APT and the AARC

American Association of Sleep Technologists
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American Association for Respiratory Care
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American Society of Electroneurodiagnostic Technologists

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Postby Bobzzz » Wed Dec 03, 2003 6:25 am

They were careful not to cover too much Sleep when I went to EEG school either. I agree that this needs to be a completely separate Health profession. The one problem now with the APT having drug its feet for so long is that other fields like Respiratory or Nursing see the $$$ that can be generated by a sleep lab and are fighting for control. In some labs one cannot be a Sleep Technologist if they're not an RN first due to an internal power struggle with Nursing coming out on top, thus gaining complete control of the lab's operations and shutting everyone else out.

OJT's need to be done away with yesterday. AAS programs in Sleep Technology would start springing up across the country. I'd have to believe that a community college would love to have a "hot" program to offer students.
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In response to April 18 post by "Tech"

Postby somnonaut » Thu Dec 11, 2003 6:26 pm

Here is my quote from the APTWEB site.

"OK, I have to get on the soapbox now.

I have been around this issue for over 5 years now. The genesis of much of the Tech/therapist consternation is basically due to the history of how the therapists feel they have been crapped on by other allied health fields over the years and the erroding of their "field" and "scope of practice" by Nursing, and Physician Assistants, etc, that now allows lowly LPN's to apply Oxygen if needed. How dare they! and others to do other tasks, that were usually Respiratory's. They feel it is their time to do some crapping of their own.

The problem with their tack on assimilating sleep into their scope of practice is that they:
1) believe that it is OK for them to do a "lower form" of patient interaction, perform PSG, because they are already licensed to do a "higher form" of patient interaction. So, in effect, if their training and licensure allows them to stick trach tubes down throats, then duh, it should allow them to place a CPAP mask on someone.

The falacy of the argument is in the REASON for their intervention.

AND IT MUST BE POUNDED INTO EVERY SLEEP TECH'S BRAIN, AND THE FIELD AT LARGE

The PAP treatments provided during PSG must be to improve sleep, and not lung function. THAT is the missing link. Their scope of practice arises from the goal of imroving Lung function. If you perform BiLevel PAP to raise SaO2 then, it can be said you are increasing lung fucntion, if you are doing it to stop snoring, and/or abolish arousals, then it can be said it is to improve sleep function. This will be a cutting point.

2)WE MUST REMEMBER
The PAP (CPAP/BiLevel) PSG is a study. Repeat: The PAP (CPAP/BiLevel) PSG is a study.
Meaning, it is NOT a therapeutic intervention. It is a trial of PAP for the purposes of investigating/documenting how well someone SLEEPS at the different pressures. The Doctor makes the final decision as to prescription setting AFTER REVIEWING the study/documentation.

Coupling points 1 and 2, then yields a discipline that performs testing to invesigate SLEEP function, and invesitgates ONE method of abolishing the genesis of fragmentation of sleep. If they are to be given Carte Blanche to sleep, then the state is now allowing uneducated/unexperienced "sleep" practitioners loose in your state, and that is the fear that you need to put into your legislator. They (Resp Therapists) would then be "calling the shots" on things they have no idea about. Even the medical community says so. Go see AASM position paper, or even the AARC-APT guidelines, which says they need further training and experience in this field to perform properly.

Keep providing quality capable sleep care until we can get our own licensure if any is needed.

It all depends on how the scope of practice in your state is worded.
Please visit to see your state's scope of Repiratory Therapy practice.
http://www.aptweb.org/word/Exemptions.doc
Off box now"

If there is a statement that is arrogant and apathetic, it is yours for telling this field we will it is yours from the April 18 post:
"I, personally, am ambivalent about who wins the "right" to call sleep "theirs." APT or AARC, either is a good fit. What is needed, is that a decision needs to be made ASAP. Until that happens, we will continue to have patients subjected to inadequate labs operated by incompetent personnel."

You really have to ask yourself as a resp therapist, WHY did you seek to get the RPSGT credential in the first place? If your Rt credential is "Good enough" then why the extra effort and expense to get the other letters. Because you recognize the needed education to do the job properly. Your intial resp education did not give you the needed background to deal with sleeping people and their breathing interuptions. Period. This is not a resp field. The treatment is a sub-acute resp treatment to re-constitute sleep from the fragmentation of sleep-induced restriction of the airway. And no, CPAP CANNOT Ventilate someone. That is why it is ergulated as a non-life sustaining therapy. And yes: "I do "Pound it into every tech's head" I instruct and discuss with that a PAP PSG is a study to DOCUMENT the effect of different steps of non-life sustaining treatment trial."
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Postby Showmesleep » Fri Dec 12, 2003 5:20 am

Well said. This is 'our' field. (RPSGT's)
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APT Issues

Postby cheekybastardthat » Fri Dec 12, 2003 12:40 pm

AND IT MUST BE POUNDED INTO EVERY SLEEP TECH'S BRAIN, AND THE FIELD AT LARGE

Whoa! you need to contain your anger and lower your voice.Are you like this at work?

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Postby somnonaut » Fri Dec 12, 2003 1:37 pm

I guess your name says it all about you.
Yeah, I physically pound it ito people's skulls, they get all bloody and dripping. Its great anger managment. I like to use 8Lb sledge hammers, they inflict the most damage.

You and Tech, hello!
Its a metaphor for having that realization at the core of all of your teaching so that no matter what component of Polysomnography they are learning, they always receive the same lesson. If its during the titration instruction or the documentation, or the reporting. We are not here to turn the knobs up as fast as possible (which many resp trained individuals do because they come from a rid the body of all pathology mentality) instead of the we are performing a medical documentation process.

DUH!
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All right...everyone calm down

Postby SCNVsleep » Fri Dec 12, 2003 7:29 pm

I'm not gonna start editing anything, but under NO circumstances am I going to allow this to turn in to a flame war. Capisce?
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All right by me, but...

Postby somnonaut » Fri Dec 12, 2003 10:40 pm

I will not stand for someone telling me I an "uninformed." So if Tech gets to voice his/her opinion, then I get to voice mine. Don't go down the way of the original APTweb boards of old (on the site I started, BTW,) where this whole topic ended up being verboten. My 20 years performing polysomnography in purely academic facilities and training techs and pulmonary, critical care, sleep fellows offords me some latitude in metaphorical speech.
I have a pretty good idea who Tech is, and we have crossed paths before. Just, I use my name he doesn't.
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Postby cheekybastardthat » Sat Dec 13, 2003 1:35 am

Sorry.Did not mean you any harm.Just trying to be helpful as you appear really tensed up and angry.That was away back in April that the Tech person
wrote their opinion.Somnonaut,this is Dedember.You are casting up past hurts and slights.It doesn't seem that serious a thing to me.
Buy the Daily Racing Form,go to the track and drink a cup of coffee and "Forgetaboutit".
I'm trying to be nice here so don't take offence at my smilie.
cheekybastardthat :P :P

<This post edited by Sleepadmin. Text in red reflects changes made>
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Somnonaut...

Postby SCNVsleep » Sat Dec 13, 2003 2:31 am

Listen, I agree with you original post. But:

1. This place is for people to post info and exchange ideas. It is not a place to start flaming people because you are, in essence, flaming a person for a post they made 8 months ago.

2. I don't care if you are the second coming of Jesus Christ himself. Just because you started a board on the APT site, doesn't mean you can come to THIS board and act any way you want. We all behave in a very civil manner here and anyone who doesn't will be dealt with. Don't ask me how, because we haven't HAD to deal with it, and I don't want to start now.

I respect your past accomplishments and your experience and look forward to talking to and learning from you. But this isn't your board. It's Andrew's. The moderators here have been entrusted to make this place a pleasurable, entertaining and educational experience for EVERYONE without fear of censorship or flaming.

Any further comments about the content or administration of this board may be directed to me via PM. I don't want to drag the whole board into it.

Have a great weekend everyone!

Stew
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Postby Tech » Sat Dec 13, 2003 12:42 pm

Re: somnonaut

I carefully re-read both messages, from somnonaut, and from me. I stand by my comments. What’s more, I assert that my comments were carefully reviewed before posting, to take out language which I thought was unduly “frank” (and to correct spelling and grammatical errors). (“Hogwash” was not my first choice, but I felt it best to be polite). Somnonaut, your letter was offensive to me, full of presumptions, speculation, and non-sequitors, not to mention ample amounts of invective and crass vernacular. I do admit, however, that I’ve spit a few tacks in the forums, myself.

I don’t know what I’ve done to be referred to as “that Tech person,” If you find my contributions to these pages, I think you’ll agree that my comments are carefully considered, and I attempt to be contributory. I do speak frankly on issues that I feel are important. I monitor myself closely, trying to be clear, and not to offend, while offering straight talk.

I have no doubt that you are a person of sincere interest in sleep medicine, who has made and continues to make a contribution to the discipline. Twenty years in the field is a substantial credential. Your dedication and service are a credit to you, and a benefit to your patients. I salute you, regardless of our differences.

But let me say this: Tech person here, has 30+ years in health care, mostly as an RCP (at night), but with almost 10 years now in sleep (retaining RT credentials). I am an RPSGT and member of the APT. I do not take kindly to having anyone literally or figuratively thinking to “POUND” anything into my (or any one else’s) head. The presumption of personal superiority, that would grant anyone the right to do such pounding is to me, remarkable in its self-assumption and condescention. As a metaphor to use in dialogue with colleagues, it is, in my estimation, very poorly chosen, and likely to be counterproductive. Clearly others have seen this as well. Sir, you have distinguished yourself. It is very telling that you won’t back off from this language.

I’m sorry that you found my comment about ambivalence to be “arrogant.” I suggest that was a projection of your own attitude upon my words. I meant to be hopeful, if resigned, that things would eventually work out to the best benefit of patients, regardless of the petty turf wars.

Let me say that when I initially responded to your post at the aptweb site, I was just fresh from an APT meeting, where I’d been chewed up and spit out by the members there. I had recommended that people visit Sleepnet, as it was a site with a vital and energized forum for sleep professionals. At that time the APT site’s forum was linear and hard to use for continuing discussion. My suggestion was denigrated. Everybody should go to the aptweb forums. I later had several discussions about this with Teresa Shumard, saying that the APT should strive to be the place sleep professionals would go to share ideas and info, the “right” place for this to be happening. I am glad to see that recently the format for the forums has improved. At that same APT meeting, I also naively advanced the Idea that RCP’s had value in the sleep lab. I was immediately surrounded by people with bared teeth and blazing eyes, on the attack. I confess, I was overwhelmed. I felt like Donald Sutherland in “Invasion of the Bodysnatchers,” if you know what I mean. It was a shrill response, filled with loathing. Heck, I was just there, thinking that I was among colleagues and friends, that I could speak freely and be respected. I got blind-sided. I was blithely thinking how cool it was to be there, never suspecting that I’d be seen as the enemy. Clearly the APT leadership present there had no tolerance for disagreement.

Somnonaut, your message was more of the same to me, i.e., the hostility to which I alluded in my original message regarding your posting, and I guess I was primed to respond, more or less in kind. It is truly remarkable to me, that there isn’t room for a collegial dialogue on this point at the APT. Unfortunately, there appears to be no room for discussion, nor respect for anyone, member or not, who holds a view which is at variance with the leadership. We must all believe the same thing, and march lock-step, “to protect our profession”. At that time, as a consequence, I gave up on the APT forums, and gravitated to Sleepnet, and as the Sleepnet forum proceeded to unravel, I went on to Binary sleep.

My sincere thanks to Binarysleep, for striving to maintain a civil dialogue. I think it’s unfortunate that aptweb has been unable to offer a “home” for sleep techs, where the dialogue is open and nurturing, and the forum format friendly and conducive to exchanges of many views. Instead, here we all are at Binarysleep, aptweb forums being at least two big steps behind the curve.

<This post edited by Sleepadmin. Text in red reflects changes made>
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Postby Tech » Sun Dec 14, 2003 12:06 am

Sorry cheekybastardthat. I misquoted you.
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Let cooler heads prevail

Postby Ted the Sleep Guy » Sun Dec 14, 2003 2:10 pm

To all parties concerned: Look, this is a tender subject. There is no need or advantage to throw slurrs at each other. Nothing will be gained by it. I don't think anyone has changed anyone elses mind by these communications. Worse, there may be other members out there with opinions that are being witheld for fear of being attacked by you guys. So lighten up----please. Tech--- I know how you feel. I have been in work situations where I was the only RT among sleep people. I was treated badly. I see them as very small people and part of the reason the sleep profession has not progressed the way respiratory has. Tech, its better to rise above it. Somnonaut, you and I have never met. I am from the NY area. I live and work on Long Island. I happen to be registered in both Resp and Sleep. I have had the priviledge of working and studying with the best that have been. RRT need not be referred to as DUH. I do know people that have known you. Your reputation preceeds you. Your name has been connected with the word GURU. You have my respect. Lets all keep the shots above the level of the belt. I plan to be at the Focus meeting in Baltimore this April. I will also be in Philly this June. Why don't we all meet and have afew beers and some laughs. Its more pleasant than reading the past few posts. One more thing. Hey SCNV---- this was a good lesson on how to be a moderator. Thanks

<This post edited by Sleepadmin. Text in red reflects changes made>
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My last word on this for now...

Postby somnonaut » Sun Dec 14, 2003 6:26 pm

I re-read both statements also, and never referred to you as "the Tech person"

You have now attributed things to me multiple times, and you 'Tech' and the powers that be, better have your I's dotted and your T's crossed, because you are treading on "allowing/making slanderous statements" territory.

Since Tech's original posting was directly referring to an APT member's only posting, I would think that you, Sleepadmin, would not have allowed Tech to make an objectively un-checkable reference. This allowed him/her unchecked power of reporting, that has possibly hurt my name and reputation. And he made it anonymously, we must all keep that in mind.

As I sit here figuring out which reply to post, I keep hearing a word..."Paternalism".

This is exaclty what you are preaching, Tech.

And this paternalistic attitude is a microcosm of the whole Respiratory /Sleep fight.

For all those with the feeling;
"Respiratory has been here before, listen to the way it turned out for us."
You are speaking of a history that is respiratory's, not sleep's.
The threat from Nursing for the development of the Resp therapy field was nothing, when compared to the sheer all out threat of assimilation that Repiratory is making for Sleep.
Nursing is so wide, that any patient interaction could be labeled nursing. It is too nebulous as a "field."
Therefore, I am sure carving out a niche, and labeling it "Respiratory Care", was hard, but realistic and obviously doable. There was no one else in your path.

The current Respiratory threat to Sleep Medicine is different, in that, you are saying to the rest of medicine,

"Oh, the niche that we carved out for ourselves (Respiratory Therapy) also now includes Sleep." which nobody else in Medicne gives a hoot about anyway, except those directly involved in it. It is this "under the radar" (just like SWSerp questions) that has been carried out from the resp side over the last decade.

Yes, AMP is a management company, a wholly owned subsidiary of the NBRC (National Board of Respiratory Care),

and yes, the NBRC is the credentialing body of the AARC (American Association of Respiratory Care) and the test to pass for many states' license , and yes, the AARC is the professional representative arm of the Respiratory Therapy field, and yes, those same resp people also are the ones who run, or own, and place on patients the highly used modality of treatment (CPAP) in the sleep field, because they (the RT's) own or moon-light in Homecare. And yes, they tend to "make it" from both ends.

But that, according to you, is not the issue. It is supposedly, that we all don't know what is good for us, or even how to go about finding out what is good for us, and we need the highly experienced/multi-credentialed, people to "show us the way" And the best way to do that is to shut up the most vocal opponents. Namely, people like me. In your view, it is much better for the whole "movement" if the sleep field just sits back and waits to find out what will happen. At least it is best for the respiratory field.

Look, I have seen the enemy also and it is not us, it is the likes of those who refuse to help our field (Sleep

Medicine), as you stated:
"I, personally, am ambivalent about who wins the "right" to call sleep "theirs." APT or AARC, either is a good fit. What is needed, is that a decision needs to be made ASAP. Until that happens, we will continue to have patients subjected to inadequate labs operated by incompetent personnel."

Well you know what, "either is 'NOT' a good fit". It will be a cold in hell before I let go of this issue and let the likes of apathetic individuals take the reigns of this field and lead us down the path of uncaring like you have stated. So, in effect, that would also mean that the discipline of clinical sleep medicine would only be under the purview of pulmonary practitioners?

This fight has caused MORE poor quality sleep medicine than not having this fight. The inadequate labs you speak of are created more by respiratory people now thinking they have license to do sub-par sleep testing, than it is from untrained people, who all of sudden think they can do sub-par sleep testing. The labs that are sprouting up are more in Pulmonary MD's Offices than in GP, or non-resp Docs offices.

Repiratory Therapy Medicine is not the right discipline to run the sleep field.

It is not a time for talking, it is a time for doing. I DO CARE WHAT HAPPENS TO THE SLEEP FIELD, as a sleep clinican, a Sleep technologist and as a sleep patient.

Sleepadmin:
I didn't start the APT boards, Todd Eiken started that aspect of the website, I started the APTWEB site as a whole. I don't want, nor require kudos for anything, just the realization that now this field has no place to turn to vent their frustration. They can't turn to the APT website, they can't say anything on Sleepnet, and now, possibly not even here, where an off the hip reference to a training mindset made on a secure forum is taken out of context and attributed a physical nature to it rather than the educational nature that it clearly has when in context, it is a pity that you, Sleepadmin, are telling me to shut up, and letting the initial post of Tech's, flaming me for a post not even originally on this site! Maybe, that is your takeaway lesson. Talk a bout Flame bait.

Here is what I see, "Tech"

You never answered why you spent the extra effort for the RPSGT credential? "Tech."

If you would look into the history of sleep medicine a little, Tech, you would find that the sleep field has been open to all comers since its inception (from neurology, I might add.) It has welcomed with open arms, anyone willing to undertake the discipline and learn the knowledge base, no matter what, where or who they were or from. I still see the field like that. And others in the field recognize the exceptional nature of the field itself, Tech.

You say Discussion is in order?
You think it is time for discussion, where have you been, Tech?
Discussion is when both sides think there is something to gain. The respiratory side just feels Sleep people
are treading on "their turf" and we need to shrink into some hole, wither and die.
But, Tech, yet, when Colin Sullivan perfected CPAP for Sleep apnea, it wasn't even on anyone in respiratory's radar
or interest. This is proven by the respiratory license acts that carved out the scope of practice for many
states in the early 90's, well into the period of treating CPAP by the sleep clinicians. And do you know what
we find, lo and behold, no mention of sleep, sleep related treatments, education or sleep mentioned anywherein
these acts. They were not thinking that sleep was a part of their scope of practice, because it was not then,
is not now, and never will be, period, end of story.

We won't happen to mention that all of the licensed respiratory people then supposedly capable, "by virtue of
their license", to perform polysomnography, score it, and educate patients, actually do not have one iota of
relevant sleep education or knowledge amongst them. Unless they gained it from outside, like you did, Tech.

Now, you want the sleep people to help the patients' of our states by sitting by and waiting for respiratory people to get "up to speed", while the Resp people hope that all of the sleep people, who have been doing a very good and safe job in sleep medicine for over 3 decades, all of a sudden become benevolent and train the respiratory people to take their jobs? Tech?

And oh, by the way, there now will be many fewer sleep lab beds, helping even less patients in our state, because all the sleep jobs and respiratory jobs will have to be filled from the same pool of graduates of the resp schools. That is serving/protecting the citizens of state X real well. Plus how much the cost will grow, as a result of the lessened workforce, and the heightened demand.

"What's that you say, the credentialing body of the nation's allied health schools has now recognized Sleep as its own discipline. How can that be, Respiratory is sleep?" Thank you Dr. Shelledy

Yes, I like my run-on sentences, and my comma-splices. Especially because these forums are not about hoopdedo writing, but about expressing one's views.

It is too bad that as the volume gets a little loud, all of a sudden we are threatened with shutdown or censure. I will still fight to allow you, Tech, to express your views; No matter how mindless or wrong they are. I hope you will fight to fight for me to express my "mindless and wrong" views.

SWSerp:
APT Executive Office
1 Westbrook Corporate Ctr.
Suite 920
Westchester, IL 60154
Not under AMP anymore as far as I know.
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Re: My last word on this for now...

Postby sleepadmin » Sun Dec 14, 2003 7:13 pm

somnonaut wrote:Sleepadmin:
I didn't start the APT boards, Todd Eiken started that aspect of the website, I started the APTWEB site as a whole. I don't want, nor require kudos for anything, just the realization that now this field has no place to turn to vent their frustration. They can't turn to the APT website, they can't say anything on Sleepnet, and now, possibly not even here, where an off the hip reference to a training mindset made on a secure forum is taken out of context and attributed a physical nature to it rather than the educational nature that it clearly has when in context, it is a pity that you, Sleepadmin, are telling me to shut up, and letting the initial post of Tech's, flaming me for a post not even originally on this site! Maybe, that is your takeaway lesson. Talk a bout Flame bait.



Whoa! :shock: Hold on there.... I (Andrew Korbel) NEVER told you to shut up. In case you missed it, I have not even posted in this topic until now. Furthermore, I encourage livley debate, and wish to encourage a forum whereby people can express their opinions freely. Notice that word opinion. As long as it is not libelous (slander is a statement, libel is print) it will stay.

As far as your accusation of libel... As I read it, he expressed his opinion about your post, not an opinion of you.

If you had contacted me before registering with your name, I would have given much more consideration to removing your name from Tech's post. But, by registering with your name (and reprinting your original APT post) you apparently are not too concerned with your "hurt name and reputation."

This forum is not a free for all. Yes we will censor IF NECESSARY. Libel would be one such situation. It requires a few things though. The person who feels as though he is the victim of libel should take the first logical step of contacting a moderator or me. I have in fact been contacted a few times regarding other posts, and taken appropiate action where necessary.

Thanks for your participation
Last edited by sleepadmin on Mon Dec 15, 2003 2:25 pm, edited 1 time in total.
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Your agents (moderators) are you

Postby somnonaut » Sun Dec 14, 2003 9:22 pm

Period.
You should have stricken the posting when you realized it was about a memeber only forum. Period.
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