Are We Falling Asleep on Sleep?

The field of sleep medicine is, in my opinion, the connecting link between all other healthcare-related professions. However, we often are not the first profession to be called to be considered as a vital component of a public health campaign and certainly, rarely, if even thought of as a career choice for high school graduates. Why is that? Why is arguably one of the most essential health professions, one of the least likely to be chosen as a first-choice career option? To answer those questions, this article will delve into the challenges, barriers, and possibilities that should be of critical concern for the sleep health professional, if not all healthcare.

According to Zippia.com, (a reputable company cited by Forbes, LinkedIn, USA Today, and developed to help people find the career that is right for them), there are just over 10,250 sleep technologists currently employed in the United States.²  Of that 63.1% identify as women. The average sleep technologist is 43 years old with a disproportionate number of minorities represented in the field: 8.8% Asian, 9.7% Black or African American, and 18% Latino or Hispanic.²

To put this in comparison, there are approximately 135,800 respiratory therapists² & 5.2 million registered nurses (RNs) nationwide³. Important to note that Nursing is the nation’s largest healthcare profession..

Now, do I believe that we need to have 5.2 million sleep technologists? No. There is definitely a rationale behind the number of nurses and respiratory therapists per capita that is dependent on career options, scope of practice, and educational and training opportunities. Simply put, there are more options for people to enter & advance in these professions into other roles when compared to that of what is currently available for a sleep technologist. Factoring in the limited career pathways, current shortage of sleep technologists, and the average age of sleep technologists currently in the field, you begin to appreciate my concern for the future of our profession.

As well as the need to pivot our approach to recruitment, training of new sleep technologists, and increasing the number of potential career pathways in the profession is evident.

Current Pathways in the field of Sleep Health

At the time of writing this, there are 100 sleep physician fellowships⁴, 31 A-STEP Providers⁸, 39 Stand-Alone CoA polysomnographic (PSG) Programs, 5 CoARC PSG Concentrations, and 13 electroneurodiagnostics technologist programs with PSG concentrations⁵. The number of programs to train individuals in the field of sleep health may seem adequate, however, allow me to explain two factors that contribute to the completion rate of these programs, which being the concepts of recruitment and attrition. Recruitment is simply sparking interest in a prospective student/employee that we get to join our programs/sleep labs. While attrition is a reduction in numbers usually because of students dropping out/quitting a program, resignation, retirement, or death⁶.

An example would be a school accepting ten sleep students per academic year, with only six students graduating the program. That is an attrition rate of 4 students or 40% of the initial cohort. Although that number may seem insignificant in the grand scheme of things, the impact of attrition should not be overlooked. By the time you factor in the attrition rates of all the various sleep technologist training programs, you begin to appreciate the significance. Especially in Academia, where the waiting time for new techs can be upwards of 2-years from the start of a program to the completion.

By having a smaller sample size or pool of interested individuals, we have a smaller margin of error when it comes to our attrition compared to completer rates. The reality is, we need more students in all of the current programs, combined with a unified effort by all communities of interest, which is anyone that benefits from sleep technology education programs, to increase our matriculation (progression) rate of students to complete the programs. That is if we aim to meet the demands of sleep technologist in the field for today & tomorrow.

Sleep Techs to Sleep Specialist

Another shortage in the field of sleep that we face is the number of sleep specialists. According to the American Board Internal Medicine (ABIM), there are 3,509 valid sleep medicine certificate holders⁷. According to the American Board of Sleep Medicine (ABSM), the last report created in 2006 showed 3,445 cumulative (living & deceased) individuals that have the life-long credential¹¹. Although this is only factoring in two of the six physician boards listed as a sleep physician training pathway on the AASM website⁹. The real number of sleep specialists may be higher but not to the level needed in the field. A rather intriguing reasoning for this shortage is the bottleneck for prospective individuals to become sleep physicians. Currently, individuals interested in becoming a sleep physician are not able to go right into sleep medicine. They must first become a physician in one of the specialty areas that has a pathway towards sleep specialty. Depending on which concentration they decide on, the time commitment can be about 8 – 10 years before pursuing a sleep fellowship⁹.Subsequent to completing these requirements can a physician sit for the boards to become a board-certified sleep physician.

In contrast, the pathways for other professions such as nursing or respiratory therapy to broaden their scope of practice are more straightforward and readily available compared to that of a sleep technologist. Currently there is no direct pathway to advance as a sleep technologist in the context of working independently in the sleep profession. Great work is being done with the certification in clinical sleep health (CCSH) credential but is a way out before we can evaluate the benefit of this credential with respect to career advancement and diversification.

To support this claim, the nursing profession has the nurse practitioner (NP) or Doctor of Nursing practice (DNP) pathways that career advancement as a mid-level practitioner which grants the individual more autonomy and the ability to diagnose and prescribe, however states may have differing scope of practice. For sleep technologists and respiratory therapists, there is the option of a physician-assistant (PA) given that the individual meets the requirements of those programs. Which usually requires a higher level of education, i.e., a bachelor’s degree, to even begin a program. While this option is significantly less time than becoming a sleep-physician (2-3 years)¹⁰, it has limitations. Mainly these individuals can only work under the supervision of a sleep physician and not as a stand-alone practice.

Further research and work are needed into creating a reasonable pathway that will allow experienced sleep technologists to enlarge their practice as a sleep specialist without having to first go through the lengthy educational process of being certified in another area of medicine. Although, for the purpose of this article, we will leave that thought and move onto what obstacles are present for people interested in becoming a sleep technologist.

The Career Obstacle Course

In addition to the limited number of schools and pathways for those interested in becoming sleep technologists, one of the biggest hurdles we must overcome is the lack of awareness of the field by the general public. When most people hear polysomnography, they immediately ask. “What is that?” To which many simply respond by saying “It is A sleep study”. The next question is usually, “So, do you just watch people sleep?” While many may be inclined to just say “Yes!” in an effort to be humorous, the official answer would be “Polysomnography is a test which records people while they sleep, my role as a sleep technologist is to prepare, conduct and monitor, and summarize the data”. It is after explaining all of this that we hope people will become intrigued by the profession and seek out how they can start the process of becoming a sleep technologist. However, this recruitment strategy is slow-moving and usually stops before it starts due to the limited awareness of access to resources & training programs near the individual.

The profession of sleep medicine is still relatively new in the eyes of the public, so it is easy to understand why the lack of awareness is one of our biggest challenges when it comes to recruiting people into the profession. Outside of accredited sleep technologist educational programs, there is not an effective marketing strategy being widely used to educate the public on career opportunities within the field. The typical practice for recruiting individuals into the field usually involves sleep laboratories that have an A-STEP or STAR Program already established, recruiting internally or through friends and family. Evident by the many conversations I have had with current sleep technologist that say they got into sleep by happenstance. They either had a friend in it or stumbled across it one day. Not many say they purposefully pursued a career in sleep technology.

Returning back to the main point of this section, AASM A-STEP and BRPT STAR program pathways are great resources that allow sleep labs to quickly educate and train individuals in the basics of sleep technology. However, many of these programs seem to only be utilized by sleep laboratories seeking to fill their employment needs in an isolated moment at their respective facilities, versus long-term sustainability of the field as a whole by training year-round.

Meaning that once the sleep lab is fully staffed, the use of these types of programs seems to decline. This is not always the case but is very common due to the very fact that sleep laboratories need and want a quick solution to their staffing needs versus waiting for schools to put out sleep technologist. The rationale behind not running an A-STEP program year-round is easily understandable when you think about what that would mean for the facility doing the training. The cost to educate and train new technologists is expensive and there may be a mindset as to why continue training if the outcome is that the newly trained technologist can go work for a competitor? This is where educational institutions step in and thrive. Educational programs for sleep technology are well positioned to deliver a high level of clinical and didactic educational components to ensure robust training, leading to optimizing job placement in various communities, outside of the individual facilities.

No Rest for the Weary

In conclusion, the field of sleep medicine should focus on innovative approaches to attract more individuals to the profession. I commend all our national professional sleep organizations that are conducting more research and marketing resources to help further the field. One notable mention is the American Academy of Sleep Medicine with the High School Video Contest¹². Obtaining buy-in and interest from the youth of today means that we will have technologists for tomorrow. Remembering that many technologists that I have interacted with stumbled into this profession as a second or third career choice versus actively pursuing a career in sleep straight out of high school. This is our challenge…To bring awareness to the field so that people do not fall asleep on sleep.

Source: SleepWorld Magazine

References

1. Landry J, BS, RRT. 97+ Statistics and Facts About Respiratory Therapists (2024). Respiratory Therapy Zone. Published December 19, 2023. Accessed January 31, 2024. https://www.respiratorytherapyzone.com/respiratory-therapist-statistics/#:~:text=There%20are%20approximately%20135%2C800%20respiratory
2. Sleep Technician Demographics and Statistics [2024]: Number Of Sleep Technicians In The US. http://www.zippia.com. Published January 29, 2021. Accessed January 31, 2024. https://www.zippia.com/sleep-technician-jobs/demographics/
3. Rosseter R. Nursing Workforce Fact Sheet. http://www.aacnnursing.org. Published July 2023. Accessed January 31, 2024. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet#:~:text=Nursing%20is%20the%20nation%27s%20largest%20healthcare%20profession%2C
4. Choose Sleep | Paths to Sleep Medicine. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. https://aasm.org/professional-development/choose-sleep/paths-to-sleep-medicine/
5. Formal Accredited Programs – Board of Registered Polysomnographic Technologists. BRPT.org. Accessed January 31, 2024. https://www.brpt.org/learn/formal-accredited-programs/
6. Merriam-Webster. Definition of ATTRITION. Merriam-webster.com. Published 2019. https://www.merriam-webster.com/dictionary/attrition
7. Candidates Certified -All Candidates. Accessed January 31, 2024. https://www.abim.org/Media/vaqdilmh/candidates-certified-all-candidates.pdf
8. American Academy of Sleep Medicine – A-STEP. Published January 31, 2024. Accessed January 31, 2024. https://myastep.aasm.org/DirectoryProviders.aspx?_gl=1
9. Choose Sleep | Sleep Physician Training. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. Accessed January 31, 2024. https://aasm.org/professional-development/choose-sleep/sleep-physician-training/
10. Uche N, Beagle V. How To Become A Physician Assistant – Forbes Advisor. http://www.forbes.com. Published August 23, 2023. Accessed January 31, 2024. https://www.forbes.com/advisor/education/healthcare/how-to-become-a-physician-assistant/
11. The American Board of Sleep Medicine – Verification of Diplomates. American Board of Sleep Medicine – ABSM. Published December 2006. Accessed January 31, 2024. https://my.absm.org/listing.aspx
12. Troy D. High School Video Contest – Sleep Education by AASM. Sleep Education. https://sleepeducation.org/get-involved/campaigns/high-school-video-contest/

About the Author

Colton Wiggins, MSML, BBA-HCM, RRT-SDS, RPSGT

A dually registered and licensed health care professional as a respiratory therapist and sleep technologist. Currently, Mr. Wiggins serves as the Program director of Polysomnographic Technology at Southern University at Shreveport in Shreveport, LA.