Andra Gauge has won Medical Innovation Awards and Dental Products Report had it in their “Top 10 Most Wanted Products”. As a regular on the sleep industry speaking circuit, Jeremy Andra is known for bringing both medical and dental professionals together to create successful business and patient models for Sleep Medicine. Mr. Andra now serves as Product Manager and Business Development Manager for Cadwell Laboratories.

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The Most “Under-Appreciated” Health Problem in America? Sleep


Heavyweight media outlets The Huffington Post and The Oprah Winfrey Network (OWN) have been pumping out strong statements in recent weeks, and it backs up what sleep publications have been trumpeting for years: sleep matters to health. A recent Huff Post article quotes celebrity physician Mehmet Oz, MD, MBA, saying that sleep is nothing less than the “single most under-appreciated health problem in America.”


The article even poses the provocative question—What’s more important? An hour at the gym or an extra hour of sleep? Dr. Mehmet Oz, starring in the new series “Surgeon Oz” on OWN, says there is a definitive answer. “I feel pretty passionately about this,” he says. “If you have the choice between an extra hour of sleep or an extra hour of working out, you sleep.”


Although exercise has enormous value, says Oz in the #OWNSHOW video, he points out that “people who don’t sleep, gain weight. People who don’t sleep have immune problems and a whole slew of other problems. Why deal with that?”


The sleep hygiene advice is well known by members of the sleep industry, but Oz’s reach to consumer audiences is vast, particularly with the new backing by Oprah Winfrey. As far as how many hours of sleep are needed each night, Dr. Oz says in the Huff Post that it’s cut and dry. “95 percent of people need somewhere between 7 and 8 hours,” he says. “On average, women need 7 to 7.5 hours, while men – who are needier, need 7.5 to 8.”


Source: Doctoroz.com

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Analysis: A Bad Night’s Sleep Helps…Nothing

Sleep 3rd Pillar1 Analysis: A Bad Night’s Sleep Helps...Nothing

With celebrity physician Dr. Oz recently proclaiming that poor sleep is the “single most under-appreciated health problem in America,” the business and clinical practice of sleep medicine seems poised to explode. Sleep awareness has arrived like the Beatles in 1960’s America, or Taylor Swift on the red carpet at the VMAs.


Like so many “overnight” successes, awareness has actually built gradually, with study results published week after week in relatively obscure journals. The message comes in different forms, but it all comes down to an inescapable conclusion: chronically bad sleep goes way beyond daytime sleepiness, affecting virtually every aspect of health.


Does bad/shortened sleep help anything? It might help procrastinating college kids make tight deadlines, or propel high-tech start-up mavens to stunning IPOs, but for the vast majority of people, the answer is poor sleep has zero benefits. And over the long haul, poor sleep (ravaged by sleep apnea) can lead to a long list of co-morbidities. These real health problems can take years off of the average human’s life expectancy.


It sounds melodramatic, but it’s the truth. Major consumer magazines, Oprah Winfrey, and the New York Times are firmly on the sleep bandwagon, and they are not jumping off. For sleep centers, CPAP providers, and sleep physicians, it all adds up to opportunity.


Fortunately, this opportunity (and its inevitable financial rewards) is nourished by helping patients. There is no snake oil element to satisfying the demand for sleep apnea relief—through CPAP, oral appliances, and surgical alternatives. Far from being threatened by diverse treatments, ethical providers know that free-flowing referral streams, based on patient need, will help all concerned.


Long-time sleep clinicians are no doubt reading all the hype with an “I told you so” grin, and these grizzled veterans are well positioned to take advantage of increased awareness. If they continue to put patient needs first, the new age of sleep could have considerable legs.


Source: Sleep Diagnosis and Therapy Journal


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Night Owl Nonsense? New Study Suggests Four Sleep Types


As reported in Atlantic.com, scientists in Russia are proposing that there are actually four chronotypes beyond the late (owls) and early (larks) risers. Instead, there are people who feel energetic in both the mornings and evenings, as well as people who feel lethargic all day.


In a study detailed in the journal Personality and Individual Differences, biologist Arcady Putilov, and his colleagues at the Siberian Branch of the Russian Academy of Sciences, asked 130 people to stay awake for 24 hours. The subjects filled out questionnaires about how awake they felt, their sleep patterns, and how well they had functioned during the previous week.


“The results showed that among them were 29 larks, who showed higher energy levels at 9 a.m. than at 9 p.m., and 44 owls, for whom the opposite was true,” writes Olga Khazan for The Atlantic. “The owls also went to bed about two hours later, on average, than the larks. But the rest of the group fell into neither of these patterns.”


As BPS Research Digest puts it: There was a “high energetic” group of 25 people who reported feeling relatively sprightly in both the morning and evening; and a “lethargic” group of 32 others, who described feeling relatively dozy in both the morning and evening.


The next big question is, writes Khazan with tongue firmly in cheek: “What bird names to assign these two new groups. Lazy Bird and hummingbird? The albatross and the peregrine falcon?”


Source: The Atlantic

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A ‘touch-me-not’ sensor for improving sleep and fatigue


Imagine a device that measures your sleeping patterns. Imagine it sending the information gathered to the cloud for sleep and fatigue analysis. And imagine it giving you advice on certain actions (like exercise or diet) you can take to improve your fatigue.


Could this be an effective replacement to the wearable sensors in the market today?


Nintendo’s QOL Sensor, being made in collaboration with ResMed, is designed to sit on the user’s bedside. Using a non-contact radio frequency sensor it measures body movements, breathing and heartbeat without physically touching the user’s body. User feedback will be developed with inputs from renowned fatigue scientists Dr Yasuyoshi Watanabe, Dr Hirohiko Kuratsune and Dr Seiki Tajima.


Unveiled during Nintendo’s latest financial results briefing, Nintendo’s President Satoru Iwata detailed the five ‘non’ sensing elements” of this new QOL platform.

According to Iwata, this device is non-wearable, non- contact, non-operating, non-waiting and has no installation efforts. And rather than deploy the standard communication with a game system QOL will involve numerous platforms, as well as the QOL sensor and the QOL cloud servers it sends information to. Game systems and smartphones will also communicate with the cloud servers to retrieve information and feedback.


The magic of touching one’s quality of life without an uncomfortable physical contact, would you say?



Source: Computerandvideogames.com

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Wikipedia is No Substitute for Doctors


The “Mail online” recently trumpeted what physicians have been lamenting since the beginning of the Internet age: the web is not necessarily reliable for medical information. Call it a validation of sorts, courtesy of Dr. Robert Hasty of Campbell University in North Carolina colleagues.


The team concluded that many entries in Wikipedia, especially medical entries, contain false information. The message? Don’t use Wikipedia in place of your doctor.


The team published its study titled “Wikipedia vs Peer-Reviewed Medical Literature for Information About the 10 Most Costly Medical Conditions” in the Journal of the American Osteopathic Association, calling the information published in 20,000-plus medical related Wikipedia entries into question.

Click Here to read study

According to the report, researchers identified the “10 costliest conditions in terms of public and private expenditure”—which included diabetes, back pain, lung cancer and major depressive disorder—and compared the content of Wikipedia articles about those conditions to peer-reviewed medical literature. Two randomly assigned investigators found that 90% of the articles contained false information, which could affect the diagnosis and treatment of diseases.


Also from the Post, “Pew research suggests that 72 percent of Internet users have looked up health information online in the last year. False information on Wikipedia accounts — like a edited information about the side effects of a medication or false information about the benefits of one course of treatment over another — could encourage some patients to push their doctors toward prescribing a certain drug or treatment.”


Source: Mail Online

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2014 Will be the Year of Years

As I look back on the year we had in the Dental Sleep Medicine industry and especially at Gergen’s Orthodontic Lab, I really am pleased.  I know that we made a lot of progress in our business, and in the businesses of the dentists we work with.  Heck, we even made an impact for dentists that don’t work with us!

My trip to Washington D.C. for a meeting in the office of Secretary of Transportation Anthony Foxx helped to keep policy makers aware of the dangers of untreated Sleep Apnea and the effectiveness of Oral Appliance Therapy.

If you know anything about me outside of the dental lab or sleep industry, you know my affinity for Bob Dylan. So as I look forward to 2014 a line from “It’s Alright, Ma” comes to mind, “He not busy being born is busy dying.”  2013 was the 3rd year that our lab has managed to double in size, so I better get busy being born if I want to try and do it again.

The same thing goes for the dentists I work with.  In dentistry, the new year usually means that dental insurance starts over and we get a new set of visits and benefits for procedures that we used up last year, but with the sleep side it’s completely opposite.

Come January 1st every medical insurance plan in the nation resets, which means some patients will carry a $5000+ deductible. This can only make it more difficult to qualify a patient for an oral appliance. Traditionally this results in a drop in the number of sleep studies and correspondingly the number of therapies that go with them.

I brought this up in a recent conversation with Matt Kaplan of Sleep Services, and I believe their approach can help alleviate some of the financial burden that the patients face when we come back to the office in January.

When Sleep Services provide a home sleep test to a patient, they bill the patient’s medical insurance, and sometimes it can wipe out that new deductible.  Fortunately for the patient, Sleep Services is very flexible and offers payment plans for patients who end up having to pay out of pocket.  Home sleep testing services at $295 is one of the lowest that I’m aware of, but more importantly, I know that they do a good job and are the most dentist friendly sleep testing lab that I have ever worked with.

I hope that all the folks I’m lucky enough to know in this industry can look back on 2013 and see it as a success, but if you’re like me, you’re probably not ready to be busy dying in 2014. For me, when the New Year rolls around, it’s time to “Step It Up and Go”.


David Gergen CDT

David Gergen CDT

David Gergen, CDT and President of Pro Player Health Alliance, has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also has been appointed Executive Director of the American Sleep and Breathing Academy Dental Division, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members. David rolled out of bed on December 4, 1982 and had his career “ah ha” moment. He knew he was going to be an orthodontic technician and he knew he was going to help people all over the country to help treat their sleep disorders in partnership with their dentists. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Harold Gelb, Dr. Joseph R. Cohen, Dr. Rodney Willey, Dr. Allan Bernstein, and Dr. Thien Pham. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004.

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Out of Center Sleep Testing (OCST) in Adult Patients – AASM Accreditation

Standards for Accreditation of Out of Center in Adult Patients

New policies related to out of center diagnostic testing for apnea and the evolution of portable technology has shaped the diagnosis of patients with apnea.  The AASM announces a new program, Accreditation of Out of Center for Adult Patients, to meet the changing needs of members, disorders centers, and the medicine field.  The new Standards of Accreditation of Out of Center  are available on the AASM website.

Earning accreditation for out of center from the leader in medicine enables medicine providers to offer broader options to patients and for facilities to gain recognition as a out of center provider that meets the highest standards of quality care. AASM-accredited facilities will receive an e-mail that details their respective application process and information on an application for stand-alone entities will be communicated next week.


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Spotlight on Sensors

Obtaining Accurate Signals

At the base of all units, the question is essentially the same: Is what you see on the screen an accurate reflection of what is physiologically going on with patients? The recorded and displayed signals have meaning to the trained eye, but are they reliable? If you can’t trust your equipment, or know how to effectively use it, says Bradley, you have a fundamental problem. Sensors are the primary piece of equipment for obtaining signals and they must accurately reflect the physiological event being measured.

All sensors have limitations, and those limitations must be understood. Without proper understanding, you cannot expect to obtain accurate signals. The same type of sensor can use different technologies to give you a signal.

Accurately assessing the chest and abdominal effort of breathing is a basic function. When sensors are plugged into a PSG , some technicians are simply hoping the filters and sampling rates are set right and that the sensor is working according to what they need. “The information comes up on the screen and you take that as gospel,” says Bradley, who in addition to his role as founder also serves as chief technology officer at Braebon. “But is that really what is happening? Is there effort happening on the chest and abdomen? One cannot answer that question without having a basic understanding of the technology involved.”

Quality Sensors Matter
There are many technologies and methods for measuring airflow: pressure sensors; thermal sensors; and esophageal balloons to name three. Whatever method is used, Bradley contends that quality matters. “I could go out and buy the cheapest pressure sensor, and then I could buy a more expensive one,” says Bradley.

“If you put a cannula on the patient and feed it simultaneously to both pressure sensors, you will see two totally different signals—yet people think if it is a pressure sensor, they are measuring accurately.”

In fact, the signal from the lower quality unit will be heavily filtered, as well as baseline shifted, leading to inferior and possibly inaccurate information—which in turn can lead to a poor diagnosis. On the other hand, more expensive sensors may yield a more realistic representation, but require more initial effort to set up on the PSG . “This isn’t necessarily always the case,” cautions Bradley. “It just goes to show that you need to understand the technology being used and see if you are getting the signals you want.”

The effort could be worth it, because once the technology is understood better, increased accuracy will likely follow. Troubleshooting time will be reduced, and patient setup will be faster. That accuracy, says Bradley, will ultimately lead to better interpretations and improved patient outcomes.

Inaccurate data collection during the study causes a domino effect that wastes the time of all concerned. Manufacturers can halt this chain reaction through renewed efforts to educate technicians about what is really going on with their devices.

In keeping with this philosophy, Braebon started offering courses to train people on the technology and show them simple techniques that can improve patient care. “For example, if you are measuring a breathing signal, don’t set the low frequency filter at 1 Hz simply because it looks nice,” says Bradley. “I’ve seen techs do that. We are also trying to improve the understanding of piezo-electric pressure sensors. The less expensive ones do not have the frequency response necessary to indicate UARS—that is, the sensor inside does not have the frequency response capability to give you an accurate signal. The signal will have premature decay because of the technology used.”

You Get What You Pay For
In medicine as in life, price typically goes up with quality. More expensive pressure sensors have batteries and the technology inside to give accurate signals. “As an example, if there is constant flow as in UARS, then you should see a plateau or flattening in the signal,” explains Bradley. “In the piezo (non battery) type pressure sensors, you will not see this flattening. You will see a significant decaying of the signal to the zero baseline. This is due to the poor frequency response of the sensor technology used with respect to the physiological event being measured. In the end, paying a bit more for higher quality technology may be worth it.”

Technicians typically want sensors to have a frequency response similar to that shown in Figure 1. In this illustration, the sensor is able to output the entire input signal at all frequencies. However, Bradley points out in Figure 2 that typical piezo sensors only output signals in a specific frequency band. There is a usable region for this type of sensor, and this is why piezo sensors make good snoring sensors and poor respiratory effort sensors.

ScreenShot051 Spotlight on Sensors

If a patient inhales and holds his breath, we want to see that signal. A piezo-based sensor will show the signal decaying to zero fairly rapidly. This is why they are not the greatest for measuring UARS. Figure 3 shows the outputs from a piezo-based pressure sensor and a Braebon PT1 pressure sensor. Both sensors were simultaneously connected to the same patient. One can see the decay in the UARS, the poor quality in the snoring signal, and the shifted baseline in the Piezo-based sensor compared to the PT1 signals.

ScreenShot052 Spotlight on Sensors

Merely paying attention to these differences is often a foreign concept, and that can also be the case with snoring. In determining snores per hour, Bradley again casts a skeptical eye on much of the industry’s existing technology. If you have the number of snores per hour, asks Bradley, then what about the effect in magnitude i.e. volume? Is it not important to know the actual change in volume when a patient undergoes therapy? That is one reason why Braebon developed the Q-Snor, as well as placing this technology within the MediByte portable screener.

Within the three main types of technologies used to determine snoring, technicians can access sensors that qualitatively measure vibrations on the neck, or qualitative auditory signals, or quantitative auditory signals. “The vibratory signal may contain movement artifacts such as cardiac pulses or head movements,” explains Bradley. “The qualitative or quantitative audio sensor may contain external artifacts such as talking. It is the quantitative audio sensor that can give us the most valuable information related to snoring in the patient. The quantitative audio sensor (Braebon Q-Snor) allows you to do a proper pre- and post-comparison of both snoring indices and change in overall volume in patients. This is paramount if one is to assess the effectiveness of certain types of therapies.”

Bradley explains that understanding sensor technology is paramount in ensuring the collection of accurate signals. As an example, piezo technology cannot measure events with low frequency content. At 10 Hz or higher, a piezo sensor responds acceptably well to what is going on. “If, however, you are looking to measure respiratory effort in patients with breathing rates of between 6 to 30 breaths per minute, and look for relative amplitude changes for each breath, a piezo sensor cannot give you what you need.” explains Bradley. “An accurate signal refers to not only the sensor’s ability to react quickly enough to the physiological event being measured, but to also output a signal that should be linearly proportional to the physiological event being measured.

“If I inhale and then exhale quickly, you won’t see the proper signal with a piezo-based sensor,” continues Bradley.

“There will be a slow decay because of the filtering that has been added by the manufacturer to generate signals in the low frequency band that do not really exist. Properly developed sensors ensure that the sensor technology used generates an accurate signal. Some technologies are better than others. One must also consider the fact that just because a manufacturer states a type of technology is being used, it is not a guarantee that the sensor will accurately reproduce the physiological signal being measured.”

Respected organizations such as the American Academy of Medicine (AASM) are always concerned with accuracy standards for things such as oral hypopneas. Bradley points out that the AASM did in fact come out with guidelines on oral hypopneas. Calling them “a great first stab” he laments that the guidelines could only go so far since there has not yet been enough research to substantiate measuring oral pressure.

Problems with Pressure
There are several different types of cannulae used to measure airflow to gauge the nasal and/or oral breathing component. “You’ve got the thermal side, so you can measure nasal and oral apneas because you’ve got a thermal sensor,” says Bradley. “However, you don’t have the oral component on the cannula, and that is something Braebon looked at and worked out. We have the PureFlow and PureFlow Duo cannulae, These cannulae have a big scoop designed to give you an accurate, almost 1:1 relationship between the nasal breathing and the oral breathing—as well as give you a reliable signal. The PureFlow combines both the nasal and oral component into one signal where as the PureFlow Duo, when working with the Braebon PT2 Dual Pressure Transducer, gives you separate oral and nasal signals. This family of cannulae will allow you to now look into oral breathing and be able to determine oral hypopneas or other phenomena that may be present in the oral signal and not in the nasal signal.”

There are a lot of technical issues in trying to grab oral pressure and accurately represent it, because engineers are not dealing with an enclosed . “You’ve got leaks everywhere as well as the changing shape of the oral orifice,” laments Bradley. “The nasal one is a little easier because you design prongs that go in and they act like pitot tubes so you can measure the pressures and infer airflow fairly accurately. Even though people have different diameters on their nose, there is not that much of a change. But the mouth really changes shape throughout the night plus, it has been shown, people change their breathing patterns throughout the night between nasal and oral. They have even had studies showing that the person will actually change their breathing between left and right nostrils throughout the night. It is almost like we are just getting into the science of these types of things and it is all coming down to how can we easily and accurately measure the amount of air moving in and out of the patient.”

Determining the inherent truth in any testing scenario can be hampered by complacency, and Bradley believes that technology has been taken for granted for too many years. The answer is a deeper understanding and a renewed focus on issues such as filters, or even the positioning of sensors. “A tech may say the body position sensor does not work, but if you have a well endowed lady and you’re putting a body sensor on, then you have to be careful about how you put it on,” cautions Bradley. “Many body sensors out there will report standing when the person is lying down when the sensor is not within a few tens of degrees of horizontal.”

The upside of better understanding is that correcting problems during tests can suddenly become easier. If a signal on the PSG goes flat, for example, it could be something as simple as sensor positioning, but all too often the problem does not get addressed as going in to fix something will take too long. “The technologist or physician may think s/he can’t interrupt the patient’s , and I understand that,” says Bradley. “But if you need accurate quality information, you can go in and fix it—and get out quickly—if you know exactly what to look for. I would rather have somebody come in and wake me up for five minutes to fix something, so I know that we are going to have accurate data at the end of the night.”

It all goes back to knowing what you are working with. As another example, Bradley says he has visited a couple of labs were the filters were set so that they would get a nice looking waveform on their respiratory effort signals. The people in the lab wondered why at times there was almost no movement on the effort signals, yet they had flow and no desaturations. Ultimately, understanding the tools is critical to ensuring accurate data collection.

Speaking of Signals

As an inventor, Bradley is keenly aware of how signals are collected, interpreted, and represented. Variations in breathing, such as hyperventilation, can wreak havoc on some systems and these problems must be addressed. Indeed, with some manufacturers, hyperventilation will cause the signal to be completely filtered away. A good technologist wants to see that hyperventilation on the screen, but these limitations are often unknown until the equipment is sold and returns are a hassle.

As someone who has actually written many programs on RIP calibration, Bradley knows that unexplained signal changes can happen in some RIP systems when the output recalibrates on its own. “We take the actual output and recognize it as a one-to-one calibration,” says Bradley. “You take the chest and abdomen, add them together, and look at the sum. When you use our , you can see what is going on and get an accurate indication of what is happening. You can know whether to trust the signal or not. In other words you know when you have adjusted gain on poor effort signal and can then make a properly informed decision to ignore or fix it.”

Tracking the nuances of human is one thing, but predicting the future is an endeavor that Bradley and his colleagues rarely indulge. Admittedly reluctant to reveal Braebon’s plans, Bradley will concede that smarter sensors are likely on the horizon. “This is something we developed with our titration sensor for manufacturer Fisher and Paykel, where you have ‘brains’ inside the sensor and it operates like a mini PSG , digitizing the signal and processing the signal that is taken in,” reveals Bradley. “If you are measuring a pressure, you may translate it into an accurate flow signal that comes out. This is done within PSG systems, but I think you are going to see sensors start to build up and get real time information to the technicians.”

In the realm of pressure sensors, improved amplitude response could be on the horizon to accurately output a qualitative flow signal. Bradley laments that many sensors are not linearly proportional and lack a linear relationship between the input signal being measured and the output signal (what the sensor is sending out [See Figure 4]). This can cause issues when trying to make decisions based on relative amplitude comparisons.

ScreenShot053 Spotlight on Sensors

Some sensors are linear on the positive scale, but when they go negative they may end up changing the equation which equals a change in flow. “In that case, you would have a sensor that does not report on both the positive and negative side accurately,” says Bradley. “This is something that nobody really goes into and asks: What is the amplitude response of your sensor? How does it work compared to the physiological conditions I am trying to measure? How does the sensor’s output respond to the input? If I hold a constant flow, what is the amplitude output of the sensor? Is it linear? Is it a quadratic equation? Is it an equation that I can’t even define?” The quality of the oral/nasal cannula can directly influence the usability of information. For example, pressure loss due to a common chamber between the nose and the mouth can compromise the signal. While some techs may not understand these nitty gritty details, Bradley believes they can comprehend enough to help patients and make better choices when it comes to selecting equipment. “The bottom line is that if patients are going to undergo a medical test, they want to make sure that the person giving the test is using the best possible equipment,” says Bradley. “The best equipment is also the most accurate, and that means fewer misdiagnoses.”

__________________________________________________________________________________________Don Bradley is founder and chief technology officer for Braebon. He has worked in the diagnostic industry for over 19 years. He has designed and developed many medical devices included PSG systems and sensors and authored several articles in technical and research publications as well as given talks on technology in .


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