Replies to This Discussion

Permalink Reply by cathy huffman on April 11, 2009 at 10:18pm

yikes!!!! Do you have any other options on doctors/ clinics. I went in for a retest in November called and had an appt. for 3 days later to do the study. Now i do have concerns with the fact it took the respiratory company nearly a month to contact me (don't know when they got the dr.'s orders) that my pressure needed to be changed from a 7 to a 10. it still hasn't been changed :-( and it has been 3 1/2 months. They don't seem to find this as serious as I do.

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Permalink Reply by RockRpsgt on April 12, 2009 at 8:17am

If it was not for my oldest I would be on my way!
Mike said:

Come on out to sunny California, Rock! We'd love to have more wonderful sleep techs like yourself out here.

Duane McDade said:

Not to far from los angeles
Rock Hinkle said:

sounds great Duane! where do I sign up?
Duane McDade said:

I score all my test on the fly, so the Dr. has a report in his hands 1st thing in the morning. Then he does his report before the office opens. He see's most of the patients the next day for follow ups. But, we run a very tight ship. I can't see a reason not to. It's too important for treatments to start right away. That's just what I'm used to.

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Permalink Reply by Judy on April 12, 2009 at 9:13am

TushyGalore, whilst you are waiting you may well find that sleeping in a recliner chair may help you avoid the worst episodes of waking fighting for air. If you don't have a recliner chair then you can try propping yourself up w/lots of pillows but this is much less satisfactory as you are more inclined to slip down flat in the bed or where your body is bending higher up than at the waist/hips and thereby putting more pressure on the diaphragm than you would in a recliner.

Duane McDade, you said:
"I score all my test on the fly, so the Dr. has a report in his hands 1st thing in the morning. Then he does his report before the office opens. He see's most of the patients the next day for follow ups. ..."
I've seen quite a few RPSGTs who are not in favor of scoring on the fly, feeling that it takes away from patient care during the night's testing and I've also seen them insisting on additional pay for scoring on the fly.

The local sleep lab that I use has a daytime RPSGT who comes in each day to do the scoring and two or three alternating sleep pulmos come in two or three days a week to go over the PSGs and consult w/the patients. The slelep lab owner/manager is also an RRT, RPSGT and comes in a does scoring too as needed. The patients do get a consult before and after each evaluation and titration (well, just one consult between evaluation and titration). The script is FAXed to the local DME of patient's choice at the end of the titration consult. My first titration at this lab I was scheuled for the doctor consult four days later and before I got home from the consult the DME had called to schedule delivery of my equipment the next day. My titration consult was Wednesday, the DME delivered Friday, I returned the CPAP Monday morning as it was NOT a fully data capable CPAP which I had insisted on, they didn't explain they didn't have the one I wanted on hand and had to order a fully data capable CPAP in so this was just a loaner. Their mistake. I went to the second local DME supplier contracted w/my secondary insurance. The sleep lab had already ensured that this supplier DID have a fully data capable CPAP on hand before FAXing the script to them.

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Permalink Reply by RockRpsgt on April 12, 2009 at 2:41pm

Scoring on the fly is a touchy subject right now it seems. I feel that doing this better connects me with what is going on with the pt. it Is not that hard to score a study as you go and keep up with your pt. Regardless of a day tech or not the night tech has got to be able to score on the fly to determine if a pt needs to be split or not.

Judy said:

TushyGalore, whilst you are waiting you may well find that sleeping in a recliner chair may help you avoid the worst episodes of waking fighting for air. If you don't have a recliner chair then you can try propping yourself up w/lots of pillows but this is much less satisfactory as you are more inclined to slip down flat in the bed or where your body is bending higher up than at the waist/hips and thereby putting more pressure on the diaphragm than you would in a recliner.

Duane McDade, you said:
"I score all my test on the fly, so the Dr. has a report in his hands 1st thing in the morning. Then he does his report before the office opens. He see's most of the patients the next day for follow ups. ..."
I've seen quite a few RPSGTs who are not in favor of scoring on the fly, feeling that it takes away from patient care during the night's testing and I've also seen them insisting on additional pay for scoring on the fly.

The local sleep lab that I use has a daytime RPSGT who comes in each day to do the scoring and two or three alternating sleep pulmos come in two or three days a week to go over the PSGs and consult w/the patients. The slelep lab owner/manager is also an RRT, RPSGT and comes in a does scoring too as needed. The patients do get a consult before and after each evaluation and titration (well, just one consult between evaluation and titration). The script is FAXed to the local DME of patient's choice at the end of the titration consult. My first titration at this lab I was scheuled for the doctor consult four days later and before I got home from the consult the DME had called to schedule delivery of my equipment the next day. My titration consult was Wednesday, the DME delivered Friday, I returned the CPAP Monday morning as it was NOT a fully data capable CPAP which I had insisted on, they didn't explain they didn't have the one I wanted on hand and had to order a fully data capable CPAP in so this was just a loaner. Their mistake. I went to the second local DME supplier contracted w/my secondary insurance. The sleep lab had already ensured that this supplier DID have a fully data capable CPAP on hand before FAXing the script to them.

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Permalink Reply by Duane McDade on April 16, 2009 at 8:33am

Judy I have to agree with Rock. When a technician scores on the fly he hears and sees exactly what is happening. Where when someone comes in to score a test later that da , well he must guess if that was a snore, If that was an apnea or maybe the mouth was just open....I could go on but there's 100's of things that could be scored wrong, and yes it could change the treatment that the Doctor would suggest.

Rock Hinkle said:

Scoring on the fly is a touchy subject right now it seems. I feel that doing this better connects me with what is going on with the pt. it Is not that hard to score a study as you go and keep up with your pt. Regardless of a day tech or not the night tech has got to be able to score on the fly to determine if a pt needs to be split or not.

Judy said:

TushyGalore, whilst you are waiting you may well find that sleeping in a recliner chair may help you avoid the worst episodes of waking fighting for air. If you don't have a recliner chair then you can try propping yourself up w/lots of pillows but this is much less satisfactory as you are more inclined to slip down flat in the bed or where your body is bending higher up than at the waist/hips and thereby putting more pressure on the diaphragm than you would in a recliner.

Duane McDade, you said:
"I score all my test on the fly, so the Dr. has a report in his hands 1st thing in the morning. Then he does his report before the office opens. He see's most of the patients the next day for follow ups. ..."
I've seen quite a few RPSGTs who are not in favor of scoring on the fly, feeling that it takes away from patient care during the night's testing and I've also seen them insisting on additional pay for scoring on the fly.

The local sleep lab that I use has a daytime RPSGT who comes in each day to do the scoring and two or three alternating sleep pulmos come in two or three days a week to go over the PSGs and consult w/the patients. The slelep lab owner/manager is also an RRT, RPSGT and comes in a does scoring too as needed. The patients do get a consult before and after each evaluation and titration (well, just one consult between evaluation and titration). The script is FAXed to the local DME of patient's choice at the end of the titration consult. My first titration at this lab I was scheuled for the doctor consult four days later and before I got home from the consult the DME had called to schedule delivery of my equipment the next day. My titration consult was Wednesday, the DME delivered Friday, I returned the CPAP Monday morning as it was NOT a fully data capable CPAP which I had insisted on, they didn't explain they didn't have the one I wanted on hand and had to order a fully data capable CPAP in so this was just a loaner. Their mistake. I went to the second local DME supplier contracted w/my secondary insurance. The sleep lab had already ensured that this supplier DID have a fully data capable CPAP on hand before FAXing the script to them.

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Permalink Reply by Judy on April 16, 2009 at 9:25am

So, Duane, Rock, you think maybe NOT being scored on the fly is why the sleep techs in my prior titrations until last fall never said or did anything about high leaks, nor did the doctors? And despite providing data from a fully data capable xPAP for 2 years NO ONE mentioned concern about my high leak rate except my fellow apneans at cpaptalk. When "I" asked about my high leak rate I was told "these xPAPs compensate nicely for leaks".

I was resistant to mouth taping altho I did try the PoliGrip DentureGel which worked great - WHEN I used it. I was just too lazy to be bothered adding one more thing to my bedtime routine. No professional ever suggested a chin strap. Until my titration last fall. And THAT was a great sleep tech who actually took the time to LOOK at the data from my VPAP and picked up right away on my high leak rate. The other sleep tech who actually conducted the titration suggested and gave me a chin strap about half way thru the night due to mouth leaks.

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Permalink Reply by Duane McDade on April 16, 2009 at 9:59am

Yes you don't score what you didn't hear. And most software will not show leaks. Your controls (remote) for the CPAP/BI-LVL have that on them. The leak value is not on the test/study you can leave notes but, looking back 5 years ago.....the scoring tech we used never read my notes. Yes or maybe to all of your statements.

Judy said:

So, Duane, Rock, you think maybe NOT being scored on the fly is why the sleep techs in my prior titrations until last fall never said or did anything about high leaks, nor did the doctors? And despite providing data from a fully data capable xPAP for 2 years NO ONE mentioned concern about my high leak rate except my fellow apneans at cpaptalk. When "I" asked about my high leak rate I was told "these xPAPs compensate nicely for leaks".

I was resistant to mouth taping altho I did try the PoliGrip DentureGel which worked great - WHEN I used it. I was just too lazy to be bothered adding one more thing to my bedtime routine. No professional ever suggested a chin strap. Until my titration last fall. And THAT was a great sleep tech who actually took the time to LOOK at the data from my VPAP and picked up right away on my high leak rate. The other sleep tech who actually conducted the titration suggested and gave me a chin strap about half way thru the night due to mouth leaks.

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Permalink Reply by Judy on April 16, 2009 at 11:34am

Thank you, Duane. I'm surprised that high leaks don't show up on the equipment recordings. I watched the monitor during part of a scoring the day after my first sleep evaluation while I was undergoing an MSLT. Every nown and then there would be this drastic change in a line of the squigglies that almost covered out the rest of the squiggly lines (for lack of a better description) and I assumed they were leaks. Maybe they were coughs tho, cause I do remember reading the tech's notes where he/she recorded every cough all night long!!! A full 8 x 20 sheet w/regular lines like a sheet of notebook paper but in two colums and both colums full to w/in 1 or 2 lines of the bottom of the second colum. HOW I WISH NOW I HAD KEPT COPIES OF ALL THAT!!! But I took it to Cleveland Clinic w/me and gave it to them. *sigh* I never got it back and that was in 1996-1998 so I doubt CC or the local hospital sleep lab still has the detailed data. *sigh* It sure would be INTERESTING and FASCINATING now that I know and understand more. (I didn't start xPAP therapy until Oct 2006). *sigh*

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Permalink Reply by RockRpsgt on April 16, 2009 at 12:32pm

If a tech does not score on the fly he/she must be counted on to take very good notes. Their note taking skills are going to based on their own work ethic, their attention spand, and the amount of training they recieved. Before I began scoring I believe I had too much idle time as pertaining to my studies. As we all know men in general should not have to much of this kind of time. I am no exception! I can recall numerous times that my mind would wander away from the studies. Scoring as you go requires a certain attention to detail that I feel is important to the interpretation, and documentation of the study. Some patients need more attention than others. This can sometimes make this process difficult if not impossible, but I try to score every study I do even though it is not always required of me.

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