If your sleep is bad, chances are other aspects of your health are, too.

“It’s got its fingers in everything,” said Jacob Espinoza, a sleep technologist and manager of clinical operations for St. Charles Health System’s Sleep Center in Bend and Redmond. “We affect cardiology, primary care, pulmonology, behavioral health, orthopedic surgeries — we’re there.”

Ever-accumulating research is warning people about the dangers of a lack of quality sleep. While the effects on mood and mental ability are perhaps more obvious, it’s more difficult to perceive on a day-to-day basis poor sleep’s ability to put people at risk of serious chronic conditions like obesity and heart disease.

“If we can get sleep treated, then patients tend to do much better in all other aspects,” he said.

That’s where medical professionals called sleep technologists, also known as polysomnographic technologists, come in. They’re the ones who perform sleep studies on patients. Most people who see a sleep physician, like the ones at St. Charles Sleep Center, are referred for a sleep study, which typically requires spending a night at the sleep center hooked up to a plethora of monitors.

Although the doctor is the one who interprets test results and slaps on a diagnosis, sleep technologists are the ones who actually perform the sleep study. They painstakingly apply each electrode and watch monitors throughout the night (or during the day, if the patient works at night). That’s no small task; sleep studies at St. Charles last an average of eight hours, and a minimum of six.

“We want to make sure that the patient goes through enough sleep stages so we can really know what’s going on,” said Espinoza, who no longer performs the sleep studies himself and instead oversees St. Charles’ 10 other sleep technologists.

Espinoza said he views his role as being an extension of the physician. Once the study is complete, the night sleep technologist prepares the report and hands it over to the day sleep technologist, who checks it over to make sure nothing was missed before it goes to the physician. Only a physician who is board-certified in sleep medicine can interpret a sleep study.

During the sleep study itself, the patient is monitored on several fronts to try to learn what’s causing the sleep problems.

First off, sleep technologists measure heart signals using an electrocardiogram, or EKG. That’s to measure whether the patient has an abnormal heart rhythm, such as being abnormally fast or slow. In a conventional EKG, 12 electrodes are placed on the body, but it’s usually fewer than that during a sleep study, Espinoza said. St. Charles’ technologists are required to use a minimum of two electrodes, or leads, during its studies, he said.

In rare cases, Espinoza said, his clinics have uncovered serious heart rhythm issues that required the patients to be sent to the emergency room.

Sleep technologists also monitor patients’ breathing, both the temperature and the pressure. Pressure is measured using a device technologists jokingly call the “fake mustache.” It’s essentially a sensor placed above the patient’s upper lip.

Another aspect of breathing is called “abdominal efforts.” To learn about that, Espinoza said technologists wrap belts around patients’ chests to measure the correlation between work the diaphragm and the lungs are doing.

Additional sensors are placed on patients’ legs to rule out restless leg syndrome, a nervous system disorder that causes uncomfortable sensations in the legs. For some patients, technologists will also measure activity in their arms, especially if they’re trying to rule out a condition like sleepwalking.

Oxygen intake is another important measure of sleep. For some patients, especially kids, technologists also measure carbon dioxide levels, but that’s not always the case, Espinoza said.

Most sleep studies take place in the sleep lab, but St. Charles also has sleep study equipment patients can use at home if their cases aren’t as serious. Patients who take the equipment home are first trained to use it. The problem with the home studies is they don’t measure everything technologists would in the lab, such as brain activity or carbon dioxide levels, Espinoza said.

Home sleep studies are generally for people who likely have sleep apnea, a common sleep disorder that’s believed to affect more than 18 million American adults, according to the National Sleep Foundation. Sleep apnea is characterized by pauses in breathing during sleep.

If the patient has other serious conditions in addition to their sleep problem or if they’re under 18 years old, they always go to the lab for the study, Espinoza said.

When home tests for sleep apnea hit the market in 2013, it initially caused demand for sleep technologists to drop, said Laura Linley, a sleep technologist in Dallas and president of the American Association of Sleep Technologists.

Nowadays, she said demand has improved as sleep technologists expand their job duties from only tending to monitors and preparing reports to helping patients manage their conditions. That means they now have to understand how patients’ other disorders, such as heart disease, pulmonary disease or diabetes, affect their sleep disorder, and help them manage that.

Sleep technologists also partner with doctors to help patients understand their treatment plans and make sure they’re able to stick with them, Linley said. Often that means making sure patients can use their CPAP — continuous positive airway pressure — machines, which treat sleep apnea by pushing air into the back of the throat.

“We have to stay relevant,” Linley said.

The American Board of Sleep Medicine certifies sleep technologists to practice once they’ve completed training and passed its exam. Training can include either a six- to 18-month certificate program or an associate degree, Linley said. The certificate option is being phased out, however, so in the future the associate degree will be the only option, she said.

The Board of Registered Polysomnographic Technologists also offers credentials for sleep technologists.

Training programs encompass how to set up and use the many different pieces of equipment necessary for a sleep test. Students also learn how to score the data from the tests to prepare the report that goes to the physician.

Sleep apnea is the most common diagnosis the St. Charles Sleep Center uncovers during a sleep study, Espinoza said. Insomnia is another big one, although patients suspected of having insomnia typically don’t undergo a sleep study, Espinoza said. Instead, a physician diagnoses insomnia based on symptoms, such as an inability to fall asleep, waking up constantly and racing thoughts at night.

Restless leg syndrome and narcolepsy are other common diagnoses for the center.

Most of the patients who need sleep studies, especially if they have conditions like sleep apnea or narcolepsy, don’t have problems falling asleep, Linley said. That means they don’t tend to have trouble falling asleep in the sleep lab, either.

“It’s amazing to me,” she said.

There is that “first night experience effect” of being in a different environment surrounded by sensors, but almost everyone falls asleep, Espinoza said. He’s been a sleep technologist for nine years and has had only one patient who didn’t sleep the entire night.

“For the most part, everyone kind of falls asleep eventually,” he said.

Espinoza even tried it for himself once and said it took him about 15 minutes to fall asleep. The only thing that bugged him was the oxygen monitor, a tiny device that’s placed like a bandage over the tip of one finger. It had a red light on it.

“I felt like ET,” he said, laughing. “I was trying to put that under the cover so I wouldn’t see it.”

Most of St. Charles’ sleep study patients are over 50 years of age. Males are more likely to have sleep issues than females.

Espinoza said he’s watched the demand for sleep studies nationwide grow rapidly over the past decade, especially as research increasingly links poor sleep to a host of health conditions.

“It makes sense, right? One-third of our life is spent sleeping,” he said. “It’s how we recover our bodies.” •