Replies to This Discussion

Permalink Reply by 99 on September 10, 2010 at 6:06am

i think judy was saying i law that you are treated like that

Because we know you are more than quailfied to do all that am probable a lot more
but you are prevented by ethics to do what you have the ablity to do, probably much better than most doctors

Louise Dover said:

Just so you know, Judy, my medical director (a board-certified sleep physician) comes in every single morning and reviews every study that ran the night before, meets with the patient before they leave the lab, and dictates the report before he leaves. Our patients are extremely well cared for, considering I have over 15 years of sleep experience behind me. And on the rare occasion that my medical director is unable to appear in the sleep lab the following morning, he depends on me, yes - ME - the lowly sleep tech who ain't qualified for crap as far you are concerned, to review the study with the patient and make sure they leave the lab with their CPAP prescription in place, or a follow-up study appointment - if necessary. Apparently whatever lab you went to wasn't worth their salt, because I would never work in a place that treated their patients the way you described. So before you start belittling me and my profession, back the truck up and look at who you are speaking to before you speak - it makes you appear shallow and uneducated. If you are unhappy with your sleep lab experience, I would suggest you find a PROFESSIONAL lab.

Judy said:

Louise said:
"...It seems to me that the AHA is in need of "clear direction" when it comes to the link between OSA and CVD. She needs to understand that those of us in the sleep profession have no need for additional research as we see the connection quite clearly and up close every night in every sleep center across the entire world. ..."

Yeah but, yeah, but, geeze, Louise!!!! You RPSGTs "ain't" medical professionals, most of you have no medical background whatsoever, shucks youse guys "ain't" even allowed to provide us much info at all about our PSG the next morning 'cause you "ain't" no medical "professional".

Per centage wise, the RPSGTs are the real heroes of sleep medicine, but they aren't "good enough" to tell us patients much 'cause they "ain't" no medical professional.

Of course, your sleep doctor (the medical professional) in all too many cases can't even be bothered consulting w/us, preferring to send their dictation to our referring doctor to let him/her "waste" their time consulting w/us, or if they do condescend to consult at all w/us, its an "in and out", 10 minute, yuo've got OSA, here's your script, bye. IF we are lucky enough to get a fully data capable PAP our "medical professional" isn't interested in really looking at the data and just glances at it at best w/o paying any real heed to it.

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Permalink Reply by Banyon on September 10, 2010 at 8:31am

Louise Dover, Does your practice make sure each patient gets a data capable machine and knows how to read and interpret the data? If your answer is, "No", you are part of the problem not the solution.

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Permalink Reply by Carl on September 10, 2010 at 8:45am

Ok, after reading all of this I have to admit that I felt that I was in the dark and had questions about a few things so I did some online research and here is what I have found. Much of this information is from bprt.org (board of registered polysomnographic technologists). The whole concept of being a "board registered psg technologist" sounds very official and medical, doesn't it - it sure did to me!

Anyhow, in light of the discussion on this board, I wanted to learn a bit more about it. What I found was that there are 4 ways of being able to take the RPSGT exam. Here is one way...

QUOTE
Pathway #1 - for candidates with 18-months of PSG experience (on-the-job training)

1. Candidates must complete a minimum of 18 months of paid clinical experience where at least 21 hours per week per calendar year of on-the-job duties performed are Polysomnography direct patient recording and/or scoring. Duties must be within a 3-year period prior to the exam.
2. Candidates must complete the AASM A-STEP Self-Study (online) Modules or a BRPT-designated alternate educational program. Proof of completing the modules must be submitted with the application. Acceptable forms of proof are:
1. Copies of the 14 certificates of completion from each module, or
2. An official transcript from the AASM.
3. Candidates must include proof of completing secondary education. Acceptable forms of proof are copies of transcripts or diplomas from high school, GED or equivalent, or college or university education.
UNQUOTE

So, by a) having a high school diploma or GED and 2) essentially DOING the job for 18 months - HALF TIME (ok, 21 hours/wk) and 3) taking an "online" course, you can sit for the RPSGT exam. Call me jaded, but this just doesn't sound like very much of a "real medical professional" to me.

Granted, REAL medical professionals DO have ways to take the exam and become certified, but, at the lowest common denominator, there simply isn't a whole lot here. And, I have to wonder about any job that essentially says you actually have to PERFORM the duties that you're going to be tested on before you can be tested and put some letters in front of or behind your name. I mean - seriously - think about what it would be like if that's how they approached getting an MD.... go out, be a doctor for a couple years - then you can come back and sit for the exam... Substitute ANY profession for this and see how absurd it sounds. Quite frankly, those letters "RPSGT" don't mean a whole lot, at least not to me. Now, people who have this certification and have other (TRUE) medical certs (like RN, etc) - THAT is a different story, they DO have a medical background.

At the end of the day, Judy was correct when she said.....

QUOTE
Yeah but, yeah, but, geeze, Louise!!!! You RPSGTs "ain't" medical professionals, most of you have no medical background whatsoever, shucks youse guys "ain't" even allowed to provide us much info at all about our PSG the next morning 'cause you "ain't" no medical "professional".
UNQUOTE

Of course any organization like this is often more about collecting dues, fees, and, of course, providing "continuing education" for those in the field. Here's what I think about that.... Years ago, when my wife was pregnant with my 1st son I took an EMT course. I figured it would be good to know some emergency procedures "just in case". The course took something like 121 hours, plus I had to observe for 8 hours in an emergency room. During the course I observed the OTHER people taking the class. The four firemen were very professional and worked diligently. MANY of the other people were kids that just graduated from high school and were looking for an easy job that paid a bit more than minimum wage - in other words - they wanted to work for an ambulance company. I had never seen such a group of people like this together before. Thankfully, my partner didn't pass the exam, but some of the kids that DID pass were, well, unbelievable (and NOT in a good way, either).

In the end, the ONE thing that this class taught me was that if I or ANY of my family members were ever injured I would NEVER let an EMT touch me - unless they were firemen, and then I would still be cautious! I maintained my EMT through a couple of re-certs, which meant CEUs. Sadly, and for the most part, the "continuing education" was useless, clearly a method of making money FAR MORE than really providing useful information. I could UNDERSTAND if you had to retake the final exam (with practical portion) periodically, but these continuing education classes were just junk. Perhaps this really skewed my opinion on putting initials around my name, but, I definitely always want to know just what do those initial represent, what do they mean, and what is REALLY behind them other than paying dues and taking CE classes from some organization.

Louise Dover said:

Just so you know, Judy, my medical director (a board-certified sleep physician) comes in every single morning and reviews every study that ran the night before, meets with the patient before they leave the lab, and dictates the report before he leaves. Our patients are extremely well cared for, considering I have over 15 years of sleep experience behind me. And on the rare occasion that my medical director is unable to appear in the sleep lab the following morning, he depends on me, yes - ME - the lowly sleep tech who ain't qualified for crap as far you are concerned, to review the study with the patient and make sure they leave the lab with their CPAP prescription in place, or a follow-up study appointment - if necessary. Apparently whatever lab you went to wasn't worth their salt, because I would never work in a place that treated their patients the way you described. So before you start belittling me and my profession, back the truck up and look at who you are speaking to before you speak - it makes you appear shallow and uneducated. If you are unhappy with your sleep lab experience, I would suggest you find a PROFESSIONAL lab.
Judy said:

Louise said:
"...It seems to me that the AHA is in need of "clear direction" when it comes to the link between OSA and CVD. She needs to understand that those of us in the sleep profession have no need for additional research as we see the connection quite clearly and up close every night in every sleep center across the entire world. ..."
Yeah but, yeah, but, geeze, Louise!!!! You RPSGTs "ain't" medical professionals, most of you have no medical background whatsoever, shucks youse guys "ain't" even allowed to provide us much info at all about our PSG the next morning 'cause you "ain't" no medical "professional". Per centage wise, the RPSGTs are the real heroes of sleep medicine, but they aren't "good enough" to tell us patients much 'cause they "ain't" no medical professional.

Of course, your sleep doctor (the medical professional) in all too many cases can't even be bothered consulting w/us, preferring to send their dictation to our referring doctor to let him/her "waste" their time consulting w/us, or if they do condescend to consult at all w/us, its an "in and out", 10 minute, yuo've got OSA, here's your script, bye. IF we are lucky enough to get a fully data capable PAP our "medical professional" isn't interested in really looking at the data and just glances at it at best w/o paying any real heed to it.

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Permalink Reply by Banyon on September 10, 2010 at 8:57am

Carl, You hit the nail on the head - that is what licensing is about in all areas. That is, it is about the licensing agencies, keeping competition out, and keeping the wages up. It is not about the consumer.

Licensing of professions is a growing cancer in the U.S.

Todays 30% of all professions have government-required licensing. In the 1950s only 5% required licensing.

Licensing is a racket that hurts the consumer.

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Permalink Reply by Judy on September 10, 2010 at 10:12am

Aw, geeze, Louise. Obviously sarcasm is NOT my forte. I truly meant it when I said that for the most part the RPSGTs are the "true" heroes of sleep medicine.

As I read thru the 4 apnea support forums I tend to hang around I almost never see a complaint about the RPSGT. BUT I DO see plenty of complaints by posters about sleep labs that do NOT have a sleep doctor that actually consults w/the patients, that have some sleep doctor somewhere who supposedly goes over the PSG scoring by an RPSGT, then dictates results and recommendations and turns them over to the referring doctor.

I see plenty of complaints about sleep doctors who gloss over the PSG scoring, dictate some results, spend 5-10 minutes w/the patient and tell the patient the local DME provider will be contacting them to give them their equipment.

I see plenty posts about local DME provider RRTs who not only don't know how to do a proper mask fitting, they don't even always know how to properly set up the PAP being provided, or who only knows what the Quick SetUp Guide tells them about how to set it up.

And, I've even read repeatedly about patients receiving their CPAPs and equipment by "drop shipment" via USPS or UPS or FedEx, etc.

I could go on and on ... the LEAST amount of complaints are about the RPSGTs, the MOST complaints are about the local provider RRTs w/the sleep doctors not far behind in list of complaints.

Our local hospital's sleep lab USED to provide and require a sleep doctor/patient consult before and after each PSG. They've changed. Now the patient and sleep doctor never consult. The sleep doctor is available for consultation W/THE REFERRING PHYSICIAN.

The sleep lab I've used is owned/managed by an RRT/RSPGT who ran the above hospital's sleep lab's PSG scoring for years, coming up thru the ranks. Unfortunately, she has to rely on 4 alternating sleep pulmonologists rather than one or even two sleep pulmos. Neither of us is really 100% thrilled that the sleep doctors choose to alternate, both of us preferring more continuity of care w/just one or two sleep doctors. But, she wanted good, experienced sleep pulmo/critical care doctors working her sleep lab. She does provide OTJT but she also sends her techs to one of the few schools for PSG training and pays their "tuition".

Which takes us to the local DME providers and their RRTs ..... my first local DME provider and RRT were ... sheisters. Less than truthful or dumb as a rock, guilty of sins of omission .... etc., etc. My second (current) local DME provider and RRT have done well by me.

I've said it before and I will say it again, while the RPSGTs don't always, or even usually, have any medical training or background, the RPSGTs are the "true heroes" of sleep medicine. The RPSGTs are the ones we could truly get the nitty girtty of our PSG experience and results from IF the freaking "medical professionals" would just let them talk to us and share info w/us.

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Permalink Reply by Judy on September 10, 2010 at 2:04pm

Right on, jnk, right on! Our sleep techs must have been related!!! *wicked grin*

And I once met an RPSGT briefly at a sleep lab I only had one titration at. She was training that night so wasn't my tech other than to get me introduced to the lab and set up, etc. We did get into a friendly discussion and I showed her my previous night's data on my professional software for my "Australian" PAP. She said she wished ALL of her patients could have such access to their own data and such interest in their own therapy.

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Permalink Reply by Heather Dent on September 10, 2010 at 5:48pm

Judy, I agree with everything in your post. It's thorough and very well stated. As a Canadian living within the GTA (Greater Toronto Area) in a city (Oshawa) that has 2 sleep laboratories, my experience pretty well parallels your own. My general physician referred me to the sleep lab (clinic) that is part of the very large LHIN Clinic (Local Health Integrated Network). Due to universal (government) health care in Canada, these sleep labs must be licensed and regulated by the government (whom they bill for their services). In my province (Ontario) this is OHIP -- Ontario Health Insurance Plan. Four different doctors (who are also pulmonary or heart specialists, with their own practices, but 1 semi-retired) act as consulting doctors for the sleep lab. BUT once a patient is assigned to a SPECIFIC doctor they are treated only by that one sleep doc, so that does give some continuity to treatment. Having outlined that one difference, I have to say that my experience and observations seem strikingly similar to what you describe.

I received instructions from clinic support staff prior to my first overnight PSG. I was then given an app't with my assigned sleep doc (an elderly man) for about 10 days later, at which time he whizzed through the results of my PSG (more like he was muttering to himself and the computer, as he looked at graph results) in totally technical language which at that time meant absolutely nothing to me, other than the diagnosis that I suffered from sleep apnea and my oxygen dropped very low (71%) during "low breathing episodes", hence he was going to prescribe CPAP therapy. It was rushed and he seemed grumpy, so no Q and A. He did explain that the DME would provide a "mask & loaner machine" which would be set at a trial pressure of 7, and after a month of using it I would return for another overnight PSG study. They don't give sleep therapy prescriptions directly to patients, so he asked which DME provider to fax the script to, and not knowing better I said the one closest to where I lived -- BIG MISTAKE). The doc must think all DME's are created equal and would give me all further information and support. The rep at the DME gave very basic information about the machine and mask SHE had chosen and I proceeded on my way home with it. The (full face) mask was poorly fitted (headgear straps of a different size than the mask itself), and she was rude, snotty, and refused to let me try another mask when I encountered serious difficulty (threw the mask off during sleep). She said she had no more masks, so I must try harder (don't know how you can 'try harder' when you are unaware of throwing off the mask DURING SLEEP ! After 3 weeks, I packed up the stuff and returned it to the DME (although she was not present when I returned the equipment). She phoned me the next day to VERY ICELY tell me to come by and pick up the equipment including the alternate mask I had requested (since the mask was brand new, it was obvious she could have provided it the first time I asked, but SIMPLY DID NOT WISH TO DO SO. It was that mask that I used a few days later for the overnight titration PSG, although the machine used was a bipap belonging to the sleep clinic.

Now comes THE PART THAT I WISH TO EMPHASIZE.......in the morning, the RPSG Technician asked me about the mask which I had used (Liberty -- the Resmed version of a hybrid), which he said had performed quite well, better than he had expected, but asked me if I had tried the Resmed Quattro full face mask? I told him that I had tried it but had repeatedly thrown it off while sleeping, with no recollection of doing so. He asked me how the Quattro had felt BEFORE I fell asleep each night and I said it felt claustrophic and somewhat "suffocating" (almost gasping for air) if that made any sense to him. He said it did make sense, because before actual titration detemined my true pressure needed, the doc orders a standard preliminary setting of 7. The RPSGT told me that my required setting determined that night was 12 and that the suffocating feeling I had experienced during my trial (loaner) period was probably due to the air pressure being at 7 and below what I actually required according to titration results. He also asked if the DME rep had explained that this might be the reason I turfed the Quattro off during the night. I said "No, she offered no possible reasons for me doing that, just expressed annoyance that I was not keeping the mask on.......and told me it WOULD WORK if I just kept on trying.......because it works for her other clients !!! In other words it was MY FAULT and there was no possible reason why it shouldn't work for me. After all, she said she should know since she has a Bachelor of Science degree !! At that time I exercised more restraint than usual and resisted the urge to say "I have TWO university degrees but that means diddly-squat when neither of them qualify me as a RRT or a RPSGT. My titration RPSG tech just smiled and said that at some time I might want to re-try a Quattro because they have a really low leak rate and I might find that I don't throw off a Quatto when the air pressure is at my correct titrated level. As it happened within the same week I began to awaken with my mouth hanging out of the Liberty (even though tightly fastened) in other words "jaw drop" since I am a mouth breather. Having read that chin straps only work for some people, I opted to re-try the Quattro (as suggested by the RPSGT, during his explanation). This necessitated another trip back to the DME rep.....talk about icy cold and uncivil......she totally displayed her disgust at having to do her job of helping clients. (Incidentally I said NOTHING about what the titration RPSGT had told me, since she was such a nasty person that I figured she would complain to the sleep doc about the RPSGT. I did not want that to happen, since he was THE MOST HELP TO ME, OF ALL THE PROFESSIONALS INVOLVED. He had the knowledge and the experience AS WELL AS THE INCLINATION TO SHARE THAT WITH ME, in order to see that I received the maximum benefit of my CPAP therapy. And he behaved like a true professional when he had not made any negative comment about the DME rep's less than satisfactory service to me. So I certainly didn't want this potentially vindictive woman to insinuate to the doctor that the RPSGT had overstepped his boundaries in talking to me. I know she would have done so, because this woman was ALL ABOUT BOUNDARIES......nothing more.

The RPSGT had been give the authority by the doctor of changing the pressure on my "loaner" machine before I left the clinic after the titration sleep-over. So OBVIOUSLY, THE SLEEP DOC CONSIDERS THE RPSGT TO BE A "MEDICAL PROFESSIONAL" WITHIN THE TEAM. He told me the sleep doc would be reviewing the titration results and the titrated pressure at my next appointment with him. At all times my DME was totally uselessand so I realized that I MUST EDUCATE MYSELF about sleep apnea, CPAP therapy, the various CPAP and other PAP machines, all of the associated jargon, etc. etc. I spent about 8 - 10 hours a day reading books, articles, and perusing the hundreds of posts on various apnea support forums (after my first encounter with the DME. There are some very intelligent and experienced sleep apnea patients as well as professionals in the field that formed an integral part of my education. I'm grateful to all of them for their ADVICE and THEIR MORAL SUPPORT. They made a rough road so much easier.

But I will take issue with Carl, or anyone else that belittles the credentials of an RPSGT. And I was most pleased to see my sleep doc treat them with the respect they deserve, both when conversing with them in person or reviewing the information they provided re: titration. In this day and age, more emphasis is being put on the "practical on-the-job training" hence the prolific number of "practicums" that are required as part of the educational requirements for certification within a variety of fields. As for Carl's comment that he wouldn't want to be treated by a doctor that was receiving on-the-job training........guess what Carl.......what do you think a doctor's residency comprises? Two years of req'd on-the-job training FOLLOWING GRADUATION from medical school, BEFORE he/she becomes a LICENSED DOCTOR. FOR HIS RESIDENCY my nephew was required to take an additional 6-week "Trauma" course, then travel for 3-month placements in the EMERG departments of hospitals in various towns and cities, for a total of 2 years. Or he could have remained in one hospital for the 2 year residency period, serving in Emerg and possibly other departments. He opted for the former, since it provided a more varied experience and Trauma salary helps to pay down the massive debt of student loans incurred in medical school. The process of residency is the same as that req'd in the USA. So the "doctor" (as a resident, still called Dr. So-and-So) that Carl would insist on being treated by, is OFTEN receiving his practical "on-the-job" training.

I received very helpful information from my particular RPSGT, without which I might still be stumbling along without the best mask and therefore with limited therapeutic value; indeed I might have given up entirely on CPAP therapy, due to frustration. I also received excellent assistance from knowledgeable sleep apnea support forum contributors regarding data capable machines. When told the DME rep that I would be purchasing a "data capable machine", she literally "flew into a rage" and launched into a tirade (the long and the short of which was that NO GOOD could come of mere peasants like myself having access to data, because all they want to do is change the pressure -- which incidentally I have no interest in doing). She even called the sleep clinic to complain to my doc about me (see what I meant above when I used the words "potentially vindictive"). Thankfully, my sleep doc gave me a chance to explain that FOR ME to remain totally committed to my therapy I NEED TO SEE FOR MYSELF (IN THE DATA figures of the machine) that it is working to the best possible extent. Surprisingly, he said that in general patients with knowledge of the data remain more committed to CPAP therapy and work harder to iron out any difficulties, so he thinks data capable machines are an excellent idea. So he ordered data capable for the client on the prescription he faxed to the DME, and said if she didn't co-operate, he was "cutting her loose" and would send me to a different DME evem at this late stage !! She complied, but was still ICY.

Sorry this is a long post, but I just wanted to emphasize that a good RPSGT must never be undervalued. With the added burden of being a mouth breather (and having a bitchy DME rep) I might never have gotten past the mask problems (which I'm told is the deal-breaker in CPAP use) if it were not for a wise and knowledgeable RPSGT !! They are INDEED a medical professional !! Which is why you see VERY FEW IF ANY complaints about them on ANY discussion forum.

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Permalink Reply by Judy on September 10, 2010 at 6:13pm

Heather, THANKS FOR SHARING! The next time you are in the area, drop off a plate of home made cookies or some such w/the sleep tech's name on it. Or even a short thank you note, letting your tech know you probably would never have "made it" w/CPAP w/o his help and kindness and caring.

We need a "I Love My RPSGT" bummer sticker!!! Or, maybe, "Thank God for RPSGTs".

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Permalink Reply by Carl on September 10, 2010 at 7:10pm

You can TAKE ISSUE with ME all you want. All I did was point out FACTS... FACTS that aren't CONVENIENT for you and point to the WEAKNESS in the (sic) credentialing process of RPSGTs.

And, as far as a doctor doing "on the job training"... well, I have news for you. MED SCHOOL is a little bit MORE THAN a "home study" course like the RPSGT can be!!! After TWO FULL YEARS of medical schooling (and yes, that is more than 21 hours a week "on the job" - many hours of which you may be doing nothing) you take USMLE Part 1. Then, in the 3rd year you go through 1-2 months of the major specialty rotations UNDER THE SUPERVISION of a doctor. In the 4th year you take electives based on preferred specialty; apply to residency programs; pass the USMLE Step 2. At THAT point you get "on the job training"... after FOUR YEARS, not 18 months part time and a home study course. If you FAIL to see the difference there, well, I guess that's the difference between you and me.

And yes, I DO think credentialing agencies are often quite full of themselves, self serving and, in the end, pretty much useless. There is no TEETH to being an RPSGT, only a piece of paper and I can guarantee you that I can find ones that have that piece of paper who aren't worth the ink used to print it, just as I can find people without it who are fantastic.

I don't know about YOU, but I have a primary care physician who is BOARD CERTIFIED - NOT a resident somewhere. The specialists I see are BOARD CERTIFIED, NOT a resident, so NO, I am NOT being taken care of by a resident. I have been ASKED by my specialists if RESIDENTS can OBSERVE and I always agree to that, but I would NOT trust my care plan to a resident for the very reasons provided earlier.

So - go ahead - take "issue" with me all you want, it's not going to buy you anything - nope, nothing at all. Like I said, all I did was point out FACTS and you did not challenge ONE of my FACTS!!! If you think I'm belittling the "credentials" of an RPSGT well then, yes, I guess I am, these "credentials" are nothing more than a way for an agency to rake in profits and charge for CEUs, accreditation, etc.

Heather Dent said:

Judy, I agree with everything in your post. It's thorough and very well stated. As a Canadian living within the GTA (Greater Toronto Area) in a city (Oshawa) that has 2 sleep laboratories, my experience pretty well parallels your own. My general physician referred me to the sleep lab (clinic) that is part of the very large LHIN Clinic (Local Health Integrated Network). Due to universal (government) health care in Canada, these sleep labs must be licensed and regulated by the government (whom they bill for their services). In my province (Ontario) this is OHIP -- Ontario Health Insurance Plan. Four different doctors (who are also pulmonary or heart specialists, with their own practices, but 1 semi-retired) act as consulting doctors for the sleep lab. BUT once a patient is assigned to a SPECIFIC doctor they are treated only by that one sleep doc, so that does give some continuity to treatment. Having outlined that one difference, I have to say that my experience and observations seem strikingly similar to what you describe.
I received instructions from clinic support staff prior to my first overnight PSG. I was then given an app't with my assigned sleep doc (an elderly man) for about 10 days later, at which time he whizzed through the results of my PSG (more like he was muttering to himself and the computer, as he looked at graph results) in totally technical language which at that time meant absolutely nothing to me, other than the diagnosis that I suffered from sleep apnea and my oxygen dropped very low (71%) during "low breathing episodes", hence he was going to prescribe CPAP therapy. It was rushed and he seemed grumpy, so no Q and A. He did explain that the DME would provide a "mask & loaner machine" which would be set at a trial pressure of 7, and after a month of using it I would return for another overnight PSG study. They don't give sleep therapy prescriptions directly to patients, so he asked which DME provider to fax the script to, and not knowing better I said the one closest to where I lived -- BIG MISTAKE). The doc must think all DME's are created equal and would give me all further information and support. The rep at the DME gave very basic information about the machine and mask SHE had chosen and I proceeded on my way home with it. The (full face) mask was poorly fitted (headgear straps of a different size than the mask itself), and she was rude, snotty, and refused to let me try another mask when I encountered serious difficulty (threw the mask off during sleep). She said she had no more masks, so I must try harder (don't know how you can 'try harder' when you are unaware of throwing off the mask DURING SLEEP ! After 3 weeks, I packed up the stuff and returned it to the DME (although she was not present when I returned the equipment). She phoned me the next day to VERY ICELY tell me to come by and pick up the equipment including the alternate mask I had requested (since the mask was brand new, it was obvious she could have provided it the first time I asked, but SIMPLY DID NOT WISH TO DO SO. It was that mask that I used a few days later for the overnight titration PSG, although the machine used was a bipap belonging to the sleep clinic.
Now comes THE PART THAT I WISH TO EMPHASIZE.......in the morning, the RPSG Technician asked me about the mask which I had used (Liberty -- the Resmed version of a hybrid), which he said had performed quite well, better than he had expected, but asked me if I had tried the Resmed Quattro full face mask? I told him that I had tried it but had repeatedly thrown it off while sleeping, with no recollection of doing so. He asked me how the Quattro had felt BEFORE I fell asleep each night and I said it felt claustrophic and somewhat "suffocating" (almost gasping for air) if that made any sense to him. He said it did make sense, because before actual titration detemined my true pressure needed, the doc orders a standard preliminary setting of 7. The RPSGT told me that my required setting determined that night was 12 and that the suffocating feeling I had experienced during my trial (loaner) period was probably due to the air pressure being at 7 and below what I actually required according to titration results. He also asked if the DME rep had explained that this might be the reason I turfed the Quattro off during the night. I said "No, she offered no possible reasons for me doing that, just expressed annoyance that I was not keeping the mask on.......and told me it WOULD WORK if I just kept on trying.......because it works for her other clients !!! In other words it was MY FAULT and there was no possible reason why it shouldn't work for me. After all, she said she should know since she has a Bachelor of Science degree !! At that time I exercised more restraint than usual and resisted the urge to say "I have TWO university degrees but that means diddly-squat when neither of them qualify me as a RRT or a RPSGT. My titration RPSG tech just smiled and said that at some time I might want to re-try a Quattro because they have a really low leak rate and I might find that I don't throw off a Quatto when the air pressure is at my correct titrated level. As it happened within the same week I began to awaken with my mouth hanging out of the Liberty (even though tightly fastened) in other words "jaw drop" since I am a mouth breather. Having read that chin straps only work for some people, I opted to re-try the Quattro (as suggested by the RPSGT, during his explanation). This necessitated another trip back to the DME rep.....talk about icy cold and uncivil......she totally displayed her disgust at having to do her job of helping clients. (Incidentally I said NOTHING about what the titration RPSGT had told me, since she was such a nasty person that I figured she would complain to the sleep doc about the RPSGT. I did not want that to happen, since he was THE MOST HELP TO ME, OF ALL THE PROFESSIONALS INVOLVED. He had the knowledge and the experience AS WELL AS THE INCLINATION TO SHARE THAT WITH ME, in order to see that I received the maximum benefit of my CPAP therapy. And he behaved like a true professional when he had not made any negative comment about the DME rep's less than satisfactory service to me. So I certainly didn't want this potentially vindictive woman to insinuate to the doctor that the RPSGT had overstepped his boundaries in talking to me. I know she would have done so, because this woman was ALL ABOUT BOUNDARIES......nothing more.

The RPSGT had been give the authority by the doctor of changing the pressure on my "loaner" machine before I left the clinic after the titration sleep-over. So OBVIOUSLY, THE SLEEP DOC CONSIDERS THE RPSGT TO BE A "MEDICAL PROFESSIONAL" WITHIN THE TEAM. He told me the sleep doc would be reviewing the titration results and the titrated pressure at my next appointment with him. At all times my DME was totally uselessand so I realized that I MUST EDUCATE MYSELF about sleep apnea, CPAP therapy, the various CPAP and other PAP machines, all of the associated jargon, etc. etc. I spent about 8 - 10 hours a day reading books, articles, and perusing the hundreds of posts on various apnea support forums (after my first encounter with the DME. There are some very intelligent and experienced sleep apnea patients as well as professionals in the field that formed an integral part of my education. I'm grateful to all of them for their ADVICE and THEIR MORAL SUPPORT. They made a rough road so much easier.

But I will take issue with Carl, or anyone else that belittles the credentials of an RPSGT. And I was most pleased to see my sleep doc treat them with the respect they deserve, both when conversing with them in person or reviewing the information they provided re: titration. In this day and age, more emphasis is being put on the "practical on-the-job training" hence the prolific number of "practicums" that are required as part of the educational requirements for certification within a variety of fields. As for Carl's comment that he wouldn't want to be treated by a doctor that was receiving on-the-job training........guess what Carl.......what do you think a doctor's residency comprises? Two years of req'd on-the-job training FOLLOWING GRADUATION from medical school, BEFORE he/she becomes a LICENSED DOCTOR. FOR HIS RESIDENCY my nephew was required to take an additional 6-week "Trauma" course, then travel for 3-month placements in the EMERG departments of hospitals in various towns and cities, for a total of 2 years. Or he could have remained in one hospital for the 2 year residency period, serving in Emerg and possibly other departments. He opted for the former, since it provided a more varied experience and Trauma salary helps to pay down the massive debt of student loans incurred in medical school. The process of residency is the same as that req'd in the USA. So the "doctor" (as a resident, still called Dr. So-and-So) that Carl would insist on being treated by, is OFTEN receiving his practical "on-the-job" training.

I received very helpful information from my particular RPSGT, without which I might still be stumbling along without the best mask and therefore with limited therapeutic value; indeed I might have given up entirely on CPAP therapy, due to frustration. I also received excellent assistance from knowledgeable sleep apnea support forum contributors regarding data capable machines. When told the DME rep that I would be purchasing a "data capable machine", she literally "flew into a rage" and launched into a tirade (the long and the short of which was that NO GOOD could come of mere peasants like myself having access to data, because all they want to do is change the pressure -- which incidentally I have no interest in doing). She even called the sleep clinic to complain to my doc about me (see what I meant above when I used the words "potentially vindictive"). Thankfully, my sleep doc gave me a chance to explain that FOR ME to remain totally committed to my therapy I NEED TO SEE FOR MYSELF (IN THE DATA figures of the machine) that it is working to the best possible extent. Surprisingly, he said that in general patients with knowledge of the data remain more committed to CPAP therapy and work harder to iron out any difficulties, so he thinks data capable machines are an excellent idea. So he ordered data capable for the client on the prescription he faxed to the DME, and said if she didn't co-operate, he was "cutting her loose" and would send me to a different DME evem at this late stage !! She complied, but was still ICY.

Sorry this is a long post, but I just wanted to emphasize that a good RPSGT must never be undervalued. With the added burden of being a mouth breather (and having a bitchy DME rep) I might never have gotten past the mask problems (which I'm told is the deal-breaker in CPAP use) if it were not for a wise and knowledgeable RPSGT !! They are INDEED a medical professional !! Which is why you see VERY FEW IF ANY complaints about them on ANY discussion forum.

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Permalink Reply by Judy on September 10, 2010 at 9:08pm

Yeah, well, the only really BAD sleep doctor I ran across was accredited and on staff at a MAJOR LEADING medical clinic in the USA. He was a lousy excuse for a sleep doctor and would also have been a lousy excuse for a doctor. I can only assume he holds onto his position due to his research. Maybe he needs to stick to research and give up consulting w/patients.

Due to my local sleep lab having alternating sleep pulmonologists consult w/patients I've had the opportunity to meet and consult w/5 other sleep doctors besides the sorry excuse for one mentioned above. All were pleasant, but none too impressive, nor really interested.

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Permalink Reply by Heather Dent on September 10, 2010 at 11:37pm

Yes Judy, I believe your assessment of the sleep docs to be accurate. But it seems that Carl has never run across any poor doctors, or else his powers of observation were blinded by the letters MD after their name, or by the fact that they have spent more years and hours studying while at medical school. Of course they have, no one's disputing that. But there is such a thing as being a "Jack of All Trades" but "master of none", even when viewing the great number of things in the curriculum that must be covered at medical school (some more intensively, others not). AND it is wise to bear in mind that there is always A BOTTOM HALF in each graduating class at medical school, who nevertheless are out there practising medicine. In fact with the limitations of that group in mind "practising" may very well be the operative word here (LOL). Poor Carl missed the point.......that in the event of his being in an accident and driven by ambulance to the hospital, the Trauma doctors in Emerg may ALL be resident doctors (getting OTJ training) and he might not be physically able to question them individually about their exact status, before life-saving treatment !! Some people just don't "get it" do they ?

And yes, I'm going to take your suggestion about dropping off a plate of cookies (with a thankyou note) for the nice RPSGT at the sleep clinic. I'll throw in a gift certificate for the nearby coffee shop.

Judy said:

Yeah, well, the only really BAD sleep doctor I ran across was accredited and on staff at a MAJOR LEADING medical clinic in the USA. He was a lousy excuse for a sleep doctor and would also have been a lousy excuse for a doctor. I can only assume he holds onto his position due to his research. Maybe he needs to stick to research and give up consulting w/patients.

Due to my local sleep lab having alternating sleep pulmonologists consult w/patients I've had the opportunity to meet and consult w/5 other sleep doctors besides the sorry excuse for one mentioned above. All were pleasant, but none too impressive, nor really interested.

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Permalink Reply by RockRpsgt on September 11, 2010 at 1:46am

Thanks for your appreciation Carl.

Carl said:

Ok, after reading all of this I have to admit that I felt that I was in the dark and had questions about a few things so I did some online research and here is what I have found. Much of this information is from bprt.org (board of registered polysomnographic technologists). The whole concept of being a "board registered psg technologist" sounds very official and medical, doesn't it - it sure did to me!

Anyhow, in light of the discussion on this board, I wanted to learn a bit more about it. What I found was that there are 4 ways of being able to take the RPSGT exam. Here is one way...

QUOTE
Pathway #1 - for candidates with 18-months of PSG experience (on-the-job training)

1. Candidates must complete a minimum of 18 months of paid clinical experience where at least 21 hours per week per calendar year of on-the-job duties performed are Polysomnography direct patient recording and/or scoring. Duties must be within a 3-year period prior to the exam.
2. Candidates must complete the AASM A-STEP Self-Study (online) Modules or a BRPT-designated alternate educational program. Proof of completing the modules must be submitted with the application. Acceptable forms of proof are:
1. Copies of the 14 certificates of completion from each module, or
2. An official transcript from the AASM.
3. Candidates must include proof of completing secondary education. Acceptable forms of proof are copies of transcripts or diplomas from high school, GED or equivalent, or college or university education.
UNQUOTE

So, by a) having a high school diploma or GED and 2) essentially DOING the job for 18 months - HALF TIME (ok, 21 hours/wk) and 3) taking an "online" course, you can sit for the RPSGT exam. Call me jaded, but this just doesn't sound like very much of a "real medical professional" to me.

Granted, REAL medical professionals DO have ways to take the exam and become certified, but, at the lowest common denominator, there simply isn't a whole lot here. And, I have to wonder about any job that essentially says you actually have to PERFORM the duties that you're going to be tested on before you can be tested and put some letters in front of or behind your name. I mean - seriously - think about what it would be like if that's how they approached getting an MD.... go out, be a doctor for a couple years - then you can come back and sit for the exam... Substitute ANY profession for this and see how absurd it sounds. Quite frankly, those letters "RPSGT" don't mean a whole lot, at least not to me. Now, people who have this certification and have other (TRUE) medical certs (like RN, etc) - THAT is a different story, they DO have a medical background.

At the end of the day, Judy was correct when she said.....

QUOTE
Yeah but, yeah, but, geeze, Louise!!!! You RPSGTs "ain't" medical professionals, most of you have no medical background whatsoever, shucks youse guys "ain't" even allowed to provide us much info at all about our PSG the next morning 'cause you "ain't" no medical "professional".
UNQUOTE

Of course any organization like this is often more about collecting dues, fees, and, of course, providing "continuing education" for those in the field. Here's what I think about that.... Years ago, when my wife was pregnant with my 1st son I took an EMT course. I figured it would be good to know some emergency procedures "just in case". The course took something like 121 hours, plus I had to observe for 8 hours in an emergency room. During the course I observed the OTHER people taking the class. The four firemen were very professional and worked diligently. MANY of the other people were kids that just graduated from high school and were looking for an easy job that paid a bit more than minimum wage - in other words - they wanted to work for an ambulance company. I had never seen such a group of people like this together before. Thankfully, my partner didn't pass the exam, but some of the kids that DID pass were, well, unbelievable (and NOT in a good way, either).

In the end, the ONE thing that this class taught me was that if I or ANY of my family members were ever injured I would NEVER let an EMT touch me - unless they were firemen, and then I would still be cautious! I maintained my EMT through a couple of re-certs, which meant CEUs. Sadly, and for the most part, the "continuing education" was useless, clearly a method of making money FAR MORE than really providing useful information. I could UNDERSTAND if you had to retake the final exam (with practical portion) periodically, but these continuing education classes were just junk. Perhaps this really skewed my opinion on putting initials around my name, but, I definitely always want to know just what do those initial represent, what do they mean, and what is REALLY behind them other than paying dues and taking CE classes from some organization.

Louise Dover said:

Just so you know, Judy, my medical director (a board-certified sleep physician) comes in every single morning and reviews every study that ran the night before, meets with the patient before they leave the lab, and dictates the report before he leaves. Our patients are extremely well cared for, considering I have over 15 years of sleep experience behind me. And on the rare occasion that my medical director is unable to appear in the sleep lab the following morning, he depends on me, yes - ME - the lowly sleep tech who ain't qualified for crap as far you are concerned, to review the study with the patient and make sure they leave the lab with their CPAP prescription in place, or a follow-up study appointment - if necessary. Apparently whatever lab you went to wasn't worth their salt, because I would never work in a place that treated their patients the way you described. So before you start belittling me and my profession, back the truck up and look at who you are speaking to before you speak - it makes you appear shallow and uneducated. If you are unhappy with your sleep lab experience, I would suggest you find a PROFESSIONAL lab.
Judy said:

Louise said:
"...It seems to me that the AHA is in need of "clear direction" when it comes to the link between OSA and CVD. She needs to understand that those of us in the sleep profession have no need for additional research as we see the connection quite clearly and up close every night in every sleep center across the entire world. ..."
Yeah but, yeah, but, geeze, Louise!!!! You RPSGTs "ain't" medical professionals, most of you have no medical background whatsoever, shucks youse guys "ain't" even allowed to provide us much info at all about our PSG the next morning 'cause you "ain't" no medical "professional". Per centage wise, the RPSGTs are the real heroes of sleep medicine, but they aren't "good enough" to tell us patients much 'cause they "ain't" no medical professional.

Of course, your sleep doctor (the medical professional) in all too many cases can't even be bothered consulting w/us, preferring to send their dictation to our referring doctor to let him/her "waste" their time consulting w/us, or if they do condescend to consult at all w/us, its an "in and out", 10 minute, yuo've got OSA, here's your script, bye. IF we are lucky enough to get a fully data capable PAP our "medical professional" isn't interested in really looking at the data and just glances at it at best w/o paying any real heed to it.

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