Therapeutic Interventions, Patient Safety, and Professional Standards
Positive airway pressure and titration
During a PAP titration the technologist raises pressure until apneas, hypopneas, hypoxemia, and arousals are eliminated, with the goal of covering supine REM sleep. A split-night study is generally appropriate when the diagnostic portion shows an AHI ≥40 in the first 2 hours, or 20–40 with clinical judgment, and at least 3 hours remain for titration. Bilevel PAP is used for CPAP intolerance or hypoventilation. Adaptive servoventilation is contraindicated in central sleep apnea with symptomatic heart failure and ejection fraction ≤45%. Supplemental oxygen is bled into the PAP circuit, never substituted for pressure. Other therapies include oral appliances, positional therapy, hypoglossal nerve stimulation, weight management, and CBT-I; MSLT for suspected narcolepsy follows an adequate overnight PSG.
Safety
Anticipate falls (bed rails, call bell, low bed), screen for latex allergy, and keep oxygen away from open flame and petroleum products. Follow standard precautions and equipment disinfection protocols, and know the emergency plan and location of emergency equipment.
Professional standards
Practice within scope, maintain licensure and credentialing, protect confidentiality, and document objectively. Interrater reliability targets - roughly 90% for staging and 80% for event scoring in many QA programs - reflect that scoring is a calibrated skill, not a personal opinion.
Traps
Questions often test the split-night hour thresholds, the ASV contraindication, and the rule that PAP is not started or changed during an MSLT.
Rule of thumb
Never declare an optimal pressure without evidence that supine REM sleep was actually treated.