How would you like to have a job where you stay up all night and watch someone else sleep? That's the job of the polysomnographic technologist, the technician who works in a sleep lab or clinic and monitors patients during a sleep study.

"Polysomnographic" refers to "many graphs," which aptly describes the work involved. During a sleep study, the technologist is typically looking at 10-20 channels of physiologic recordings, including brain activity, eye movement, muscle tone in the body (including arms and legs), breathing, airflow and oxygen saturation. They also need to be on the lookout for abnormal cardiac arrhythmias, severe oxygen desaturation, or behaviors like night terrors, REM behavior disorder, or even seizures.

"It's a fascinating field, and it's still growing," says Mark A. DiPhillipo, RPSGT (which stands for Registered Polysomnographic Technologist, the highest credential in the field of polysomnographic technology). "Some people really like working the night shift—they like being independent and having their days to attend to other activities." DiPhillipo, who works for the Center for Sleep Medicine in Lafayette Hill, PA, is president of the Board of Registered Polysomnographic Technologists.

"There are many personal rewards to working in this field," adds DiPhillipo. "I like working with patients and being able to see positive changes. In many fields of medicine, you only see the problems; but RPGSTs work with patients and can see positive results—sometimes overnight."

However, not all sleep techs work only at night. Many work split shifts, several at night and others during the day, when they review records of sleep studies. Others will work three or four nights, and after their days off, they may go back to a day shift. "I usually work three 12-hour shifts, from 7:00 p.m. to 7:00 a.m.," says Michele Castonguay, RPGST, who is employed by Ottowa Hospital in Ottowa, Ontario. "From 7–9 p.m., I analyze sleep recordings from the previous night. Then I work with patients by setting them up with electrodes for monitoring. The patients are usually in bed by 11:30, and I spend the night monitoring, doing therapeutic titration (an adjustment of air pressure for a patient using continuous positive airway pressure, or CPAP). I'm here to be of assistance to the patient and to make sure we get a clear recording. I get the patients up at 6:00 a.m. and leave work at 7. Then I go home and collapse."

Ms. Castonguay is only partly joking. She and other sleep techs are very much aware of the difficulty of working different shifts, particularly working at night, and balancing home and family responsibilities. "They're human, just like everyone else," says David Davila, MD, Medical Director of the Sleep Center at Baptist Health Medical Center in Little Rock, AR. "They're subject to all the social and family stressors we all have. They know that sleep is a precious commodity that they need to protect during the day."

Dr. Davila, who is a member of the Board of Registered Polysomnographic Technologists, makes a point of regularly reviewing sleep hygiene practices with his sleep techs, such as keeping out light and sound when they sleep during the day. But the hard part seems to be adjusting to a "normal" schedule on off days.

Sleep technologists are particularly helpful in working with patients who work untraditional shifts or who have sleep problems, Davila adds. "The schedule that RPSGTs work gives them a special understanding of the sleep problems our patients are dealing with."

"Most shift work patients ask me how you deal with having a regular life when you're not working different shifts, and how to get back into the 'day mode' on your days off," says Castonguay. "Mostly they want to know how they can sleep well during the day.

"I tell them to get the people around them to respect that you're sleeping during the day and not to call at 2:00 in the afternoon, because that's like calling a person who works days at two o'clock in the morning!

They should unplug the phone or get a cell phone and give the number out only to people who are aware of your sleep patterns. I recommend blackout curtains and eyeshades, because it's important to shut out daylight to get restful sleep.

"It's hard to adjust to being awake on days off. I recommend 'anchor sleep': on your days off, cut your sleep period in half so your sleep is still anchored in the same time frame that you usually sleep. For example, when I come home, I may sleep until noon, get up for awhile, then nap between 3:00 and 5:00 p.m. That way I can still be awake to spend time with family and friends."

For more information on polysomnographic technology.

For information about sleep and shift work, see NSF's online brochure, "Sleep Strategies for Shift Workers."

How Does a Sleep Technologist Stay Awake All Night?

Staying up all night and watching recordings can be a challenge, says Michele Castonguay: "My primary duties are sitting and watching, being vigilant, and correcting sources of errors in the polysomnographic recordings. I'm aware that no matter how used to working nights you are, you are still not cognitively as sharp as you would be in the daytime mode.

"Working with another person helps me stay alert. I try not to get too involved in some other activity, such as watching a video or reading a book. I like to do crossword puzzles—something alerting that keeps your mind clicking but doesn't demand constant attention, and I can look at the recording every few moments. I used to rely on coffee to

stay awake, but I found it made me jittery and agitated. "To work the night shift successively, you have to realize that it's never going to be perfect. You will need some recovery time when you change shifts and sleep patterns. You need cooperation and support from family and friends. If you can get your family and your employer to work toward your best interests—as well as eat properly, exercise,

and get enough sleep—you'll do fine. But you must be disciplined about both work and sleep."

This article was published in the Fall 2004, Volume 6, Issue 4 of sleepmatters.