Q&A: The Future of Sleep Technology in an Evolving World with Laura Linley

On a recent EnsoData webinar, Today is NOT tomorrow in Sleep Technology, sleep technologists and physicians asked questions on the future of sleep medicine, the growing impact of AI on sleep, and how labs are handling modern challenges, like authorization issues and staffing shortages. 

The webinar host, Laura Linley, CRT, RPSGT, FAAST, and Executive Vice President of Operations at Advanced Sleep Management, shares her insights from decades of experience in the sleep field. Watch the full presentation on-demand – before or after reading – to gain additional insights from Laura and the EnsoData team. 

Challenges Associated with Insurance Authorizations

Question: Why have there been so many more authorization denials from insurance companies for PSG sleep studies in recent days/years? 

Answer: When you look at preauthorizations, what their expectations are, and how they’re actually using algorithms to determine testing, you’ll notice that if you have a patient with a high probability of OSA and no other health impairments, the insurance companies are going to drive you to a home sleep apnea test regardless of what the doctor really wants. And in short, the decision is driven by algorithms in their database.

Question: If you have a home sleep test where you are not comfortable with what the data says, how do you get approval to validate that diagnosis?

Answer: We should be pushing back as an industry to make sure we can get a split-night study ordered after a questionable home sleep study. But at the end of the day, if there’s a diagnosis of OSA, that patient is probably going to have to try CPAP at home for 12 weeks and if they don’t do well with that, then you have the ammunition to bring a patient back in for an in-lab study. I don’t wanna say it’s “a game,” but it’s very important you have the appropriate documentation (which the above would be a good example).

Challenges associated with Bed Utilization Numbers

Question: Another challenge that is affecting lab utilization, especially in the VA (veteran affairs) system, is patients going from HSAT straight to AutoPAP. However, patients need help with titration, then they struggle with therapy, and finally, after a period of time, they are brought in for formal titration. This is leading to more and more patients who are jaded toward PAP therapy. (More than 50% need advanced therapy). This has really changed the dynamics in the lab and the outcomes we’re seeing. Do you see this trend increasing? 

Answer: I 100% agree. And it’s worrisome, right? Because our patients are complicated, they’re very complex. In today’s world, if they’re in a sleep lab at all, they’re complex. So, we’re constantly looking at our staffing and making sure we have the appropriate competencies in place to manage these patients. One thing we do in our organization is a chart review on all of our ordered patients. We have a very well-trained intake team, and while I ask my intake team clinical questions all the time because they know what insurance needs for authorizations, that should not be their responsibility or the expectation. That responsibility should live with your clinical team. 

Our clinical team performs the chart review on all patients that are ordered to make sure that there aren’t any complex patients that will be a surprise. Because as most sleep technologists know, there’s nothing worse than having somebody coming in for an in-lab, but their order says that they should be tested at home. What are you supposed to do in that situation? It can be especially challenging at a hospital-based sleep center like ours. 

On site, we’re not looking at compliance; we’re not looking at reports; those tasks are being managed in the doctor’s office. Then, when a patient comes in who had a bad experience with CPAP and their wheels are falling off, it’s us who have to try and fix them. It’s a common experience in sleep medicine and a constant challenge for sleep teams. 

Impact of Virtual Sleep Clinics on the Market

Question: There appears to be a significant increase in virtual sleep clinics coming to the market to solve the access challenge. Can you speak to the role of these new care pathways in addressing the millions of people who are undiagnosed?

Answer: That’s the real question. When you look at initiatives addressing how we go about increasing the availability of testing so that we don’t have this big disparity of patients out there that don’t have a diagnosis and treatment, the key is involvement from the overall medical community. As a way to see if these groups are able to manage this care, I’ve been a secret shopper for various pop-up providers of home sleep testing. We’ve sent team members in to request a sleep study. Some providers won’t follow up to see whether you have an order, they’ll simply ship out the home sleep test and patients are then expected to pay the out-of-pocket cost, which can be $350 or more. 

And yes, you’ll have a diagnosis by a sleep physician and it’s on their report, but since you didn’t have a face-to-face visit ahead of time, you don’t have that information in order, so now, this is an out-of-pocket cost for a screen and not a diagnostic test. So what worries me is that we’re getting these diagnoses made, but there’s no way that we can get the patient on treatment. And that’s your high-risk situation. 

How the Sleep Technologist Profession is Evolving 

Question: The number of technologists coming into the field is significantly lower compared to those leaving the field. What can we do to focus on meeting the growing need for sleep technologists?

Answer: I think we need to get more aggressive educating high school students and making sure that students are interested in health care, that they understand what the sleep tech profession is, and to make sure that sleep is represented. And education is everyone’s responsibility. What can you do? Go get in front of your local high school students and start talking about sleep as a career. We have to start doing this locally. Nationally, we can support these folks with more educational content. But the short answer is that you really have to get out there locally and get people excited about working in sleep. On a personal note, I’m worried, definitely worried. With my own business, staffing is always a priority. But the current staffing shortage is a nationwide challenge.

Volunteering and Advocacy are our Best Tools

Question: Moving to volunteering and local advocacy actions, it’s not just what we do for our day jobs, but it’s the work we do and the time we spend outside of our roles within the sleep community that is most impactful. With that in mind, how do you feel about volunteering and if someone is looking to volunteer in sleep medicine, what would you suggest to them? 

Answer: Well, finding the time for volunteering is important. But, as a single mom trying to make ends meet and being asked to volunteer, it almost felt like an obligation, both to volunteer and to mentor those people who knew less than me. And with volunteering, you get so much more out of it than you put in. 

Honestly, the personal and professional development that I’ve received by being a volunteer has been incredible. I’m so incredibly grateful for both the AAST and the BRPT and the opportunities and trust that they gave to me to be able to help support this industry and work with all of our partners. So, while it does seem like work, and it is a commitment, you get back so much more than you put in. It’s an incredible, great experience. So, even if it’s just starting out small, I would highly recommend it to everyone. 

More Content on the Evolving Role of the Sleep Technologist

That’s all we have in this Q&A, but if you enjoyed Laura’s responses, we highly recommend the following resources: 

Standardization Leads to Success: a Case Study featuring Linley’s organization


1 Comment

  1. With the current and future complexity of in-lab patients when are we as the Leaders of the profession going to wake up (pun intended) and require at least a 2 year degree in some sort of hard science to work as a technician even! I did an interview with Dr. Kryger in 2021, where he agreed with me that in just a few short years in labs will be like running an ICU and in some places we’re already there.

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