The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Sleep Medicine Curricula

Pamela Minkley, RRT, RPSGT Tuesday, November 5, 1996

Designing New Curricular Components: Sleep Medicine and Technology

RCPs are well suited for career opportunities in sleep medicine and technology. Their critical thinking skills and cardiopulmonary physiology training give them a good base. Studies in general practices of healthcare, basic sciences, clinical sciences, emergency management, electronics, instrumentation, therapeutics, ancillary instrumentation, data assessment and tabulation, and management included in most RCP curricula all contribute to a strong foundation for sleep medicine and technology. The RCP who chooses sleep medicine and technology as a career option will often harbor the most extensive knowledge of sleep pathologies, physiology, diagnosis, and treatment available in his/her location. The skills necessary to adequately perform in a sleep center are greatly underestimated. The technologist in a full service center is frequently working alone, in a remote site, with complicated equipment and sometimes unstable patients, analyzing data real time, and making decisions about therapeutic intervention based on therapist driven protocols. They must be well trained.

In addition to RCP program curricula, courses specific to polysomnography and its related medical disciplines must be added to adequately prepare the RCP to function safely and effectively in this frequently solo environment. Polysomnographic techniques must be presented in depth. The application, principle of operation, and signal and artifact recognition for sensors and electrodes used for non-invasive monitoring of biopotentials such as electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory flow and effort, oximetry, pulse rate, and blood pressure are but a few examples. Some invasive procedures to record and measure physiological changes in body temperature and esophageal pH and pressure are also included in the polysomnographic technologist's job description. Neurophysiology, behavioral psychology, sleep/wake physiology and pathology, and polysomnography scoring and interpretation are other additions to the curricula that are needed. Logistical operation of the sleep center will frequently fall to an RCP working in a sleep center and may include marketing of the center's products which requires additional training in increased emphasis in existing management courses.

Implementing these additions to an RCP program already straining to fit into a shrinking time frame and budget can be a challenge! In addition to traditional lecture settings, sleep medicine can be integrated with other traditional RCP modules, particularly in a problem based learning format. For instance a case study/problem for a patient in respiratory failure can include non-invasive ventilatory support and address issues of respiratory physiology in sleep versus wake. Application of treatment interventions, ventilatory principles, pulmonary diagnostics, and even basic gas laws can be significantly different in the arena of sleep diagnostics and polysomnography. Again problem based learning and critical thinking formats allow opportunities to integrate new knowledge in sleep medicine and technology.

Integration of sleep medicine and technology into an existing program is challenging. Its complexity is frequently misunderstood or viewed only in reference to sleep disordered breathing. To provide students with minimal training or training focused only at the obstructive apnea patient may be a dis-service unless the limitations are divulged. In locations where an EEG program exists, combination of resources is cost effective but courses specific to polysomnography and sleep/wake physiology and pathophysiology are still needed. It is usually easy to create interest because literally ALL students will identify with at least one of the sleep medicine pathologies (excessive sleepiness, self induced sleep restriction to name a couple)!.

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