Sleep - American Association of Sleep Technologists

PUBLICATION OF THE APT 

ASSOCIATION OF POLYSOMNOGRAPHIC TECHNOLOGISTS 

SUMMER 2006 • VOLUME 15 • NUMBER 3 

You May Be 

Losing Your Hearing 

As You Sleep 

HIPAA Compliance 

in the Sleep Lab 

Cardiac Pacing and 

Sleep Disordered 

Breathing 

Can We Learn 

While Sleeping? 

A.W.A.K.E. 

Official Talks 

About Life Before 

and After CPAP 

Sleep and the 

Immune System

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Editorial 

Publication of the Association of Polysomnographic Technologists • Summer 2006 • www.aptweb.org 

Editorial 

BY THERESA SHUMARD 

As allied health care providers in the field of sleep, I think many of us 

feel that it’s within our boundaries, and part of the fabric making up 

our level of consciousness, to promote the benefits of good sleep and raise 

awareness of sleep disorders for the public-at-large. Besides the sector of 

untreated people that will undoubtedly always shun sleep disorders screening 

all-together — and this despite our own public awareness efforts to 

bring them into the sleep centers — there is a whole other subset of the 

population that will probably never be helped because reaching them would 

be extremely complex, if not unfeasible. This group is the homeless. 

Having insurmountable obstacles to overcome where just attaining some 

sleep is concerned, homeless citizens with sleep disorders can most likely 

write off screening or treatment (let alone a good night’s sleep) as a pipedream. 

They also can perhaps look forward to some criminalization issues 

to boot. It’s apparently a crime to sleep in some cases. The National Coalition 

for the Homeless (NCH) and the National Law Center on Homelessness & 

Poverty (NLCHP), prepared a federally-commissioned report from study 

results titled, A Dream Denied: The Criminalization of Homelessness in U.S. 

Cities, tracking a growing trend in U.S. cities — the criminalization of homelessness. 

The report, which includes information regarding 224 cities in the 

U.S., focuses on specific city measures that have targeted homeless persons, 

such as laws that make it illegal to sleep (or eat or sit) in public spaces. 

One of the predicaments for people who are homeless in US cities is not 

being able to get a decent eight hours sleep because they’re moved all the 

time or badgered until they are awakened. As sleep professionals, we know 

all too well that there is indeed a law far above any city ordinance in the land 

that requires human beings to sleep. We’ve all seen or heard of cases where 

people are not homeless by choice. Some individuals fall upon hard times and 

have no resources for basic necessities such as roofs over their heads. 

The Dream Denied document also ranks the top cities with the worst 

practices in relation to criminalizing homelessness. Ranking as the top five 

cities are: #1- Sarasota, Florida; #2- Lawrence, Kansas; #3- Little Rock, 

Arkansas; #4- Atlanta, Georgia; and #5- Las Vegas, Nevada. The national 

ranking is based on a number of factors, including the number of anti-homeless 

laws in the city, the enforcement of those laws, and the general political 

climate toward homeless people in the city. It also reveals a history of 

criminalization measures. There is, indeed, diversity among anti-homeless 

policy. Certain laws disallow behavior somewhat common among homeless 

people, and in retort to the rise of such directives, homeless people and 

advocates have brought lawsuits challenging the constitutionality of such 

regulation. There is an assortment of results related to these grievances, 

but moreover, outcomes consist of bans on sleeping in public. Homeless 

shelter space is limited, and when confronted with the fact that most of 

these individuals have no substitute places to sleep, vulnerable legal challenges 

exist. Emergency shelter requests by homeless families are unmet, 

and at the same time, Congress cutting key social programs that could help 

reduce homelessness only boosts the quandary. Regarding criminalization 

measures geared towards the homeless, Chris Cosden, a Sarasota attorney, 

who has represented homeless clients in court challenges to three different 

anti-lodging laws, said, “These laws attempt to make the lives of 

homeless people so wretched that they are compelled to go elsewhere ... 

for a legislative body to intentionally do that is just plain mean.” 

The following are some examples of decrees that have been enacted and 

the legal challenges that have been brought in reaction. In Pottinger v. Miami, 

a federal court held that punishing people 

for sleeping in public when they had no 

alternative place to sleep violated their right 

to be free from cruel and unusual punishment 

under the Eighth Amendment. As a 

result, homeless people in Miami cannot be 

arrested for sleeping in public places if they 

have no alternative. In contrast, a Santa 

Ana, California decree that forbids sleeping 

in designated public places was found to be Theresa Shumard, Editor 

constitutional. The California State Court of 

Appeals, however, reversed the conviction of a homeless man because he 

was not allowed to present a necessity defense at trial. Now the man will 

have the chance to prove that he was involuntarily homeless and that there 

were no available shelter beds on the night of his arrest. In Cleveland, four 

homeless persons and an advocacy organization contested the police practice 

of eradicating homeless people from the city by transporting them to 

remote locations outside of the city and abandoning them. As part of the settlement, 

the city issued a directive to the police forbidding them from picking 

up and transporting homeless people against their will. 

Criminalization provides no long-term benefit for homeless individuals 

nor does it provide a lasting solution to the conflicts over public space. 

Moreover, it is likely to cost significantly more money in civic resources 

since studies reveal that police time and jailing individuals is substantially 

higher than the cost of providing a combination of shelter and social 

services. Not only is it much less expensive to provide supportive housing 

to homeless people than to imprison them, but the services associated 

with supportive housing can potentially move people out of homelessness 

for a long-term solution. 

For the “unkindest cities in the U.S” regarding the homeless, the 

Dream Denied report points to paradigm-shift approaches to homelessness 

which would be more affirmative in nature — measures that aim 

to solve homelessness, rather than make it worse. Realizing criminalization 

is poor public policy, lawmakers are opening their eyes. In 

Portland, Oregon, local agencies and police now work together weekly in 

regard to homeless encampments. Outreach workers work with the 

homeless to move them into shelter and services, and they are transitioning 

about three people a week into housing. Due to its success, the 

project is to receive more funding from the city in future years. Other 

revisions suggested include imposing a time limit where it would be okay 

to sleep in public between the hours of 11:00 p.m. and 6:00 a.m., or 

banning tents, but allowing sleeping in public. It’s one thing to prohibit 

putting up a tent in the middle of the sidewalk, and quite another to say 

that someone can’t just lie down and have some sleep. 

While constructive alternatives represent a step in the right direction, 

they are by no means perfect. They are offered as examples of what cities 

can do when addressing the problem of homelessness and public space 

issues. Constructive alternatives often offer solutions to the visible ramifications 

of homelessness while still failing to address the underlying causes 

— the lack of affordable housing and the scantiness of services. Local 

policymakers must identify the distinction between intolerance of homeless 

people and intolerance of the manifestations of the problem of homelessness. 

Ultimately, the cycle of homelessness will only be crushed when 

policies address the causes and effectively shift people into housing. ★ 

4


A2ZZZ MAGAZINE, 

EDITORIAL BOARD 

THERESA SHUMARD, EDITOR-IN-CHIEF 

ASSISTANT EDITOR 

ROBERT LINDSEY, MS, RPSGT 

APT BOARD OF 

DIRECTORS LIAISON 

JON ATKINSON, RPSGT 

CARTOONIST 

BARBARA LUDWIG CULL, RPSGT 

SLEEP ARTS 

TERRIE EUBANKS, RPSGT 

CORRESPONDENTS 

IAIN BOYLE, RPSGT, CANADA 

PAMELA JOHNSON, RPSGT, 

AUSTRALIA/NEW ZEALAND 

WAYNE PEACOCK, RPSGT, 

UNITED KINGDOM 

ROGERIO SANTOS DA SILVA, BRAZIL 

ASSOCIATE EDITORS 

JOSEPH ANDERSON, RPSGT, 

RPFT, CRTT 

KIM BURNS, RPSGT 

EDWIN CINTRON, RPSGT 

JOSHUA COLE, RPSGT 

BRENDAN DUFFY, RPSGT 

WILLIAM ECKHARDT, BS, RPSGT 

REG HACKSHAW, EDD, RPSGT 

JOANNE HEBDING, RPSGT 

REGINA PATRICK, RPSGT 

KIMBERLY TROTTER, RPSGT, MA 

SPECIAL PROJECTS 

JAYME MATCHINSKI, ESQ. 

TRACY NASCA 

MARY JONES-PARKER, RRT, 

RPFT, RPSGT 

ADVERTISING 

SCOTT COLE, RPSGT 

LAURA LINLEY, RCP, RPSGT 

MISSION STATEMENT 

A2Zzz Magazine is a peer-reviewed publication addressing the educational 

needs of the Sleep Technology Profession. Its mission is to provide 

progressive technical information, current events relevant to the field, and 

an avenue of communication for members, presented in a professional and 

constructive manner, to further the goals and promote unity in the Sleep 

Technology Profession. Readers of A2Zzz Magazine should be able to: 1) 

appraise Sleep Technology in basic science and clinical investigation; 2) 

interpret new information and updates on clinical diagnosis/treatment and 

apply those strategies to their practice; 3) analyze articles for the use of 

sound scientific and medical problems; and 4) recognize the inter-relatedness/dependence 

of sleep medicine with primary disciplines. 

ADVERTISING POLICY 

As a service to our membership, A2Zzz Magazine prints information on 

educational programs and products. It is not intended to imply that the 

programs and products are approved by the Association of 

Polysomnographic Technologists (APT) or the Board of Registered 

Polysomnographic Technologists (BRPT), or that they are endorsed as a 

method of preparation for the BRPT examination. Professional products 

and services are subject to approval by the A2Zzz Magazine Editor-in- 

Chief. Ad inquiries may be directed by e-mail to aptads@aptweb.org. 

For advertising billing questions, call 708-492-0796. Advertising rates, 

specs and info: www.aptweb.org/advertising.asp 

ARTICLE SUBMISSIONS GUIDELINES 

Research, feature and news manuscript submission guidelines, word limits 

and e-mail submission instructions may be obtained from the Editor-in- 

Chief. All articles subject to standard, blind peer review. Article queries 

should be mailed directly to: 

Theresa Shumard, Editor-in-Chief • A2Zzz Magazine Editorial Office 

25 Madison St. • Shillington, PA 19607 

Phone: 610/796-0788 • Fax: 781/823-4787 

E-Mail: theresa.shumard@sunmed.com 

Copyright © 2006 by the Association of Polysomnographic Technologists. All 

rights reserved. No part of this publication may be reproduced or transmitted 

in any form or by any means, electronic or mechanical, including photocopy 

or recording, or any information and retrieval system, without permission 

in writing from: APT National Office, One Westbrook Corporate Center, 

Suite 920, Westchester, IL 60154. Opinions expressed in A2Zzz Magazine 

are not necessarily those of the APT Board of Directors. 

In This Issue… 

Editorial ....................................................................................4 

President’s Message ..................................................................6 

A2Zzz Magazine Continuing Education Credit Offering ......................8 

APT CEC Evaluation Form ............................................................9 

A.W.A.K.E. Official Talks About Life Before and After CPAP ............10 

Can We Learn While Sleeping? ..................................................11 

You May Be Losing Your Hearing As You Sleep..............................12 

Cardiac Pacing and Sleep-Disordered Breathing ............................14 

Sleep and the Immune System ....................................................16 

The Tsetse Fly and Sleeping Sickness ..........................................17 

APT Awards Presented in Salt Lake City ..................................20-21 

A2Zzz Technical Corner..............................................................24 

HIPAA Compliance in the Sleep Lab ............................................26 

NewZzz Briefs......................................................................28-29 

“GIGO” ....................................................................................30 

Product Order Form ............................................................31-32 

APT Membership Form ..............................................................33 

SleepLand Calendar ..................................................................34 

APT Committee Roster, Board of Directors and Directory ..............35 

Sleep Arts................................................................................36 

ADVERTISING INFORMATION 

The APT offers a full range of advertising services. See 

the advertising page drop-down menu at www.APTWEB.org, 

fax 708-273-9344, e-mail APTads@aptweb.org or phone 

708-492-0796 for details. 

? 

Have you moved? 

Changed your email address? 

Your phone number? 

If you have and have not notified 

APT, you can go to the home page of 

APTWEB to fill in your updated 

information (www.APTWEB.org). 

You wouldn’t want to miss your 

membership benefits! 

5

APT NewZzz 


President’s Message 

BY CYNTHIA MATTICE, MA, RPSGT 

You will enjoy this edition of A2Zzz Magazine from cover to cover — 

there are great articles that highlight the 28th Association of 

Polysomnographic Technologists (APT) Annual Meeting, the Sleep 

Technology Profession, and much more. My thanks and appreciation 

goes to the many individuals who work diligently to publish A2Zzz 

Magazine, especially to Theresa Shumard, Editor-in-Chief, and the contributing 

authors. I also want to thank the advertisers who support the 

APT and the profession by advertising in A2Zzz Magazine. There is no 

other publication which provides its readers with such a wide variety of 

topics from new discoveries to issues that impact our profession while 

providing APT Continuing Education Credits (CECs). 

Cynthia Mattice, MS, RPSGT, President 

Jon Atkinson, RPSGT, Past Elect 

Cindy Kistner, RPSGT, REEGT, Secretary 

Bill Rivers, RPSGT, Treasurer 

Debbie Akers, RPSGT, RRT 

Kristine Bresnehan Servidio, RPSGT 

William Eckhardt, RPSGT, CRT 

Terri Eubanks, RPSGT 

David Gregory, RPSGT 

Joanne Hebding, RPSGT 

Marilyn Swick, RPSGT 

Cynthia Mattice 

The 28th APT Annual Meeting held in Salt Lake City, Utah was one 

of the best to date. The Education Committee and the staff at the APT 

national office did a fantastic job of putting it all together and carrying 

out the program this year. This is the second year in 

which the APT Annual Meeting format provided registrants 

with the opportunity to participate in and take 

advantage of more offerings. In addition to the 

workshops and general session, attendees were 

able to attend the APSS Plenary Session, the 

APT Awards Ceremony and APT Annual 

General Membership Meeting. With rapid 

technological advances in the Sleep 

Technology Profession, dedicated time to 

visit the Exhibit Hall insured that attendees 

were able to see “the latest and greatest”. 

Work has already begun on the 29th APT 

Annual Meeting in Minneapolis, Minnesota, 

June 10-13, 2007. For the first time, the APT 

will be conducting a ‘Call for Proposals’ this fall. 

The ‘Call for Proposals’ will be sent to each member 

of the APT requesting proposals for presentations 

and lectures for postgraduate courses, workshops 

and sessions for the 2007 APT Annual Meeting. I hope you 

will consider participating in the “Call for Proposals”. Additional 

information will be posted on the APT Web site, www.aptweb.org, in 

September. 

The APT conducted the 2nd Annual Awards Ceremony on Tuesday, 

June 20, 2006, prior to the first day of General Sessions during the 

APT Annual Meeting. This venue provides the APT Board of Directors, 

membership and the award’s sponsors an opportunity to specifically recognize 

each award recipient for their accomplishments. More information 

about this year’s awards ceremony and award recipients can be 

found on page 20. 

During the APT Annual General Membership Meeting the new officers 

and directors were installed as members of the APT Board of 

Directors: Jon Atkinson, Debbie Akers, Kristine Bresnehan Servidio and 

William Eckhardt. When Mr. Atkinson was installed to the office of 

President-elect, this appointment created a Director-at-Large (one year 

term) vacancy on the Board of Directors. The Board of Directors 

appointed Terrie Eubanks to fill the vacancy. I am pleased to introduce 

you to the 2006-2007 APT Board of Directors: 

6 

With the conclusion of the meeting Rose Ann Zumstein, RPSGT, 

Theresa Shumard, BA and Todd Smeltzer, RPSGT, RRT completed 

their terms of office. Ms. Zumstein, Ms. Shumard and Mr. 

Smeltzer were each presented with the APT Distinguished 

Service Award, in recognition for their outstanding 

service and dedication to the association and the 

APT Board of Directors. Their contributions while 

on the board of directors provided positive 

direction for the organization. I look forward to 

what they will bring to APT activities far into 

the future. 

Recently, the Board of Registered 

Polysomnographic Technologists (BRPT) 

announced the new recertification policy for all 

Registered Polysomnographic Technologists 

(RPSGT’s). In order to maintain their credentials, 

all RPSGT’s will be required to go through 

the recertification process every five years. 

Recertification can be obtained by accumulating 

50 continuing education credits (CEC) or by re-taking 

the RPSGT examination. For detailed information 

on the new recertification and continuing education credit 

requirements visit the BRPT Web site at www.brpt.org. 

The APT Board of Directors fully supports the recertification policy 

instituted by the BRPT. The future of the profession and its direction 

depends on well trained professionals and their expertise in the 

field of Sleep Technology. This new policy creates an opportunity for 

RPSGT’s to advance their skills and expand their current expertise as 

the profession continues to grow and expand. The need to maintain 

your credential is extremely important in light of changes for reimbursement, 

which reflect the move towards verification of standards 

within the profession. 

To assist RPSGT’s in meeting the new recertification criteria, the 

APT has expanded its CEC program. Technologists working in sleep disorders 

centers and labs that conduct one-hour monthly in-service trainings 

or case conferences may apply for 1.0 APT CEC for each meeting. 

Individuals who read A2Zzz Magazine and submit the appropriate documentation 

will earn up to 1.5 APT CECs per issue. In addition, the APT 

CEC program offers several opportunities to earn CECs through educational 

programs and meetings available at throughout the year. To 

locate an educational program near you, visit the CEC information sec- 

➟

APT NewZzz 


tion of the APT Web site and view the Calendar of Educational 

Programs Offering APT Continuing Education Credits (CEC’s). To apply 

for APT CECs, you will find the complete application process on the APT 

Web site. 

Our profession continues to offer new technological advancements 

and methodologies. As a result, the role of the sleep technologists 

requires continuing education to keep up with new trends and developments. 

What an absolutely fabulous time to be working in such a dynamic 

profession! 

The APT Board of Directors and standing committees are currently 

working on several projects. These include the name change for the APT, 

updating the bylaws, 2006 APT Salary Survey and a new design of Sleep 

Technologist Appreciation Week for 2007. The APT Communications 

Committee is in the process of developing systems that will provide 

members of the APT with regular updates on these projects and more 

via e-mail and the APT Web site. 

This is such an exhilarating time to be in the Sleep Technology profession! 

There are new technologies being developed to advance the 

evaluation, diagnosis and treatment of sleep disorders. There’s nothing 

like hearing a patient say “That’s the best night of sleep I’ve had 

in a long time”. Isn’t it amazing how sleep research has been able to 

provide a scientific basis for how important a “good night of sleep” “Don’t worry honey, the technican isn’t 

really is. Along with each of you, I look forward to the growth of our 

going to hurt you.” 

profession. ★Barbara Ludwig Cull, RPSGT 

7


A2Zzz Magazine Continuing Education 

Credit Offering 

Instructions for Earning Continuing 

Education Credit 

A Trainee, Technician or Technologist working in the Sleep 

Technology Profession towards achieving the Registered 

Polysomnographic Technologist (RPSGT) credential or re-certification of 

the RPSGT credential may read A2Zzz Magazine and earn Association 

of Polysomnographic Technologists (APT) Continuing Education Credits 

(CECs) by completing an APT CEC A2Zzz Magazine evaluation form, on 

the next page, and fax or mail the completed form to the APT national 

office to receive 1.5 APT CEC’s. This service is an APT member benefit 

and there is no fee to APT members. Individuals who are not members 

of the APT and are interested in earning APT CEC’s will be 

required to pay an administrative fee of $20 per issue. 

To earn APT CECs, carefully read A2Zzz Magazine and complete 

the APT CEC Evaluation Form found on the next page. The 

completed evaluation form must be received by the APT national 

office by December 1, 2006. A certificate awarding APT CECs will 

be sent within 4 to 6 weeks of the submission deadline. It is the 

responsibility of the individual to maintain a record of their APT CEC 

certificates. 

It is required that four out of the seven 

articles in this issue listed below be read 

and that a corresponding page number be 

included on your APT CEC Evaluation Form 

in order to receive APT CEC credit: 

Accreditation Statements 

This activity has been planned and implemented by the APT Board 

of Directors and approved by the Board of Registered Polysomnographic 

Technologists (BRPT). The APT Board of Directors has established this 

program to meet the educational needs of the Sleep Technology 

Profession. Each individual should only claim those credits that he/she 

actually spent in the educational activity. 

Statement of Educational Purpose / 

Overall Education Objectives 

A2Zzz Magazine is a peer-reviewed publication addressing the 

educational needs of the Sleep Technology Profession. Its mission 

is to provide progressive technical information and an avenue of 

communication for members, presented in a professional and constructive 

manner, to further the goals, and promote unity in the 

Sleep Technology Profession. Readers of A2Zzz Magazine should 

be able to: 1) appraise Sleep Technology; 2) interpret new information 

and updates relating to the Sleep Technology Profession; 3) 

analyze articles for the use of sound principles and practices; and 

4) recognize the inter-relatedness/dependence of sleep medicine 

with primary disciplines. 

Page 12: You May Be Losing Your Hearing As You Sleep 

Objective: To understand that the noise from untreated loud snoring 

may contribute to inner ear damage and hearing loss. The 

Occupational Safety and Health Administration (OSHA) recommends a 

person wear ear protection at noise levels of 85 decibels (dB). Very 

loud snorers can produce sounds close to this level, thus potentially 

causing hearing loss for bed partners or themselves. 

Page 14: Cardiac Pacing and Sleep Disordered Breathing 

Objective: Impart an understanding of new research that examines 

the potential use of cardiac pacing to treat sleep-disordered 

breathing. Scientists are working to determine which patients with 

sleep-disordered breathing will most benefit from cardiac pacing. For 

example, more studies may reveal whether cardiac pacing would be 

more beneficial for someone who would normally not meet the criteria 

for pacemaker implantation but who has a certain type of sleepdisordered 

breathing (e.g., central apnea or Cheyne-Stokes breathing 

versus OSA). 

Page 16: Sleep and the Immune System 

Objective: Validating an age-old myth, this article discusses that 

the amount of restorative sleep one is able to acquire plays a crucial 

role in strengthening the immune system. People not getting sufficient 

sleep are at risk for health problems because the immune system 

is not able to repair itself without an adequate amount of sleep. 

Page 11: Can We Learn While Sleeping? 

Discusses findings indicating that behaviors learned in a particular 

sleep stage can be repeated in the same sleep stage several 

days or even months later. This ability is known as sleep-specific 

memory. Test subjects have been observed to follow very simple 

instructions in various stages of sleep that they learned earlier while 

awake. Moving one’s finger at the sound of a click when in deep 

sleep is an example. 

Page 24: Part 1 — A2Zzz Technical Corner 

Objective: Defines that European Data Format (EDF) as a simple 

formatting of data for the exchange of multiple biological signals. EDF 

is a feature a number of sleep acquisition software programs. 

Page 24: Part 2 — A2Zzz Technical Corner 

Objective:Defines and classifies partial seizures into three subgroups: 

partial seizures with elementary symptomatology, partial 

seizures with complex symptomatology, and partial seizures secondarily 

generalized. The article further explains It is important to note 

that the onset of partial seizures during sleep occur most frequently 

during Stage II sleep and validates the existence of peak periods of 

seizure activity during sleep. 

Page 26: HIPAA Compliance in the Sleep Lab 

Objective: Discusses how the Health Insurance Portability and 

Accountability Act of 1996 (HIPAA) has impacted sleep labs and how 

labs provide services to patients. 

8


APT CEC Evaluation Form 

To earn APT CECs, carefully read four of the articles (see previous page for list) designated for APT CECs and mark your responses for each article 

and its page number on this form. Completely answer all questions and fax or mail this form to the APT national office (fax number/address indicated 

at the bottom of this page). In order to receive credit, this evaluation form must be answered completely and postmarked by December 1, 

2006. A certificate awarding 1.5 APT CECs will be mailed to you four to six weeks following this date. There is no charge to members of the APT 

for this service. Non-members must include payment of a $20.00 administrative fee with this form. 

For items 1-2, please use the following scale: 

5=Strongly Agree, 4=Agree, 3=Unsure, 2=Disagree, 1=Strongly Disagree 

Article 1 Article 2 Article 3 Article 4 

Page #_____ Page #_____ Page #_____ Page #_____ 

1. Educational value: 

I learned something new that was important. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

I verified some important information. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

I plan to discuss this information with colleagues. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

I plan to seek more information on this topic. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

My attitude about this topic changed in some way. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

This information is likely to impact my practice. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

2. Readability feedback: 

I understood what the authors were trying to say. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

I was able to interpret the tables/figures (if applicable). 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

Overall, the presentation of the article enhanced my 

ability to read and understand it. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 

Please print legibly or type: 

3. Additional comments/feedback to be used by the APT CEC Committee: ____________________________________________________________________________________ 

__________________________________________________________________________________________________________________________________________________________________________________ 

4. Commitment to change: 

What change(s), if any, do you plan to make in your practice as a result of reading any of these four articles? ____________________________________________ 

__________________________________________________________________________________________________________________________________________________________________________________ 

5. Statement of completion: 

I attest to having completed the APT CEC activity (sign below). 

Signature________________________________________________________________________ Date ______________________________________________________ 

Phone: ______/______/__________ Fax: ______/______/__________ E-mail: __________________________________________________________________________________ 

Name (please print legibly) __________________________________________________ RPSGT ❑ 

Address __________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

City_______________________________________________________________________ State_______________ Zip ______________________________________________________________________ 

Are you a member of the APT? (circle one): Yes / No APT Membership No:_____________ (If no, complete the following payment information) 

❑ Check made payable to the APT for $20 is enclosed or ❑ Charge $20 to (circle one): Visa / MasterCard / American Express 

Card Number__________________________________________________________ Expiration Date ______/______ 

Cardholder name (please print)_____________________________________________ Signature________________________________________________________ 

Cardholder Address ______________________________________________________________________________________________________________________________________________________________________________________________________________ 

Please return this completed form, postmarked no later than September 22, 2006, to the APT National Office: 

One Westbrook Corporate Center, Suite 920, Westchester, IL 60154, or fax to (708) 273-9344 

9


A.W.A.K.E. Official Talks About 

Life Before and After CPAP 

BY DAVE HARGETT, CHAIRMAN, AMERICAN SLEEP APNEA ASSOCIATION 

It was the worst of times, the absolute worst of times. At age 45 I was 

a sleepy, grumpy, irritable old man. I was having trouble staying awake 

on the highway and trouble concentrating at work. My wife had moved 

out of the bedroom because she couldn’t stand my snoring and the pauses 

in my breathing. I was tired all the time; I was up almost hourly to urinate. 

I was sure I had a bladder or prostate problem, but like most guys, 

going to the doctor was a chore to avoid. To quote Garth Brooks, I was 

“much too young to feel this darn old!” 

The Chicago Tribune saved my life. I happened to read an article in 

September of 1993 about sleep apnea. I began to see that maybe I did 

have something wrong with me that was “fixable”. Six months later I tried 

to talk to my primary physician about apnea. He told me he knew nothing, 

but that he could refer me to someone. My wife and I finally made 

it to a community lecture on sleep apnea. At age 45, my wife and I were 

the youngest folks in the room. The one-hour lecture/Q&A session was 

still going 2-1/2 hours later when we left. Lots of people and lots of 

questions. If the speaker had mentioned 20 symptoms, I had at least 

18! We now knew the problem and were motivated to find a solution. 

After some insurance annoyances, I was finally diagnosed in August 

and started continuous positive airway pressure (CPAP) in September, 

almost exactly a year after I first read about sleep apnea. I had severe 

apnea, with an AHI of 82 and desats as low as 52%. I was started on 

CPAP at 8 cm, without a titration study (those insurance hassles). The 

homecare rep showed up with A machine and A mask — no choices for 

me! Luckily, at the time I didn’t know any better and I just hunkered down 

and used what I was given. 

I expected a miracle on the first night. I didn’t get it. I had slept for 

almost 5 hours straight and my wife said I didn’t snore much, but I still 

10 

felt lousy that first morning. I wasn’t sure 

this was going to work. I still felt lousy on 

morning two, three, and even morning 

four. Day four was a Saturday, though, 

and I ran some errands, did some office 

work, and about 11 pm realized that I 

hadn’t been sleepy all day! I had even 

skipped my normal 2-hour nap. By golly, 

this thing was working! 

Dave Hargett 

That moment of self discovery led me to believe in CPAP therapy. 

And I began to feel better quickly. But I soon realized that I was dealing 

with a medical disorder that I knew very little about and I didn’t know anyone 

else who had this problem. 

Enter the A.W.A.K.E. Network of support groups! About 4 months 

after I had started treatment, I got an announcement from the sleep 

center where I had been tested. They were starting a support group for 

sleep apnea patients and family members. This sounded promising. I 

was macho enough to believe that “I don’t need no stinking’ support 

group”, but I thought, just maybe this has some merit. 

I missed that first meeting, but I made the second, and the third, and 

then got involved with the leadership of that group. When the two founders 

(a homecare rep and a nurse from the sleep physician’s office) changed jobs 

that summer, I stood up to lead the group for a little while. Eleven years later, 

I’m still the coordinator of the Elk Grove Village A.W.A.K.E. group, and I’ve 

been running a second group in Naperville, IL for the last three years. In both 

cases I work with the staff of the sleep center and the sleep physicians’ office. 

I moved from being an undiagnosed patient with terrible sleep and a 

poor quality of life to be a well-rested, very compliant 

patient who got involved with a support group. The knowledge 

and self-confidence I picked up from that group 

helped me move on to become a sleep activist with 

William Dement, M.D., Ph.D. I was the apnea patient 

speaker at the Great American SleepWalk in 1996. My 

A.W.A.K.E. experiences and public speaking led me to a 

position on the board, and for the past couple of years, 

to become chairman of the board of directors of the 

American Sleep Apnea Association (ASAA). 

None of this would have occurred if not for the “Alert, 

Well, And Keeping Energetic” (A.W.A.K.E.) Network of 

support groups that increased my knowledge of sleep 

apnea and taught me the things I needed to know to be a 

truly compliant patient. Even good patients don’t know 

everything they should about apnea. Unfortunately many 

patients are handed a CPAP and get no follow-up knowledge 

from their personal physicians or anywhere else. We 

need to help these patients understand their disorder and 

to become more compliant patients who are truly effectively 

treated so that they can regain their quality of life. 

continued on page 25


Can We Learn While Sleeping? 

BY REG HACKSHAW, EDD, RPSGT, ASSOCIATE EDITOR 

Reprinted from A2Zzz Magazine Volume 13, Number 1 (Spring 2004) 

What the Research Says about Sleep Learning 

Experiments indicate that people can remember or recall lists of 

words spoken to them during stage 1 sleep. This is probably 

because stage 1 includes periods of wake time when learning is possible. 

In general, the longer the periods of wake time within stage 1, the 

more material can be learned. In addition to word lists, entire sentences 

have been recalled in this manner. If someone is awakened shortly after 

a dream, they are more likely to remember it. 

The awareness that one has seen or heard something before is 

known as recognition. Often, recognition rather than recall is used as 

an assessment of learning since it is a more sensitive measure of what 

was experienced during sleep. While recall depends on the specific 

organization or representation of memories in the brain, recognition 

does not. Therefore, it is possible that less mental effort is required to 

recognize material presented while asleep than is required to recall that 

same material. 

Test subjects have been observed to follow very simple instructions 

in various stages of sleep that they learned earlier while awake. Moving 

one’s finger at the sound of a click when in deep sleep is an example. An 

interesting finding was that behaviors learned in a particular sleep stage 

can be repeated in the same sleep stage several days or even months 

later. This ability is known as “sleep-specific memory.” 

mixed with an equal number of unsaid 

words. The words you select should be 

fairly common words from the subject’s 

native language with about the same number 

of letters. 

Your subject probably will recognize 

his/her name as one of the spoken Reg Hackshaw 

words; few, if any of the other spoken 

words; and probably none of the unspoken words. According to cognitive 

psychologists, these results would support “selective attention for 

semantically loaded words during behaviorally defined sleep.” As a followup, 

you could repeat this study but change the pronunciation of your subject’s 

name; then, see if this procedure influences recognition in the 

morning. A more rigorous version of these procedures would be to conduct 

the experiment during a NPSG in order to identify Stage I sleep. ★ 

Bibliography 

Bootzin RR, Kihlstrom JF & Schacter DL, eds. Sleep and Cognition. Washington, DC: 

American Psychological Assoc, 1992. 

About the Author 

Reg Hackshaw is a freelance writer on health-related historical topics and a polysomnographic 

technologist in a private sleep lab located in Huntington Station, NY. He is an associate 

editor on the editorial board of A2Zzz Magazine. 

An Easy Experiment 

The experience of suddenly hearing one’s name mentioned in a 

room full of people is a common occurrence known as selective auditory 

attention. Individuals are more likely to identify their name when 

spoken rather than less meaningful or semantically neutral words. The 

same situation evidently occurs during sleep. An individual may be able 

to recall their name spoken during light sleep yet be unable to recall 

other neutral words. 

One easy experiment to perform is to say a list of words slowly and 

quietly to someone who appears to be asleep (include that individual’s 

name) then, in the morning, show your test subject this list randomly 

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11


You May Be Losing Your Hearing 

As You Sleep 

BY REGINA PATRICK, RPSGT 

Reprinted from A2Zzz Magazine Volume 13, Number 4 (Winter/Spring 2005) 

The National Institute on Deafness and Other Communication 

Disorders (NIDCD) estimates that 30%-35% of adults over 65 

years old and 40%-50% of adults over 75 years old will suffer some 

hearing loss. Nevertheless, it is possible to avoid hastening hearing loss 

as one ages. One solution may be as simple as treating a bed partner’s 

sleep apnea. 

Two types of hearing loss that commonly 

occur in adults are presbycusis 

(age-related hearing loss) and noiseinduced 

hearing loss. Presbycusis typically 

affects one’s ability to hear highpitched 

sounds such as the ring of a 

phone, ticking of a watch, and children’s 

or women’s voices. Noise induced hearing 

loss initially affects one’s ability to 

hear a certain range of high-pitched 

sounds (e.g., 2.0-4.0 kiloherz [2,000- 

4,000 cycles/second]) but a person is still 

able to perceive other high pitched sounds but 

to a lesser degree than normal. Later, as noiseinduced 

hearing loss progresses, a person becomes unable to perceive 

low-pitched sounds. Both presbycusis and noise-induced hearing loss 

involve injury to the cochlea. In presbycusis, cochlear structures are 

destroyed. In noise-induced hearing loss, cochlear structures are damaged 

but not destroyed. 

The cochlea is a tapered cone-like structure which coils upon itself 

giving it the appearance of a sea shell. The basilar membrane runs the 

length of the cochlea. It supports the organ of Corti which contains various 

types of receptor cells involved in the neurological aspect of hearing: 

inner hair cells, outer hair cells, inner and outer phalangeal cells, 

border cells, and Hansen’s cells. Sound waves cause cochlear fluids 

(perilymph and endolymph) to flow back and forth within the cochlea. The 

hair cells, which project into endolymph, sway in conjunction with the 

fluid’s flow. Each movement of the hair cells transmits a signal to the 

cochlear nerve and from there the signal travels to the cochlear nuclei 

in the brain to be interpreted as sound. 

In noise-induced hearing loss, the hair cells — particularly the outer 

hair cells — move about excessively in response to loud noise. This causes 

them to swell, weaken, and twist. In this condition, the hair cells can 

not transmit their signals accurately to the cochlear nerve resulting in 

diminished hearing. 

In presbycusis, the hair cells die off, the organ of Corti atrophies, the 

basilar membrane thickens, and the stria vascularis (a layer of vascular tissue 

lining the cochlear duct that secretes endolymph) atrophies. Scientists 

are not sure why these changes occur but have looked to genetics, diet, 

and external factors (e.g., ototoxic drugs, noise) as a cause. 

A normal healthy human ear begins to perceive sound at 0 decibels 

(dB). Loud noise begins to cause pain at 125 dB (about the loudness of a 

car horn if you were standing less than 4 

feet away). Damage to inner ear structures 

begins at 160 dB (about the loudness of a 

jet engine at less than 100 feet). 

Destruction of inner ear structures occurs 

at 180 decibels. (The loudest sound possible 

to measure is 194 dB.) The 

Regina Patrick 

government agency Occupational Safety and Health 

Administration (OSHA) 1 recommends a person 

wear ear protection (such as ear plugs) at 85 dB 

and requires workplaces to provide ear protection 

to workers at 90 dB. 

A light snorer snores at about 38 dB. 

Most snorers snore at about 60-70 dB. Very 

loud snorers can snore as loud as 80 decibels 

— nearly the level at which OSHA recommends 

ear protection. Even though light 

and moderate levels of snoring are below the 

level considered damaging to the ear, snoring may 

still play a role hearing loss. 

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➟ 

12


In 1973, Yugoslavian scientist M. Prazic 2 was the first to examine 

whether snoring contributed to hearing loss in snorers. He expected that 

snorers would have an increased incidence of presbycusis since snorers 

are exposed to loud noise repeatedly for many years. He examined the 

audiograms of 17 snorers all of whom were 60 years or older and found 

that each had presbycusis. He concluded that their snoring had contributed 

to their presbycusis. 

Only within the last six years has Prazic’s experiment begun stimulating 

other researchers to examine snoring’s effect on hearing loss. In 

1999, Victor Hoffstein et al. 3 looked for an association between snoring 

and presbycusis. They were to conclude that no association existed. 

Hoffstein’s study involved 219 subjects; 182 of these were snorers. 

They compared each subject’s hearing threshold (i.e., the lowest signal 

a person can hear) with his maximum snoring noise level. A subject had 

a hearing loss if he could not hear high-pitched sounds greater than 

4,000 cycles/second (4.0 kiloherz). Hoffstein et al. found that the hearing 

threshold of the subjects as a group remained in the normal range 

(i.e., below 4.0 kiloherz) throughout the snoring noise range (50-100 

dB). When they compared the hearing threshold of mild snorers with 

that of loud snorers, they found no statistical difference in threshold. 

Hoffstein et al. concluded that snoring does not contribute to presbycusis 

since the hearing threshold did not increase with increasing snoring 

loudness (as would be expected if snoring were causing hearing loss) 

and since there was no difference in hearing threshold between loud and 

mild snorers. 

However, noise-induced hearing loss caused by snoring may be a different 

matter. Noting that studies such as those of Prazic and Hoffstein 

focused only on presbycusis, Canadian doctors Maya G. Sardesai et al. 4 

examined whether snoring could cause noise-induced hearing loss. Of 

particular interest to them was the impact of snoring on a bed partner’s 

hearing. 

They used four couples (i.e., eight subjects) in their study. Each couple 

was composed of a “snorer” and a “non-snorer.” All eight participants 

were given a behavioral audiogram and an otoacoustic emissions (OAE) 

test. A behavioral audiogram tests the function of a person’s hearing. It 

is used to determine speech perception (i.e., word recognition), hearing 

threshold, and the function of the auditory nerve and brain pathways 

involved in hearing. An OAE test measures the cochlea’s ability to emit a 

signal (i.e., the otoacoustic emission) in response to a test signal. 

Hearing loss has occurred if the cochlea does not emit a signal in 

response to a 30 dB test signal. 

Like Hoffstein, Sardesai et al. could find no correlation between snoring 

noise and hearing loss in the snorers. All of the bed partners, on the 

other hand, had high frequency noise-induced hearing loss in the ear 

next to the snorer during sleep. Because of this consistent pattern, 

Sardesai et al. concluded that loud snoring can result in noise-induced 

hearing loss in the bed partners. 

Snorers often suffer from sleep apnea (the cessation of breathing 

during sleep) which occurs when pharyngeal tissue collapses into and 

blocks the airway. As a result of air blockage, a person will abruptly 

arouse for a few seconds to take some deep breaths. It is during the 

arousal when snoring occurs. During snoring, pharyngeal tissue partially 

blocks the airway and flutters with each breath. 

Sleep apnea can have potentially serious consequences for a sufferer. 

Sleep apnea sufferers have an increased risk of gastroesophageal 

reflux disease; an increased risk of cardiovascular problems 

(e.g., hypertension, stroke, congestive heart failure); and increased difficulty 

with controlling obesity and associated obesity problems. 

Additionally, frequent nocturnal arousals from sleep apnea can result in 

excessive sleepiness during the day which in turn can jeopardize one’s 

ability to function at work or in social situations — a person may find 

himself inadvertently dozing at work, in social settings, or at dangerous 

times such as while driving. Sleep apnea treatment can counteract 

these consequences and, as a double benefit, protect the hearing of a 

bed partner. ★ 

References 

1. www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9735, 

(active as of 1/6/05). 

2. Hoffstein V, Haight J, Cole P, Zamel N, “Does snoring contribute to presbycusis?”, American 

Journal of Respirtory and Critical Care Medicine, 159(4):1351-1354, April 1999. 

3. Hoffstein V, Haight J, Cole P, Zamel N, “Does snoring contribute to presbycusis?”, American 

Journal of Respirtory and Critical Care Medicine, 159(4):1351-1354, April 1999. 

4. Sardesai MG, AKW Tan, Fitzpatrick M, “Noise-induced hearing loss in snorers and their 

bed partners,” Journal of Otolaryngology, 32(3):141-145, June 1, 2003. 


Regina Patrick, RPSGT, is a noted freelance medical writer and sleep technologist that works 

at St. Vincent Mercy Sleep Disorders Center in Toledo, OH. She is a regular contributor and 

serves on the A2Zzz Magazine Editorial Board as an Associate Editor. She also contributes 

to other publications in the sleep field. Patrick is a past recipient of the APT Dr. Allen 

DeVilbiss Literary Award for literary excellence for articles published in A2Zzz Magazine. She 

may be contacted through the APT National Office at apt@aptweb.org. 

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13


Cardiac Pacing and Sleep- 

Disordered Breathing 

BY REGINA PATRICK, RPSGT 

Sleep workers commonly believe that heart rhythm problems are 

triggered by sleep-disordered breathing but recent studies suggest 

that heart rhythm problems may instead trigger sleep-disordered 

breathing. Physicians have observed that when an artificial pacemaker 

is implanted to treat an abnormal heart rhythm, symptoms of sleep-disordered 

breathing improve significantly in some people. This finding 

suggests that artificial cardiac pacing could be a new treatment for 

sleep apnea. 

An artificial pacemaker consists of two parts: a pulse generator and 

one or more leads. The pulse generator (a small round device about the 

size of a silver dollar) is implanted just below the collarbone. The leads 

are wires which carry a signal from the pulse generator to the heart to 

trigger a contraction. A pacemaker in which a lead is placed in one 

chamber (i.e., usually the right atrium or right ventricle) is called a single 

chamber pacemaker. Single chamber pacemakers are typically used 

to treat sinus bradycardia, ventricular bradycardia, and second and third 

degree AV blocks. 

In some patients, both the atria and ventricles need stimulation and 

a pacemaker will have one lead going to the right atrium and another 

going to the right ventricle. This type of pacemaker is called a dual chamber 

pacemaker. Dual chamber pacemakers are typically used in patients 

with bundle branch block problems. 

Rhythm problems (i.e., arrhythmias) occur when signals are not 

transmitted normally through the heart. The signal for a heartbeat normally 

originates from the sinoatrial (SA) 

node which is located on the upper wall of 

the right atrium. It quickly spreads 

throughout both atria causing them to 

contract. The signal travels to the atrioventricular 

(AV) node which is situated 

near the junction between the left and 

right atria just above the right ventricle. Regina Patrick 

The AV node relays the signal to the bundle 

of His. The bundle of His is a network of fibers which carry the signal 

down the heart’s septum. Part way in the septum, the bundle of His 

splits into left and right bundles to spread the signal along the muscular 

walls of the left and right ventricles causing them to contract. 

In some cases, arrhythmias can be treated with medication. When 

medication can not correct an arrhythmia, implantation of an artificial 

pacemaker may restore a steady rhythm. 

Abnormal rhythms that may be treated by pacemaker implantation 

are: bradycardia (sinus, junctional, or ventricular), AV block, and bundle 

branch block. Each of these rhythms are described below: 

Bradycardia 

Bradycardia (slow heart beat) is any heart rhythm of less than 60 

beats/min. Bradycardia can be classified by which part of the heart is 

the origin for the slow rhythm. Hence, a person can have sinus bradycardia 

(i.e., the SA node is the origin of the slow rhythm); junctional 

bradycardia (the AV junction is the origin of the 

slow rhythm); or ventricular bradycardia (the bundle 

of His is the origin of the rhythm). A slow heart 

rate reduces the amount of blood available to the 

brain and heart. As a result, a person with bradycardia 

can have: syncope (fainting) or near-syncope; 

transient dizziness or light-headedness; confusional 

states resulting from reduced blood flow 

to the brain; blurred vision; shortness of breath; 

chest pain; fatigue; low exercise tolerance, or congestive 

heart failure. Some people, however, have 

no symptoms of bradycardia. 

Sinus bradycardia occurs when the SA node 

generates signals at a rate of less than 60 

beats/minute [beats/min.]. (Normally, the SA node 

acts as the heart’s pacemaker; its intrinsic rhythm 

is 60-100 beats/min.) 

Junctional bradycardia occurs when the AV junction 

(the area consisting of the AV node plus the portion 

of the bundle of His before it branches) takes 

over as the heart’s pacemaker. The AV junction’s 

intrinsic rhythm is 40-60 beats/min. Junctional 

bradycardia can occur when the SA node rhythm 

falls below 40 beats/min. 

14 

➟


Ventricular bradycardia occurs when the ventricles take over as the 

heart’s pacemaker. The intrinsic ventricular rhythm ranges from 20-60 

beats/min. Ventricular bradycardia can occur when signals are not 

relayed from the SA node (e.g., AV block or asystole). 

AV block 

An AV block occurs when some problem at the AV node, the bundle 

of His, or His bundle branches impedes a signal from being relayed 

through the ventricles. An AV block can be first degree, second degree, 

or third degree. In first degree AV block, there is a slight delay in the 

signal’s leaving the AV junction after each atrial contraction. In second 

degree AV block, the SA node rhythmically produces signals but each 

beat takes increasingly longer to stimulate the AV junction until ultimately 

a signal is not relayed and the ventricles do not contract. An 

alternative second degree block is that SA node signals contract the 

atria rhythmically but at times there is no subsequent AV junction stimulation 

(and therefore no ventricular contraction). In third degree AV 

block, there is a dissociation between the SA node signal and AV junction 

signal so that the atria beat at their own rhythm while the ventricles 

beat at their own rhythm. 

Bundle Branch Block 

In a bundle branch block, damage occurs in one branch causing a 

signal to travel through the affected branch at a slower rate than the 

opposite bundle branch. The result is that the heart will have two ventricular 

beats since the affected ventricle contracts after the unaffected 

ventricle. 

Arrhythmic heart contractions can cause improper filling and emptying 

of the heart’s chambers. This in turn can stimulate the vagus nerve 

which innervates the SA node and the AV node. Vagal stimulation slows 

the heart contractions. Vagal stimulation can potentially decrease heart 

contractions to the point of sinus arrest (i.e., no heart beat) or AV block. 

The vagus nerve also plays a role in respiration. Vagal nerve fibers 

relay signals from the aortic bodies and pulmonary stretch receptors to 

the respiratory center in the brain. The aortic bodies (glandular tissue 

found on the aortic arch) are sensitive to oxygen and carbon dioxide levels 

in the blood. In response to low levels of oxygen (i.e., hypoxia) or high 

levels of carbon dioxide (i.e., hypercapnia), the aortic bodies trigger 

hyperventilation. The vagus nerve mediates this response. 

Pulmonary stretch receptors stimulate the vagal nerve fibers during 

inhalations. As the vagal fibers are stimulated, the inspiratory neurons 

in the brain’s respiratory center begin to decrease their activity. The 

inspiratory neurons ultimately cease their activity which allows the expiratory 

neurons in the respiratory center to increase their activity so that 

exhalation can occur. 

Other neurological input (e.g., carotid bodies and central chemoreceptors) 

to the respiratory center also help to maintain the rhythmicity 

of respiration. If the neurological interplay between the respiratory center, 

stretch receptors, and chemoreceptors (e.g., the aortic bodies, 

carotid bodies, and central chemoreceptors) is altered, Cheyne-Stokes 

breathing, central apnea, or obstructive sleep apnea can result. 

In Cheyne-Stokes breathing, a person will take a few increasingly 

deep breaths followed by increasingly shallower breaths which give way 

to apnea. This pattern resumes moments later when the person again 

starts breathing. Cheyne-Stokes breathing results from chemoreceptor 

hypersensitivity to changes in blood gases. A slight drop in oxygen can 

trigger hyperventilation which subsequently gives way to apnea once 

peripheral and central receptors “perceive” that oxygen resaturation 

has occurred. 

In central apnea, the respiratory center does not send a signal to 

breathe. As a result, there is no thoracic effort to inhale or exhale and 

oxygen levels fall. Breathing usually resumes when oxygen desaturation 

falls to a certain point. 

In obstructive sleep apnea (OSA), a person stops breathing intermittently 

during sleep. Breathing ceases due to tissue blocking the 

upper airway as muscles in the upper airway relax during sleep. The 

blood oxygen level decreases which ultimately triggers the brain to 

arouse. With the arousal, muscle tone returns and the airway opens 

allowing the free flow of air and resaturation of the blood. Decreased 

vagal activity can reduce muscle tone in the upper airway thereby allowing 

for upper airway collapse. 

Artificial pacing may counteract sleep disordered-breathing through 

its action on the vagus nerve 1 . By restoring steady contractions, artificial 

pacing counteracts improper heart chamber filling and emptying. 

This in turn reduces stimulation of pulmonary vagal fibers. With less 

vagal stimulation, the respiratory center does not misperceive that a 

person is hyperoxic, hypoxic, hypocapnic, or hypercapnic (thereby preventing 

Cheyne-Stokes breathing or central apneas) and the upper airway 

muscles can maintain their tone (thereby preventing OSA). 

In 1989, Japanese researchers Ogata et al. 2 reported that artificial 

pacing improves symptoms of sleep apnea. In their report, they discussed 

the case of a 41 year old, overweight, male subject with congestive 

heart failure. Electrocardiogram (EKG) recording revealed that 

the subject had severe sinus bradycardia and periods of asystole (lack of 

heartbeat) lasting up to 6.2 seconds associated with apneic episodes 

during sleep. The patient modified his sleep position and lost weight in 

an attempt to counteract his sleep apnea. His apnea and bradycardia 

remained despite these changes. Ogata then implanted a pacemaker to 

treat the patient’s severe bradycardia. The patient’s apnea symptoms 

improved significantly after implantation. 

Stephane Garrigue et al. 3 in their 2002 study found that 

sleep apnea was reduced in subjects who had been implanted 

with an atrial-synchronous ventricular pacemaker (a type of 

dual-chamber pacemaker). Their 15 subjects, who averaged 

around 69 years old, had sinus bradycardia and either central 

or obstructive sleep apnea. All underwent a baseline (N1) 

polysomnogram before implantation. By the following night 

(N2), the subjects had undergone pacemaker implantation 

and underwent a second polysomnographic study. On this 

night, the heart rhythm of one group of subjects was allowed 

to beat in spontaneous rhythm while a second group was in 

pacing mode (i.e., the pacemaker would induce contractions 

when the rhythm became bradycardic). On the night following 

this (N3), the patients had a third polysomnogram and were 

crossed over to undergo either spontaneous rhythm (if N2 

had been in pacing mode) or pacing mode (if N2 had been in 

spontaneous rhythm). The researchers found that respiratory 

events reduced from an average of 28 events/hour in sponcontinued 

on page 27 

15


Sleep and the Immune System 

BY EDWIN CINTRON, RPSGT AND KORNELIA DENEAU, RPSGT 

It is often wondered how it is that some people are more at risk of catching 

colds, viruses, and other common illnesses while others do not. It is 

obvious that this is directly affected by the body’s immune system, but 

sleep may play a major part. The amount of restorative sleep one is able 

to acquire plays a crucial role in strengthening the immune system. 

Making sure you get plenty of rest is not just an old wives’ tale after all. 

There are no proven medications available that help to strengthen the 

immune system 1 . This makes it important to lead a healthy lifestyle, which 

includes getting enough sleep. No one is really sure about the function of 

sleep as far as its role in the healing process, but body temperature appears 

to be important. Rats that are chronically deprived of sleep show increases 

of 10° C, or more 2 . This suggests that sleep has cooling functions. 

Conversely, rats deprived of sleep for two weeks or more show a significant 

drop in body temperature suggesting that sleep may also have a role in heat 

retention 2 . Studies of sleep deprivation done by Dr. Allen Rechtshaffen, et al, 

have shown that this constant drop in body temperature leads to death after 

11-22 days in rats 3 . It is estimated that it would take as long as 7 months 

of complete sleep deprivation to result in death for humans 3 . A good, deep 

sleep (delta sleep, in particular) allows the body to produce more growth hormones. 

This, in turn, helps the body to rebuild the immune system. 

Loss of restorative sleep can lead to many different diagnoses including 

the flu, colds, or other illnesses. One theory suggests that the tiredness 

associated with the illness may be the body sending a message 4 . The message 

is simple. Sleep is needed. So why is sleep so important? To answer 

this, one must consider that when asleep, the human body is using less energy 

for other things. It can devote more energy to attack invading bacteria 

and/or viruses more effectively. In older adults, the ability to fight off infection 

is not as good as it is in younger adults 5 . In response to an infection, one 

of the body’s defense mechanisms is to increase body temperature (fever) to 

kill the cells causing the illness 5 . Since the amount of slow wave sleep is less 

in older adults 6 , this could explain why the immune system is weaker in the 

elderly. The amount of slow wave sleep in early adulthood (age 16-25 years) 

is about 18.9%, and it drops to 3.4% during middle age (age 36-50 years) 7 . 

Healthy sleep also plays a very important role from infancy through 

adolescence. The impact of poor sleep becomes apparent with this population 

in a diverse manner. The lack of restorative sleep affects not only 

the health of the child but also the physical stature. The need for sleep 

and the repair of tissues is key for further growth. It is well known that in 

normal subjects, growth hormone is released during sleep in a pulsatile 

pattern with peaks during slow-wave sleep 8 . We also know that the percentage 

of slow-wave sleep is increased during the developmental years 8 . 

In pre-pubertal children, secretion of the growth hormone is clearly coupled 

with sleep onset 9 . It peaks during the first third of the night, during 

slow wave sleep, and is secreted exclusively during other stages of sleep 9 . 

To better understand the consequences of poor sleep in the pediatric 

population, one can take into consideration the health issues of those with 

Down Syndrome (DS). Children with DS have been reported to have severe 

growth arrest and Microcephaly 10 . Additionally, it should be considered that 

many patients with DS have been reported to present with obstructive 

sleep apnea 11 . Given the above sleep alterations, the relationship between 

sleep structure and growth hormone production during sleep is strongly 

suspected in this population 12 . Growth hormone release is known to be 

16 

reduced in children with sleep apnea, 

probably due to the consequent sleep fragmentation 

12,13 . Growth hormone production 

can become normalized if the sleep 

apnea is effectively treated 14 . 

Aside from the physical status, sleep 

deprivation has an effect on a patient’s 

mental status as well. When a person is 

Kornelia Deneau 

severely sleep deprived, this has been 

known to lead to irritability, hallucinations, 

psychosis, etc... It has been shown that 

sleep deprivation leads to delusional 

thoughts and hallucinations as what was 

seen when Peter Tripp stayed awake for 

201 hours in 1959 15,16 . What makes this 

remarkable is some believe that recovery 

of these symptoms comes after just one 

night of sleep 3 . For clinical depression, 

sleep deprivation has been used as a 

treatment as well. 40-60% of cases 

showed significant and rapid improvement 

of symptoms by utilizing sleep deprivation 

as a form of treatment for Edwin Cintron 

depression 17,18 . The portion of sleep that 

seems to offer the highest amount of restitution again appears to be slow 

wave sleep, not only for immunity, but for the mental status as well 19 . 

There are other medical conditions that have been attributed to a lack 

of sleep. For example, if a person sleeps for too little or too long, it can lead 

to symptoms of Diabetes Mellitus 20 . Sleeping less than 6 hours, or for more 

than 9 hours, has been linked to this metabolic inability to stabilize glucose 

levels 20 . One study showed that when subjects were only allowed to sleep 

for only 4 hours per night, an 18 year old could not metabolize their glucose 

level any better than an 80 year old 21 . Hypertension, also, has been 

linked to not getting an adequate amount of sleep 22,23 . 80% of the growth 

hormone, which is important in healing and muscle regeneration, is 

released during delta sleep 24 . Since Fibromyalgia patients show a decreased 

level of delta sleep, this may contribute to the muscular pain involved in this 

muscle disorder 25 . Fibromyalgia is a chronic musculoskeletal pain disorder, 

which, to date, has no FDA approved treatment to help with symptoms 26 . 

The fact that some people become ill more often than others may be 

related to the fact that some people show more delta sleep than others. 

There are no known medications that improve immunity. However, slow wave 

sleep is most important in boosting the immune system, and exercise has 

been shown to increase the amount of slow wave sleep 3 . It is estimated that 

47 million adults in the United States do not get the required amount of 

sleep 27 . This puts everyone at risk of health problems because the immune 

system is not able to repair itself without an adequate amount of sleep. ★ 

References 

1. The Immune System. 9 July 2006. http://en.wikipedia.org/wiki/Immune_system 

2. Rechtschaffen, A. and Siegel, J.M. Sleep and Dreaming. Principles of Neuroscience. 

4th Ed. 936-947, New York, 2000. 

http://www.npi.ucla.edu/sleepresearch/SleepDream/sleep_dreams.htm 

continued on page 22


The Tsetse Fly and Sleeping Sickness 

BY WAYNE PEACOCK, RPSGT, UNITED KINGDOM CORRESPONDENT 

American soil, for the most part, is fortunate not to be riddled with 

insects and various pests that can carry potentially life altering or threatening 

diseases. Unfortunately, for Africa it is not. Who would believe that a 

tiny fly could inflict upon its unwilling victim a disease of sleepiness? The tsetse 

fly is one that should be avoided at all costs. As a carrier of Trypanosoma brucei 

rhodesiense (tri-PAN-o-SO-ma BREW-see-eye rho-DEE-see-ense) 3 , this 

harmless looking fly can inflict pain and discomfort beyond belief. 

The parasite carried by the tsetse fly manifest in its host as a disorder 

aptly named African trypanosomisasis, more commonly known as 

African Sleeping Sickness. There are two types of African 

Trypanosomiasis, each named for the region of Africa in which they are 

found. The variety found in Central and East Africa is called Rhodesian 

and the Central and West African variety is Gambian. There are slight 

variations in the two versions, I will address the Rhodesian variety with 

occasional comparison to the Gambian version. 

Across the globe, there are approximately 40,000 new cases of both 

East and West African trypanosomiasis reported to the World Health 

Organization 3 each year. It is believed that the majority of cases are not 

reported due to a lack of infrastructure and there are more than 100,000 

new cases annually (CDC website). Since 1967, twenty-one cases of African 

trypanosomiasis have been reported within the United States, mainly from 

holiday makers to the area of Africa in which the tsetse is indigenous 3 . 

The tsetse fly, common only to Africa, is able to bite through thin 

clothing. The fly is attracted to bright colours and dust created by moving 

vehicles and wild animals. They are less active during the hottest 

part of the day and often rest in bushes but they will bite during this time 

if disturbed. Infection transmitted by the tsetse fly is common in parts of 

eastern and central Africa, including Uganda, Kenya, Tanzania, Malawi, 

Ethiopia, Zaire, Zimbabwe, and Botswana 1 . 

The bite of the tsetse fly is often painful and may develop into a red sore 

that is called a chancre (SHAN-ker) 3 . The infected person may develop fever, 

severe headaches, irritability, extreme fatigue, swollen lymph nodes and 

aching muscles and joints 2 . Some may also develop a skin rash. As symptoms 

progress the victim will become confused and exhibit personality changes and 

is often accompanied by slurred speech, seizures, and difficulty in walking and 

talking. As a general rule these symptoms are a sign that infection has invaded 

the central nervous system. If untreated, symptoms will exacerbate and 

death will occur within six months 2 . The Gambian version of this illness could 

take up to two years before symptoms develop as it is less aggressive. 

Symptoms will present within one to four weeks after exposure. The 

illness develops in two stages. Stage one usually manifests two to three 

weeks after the redness and swelling occur. This develops as the parasite 

is carried through the blood and lymph circulation of the host. This 

systemic phase of the illness is characterised by a fever that spikes high, 

falls to normal, then respikes. An itchy rash may be present at this point, 

along with headache and mental confusion. The Gambian form will include 

swelling of the lymph tissue with enlargement of both the spleen and liver. 

During this stage there may be an inflammatory reaction of the heart 2 . 

Stage two of the illness involves the nervous system. The patient begins 

to experience slurred speech and impaired mental processes. He or she will 

often sit and stare for extended periods of 

time, or simply sleep 3 . Those inflicted with the 

Gambian version may complain of drowsiness 

during the day and bouts of insomnia at 

night. Some symptoms resemble Parkinson’s 

Disease, including shuffling gait, unsteady 

walking, trembling of the limbs, involuntary 

muscle movements, and increasing mental 

confusion. If untreated these symptoms will 

progress and eventually are followed by coma 

and ultimately death 1 . 

In order to properly diagnose this disease 

series of laboratory tests and a Wayne Peacock 

spinal tap are needed. Blood smears will 

generally demonstrate motile trypanosomes in the blood and a spinal tap 

will demonstrate the same in the cerebrospinal fluid 3 . Laboratory testing 

will show low red blood cell count, elevated globulin levels, low albumin 

levels and an elevated ESR 3 . Treatment is available through the CDC and 

hospitalisation is required due to the fact that the medications required 

to combat the parasite all have significant potential side effects for the 

patient. Suramin, eflornithine, pentamidine, and several asenic containing 

drugs are all effective anti-trypanosomal agents 3 . 

Once treatment is complete the victim will need follow-up for two 

years with routine spinal taps to ensure the parasite has been successfully 

eliminated. There are currently no vaccines for this parasite and the 

immune system is not capable of building up a resistance once you have 

been infected. The most effective way to avoid this deadly parasite is prevention 

and precaution when travelling to the regions mentioned above. 

To protect against tsetse fly bites, the CDC recommends wearing 

thick, khaki or olive coloured clothing, using a bed netting when sleeping, 

insect repellent (this has not proven effective against the tsetse fly, but will 

help avoid other bites and infections), inspecting vehicles for tsetse flies 

before entering, not riding on the back of pick-up style trucks or in open 

jeeps, and avoiding bushes. Those at highest risk for contracting East 

African trypanosomiasis are tourists, hunters, game wardens, and other 

persons working or visiting game parks in East and Central Africa 3 . ★ 

References 

1. McGovern TW, William W, Fitzpatrick JE, et al. Cutaneous manifestations of African trypanosomiasis. 

Arch Dermatol 1995;131:1178-82. 

2. Bryan R, Waskin J, Richards F, et al. African trypanosomiasis in American travelers: a 20- 

year review. Travel Medicine. Steffen R, Lobel HO, Haworth J, Bradley DJ, eds. Berlin: 

Springer-Verlag, 1989:384-8. 

3. Internet Resource http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/factsht_ea_trypanosomiasis.htm. 

Accessed 12 September 2005. 

4. Internet Resource http://www.healthatoz.com/healthatoz/Atoz/ency/sleeping_sickness.jsp. 

Accessed 19 Septmber 2005. 

5. Internet Resource http://www.nlm.nih.gov/medlineplus/ency/article/001362.htm. 

Accessed 01 October 2005. 


Wayne Peacock, RPSGT has been living and working in the United Kingdom since October 

2001. He is an active member of the British Sleep Society and serves as the Coordinator 

for the Pediatric Special Interest Group. Peacock recently joined the Respironics UK team as 

a Business Manager for Sleep and Home Care Products in the South East of England. He 

was also a key member in the discussions for implementing the Board of Registered 

Polysomnographic Technologists registry examination in the UK. 

17

The APT wishes to acknowledge and 

thank the following organizations 

for their generous support and 

investing in the future of the Sleep 

Technology Profession by becoming 

APT Supporter Members: 

Pro-Tech Services Respironics Sleepmate 

DeVilbiss 

Cadwell Laboratories

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The 6th Annual Focus Conference 

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Over 2,500 Respiratory & Sleep Medicine professionals attended and most 

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APT Awards Presented in Salt Lake City 

The Association of Polysomnographic Technologists (APT) 2006 

Awards were presented at its annual meeting in June in Salt Lake 

City, Utah. The following recipients were nominated by the APT 

Membership and were bestowed APT’s highest honors. The APT congratulates 

these individuals and is grateful for their years of service to the field. 

Dr. Elliot D. Weitzman Award 

2006 Recipient: Rita Brooks 

Rita Brooks, RPSGT, is the administrative director 

of neurophysiology and the sleep centers at Capital 

Health System (CHS). She is the past president of the 

New Jersey Association of Sleep Technologists 

(NJAST), and during her term led efforts to pass legislation 

to independently license polysomnographic 

technologists, making New Jersey the second state in the nation to achieve 

this accomplishment. Throughout her career in the sleep profession, she has 

provided training and educational programs for sleep and END. She has published 

several articles, and authored a certificate program in PSG for 

California College of Health Sciences, which is currently in process of being 

updated to meet standards for education in PSG. Brooks received an undergraduate 

degree in business administration in 2005, and is currently enrolled 

in a master of adult education program at Penn State University. 

Established in 1984, the Elliot D. Weitzman Award recognizes individuals 

who have made significant contributions to the growth and development 

of the polysomnographic technology profession. This award is 

sponsored by Nihon Khoden America, Inc. 

Peter A. McGregor Award 

2006 Recipient: Ramon Paquette, RPSGT 

Ramon Paquette, RPSGT, currently owns and 

operates two independent sleep disorders centers. 

His accomplishments include playing a key role in 

the formation of the New England 

Polysomnographic Society (NEPS), subsequently 

served as the charter president during its initial 

inception and growth. His legislative work was crucial 

to establishing the first completely exclusionary 

exception to the respiratory licensure law, which allows both seasoned technologists 

and all levels of trainees in the state to practice their vocation. 

Established in 1995, the Peter A. McGregor Award recognizes outstanding 

contributions to the professional growth of the APT. McGregor 

was instrumental in forming the APT in 1978, and his vision and leadership 

has left an indelible mark on both the organization and field. 

Sharon A. Keenan Award 

2006 Recipient: Karen Y. Allen 

Karen Y. Allen, CRT, RPSGT, is a clinical technologist 

and education coordinator at the sleep center 

at St. Vincent Healthcare in Billings, Montana. She 

has published articles in the A2Zzz Magazine, posted 

clinical protocols on APTWeb, and served on various 

APT committees as well as director at large in 

1997 and 1998. Allen has been an active member 

of the organization since starting her career in Sleep 

20 

Technology in 1992. She strives to increase awareness of sleep/wake disorders 

through presentations to the medical and public communities. 

Established in 2002, the Sharon A. Keenan Award recognizes outstanding 

efforts for advancing education in Sleep Technology. A pioneer 

in training, education and professional development for sleep technologists, 

Dr. Keenan served as APT president from 1983 to 1991. During 

this time, the APT made marked advancements in membership and 

stature. This award is sponsored by Sleepmate Technologies. 

Allen DeVilbiss Literary Award 

2006 Recipient: Kimberly Trotter 

Kimberly Trotter, MA, RPSGT, is the administrative 

director of the University of California at San 

Francisco’s Sleep Disorders Center. She also serves 

as a faculty member at The School of Sleep 

Medicine. She is a member of the APT Education 

Committee, associate editor of the A2Zzz Magazine, 

and section editor and author of the APT textbook 

project. Throughout her career, Trotter has published 

and presented sleep research; developed and taught classes on sleep 

disorders for techs; coordinated support groups for sleep apnea sufferers; 

presented educational talks to the public and written numerous articles on 

sleep. Trotter began her career in the field of sleep while completing a master’s 

degree in psychology with an emphasis in behavioral sleep research. 

Established in 2002 through an endowment from DeVilbiss, a division 

of Sunrise Medical, Inc., the Allen DeVilbiss Literary Award is presented 

annually in recognition of an original article published in A2Zzz 

Magazine deemed to represent literary excellence. A practicing physician, 

Dr. DeVilbiss was responsible for several medical device innovations. 

After retirement, he established DeVilbiss Manufacturing 

Company, which has developed and produced medical products important 

to the treatment of patients with sleep disorders. This award is 

sponsored by DeVilbiss, a division of Sunrise Medical, Inc. 

German Nino-Murcia Scholarship Award 

2006 Recipient Jeff Rowden 

Jeff Rowden, RPSGT is the lead scoring technologist 

at the Sleep Disorders Center at Washington 

Regional Medical Center in Fayetteville, Arkansas. 

The Sleep Disorders Center at Washington Regional 

is a six-bed accredited sleep disorder center, and 

Rowden has been at the center for almost three 

years. Throughout his career, he has helped establish 

the training program at the Sleep Disorders 

Center at Washington Regional, and has been a significant resource to fellow 

technologists, technicians and trainees. Rowden is an active member of 

the Association of Polysomnographic Technologists. 

The German Nino-Murcia Scholarship Award was established in 1997 

to assist an APT member who recently has successfully completed the 

BRPT comprehensive registry examination and who has displayed excellence 

in technical performance and patient care. Nino-Murcia, who was a 

leading researcher in sleep medicine, had long championed education for 

sleep technologists, and had continually demonstrated his commitment to 

the sleep field and APT. This award is sponsored by Respironics, Inc. ★


1 2 3 

4 

6 

APT 2006 ANNUAL MEETING 

Pictured are: 1. Tim Fields, Neurology Sales, Nihon 

Kohden America & Rita Brooks; 2. Cynthia Mattice, 

APT President, & Lori Kaufman, Cadwell 

Laboratories Inc., APT Supporter Member; 

3. Outgoing APT Board Members Rose Ann 

Zumstein, Todd Smeltzer & Theresa Shumard; 

4. Supporter Member, Respironics Inc. — Lori 

Speyrer, US Field Marketing Specialist, Mark 

D’Angelo, VP & General Manager Sleep Therapy, 

Don Spence, President Sleep & Home Respiratory 

Group, Cynthia Mattice, David White, M.D. Chief 

Medical Officer, & Joyce Black, Sales Training. 

5. Cynthia Mattice & Theresa Shumard, Manager 

Planning, Education, & Clinical Services, DeVilbiss, 

Sunrise Medical, APT Supporter Member; 6. Todd 

Smeltzer, Mark D’Angelo, David White, MD, & Don 

Spence; 7. Sheila P. Walters, Sleepmate (APT 

Supporter Member), VP Finance & Operations & 

Karen Allen; 8. Don Spence & Jeff Rowden; 

9: Robert D. Hoover, Jr., MD, SVP Global Clinical 

Services, DeVilbiss, Sunrise Medical & Kimberly 

Trotter; 10. Cynthia Mattice & Ramon Paquette; 

11. The APT Board of Directors; 12. Incoming APT 

Board Members Will Eckhardt, Kristine Bresnehan 

Servidio, Terrie Eubanks & Debbie Akers; 13. Jon 

Atkinson, APT President Elect & Cynthia Mattice. 

5 

7 

8 9 10 

11 12 13 

21


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continued from page 16 

3. Culebras, A. Clinical Handbook of Sleep Disorders. 1996 Butterworth-Heinemann. 

Boston. (2) 46-48, (13) 405-406. 

4. Brain Stories: Immune Responses to Sleep. University of Texas at Austin. 

http://utopia.utexas.edu/project/brainwaves/stories/immune.html 

5. Aging and Immune System. 2006 Anti Aging Research Lab. http://www.antiagingresearch.com/immune_system.shtml 

6. How Sleep Changes. 2006 National Sleep Foundation. 

http://www.sleepfoundation.org/hottopics/index.php?secid=12&id=183 

7. Van Cauter, E., Leproult, R., Plat, L. Age-Related Changes in Slow Wave Sleep and REM 

Sleep and Relationship with Growth Hormone and Cortisol Levels in Healthy Men. JAMA 

2000. 284:861-868. 

8. Feinberg, I. The ontogenesis of human sleep and the relationship of sleep variables to 

intellectual function in the aged. Comp Psychiatry 1968; 9 : 138. 

9. Parker DC, et al: Rhythmicities in human growth hormone concentration in plasma. 

Kreiger ed. Endocrine Rhythms. 1979 Raven Press. New York. 143-173 

10. Castells S, et al. Growth hormone deficiency in Down Syndrome Children. J Intellect 

Disabil res. 1992 feb. vol 36 1 29-43. 

11. Parker DC, Rossman LG. Physiology of human growth hormone release in sleep. 

Endocrinology. 1973. Amsterdam. 655-660 

12. Ferri, R, et al. Sleep Neurophysiopathology in Down Syndrome. Presented at 6th 

World Congress on Down Syndrome, Oct 1997 in Madrid Spain. http://www.altonweb.com/cs/downsyndrome/index.htm?page=ferri.html 

13. Grunstein, R., Stewart, D., Sullivan, C. Endocrine and metabolic disturbances in obstructive 

sleep apnea. Sleep, Hormones and Immunological System. 1992 111-122. 

14. Parker DC, Rossman LG. Sleep-wake cycle and human growth hormone, prolactin and 

luteinizing hormone. Advances in Human Growth Hormone Research. Washington, DC, 

U.S. Government Printing Office, 1974, pp 294-312 

15. Devillieres P, Opitz M, Clervoy P, Stephany J. Delusion and Sleep Deprivation. 

Encephale. 1996 May-Jun;22(3):229-31. 

16. Stanley Coren. Sleep Deprivation, Psychosis, and Other Mental Efficiency. 2006 CMP 

Healthcare Media Group. http://www.psychiatrictimes.com/p980301b.html 

17. Wirz-Justice, A Van den Hoofdakker, RH. Sleep Deprivation in Depression: What Do 

We Know, Where Do We Go? Biol Psychiatry. 1999 Aug 15;46(4):445-53. 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids= 

10459393&dopt=Abstract 

18. Giedke H, Schwarzler F. Therapeutic use of sleep deprivation in depression. Sleep Med 

Rev 2002 Oct;6(5):361-77 http://www.psycom.net/depression.central.sleepdep.html 

19. Alexandros Vgontzas, et al. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal 

and growth axes: potential clinical implications. Clinical 

Endocrinology, Volume 51 Issue 2 Page 205, August 1999) 

20. Daniel J. Gottlieb, et al. Association of Sleep Time With Diabetes Mellitus and Impaired 

Glucose Tolerance. Arch Intern Med. Vol. 165 No. 8 2005; 165: 863-867 

21. Lambert, C. Deep Into Sleep. Jul-Aug 2005 Harvard Mag. http://www.harvardmagazine.com/on-line/070587.html 

22. Sleep Deprivation: A Factor In Hypertension? Nature Clinical Practice Cardiovascular 

Medicine (2006) 3, 352 http://www.nature.com/ncpcardio/journal/v3/n7/full/ncpcardio0571.html 

23. JE Gangwisch, et al. Short sleep duration as a risk factor for hypertension: analyses of 

the first National Health and Nutrition Examination Survey. Hypertension 2006 May; 

47 (5) 833-9. Epub 2006 Apr 3. 

24. Leon Chaitow. Chronic Fatigue Syndrome & Fibromyalgia: The Brain/Sleep Connection. 

2006 ProHealth. http://www.fibromyalgiasupport.com/Fibromyalgia.cfm/id/5153 

25. Dauvilliers Y, Touchon J. Sleep in Fibrmyalgia: Review of Clinical and Polysomnographic 

Data. Neurophysiol Clin. 2001 Feb;31(1):18-33 

26. Arnold LM. Biology and Therapy of Fibromyalgia. New Therapies in Fibromyalgia. 

Arthritis Res Ther. 2006 Jun 1;8(4):212 

27. Sleep Deprivation. 9 July 2006. http://en.wikipedia.org/wiki/Sleep_deprivation 

About the Authors 

Edwin Cintron, RPSGT is an instructor of Polysomnography at Erwin Technical Center in 

Tampa, Florida and has been on the A2Zzz Magazine Editorial Board since 1998. Cintron 

continued on page 34 

22

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We were officially Medcare. We were also called Rembrandt… Somnologica… even Medicare. 

But that’s history. 

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New products, new organization, and a total focus on being close to our customers. 

Visit us at www.embla.com to see what’s new. 

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We’ve tamed the monster.

Technical Corner 


A2Zzz Technical Corner 

BY MARY JONES-PARKER, RRT, RPFT, RPSGT 

Part 1: Question 

I heard the term “EDF” mentioned at a recent sleep conference. 

What does “EDF” mean? 

Part 1: Answer 

Many sleep technologists, unless they are involved in data exchange 

between multi-site centers, (particularly in the research setting), are 

unaware that a number of software acquisition programs have a feature 

known as European Data Format (EDF). EDF is a simple formatting of 

data for the exchange of multiple biological signals. You may be surprised 

to learn that the idea of EDF was actually developed by European engineers 

during the 1987 International Sleep Congress in Copenhagen. In 

1990, these engineers were able to agree on the type of format, and in 

1992, EDF was published in the Journal of 

Electroencephalography and Clinical 

Neurophysiology; (volume 82, pages 391- 

393 if you wish to reference the document.) 

Since that time, EDF has become the “gold 

standard” for Electroneurodiagnostic (EEG) 

and polysomnographic (PSG) recordings in 

multi-center research projects and commercial 

equipment. 

One of the drawbacks to the original EDF 

program was that annotations were not 

transferable. Modifications were made, and 

in 2002, the new program released and 

aptly named EDF+. Changes to the original 

design allowed interrupted recordings, annotations, 

stimuli, and events to be included 

and transferred. 

The specifications for EDF+ are stricter 

than the original program so that calibration 

and automatic localization of the electrodes 

are now enabled. In 2003, EDF+ was published in Clinical 

Neurophysiology (volume 114, pp 1755-1761.) Since then, hundreds of 

EDF+ files and viewers became available on the Internet, and they are all 

free of charge. The following Web site offers the free downloads of files 

and software, the full specifications, lists of EDF+ compatible companies, 

and even list contacts in Yahoo’s EDF group: http://www.edfplus.info ★ 

References 

Internet Resource: http://www.cms.hhs.gov/clia/ Accessed July 8, 2006 

Internet Resource: Kemp, B . “European Data Format” 

http: //www.edfplus.info./ Accessed July 3, 2006 

Singh, P and Thornton, A. An Inter-laboratory proficiency testing program in South Austrailian 

sleep laboratories, 

(Abstract). APSS meeting, June 2005. 

The following is reprinted from A2Zzz Magazine Volume 13, Number 1 

(Spring 2006) 

Part 2: Question 

Tonic-clonic, or grand mal seizures are obviously easy to recognize. 

Can you explain what partial seizures are, and how to recognize them? 

Part 2: Answer 

Partial seizures originate in a localized 

area of the cerebral cortex, whereas 

generalized seizures do not have a 

local focus and are bilaterally symmetrical. 

The frontal, parietal, and temporal 

lobes are most frequently affected in 

partial seizures. 

Mary Jones-Parker 

Partial seizures may be further classified 

into three subgroups: partial seizures with elementary symptomatology, 

partial seizures with complex symptomatology, and partial 

seizures secondarily generalized. Partial seizures with elementary symptomatology 

may involve motor, sensory and autonomic signs and symptoms. 

Generally, there is no loss of consciousness 

with this type of seizure. 

In complex partial seizures, the onset may 

begin with a blank stare, unresponsiveness, 

or automatisms of nonpurposeful movements 

(lip smacking, fidgeting, or rubbing body parts 

of the body). There may be an impairment of 

consciousness although the individual usually 

retains an upright posture. It is important to 

keep in mind that partial seizures may 

progress to a secondary, generalized seizure. 

In partial seizures, the characteristic EEG 

abnormality is a spike or sharp wave that 

occurs locally. (Spike waves are defined as 

transient activity with a pointed peak and 

duration of 20-70 milliseconds. Sharp waves 

are also transient phenomena, with similar 

characteristics of a spike wave, but the duration 

is 70-200 milliseconds.) Most spike and 

sharp waves are followed by a slow wave. 

It is important to note that the onset of partial seizures during sleep 

occur most frequently during Stage II sleep. Furthermore, it has been 

documented in the literature, for more than 150 years, that there are 

peak periods of seizure activity during sleep (regardless of the type). Be 

aware that peak seizure activity occurs most often 1 to 2 hours after 

falling asleep and in the early morning, around 5 a.m. ★ 

Bibliography 

Dinner, Dudley S. “Effect of Sleep on Epilepsy.” Journal of Clinical Neurophysiology 19(6) 

2002: 505. 

Epilepsy Information, Living with Epilepsy, “Sleep and Epilepsy” 

Epilepsy Action 2004, January 16, 2004 http://www.epilepsy.org.uk/info/sleep.html 

Herman, ST, TS Walczak, and CW Bazil. “Distribution of Partial Seizures During the Sleep- 

Wake Cycle: Differences by Seizure Onset Site.” Neurology 2001;56 1453. 

The International Classification of Sleep Disorders, Revised, Diagnostic and Coding Manual. 

Rochester, MN: American Sleep Disorders Association, 1997. 

Markand, Omkar N. “Pearls. Perils, and Pitfalls in the Use of the Electroencephalogram.” 

Seminars in Neurology 2003; 23(1):7-46. 

Pallett, Phyllis J and Mary T. O’Brien. Textbook of Neurological Nursing. Boston: Little, Brown 

and Company, 1985. 

24


A.W.A.K.E. Official Talks About 

Life Before and After CPAP 


Almost all of the A.W.A.K.E. groups in the country today are run by 

wonderfully caring sleep techs. These groups would not survive without 

being nurtured and maintained by those of you who care enough about 

your patients to offer your time and effort so that you can help educate 

and support your patients. Yes, there may be some marketing benefit to 

your sleep center as well, with referrals from satisfied patients, but the 

gift of your knowledge and time is extremely important to those who 

attend the meetings. I’ve attended over 200 A.W.A.K.E. meetings in my 

apnea life, and I don’t think I’ve ever been at a meeting where at least 

one patient didn’t say that they had learned something new or learned 

something that would help them use their CPAP better or that they 

began to understand sleep apnea and its impact on their lives. 

A.W.A.K.E. groups are great for the patients, but they are also 

great for the coordinators who run the groups! The sense of self-satisfaction 

you gain from helping your patients cannot be ignored. An educated 

patient is often the most compliant patient and is a patient who 

can enjoy life because his or her apnea is treated effectively. You current 

A.W.A.K.E. group coordinators can be really proud of the work that you 

have done and continue to do! 

But we need MORE groups around the country. There are lots of 

patients who don’t have any groups at all near them. Chicago has a number 

of suburban groups, for example, but none actively meeting downtown. 

Other major metropolitan areas have no groups at all. There is no group 

Committee on Accreditation for 

Polysomnographic Technology 

Education (CoA PSG) 

Is your Polysomnographic Technology 

Training Program accredited? The CoA 

PSG is now accepting applications for 

accreditation from allied health education 

programs. 

CoA PSG accreditation is the gold standard 

for Sleep Technology educational 

programs and has several benefits: 

• Access to formal and standardized 

educational resources 

• Recognition of your program’s quality 

curriculum and instruction 

• Recognition by the Commission on Accreditation of Allied Health 

Education Programs (CAAHEP) 

• Prepares your students for the national credentialing examination 

• Recognition by professional societies, including the American 

Academy of Sleep Medicine, Association of Polysomnographic 

Technologists and Board of Registered Polysomnographic 

Technologists 

Visit www.caahep.org/accredit.aspx?ID=obtainCredit for information 

on the accreditation standards and guidelines or contact Dr. Richard 

Rosenberg at (708) 492-0930 for more information. 

in New York City or on Long Island, for example. And yet we have some 

smaller areas where there are multiple groups. The coverage is uneven. 

We really need more sleep techs to step up to the challenge — work with 

us at the ASAA to start up a new A.W.A.K.E. group at YOUR facility. Talk 

to your physicians and your managers and make it a goal of the facility to 

start a support group. Then make it successful and keep it going! 

You can learn more about starting an A.W.A.K.E. group by visiting the 

ASAA website at http:/./www.sleepapnea.org/awake. Be sure to visit 

http://www.sleepapnea.org/awake/potent.html for information on planning 

and starting up a group. We offer a set of guidelines for running a 

group; cost is $30 (to cover expenses of production) or if your facility joins 

the ASAA at a $100 professional membership level, the guidelines are free. 

Once you sign a Statement of Understanding that you will abide by the guidelines, 

we’ll charter your group and list it on the ASAA website. Groups determine 

their own meeting frequency, as well as their program topics, and do 

your own mailings to your own database of patients. The ASAA makes 

patient education materials available for distribution to your patients and we 

hope that A.W.A.K.E. group members will become members of the ASAA. 

Each year at the annual APSS/Sleep/APT meeting we offer an 

A.W.A.K.E. coordinator’s meeting, where existing coordinators and 

those interested in starting a group can get together to discuss issues 

and success stories. We are also planning a regional meeting of 

A.W.A.K.E. coordinators in Minneapolis at the end of October as part of 

a patient conference on sleep issues. 

If you are interested in starting a group, you can also write to me at 

chairman@sleepapnea.org. I’ll be happy to correspond with you or to set 

up a time where we can talk over the phone about the joys (and the 

occasional pains!) of running an A.W.A.K.E. group. I know how much the 

patients enjoy the A.W.A.K.E. meetings. I know how much our existing 

coordinators enjoy helping their patients. You, too, can get involved and 

share in the work and the satisfaction of operating an A.W.A.K.E. group. 

I hope that the ASAA, and I, personally, will hear from many of you 

who want to start up an A.W.A.K.E. group in your neighborhood. Your 

patients are waiting! ★ 

Sleep Disorder Technologists 

University Services 

Sleep Diagnostic & Treatment Centers 

Locations in PA & NJ 

Lansdale, NE & South Phila, Pottstown, Warrington, West Chester, PA & Voorhees NJ 

Full/ Part-time positions available. Qualified individuals should 

be experienced in routine PSG testing, CPAP and BIPAP 

titrations and nocturnal seizure testing. Opportunities for further 

growth and development exist for motivated individuals. Send 

resume to (610) 344-7922,employment@uservices.com. 

Or call (610) 344-9921 for further information. 

Multiple locations, good working environment, competitive pay. 

www.uservices.com 

25


HIPAA Compliance in the Sleep Lab 

BY JAYME R. MATCHINSKI, ESQ. 

The Health Insurance Portability and Accountability Act of 1996 

(HIPAA) has impacted sleep labs and how labs provide services to 

patients. HIPAA has also changed how sleep labs do business. While the 

HIPAA privacy rules have been in effect for over three years and the 

HIPAA security regulations became effective last year, sleep labs should 

continue to monitor and maintain their compliance with the HIPAA privacy 

and security regulations in order to safeguard patient information 

and reduce liability exposure. This column will provide an overview of the 

HIPAA regulations and focus on the key issues sleep labs should consider 

regarding compliance issues and business associate agreements. 

HIPAA Privacy and Security Regulations 

HIPAA creates national standards to protect individual’s protected 

health information (PHI) and gives patients increased access to their 

medical record. Sleep labs should also check state regulations because 

many states have regulations regarding 

confidentiality and medical records which 

are similar to the HIPAA regulations and in 

some states more encompassing. The 

HIPAA regulations set forth mandatory 

standards for transaction and code sets, 

security, and privacy. The HIPAA privacy 

rule requires mandatory compliance by a 

“covered entity” which is a health care 

provider, health plan, and health care 

clearinghouse that transmits health information 

in electronic form with one or more 

transactions which the Centers for 

Medicare & Medicaid Services (CMS) has 

adopted standards. HIPAA impacts how 

sleep labs use and disclose patient information 

to third parties. The HIPAA security 

regulations address the use and disclosure 

of electronic protected health information 

via the Internet. 

If your sleep lab is treating Medicare 

patients and transmitting PHI electronically 

via the Internet, make sure your lab has 

implemented the following policies and procedures: 

• Sleep labs are also required to 

enter into written agreements with 

their business associates containing 

specific provisions as required 

by the HIPAA privacy and security 

regulations. 

The HIPAA regulations impose stiff 

criminal and civil penalties for non-compliance. 

For civil violations of the HIPAA 

Jayme R. Matchinski, Esq. 

standards, the Office for Civil Rights, a 

division of the Department of Health and Human Services which administers 

and enforces the HIPAA regulations, may impose monetary 

penalties up to $100 per violation to a $25,000 cap per year for multiple 

violations of the same provision or a $25,000 cap can be applied 

for each multiple violation of each provision. 

Criminal penalties can range up to 

$50,000, imprisonment for up to one 

year or both. Criminal penalties for an 

offense committed under false pretenses 

may be up to a $100,000 fine, imprisonment 

for up to 5 years or both. Penalties 

for an offense committed with the intent 

to sell, transfer, or use for commercial 

advantage, personal gain or malicious 

harm may be up to $250,000 fine, 

imprisonment of up to 10 years, or both. 

Business Associate 

Agreements 

HIPAA requires sleep labs to have written 

business associate agreements with 

vendors, outside entities, and individuals 

who provide services to the lab and have 

access to the lab’s PHI. Sleep labs should 

make sure that their business associate 

agreements specifically provide that these 

business associates do not release any 

PHI to a third party without authorization 

or in violation of the HIPAA privacy and 

security regulations. 

26 

• Patients who receive treatment from 

the sleep lab must give specific written 

authorization before the use or disclosure of PHI for any purpose 

other than treatment, payment or health care operations. 

• Patients must receive written notice of the sleep lab’s privacy practices 

and patient privacy rights, and the sleep lab should obtain 

each patient’s written acknowledgment of his or her receipt of the 

privacy notice. 

• Patients have greater access to their medical records and can 

request changes to correct any errors. Patients can also request 

an accounting of the uses and disclosures of their health information 

by sleep labs. 

The threshold question that sleep 

labs should ask is: What is the lab’s 

exposure in relation to the actions or omissions of the lab’s business 

associate? The Sleep lab’s exposure has been difficult to assess due 

to the lack of regulatory guidelines and clarification. However, last 

year the Department of Health and Human Services published proposed 

regulations to complete the HIPAA enforcement rule. These 

regulations address a covered entity’s liability (sleep lab’s liability) in 

relation to the actions or inactions of their business associate. The 

proposed rule indicates that shared liability between a sleep lab and 

its business associate is unlikely if the sleep lab followed all of the 

requirements of the HIPAA regulations which include executed 

agreements with business associates to safeguard PHI and due dili- 

➟


gence by the lab to oversee and ensure that such protections are 

carried out. 

If your sleep lab has signed business associate agreements with 

technology vendors, consultants, accountants, lawyers, or any other 

entity or individual who needs to have access to your patients’ PHI in 

order to provide your lab with the services required, your lab should 

revisit these agreements in light of the HIPAA security regulations. If 

your lab’s business associate agreement involves access to or transmission 

of electronic PHI, the agreement should include how risk assessment 

will be conducted by the business associate to identify system vulnerabilities. 

The business associate should also have its own security 

policies and procedures. 

When reviewing your sleep lab’s business associate agreements, 

you should avoid the following pitfalls: 

• Limitation of Liability. Business associate agreements are often 

attached as addendums to underlying agreements that might predate 

the HIPAA regulations. Make sure that your business associate 

does not limit their liability under the terms of the main contract 

or any subsequent addendums. Your sleep lab should specifically 

look at the terms that relate to limitation of liability, insurance, 

and indemnification. 

• Monitoring the Activities of Business Associates. It is imperative 

that sleep labs take steps to monitor and oversee all services 

being provided by their business associates. Include provisions 

in your business associate agreements which give your lab 

the right to request and receive information and documents from 

your business associates that will enable the lab to monitor 

HIPAA compliance. 

• Evidence of Safeguards. Your lab’s business associate agreements 

should contain terms to ensure that your associates agree 

not to use or disclose your patients’ PHI or electronic PHI in any 

way other than is permitted by the agreement or as required by 

law. Make sure that the agreement requires your business associate 

to provide your lab with evidence of safeguards and written 

notice if any of these safeguards are breached or discontinued. 

HIPAA Compliance 

In order to avoid potential liability and resulting civil and criminal monetary 

penalties, make sure that your sleep lab continues to allocate the 

appropriate resources to monitor and maintain compliance with the 

HIPAA privacy and security regulations. Your lab should continually provide 

education and training for all of its employees and independent contractors. 

The sleep lab’s privacy officer should periodically conduct an 

assessment of the technical, security, and privacy measures and identify 

all authorized users of PHI and electronic PHI to determine appropriateness 

of all authorized user’s access to PHI. Make sure that the lab’s 

compliance with its policies and procedures, notice of privacy practices, 

and business associate agreements are monitored and reviewed on an 

ongoing basis. ★ 


Jayme R. Matchinski, a partner with the law firm of Harris Kessler & Goldstein LLC, in 

Chicago, concentrates on health care law and has counseled sleep disorder centers, physicians, 

and health care providers nationally. She serves on the Special Projects Team of the 

A2Zzz Magazine Editorial Board. She can be reached at (312) 280-0111 and jmatchinski@hkgold.com. 

Cardiac Pacing and Sleep- 

Disordered Breathing 


taneous rhythm to an average of 11 events/hour when 

the subject was in pacing mode. From these results, they 

concluded that artificial pacemaker implantation could 

significantly reduce the apneic episodes. 

However, pacemaker implantation does not always improve 

sleep-disordered breathing. Simantirakis et al. 4 compared the 

effect of continuous positive airway pressure (CPAP) vs. artificial 

cardiac pacing in 16 patients with sleep apnea. The patients on 

CPAP therapy had a significant decrease in the number of events 

while the patients on artificial pacing had little change in the number 

of events. Pepin et al. 5 similarly found that artificial pacing did 

not decrease the number of obstructive sleep apnea episodes in 

their subjects. Their subjects had an average of 46 respiratory 

events/hour with the heart in spontaneous rhythm and an average 

of 50 respiratory events/hour with cardiac pacing. 

Nevertheless, scientists are still intrigued by the potential use 

of cardiac pacing to treat sleep-disordered breathing. They are currently 

working to determine which patients with sleep-disordered 

breathing will most benefit from cardiac pacing. For example, more 

studies may reveal whether cardiac pacing would be more beneficial 

for someone who would normally not meet the criteria for pacemaker 

implantation but who has a certain type of sleep-disordered 

breathing (e.g., central apnea or Cheyne-Stokes breathing versus 

OSA). If a person does meet the criteria for pacemaker implantation, 

future studies may reveal whether implanting a pacemaker for 

certain types of cardiac arrhythmias is more likely to reduce sleepdisordered 

breathing. Once this is fully determined, cardiac pacing 

for sleep-disordered breathing may be useful in preventing not only 

symptoms of disordered breathing but also associated disorders 

(e.g., hypertension, stroke, etc.). ★ 

References 

1. Garrigue S, Bordier P, Barold SS, Clementy J, “Sleep apnea: a new indication for 

cardiac pacing?”; Pacing and Clinical Electrophysiology; 27(2):204-211, Feb 2004. 

2. Ogata N, Takatori H, Kamijima J, Tatsumi K, Kuriyama T, “A case of Pickwickian syndrome 

treated by implantation of a cardiac permanent pacemaker,” Kokyu to 

Junkan. 1989 Jul;37(7):791-795, 1989. 

3. Garrigue S, Bordier P, Jais P, et al., “Benefit of Atrial Pacing In Sleep Apnea 

Syndrome,” New England Journal of Medicine, 346(6):404-412, Feb 7, 2002. 

4. Simantirakis EN, Schiza SE, Chrysostomakis SI, et al., “Atrial overdrive pacing for 

the obstructive sleep apnea-hypopnea syndrome,” New England Journal of 

Medicine, 353(24):2568-2577, Dec 15, 2005. 

5. Pepin JL, Defaye P, Garrigue S, et al., “Overdrive atrial pacing does not improve 

obstructive sleep apnea syndrome,” European Respiratory Journal, 25(2):343- 

347, Feb 2005. 


Regina Patrick, RPSGT, is a noted freelance medical writer and sleep technologist that 

works at St. Vincent Mercy Sleep Disorders Center in Toledo, OH. She is a regular contributor 

and serves on the A2Zzz Magazine Editorial Board as an Associate Editor. She 

also contributes to other publications in the sleep field. Patrick is a past recipient of 

the APT Dr. Allen DeVilbiss Literary Award for literary excellence for articles published 

in A2Zzz Magazine. She may be contacted through the APT National Office at 

apt@aptweb.org. 

27

NewZzz Briefs 


VIASYS Healthcare Inc. 

Acquires Tiara Medical 

Systems, Inc. 

Acquisition Expands VIASYS’ Presence 

in Sleep Therapy 

CONSHOHOCKEN, PA — VIASYS Healthcare Inc. (NYSE:VAS) 

(“VIASYS”) and Tiara Medical Systems, Inc. (“Tiara Medical”) announced 

today that VIASYS has acquired Tiara Medical — a company focused in 

the sleep therapeutic market. 

Randy Thurman, Chairman, President and Chief Executive Officer, 

VIASYS Healthcare Inc., commented, “The acquisition of Tiara Medical 

reflects our commitment to expand our presence in the sleep therapy 

market. VIASYS is a leading global competitor in pulmonary, neurological 

and sleep diagnostics, as well as within the critical care segment. We 

believe that this acquisition positions us to compete effectively in this 

rapidly growing market segment by building on our existing product offering. 

In addition, we believe that our access to the decision makers in the 

sleep therapy market, our existing presence in this market, and our 

international sales and distribution capability will allow us to increase 

sales of the Tiara products.” 

Based in Oak Forest, Illinois, Tiara Medical designs, manufactures, 

markets, and sells Continuous Positive Airway Pressure (CPAP) masks, 

headgear, circuits, and filters. These products are complemented by a 

comprehensive product line of specialty filters and accessories for oxygen 

concentrators and mechanical ventilators. Tiara Medical offers 

home health care providers the convenience of a comprehensive range 

of products to meet the needs of patients receiving treatment for 

Obstructive Sleep Apnea (OSA) and other chronic respiratory diseases. 

Tiara Medical recently introduced The Advantage Series Full Face Mask 

and the Snapp-X Direct Nasal Interface. 

Ed Pulwer, Group President, VIASYS Respiratory Care, commented 

on the acquisition, “With the acquisition of Tiara Medical, VIASYS is 

increasing its presence in the global sleep therapy market. According to 

Frost and Sullivan, sleep therapy is the fastest growing market segment 

in the global respiratory market. VIASYS is already a market leader in 

the sleep diagnostics business, with well-established brands such as 

Jaeger and SENSORMEDICS ® . We believe that Tiara Medical’s expertise 

in CPAP and non-invasive ventilation mask design will enhance the 

VIASYS global product offering. We believe this acquisition is a key step 

following the establishment earlier this year of the VIASYS Sleep Division 

as a separate operating entity focused on this opportunity. Rebecca 

Mabry, General Manager, Sleep Diagnostics and Therapy, will be responsible 

for integrating this acquisition into VIASYS.” 

James Fitzsimmons, President and Chief Executive Officer, Tiara 

Medical, commented, “The combined product offering of VIASYS 

Healthcare and Tiara Medical will offer sleep diagnostics laboratories 

and home healthcare providers a variety of choices in the diagnosis and 

treatment of sleep disorders. We also expect that VIASYS’ global distribution 

and product support infrastructure will greatly enhance Tiara 

Medical’s ability to penetrate domestic and international markets for 

sleep diagnostic and therapeutic devices.” 

Under the terms of the acquisition agreement, VIASYS acquired all 

of the outstanding stock of Tiara Medical through one of its subsidiaries 

28 

for consideration of approximately $24.3 million. VIASYS financed the 

acquisition with cash and borrowings under its revolving credit facility. 

Tiara’s 2005 revenues were $10.3 million, and the company has grown 

approximately 15% compounded over the last three years. 

New Braebon Cannulas 

BRAEBON introduces its 

expanded line of top quality cannulas 

including: Nasal, Nasal + 

Oral, and ETCO 2 cannulas. 

These premium cannulas have 

been designed with unique features 

for today’s business of 

sleep. Available in multiple sizes 

and configurations, they also feature 

unbeatable pricing. If you 

are not buying BRAEBON cannulas you’re paying too much! Visit us at 

www.braebon.com or call 1-888-462-4841 for additional information. 

New Braebon Appliances 

BRAEBON proudly introduces 

the TheraSnore Boil & 

Bite Intra-Oral Appliance cleared 

by the US FDA for the treatment 

of snoring and sleep apnea. This 

mandibular advancement device 

comes in three sizes: small, 

medium, and large, and is entirely 

customizable in under 25 minutes. 

Offering both lateral movement 

and forward and backward 

adjustability, the TheraSnore 

offers immediate benefit the first time it is worn and is effective in up to 

93% of users. The TheraSnore will last from 12 to 24 monhts, but is 

also ideal for initial use while a more expensive custom appliance is being 

manufactured or for interim use during custom appliance repair. Available 

now for sale to physicians, dentists and sleep laboratories for $89. For 

more information contact Braebon Medical at 1-888-462-4841. 

New Pressure Sensor 

by SLP 

SLP, based in St. Charles, Illinois, just 

released a new pressure sensor in its 

SleepSense high-quality range of sleep lab sensors. 

The Esophageal Catheter Pressure 

Sensor (item #14837) was designed to 

monitor a wide range of air pressures in 

medical applications which are not life 

supporting, such as esophageal 

catheter or balloon and CPAP 

or Bilevel PAP. The output from the sensor allows the recording of pressure 

values onto a polygraph, EEG or similar types of physiological 

recorders. The sensor is powered by a medical grade, wall-mounted 

power supply or by a battery pack good for hundreds of hours of operation. 

It’s very small size and the absence of switches, lights or adjustments 

ensure ease-of-use and reliable performance for years. 

➟

NewZzz Briefs 


Highlights of the device include: Accurate, reliable, price includes 

medical power supply. Very simple to operate — no switches, lights, 

need to replace batteries. Very small and unobtrusive — as small as an 

AC pressure sensor. Variety of output configurations to match the system. 

For more details, please visit: www.sleepsense.com. 

New Wireless Device for 

Detecting Reflux Displayed 

at Annual Meeting 

SALT LAKE CITY, UT — Deirdre Stewart, Ph.D., presented information 

to a crowded audience on a new patient-friendly device for detecting 

gastric reflux in the airway and its application in sleep medicine at the 

Association of Polysomnographic Technologists meeting, which ran concurrently 

with the SLEEP 2006 Associated Professional Sleep Societies 

(APSS) event, June 17-22, 2006. 

Dr. Stewart is Vice President 

of Clinical Affairs at Restech, the 

designer and manufacturer of the 

Dx-pH Measurement System , 

which detects aerosolized upperairway 

reflux, known as laryngopharyngeal 

reflux (LPR). 

“The miniature 1.5mm diameter 

catheter,” Stewart explains, Restech’s Dx-pH Measurement System 

“is placed trans-nasally and is 

positioned behind the soft palate.” This positioning is revolutionary in that 

patients are now exempt from larger catheters stretching uncomfortably 

to their lower esophagus. 

The Restech “plug & play” Dx-Sleep Adapter accessory, released 

February 2006, allows sleep medicine professionals to track patients’ 

airway pH events in real-time on their existing monitoring equipment. 

The system can be easily set up in a sleep clinic or physician’s office. 

Since the device transfers data using wireless telemetry, there are no 

extra leads from the patient. 

Ross Tsukashima, Director of Product Development at Restech, 

rounded out the discussion with his expertise in physiologic pH measurement. 

Tsukashima has authored nine patents and was awarded a 

2002 Silver Medal in Business Week’s “Industrial Design Excellence 

Awards” for the Medtronic Bravo pH monitoring system. His final comment 

defined the Restech advantage, “This pH monitoring system will 

break down existing barriers in performing pH monitoring that allows 

greater acceptance by physicians and their patients.” 

Coupled with Dr. Gregory Wiener’s presentation last month at the international 

Digestive Disease Week (DDW) meeting, Restech is rounding the 

bases on the medical conference circuit, receiving promising reviews from 

physicians. Donald Castell, M.D., another pioneer in pharyngeal pH testing, 

praised the makers of the Dx-pH Measurement System saying, “I would like 

to thank Restech very much for bringing this technology to our attention.” 

Restech is a privately held corporation specializing in the development 

of innovative medical devices. For more information on the Dx-pH 

Measurement System, call Debra Krahel or Wal Flicker at (800) 352- 

1512 or visit http://www.restech-corp.com. 

Tactilus: A Dream Come 

True for Sleep Disorder 

Research 

Tactile Surface Pressure Monitoring 

Sensor Pad Is a Revolution in 

Actigraphy Monitoring 

Madison, NJ — Sensor Products LLC introduces Tactilus ® , a breakthrough 

in actigraphy monitoring. Tactilus ® body mapping sensor technology 

captures, maps and records body movement, across a mattress 

surface, while a patient sleeps. Actigraphy monitoring equipment currently 

used by sleep clinics worldwide, which must be physically attached 

to a patient, can be bulky and uncomfortable, and can alter or impede 

the results of a sleep study. The Tactilus ® sensor element is a thin, flexible 

mat that discreetly lies beneath a bed sheet, which virtually eliminates 

the need to affix adhesive-backed sensors and obtrusive wires to 

a patient’s skin. 

Distributed throughout 

the Tactilus ® sensor 

mat are small pressure 

sensing points that create 

a matrix large enough 

to map a patient’s entire 

body. As a patient sleeps, 

Tactilus ® silently collects 

body movement data and 

instantly translates it into 

a movie that documents 

each tiny twitch or movement 

for the duration of a 

night’s sleep. This innovative 

technology is a revolutionary approach to diagnosing age-old sleep 

disorders such as restless leg syndrome, REM sleep behavior disorder 

and other parasomnias. The Tactilus ® system is available in both a twin 

or queen size sensor pad, and includes an electronic hub and userfriendly, 

Windows-based software. Tactilus ® collects data at up to one 

frame per second over a 12-hour period and allows researchers to 

replay the entire file or a series of specified frames to closely observe 

events. This system enables detection and recording of even the most 

minute body movements that can be hidden from video cameras by blankets. 

The Tactilus sensor also has the ability to capture and record thermal 

data. Another benefit of Tactilus software is that it is modularly 

designed and can seamlessly be integrated into existing data collection 

and evaluation software packages. 

Tactilus ® systems are available for either lease or purchase. 

Demonstrations of this powerful system can be scheduled by contacting 

Sensor Products at 1.973.884.1755, info@sensorprod.com or by visiting 

www.sensorprod.com/tactilus. 

About Sensor Products LLC 

New Jersey-based Sensor Products LLC, established in 1990, is a world leader in the manufacture 

and distribution of tactile pressure sensing solutions. Their customized and off-theshelf 

products are installed within all of the Fortune 500 industrial companies as well as thousands 

of smaller manufacturing firms. Their sensors are used in applications as diverse as 

tire testing to semiconductor manufacturing and from R&D labs to space missions. Sensor 

Products also provides in-house and on-site stress and pressure mapping analysis, as well 

as a variety of regional technical seminars. Visit them at www.sensorprod.com. 

29


“GIGO” 

BY NOAM HADAS, MSC 

We were sitting for dinner the other day when my wife served 

what she called “A-stew”. I sensed some tension in her look 

when I transported some to my plate, but this was nothing compared to 

the disaster in my mouth the second I took the first bite. 

Several unpleasant minutes of coughing and two gallons of water 

later, I asked my wife, “What did you put in this stew?” But the answer 

came from Daria, our daughter. “GIGO,” she said. 

A look of pure guilt spread over my wife’s face as she described the 

ingredients, the freshest of which was a piece of turkey I was already 

suspicious about two days ago. 

“GIGO,” Daria said again, and to my wife’s surprised I started 

to laugh. 

GIGO, I explained, is “garbage in, garbage out”. The simple truth that 

no amount of processing can infuse value to what is already “garbage.” 

“You see,” I said, “It’s just like what some sleep techs do when hooking-up 

a patient.” (I work in sleep, so it’s natural for me to think up such 

examples). “They use low quality sensors that generate inaccurate signals, 

and loose electrodes that generate a lot of noise, and then trust 

their ‘top quality signal processing sleep system’ to provide a clean and 

accurate recording.” 

“Of course,” said my wife, much relieved that I so quickly forgot her 

recent “murder attempt” and landed on my favorite subject. “Any cook 

knows that quality is only as good as the weakest link, so what is the sense 

in buying top-notch sleep systems if you feed them garbage signals?” 

“Yes,” I said, “And you will never believe what some of them do, like 

counting 50 percent drops in ‘flow’ when looking at the output from a 

thermocouple, or measuring phase relationship between piezo-film effort 

belts signals. Please don’t make me say at home what I say to these people 

at work. And, by the way, what is A-stew?” 

“Ah” she said. “It stands for Anything-I-could-find-in-the-fridge stew. 

Some more, dear?” ★ 


Noam Hadas, MSc, holds his master’s 

degree in electronics engineering, with 

specialty in fiber-optic sensors. He has 

been involved as research and development 

manager of SLP, Ltd. since 

its formation in 1993, becoming 

CEO in 2002. Hadas is the 

developer and inventor of many 

of its products and is from Tel 

Aviv, Israel. 

Policy and Procedure Manual 

for Sleep Disorders Centers 

APT is proud to present a Policy and Procedure Manual for 

Sleep Disorders Centers. At the request of the APT Board of 

Directors, the Standards and Guidelines Committee created a 

reference manual to assist sleep disorders center personnel in 

the development of their own policy and procedure manual. 

This manual provides sample forms and policies, job 

descriptions and core competencies for the Sleep Technology 

Profession. The manual is intended to provide a standardized 

guideline in the development of a policy and procedure 

manual to quantify service and performance that ultimately 

delivers quality patient care. 

Order form page 31! 

30

Product Order Form 


Educational/Technical Order Form 

Educational Resources 

APT Review Course — 3rd Edition (Individual) 

Intense review preparing for the registry exam. Realtime video alongside an electronic presentation. 

Includes CD, booklet and review test to complete and return for 15.75 CEC credits. 1003 $325.00 $360.00 

APT Review Course — 3rd Edition (Institutional) 

Intense review preparing for the registry exam. Realtime video alongside an electronic presentation. 

Includes CD, booklet and five review tests to complete and return for 15.75 CEC credits per test. 1004 $895.00 $895.00 

Normal and Abnormal Record Flashcards 1020 $65.00 $85.00 

Registry Exam Flashcards 1021 $40.00 $55.00 

Technical References 

APT National Office 

One Westbrook Corporate Center, Suite 920 

Westchester, IL 60154 

Phone (708) 492-0796, Fax (708) 273-9344 

APT Policy and Procedure Manual 

A reference tool designed to assist sleep disorders center personnel in the development of their 

policy and procedure manual. This manual provides sample forms and policies, job descriptions 

and core competencies for the Sleep Technology Profession. 1140 $225.00 $260.00 

Filter Settings and Calibrations 

Technical article written by Edwin Cintron, RPSGT. 1110 $10.00 $15.00 

2003 Demographic, Salary & Educational Needs Survey 

Identifies PSG technologist practice environments, technologist characteristics, compensation, 

and education. 1120 $50.00 $85.00 

R&K Scoring Manual Technical Manual 

Written by A. Rechtschaffen and A. Kales. Includes standardized terminology, techniques and a 

scoring system for sleep stages. 1130 $60.00 $75.00 

Pediatric Manual of Standardized Terminology 

Current interest in infant sleep has made necessary a guide similar in scope to the R&K Scoring 

Manual, which applies only to adults. There has been a need for a common system for sleep scoring 

in the infant, as most researchers tend to employ diverse modifications of the adult scoring criteria. 1133 $60.00 $75.00 

Artifact & Troubleshooting Guide 1131 $25.00 $35.00 

“Sleeping on the Job” 

Answers basic questions on site location, design, setup, staffing and more. Offers resources for 

locating equipment and supplies and is highlighted by a sample Policy and Procedure manual 1132 $60.00 $75.00 

QUANTITY 

QUANTITY 

MEMBERS 

MEMBERS 

NON-MEMBERS 

NON-MEMBERS 

TOTAL 

TOTAL 

*Please note that the APT does not accept purchase orders or orders over the phone. Shipping and handling 

charges for orders over six items will be charged based on cost. Orders may be expedited via UPS 2-Day 

(where available) based on cost. International shipping is available through the United States Postal Service 

and charged based on cost. The APT accepts no responsibility for loss of product. 

Shipping and Handling* $13.00 

7.75% Sales Tax (IL residents only) 

Total 

Shipping & Payment Information 

Name: 

Shipping To: 

❑ Residential Address ❑ Commercial Address 

Member Number: 

Payment By: 

❑ Check (US bank only) ❑ Visa ❑ Mastercard ❑ American Express 

Address: 

Credit Card Number: 

City: State Zip 

Verification Code: 

Expiration: 

Phone Number: 

Rev. 8/06 

Signature: 

31

Product Order Form 


APT Promotional Item Order Form 




Phone (708) 492-0796, Fax (708) 273-9344 

APT Promotional Items 

QUANTITY 

MEMBERS 

NON-MEMBERS 

TOTAL 

APT Membership Pin 2001 $10.00 

Sleep Disorders Awareness Pin 

Show you care! Makes a great PSG Technologist Appreciation Week gift. 2003 $10.00 $15.00 

“Celestial Delectables” Cookbook 

Silver Anniversary cookbook. 2020 $25.00 $30.00 

“Guardian Sleep” Print (Signed) 

Limited edition series of 500 color prints (certificate included). 

The original painting was rendered in oil and mixed media. 2010S $40.00 $90.00 

“Guardian Sleep” Print (Unsigned) 2010 $35.00 $85.00 

“Sentries of the Night” Print 

Color print, measures approximately 8-1/2” x 11”. 2011 $8.00 $10.00 

APT Santa Flag 

Display holiday spirit in your sleep lab! Measures 24” X 36”, vibrant colors. While supplies last! 2021 $35.00 $45.00 

APT Apparel Items 

QUANTITY MEMBERS NON-MEMBERS 

APT Denim Shirt 

High-quality denim shirt featuring the APT logo. Available sizes: S / M / L / XL / XXL / XXXL 2120 $40.00 $45.00 

APT T-Shirt 

High-quality t-shirt featuring the APT logo. Available sizes: S / M / L / XL / XXL / XXXL 2130 $20.00 $25.00 

APT Sweatshirt 

High-quality sweatshirt featuring the APT logo. Available sizes: S / M / L / XL / XXL 2140 $35.00 $40.00 

TOTAL 

*Please note that the APT does not accept purchase orders or orders over the phone. Shipping and handling 

charges for orders over six items will be charged based on cost. Orders may be expedited via UPS 2-Day 

(where available) based on cost. International shipping is available through the United States Postal Service 

and charged based on cost. The APT accepts no responsibility for loss of product. 

Shipping and Handling* $13.00 

7.75% Sales Tax (IL residents only) 

Total 

Shipping & Payment Information 

Name: 

Shipping To: 

❑ Residential Address ❑ Commercial Address 

Member Number: 

Payment By: 

❑ Check (US bank only) ❑ Visa ❑ Mastercard ❑ American Express 

Address: 

Credit Card Number: 

City: State Zip 

Verification Code: 

Expiration: 

Phone Number: 

Signature: 

Rev. 8/06 

32

APT Membership Form 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

SleepLand Calendar 


8TH WORLD CONGRESS - SLEEP APNEA 2006, September 27- 

October 1, 2006, Montreal QC, Canada. www.wcsa2006.com. 

MONTANA REGIONAL SLEEP SEMINAR 2006, October 12-14, 

2006, at the Mansfield Health Education Center in Billings, Montana. 

For more information contact Karen Allen at karen.allen@svh-mt.org or 

call toll free 800-4 SNORES. 

APT FALL REVIEW COURSE, October 21-22, 2006, at the Hilton 

Indianapolis Hotel, Indianapolis, IN. For more information and registration 

visit www.aptweb.org. 

INAUGURAL PATIENT SLEEP CONFERENCE, October 27-29, 

2006, Minneapolis, MN. Hilton Minneapolis/St. Paul Airport Mall of 

America. First-of-its-kind gathering of patients and their families and 

sleep clinicians. Included are patient classes, and there will be clinical 

break-out sessions for Sleep Technologists. Sleep and respiratory CEUs 

will be awarded. Contact: tnasca@talkaboutsleep.com or call Tracy 

Nasca at (952) 358-7070 or visit www.talkaboutsleep.com. 

SPRING SLEEP SEMINAR, March 16-18, 2007, hosted by 

Washington Regional Medical Center Sleep Disorders Center, Kansas 

City Marriott Country Club Plaza, Kansas City, Missouri. For more information, 

contact Melinda Trimble at mtrimble@wregional.com or phone 

(479) 527-0178. 

WORLD FEDERATION OF SLEEP RESEARCH SOCIETIES WORLD 

CONGRESS 2007, September 1-8, 2007, Carins - QLD - Austrailia. 

www.wfsrsms.org. 

19TH CONGRESS OF THE EUROPEAN SLEEP RESEARCH SOCI- 

ETY, 2008, Glasgow, Scotland. www.esrs.org. 



4. 0 (zero) 

5. 5 (five) 

6. 50 (fifty) 

1. physical stature 

2. Bradycardia 

3. light 

was the recipient of the of the 2005 APT Sharon Keenan Award and was the first ever 

recipient of the APT Dr. Allen DeVilbiss Literary Award in 2002. 

“Slumber Tumbler” Answers 

from puzzle on page 36 

Kornelia Deneau, RPSGT has been working in the field of Polysomnography for seven 

years. She has had experience working in a trauma pediatric hospital setting, and has 

experience performing sleep studies on adults as well. She is currently the Clinical 

Coordinator at Good Shepherd Medical Center for Sleep Disorders in East Texas. 

They may be contacted through the APT National Office at apt@aptweb.org. 

34 

Show you care by 

wearing the new… 

Sleep Disorders 

Awareness Pin 

PRESENTED BY THE APT 

Order form page 32 

from puzzle on page 36 

Word Search Solution


2006-2007 APT 

Committee Roster 

COMMUNICATIONS COMMITTEE 

Kimberly Burns, Committee Louie Scalise 

Chair 

Erby Williams 

Kenneth Chapman 

Joanne Hebding, Board Liaison 

Chris Cook 

Cynthia D. Mattice, Ex-Officio 

J. L. Magee 

President 

EDUCATION COMMITTEE — CONTINUING EDUCATION CREDITS 

Melinda Trimble, Committee Ashwani Goyal 

Chair 

Kristine Bresnehan Servidio, 

W. Michael Chris, Vice Chair Board Liaison 

Cyndi Hampton 


Steven Lenik 

President 

EDUCATION COMMITTEE — EDUCATIONAL PRODUCTS 

Melinda Trimble, Committee David Wolfe 

Chair 

Kristine Bresnehan Servidio, 

Michael Delayo, Vice Chair 

Board Liaison 

Christine Magruder 


Terrance Malloy 

President 

E. Katrina Warren 

MEMBERSHIP COMMITTEE 

Jeffrey Smith, Committee Chair 

Joseph Anderson 

Iain Boyle 

Laree Fordyce 

Jane Hodges 

PROGRAM COMMITTEE 

Jeanette Robins, Committee 

Chair 

Jenny Jacobson 

Mary Jones-Parker 

Laura Linley 

Michael Rizzitiello 

Robert Evelyn 

Robert Monroe 

David Gregory, Board Liaison 


President 

Stephen Tarnoczy 

Kimberly Trotter 

Harry Whitmore 

Debbie Akers, Board Liaison 


President 

REGIONAL ACTIVITIES/GOVERNMENT AFFAIRS COMMITTEE 

Mary K Hobby, RRT, Committee Angela Neal, 

Chair 

Lori Speyrer 

Shawn Cole, Committee Vice Marilyn Swick, Board Liaison 

Chair 

Cynthia D. Mattice, MS, Ex- 

Charlotte Fromer 

Officio President 

Jennie Hall 

STANDARDS AND GUIDELINES COMMITTEE 

Tina Jenkins, Committee Chair Frank Walther 

Elise Franko, Committee Vice William Eckhardt, Board Liaison 

Chair 


Dennis Keene 

President 

Ginny Rueber 

2006-2007 APT 

Board of Directors 

EXECUTIVE COMMITTEE 

President: Cynthia Mattice 

President-Elect: Jon Atkinson 

Secretary: Cindy Kistner 

Treasurer: Bill Rivers 

APT Directory 

Contact Us 


Christopher Waring 

APT Coordinator 

One Westbrook Corporate Center 

Suite 920 


Phone 708-492-0796 

Fax 708-273-9344 

cwaring@aptweb.org 

25 Madison St. 

Shillington, PA 19607 

Phone 610-796-0788 

Fax 781-823-4787 

theresa.shumard@sunmed.com 

DIRECTORS-AT-LARGE 

Debbie Akers 

Kristine Bresnehan Servidio 

William Eckhardt 

Terrie Eubanks 

David Gregory 

Joanne Hebding 

Marilyn Swick 

If you have questions about any of the following, please 

contact the APT National Office: Membership, 

Advertising, Billing, Publications’ Circulation, Mailing 

Labels, Products, Orders and General Questions. 

Billing Questions 

Phone (708) 492-0796 

APTWeb 

Website/Technical Issues 

E-Mail support@aptweb.org 

Editorial Questions 

If you have editorial questions, please contact: 

A2Zzz Magazine Editorial Office 

Sleep-Related Organizations 

American Academy of Sleep Medicine 



Phone 708-492-0930, Fax 708-492-0943 

webmaster@aasmnet.org 

BRPT Management Office 

8201 Greensboro Drive, Suite 300 

McLean, VA 22102 

Phone 703-610-9020, Fax 703-610-9005 

brpt@amg-inc.com, www.brpt.org 

Committee on Accreditation for Polysomnographic Technology 

Education (CoA PSG) 

Visit www.caahep.org/accredit.aspx?ID=obtainCredit 

for information on the accreditation standards and guidelines, or 

contact Dr. Richard Rosenberg at (708) 492-0930. 

35

Sleep Arts 


Word Search 

BY LAURA LINLEY, APT BOARD LIAISON FOR A2ZZZ MAGAZINE 

Reprinted from A2Zzz Magazine Volume 13, Number 4 

Find each of the following words: solution on page 34 

MYOCOLONIS 

LATENCY 

CIRCADIAN RHYTHM 

APNEA INDEX 

SAWTOOTH WAVES 

AC AMPLIFIER 

SLEEP PARALYSIS 

HYPERCAPNIA 

DYSSOMNIA 

BIPOLAR 

DIURNAL 

MONTAGE 

PHASIC 

K COMPLEX 

ONDINE’S CURSE 

MONTAGE 

TRACE ALTERNANT 

PARADOXICAL SLEEP 

Top Ten Things NOT 

to Say to a Night 

Shift Sleep Tech 

BY TERRIE EUBANKS, RPSGT 

10. That must be an easy, boring job. 

9. You only work 3 or 4 nights a week? 

8. Do you get sleepy at work? 

7. You watch people what? 

6. You don’t need a nap. Let’s shop. 

5. I’m telling my friends I’ve spent the night with you. 

4. As your patient is leaving the morning after his sleep study, 

“My sister has Narcolepsy.” 

3. You want me to do what with that mask? 

2. You look tired. Are you sleeping well? 

1. How about lunch at noon? 

A2Zzz Challenge: 

“Slumber Tumbler” 

1. The lack of restorative sleep affects not only the health of the 

child but also the __________ ____________. (Reference page 16) 

2. _____________ is any heart rhythm of less than 60 beats/min. 

(Reference page 14) 

3. A ________ snorer snores at about 38 decibels (dB). (Reference 

page 12) 

4. A normal healthy human ear begins to perceive sound at ____ 

dB. (Reference page 12) 

5. In order to maintain their credentials, all RPSGT’s will be 

required to go through the recertification process every ____ 

years. (Reference page 6) 

6. Recertification can be obtained by accumulating ____ continuing 

education credits (CEC) or by re-taking the RPSGT examination 

(Reference page 6). 

Answers on page 34 

“Your future depends on your 

dreams — so go to sleep!” 

—Anonymous 

Barbara Ludwig Cull, RPSGT 

“Did you ever notice that the patients that tell 

you they don’t go to bed until 1 a.m. are the ones 

arriving at the lab before you do? Were they 

worried they wouldn’t have time to tell you that?” 

—Terrie Eubanks 

36


New 3rd Edition 

New Releases! 

APT Review Course CD Sets 

An excellent tool for registry board prep or as a review to enhance skills! 

Sleep Stage Scoring • Arrhythmia Review 

Artifact Recognition & Troubleshooting 

Sleep Report Parameters & Calculations 

Neurophysiology of Sleep • Nocturnal O 2 Titration 

For more information go to the APT website at www.aptweb.org 

or see the APT product ordering form on page 31 

37



New Releases! 









37



New Releases! 









37

® 

• 25-channel Recorder 

• Built-in Oximeter 

• Built-in Electrode/Sensor Connections 

• Pulse Transit Time (PTT) 

• Automatic Scoring Software 

• 24/7 Technical Support 

• Limited Lifetime Warranty 

Toll Free: 877-472-7779 (USA & Canada only) 

Phone: 401-828-4000 • Fax: 401-822-2430 

Email: grass-telefactor@astromed.com 

www.grass-telefactor.com 

Got 

CECs? 

Do you know where to find 

continuing education programs 

that offer APT CECs? 

Go to www.aptweb.org! 


One Westbrook Corporate Center 

Suite 920 


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