For Medical Professionals

The program begins with the Introductory Sleep Medicine Course which takes place during the initial three weeks of the fellowship. The course consists of didactic lectures on all of the major topics in sleep medicine as well as lectures in understanding neurophysiological signals, electrical safety, normal EEG, benign EEG variants, epileptiform discharges and review of laboratory protocols and procedures. Workshops are dedicated to group scoring and staging sessions of pediatric and adult studies, how to generate reports, how to protocol sleep studies, and understanding montages, polarity and localization of EEG signals. In addition, there are several lectures from the Resident Educator and Life-Long Learner (REALL) Program which are intended to prepare trainees for a career in academics. Trainees manually score four sleep studies during the Introductory Sleep Medicine Course and review them with a designated technologist. During the first month of the fellowship, trainees spend three evenings in the sleep laboratory in order to become familiar with the machine calibration, patient set-up, patient hook up and recording techniques.

Throughout the year, fellows attend the Neurological Institute Core Conference series which reviews wide ranging topics covering all of the ACGME core competencies. Fellows attend the weekly Sleep Medicine Grand Rounds which reviews various sleep medicine topics with discussion of the most recent literature and best practices. At the quarterly Medical Directors Meeting, fellows gain an awareness of the larger context of the system of health care. This includes an understanding of the American Academy of Sleep Medicine laboratory standards, management issues of a sleep laboratory, reviewing laboratory protocol changes, new policies, quality assurance parameters and results and lab accreditation issues. At the monthly Sleep Business Review meeting, fellows learn about practical day to day sleep center business management issues.

The fellowship is organized into outpatient clinic and laboratory core rotations. During the clinic rotations, fellows evaluate patients of all ages with sleep disorders under the supervision of a Sleep Medicine staff physician. Trainees also participate in two weekly longitudinal care clinics where new and former patients are evaluated and treated by the same fellow over the course of the year. During the laboratory rotation, Sleep Medicine fellows learn to score and stage sleep studies. Fellows are responsible for reviewing raw data and clinical information and generating a sleep report. Studies are reviewed daily with a Sleep Medicine staff physician in afternoon reading sessions.

Sleep Medicine trainees also spend time evaluating patients with ancillary staff in the Departments of Otolaryngology and Psychology. The Otolaryngology Sleep Clinic provides exposure to the surgical management of sleep-disordered breathing. The Sleep Psychology Clinic provides exposure to cognitive and behavioral therapy for insomnia (CBTi) and the use of biofeedback for patients with sleep disorders. Sleep fellows participate in group sleep skills meetings and learn to apply CBTi in group settings.

Sleep Medicine fellows are required to participate in research. Research proposals are presented in periodic research meetings, and completed studies are presented at the Department of Neurology Neuroscience Day, as well as, at the annual national sleep medicine meeting, Association of Professional Sleep Societies (APSS).

A variety of educational opportunities are available to Sleep Medicine trainees. Each month, four cases are presented by the fellows to the staff in case conferences. On a monthly basis, fellows attend the journal club. Visiting professorships are held each quarter in which prominent individuals in the field are invited to spend a half day with the fellows discussing interesting cases. Sleep Medicine fellows share the on-call duties of the sleep laboratory. Call is rotated on a biweekly basis and taken from home.

The ACGME guidelines specify that training in Sleep Medicine must be preceded by the completion of a residency program in neurology, child neurology, general psychiatry, internal medicine, family medicine, anesthesiology or otolaryngology. Please note, in order to apply for our program candidates must have successfully completed a residency in the US, Canada or Puerto Rico. All International Medical Graduates must submit a certified copy of their current ECFMG certificate and qualifying exam results.

• Personal Statement
• CV
• Letter from Residency Program Director in lieu of Dean’s Letter
• At least 3 letters of recommendation from physicians whom have supervised you in a clinical setting, one of which must come from the Residency Program Director
• USMLE/COMLEX Score Reports
• Certificate(s) of previous training
• Medical School Diploma

We begin accepting applications on July 1 and we will stop reviewing applications on October 1.

Carlos Rodriguez, MD
Program Director
Sleep Disorders Center
Department of Neurology, FA20
Cleveland Clinic
9500 Euclid Ave.
Cleveland, OH 44195
Phone: 216.445.7621
Fax: 216.636.0090
Email: rodrigc2@ccf.org

Robyn Perryman
Education Coordinator
Neurological Institute/S90
Cleveland Clinic
9500 Euclid Ave.
Cleveland, OH 44195
Phone: 216.444.6632
Fax: 216.445.9908
Email: perrymr@ccf.org

The following will help guide you through the ASTEP application process. Please check off the steps as you complete them, but this page does NOT need to be submitted as part of your application packet.

View the ASTEP Application Packet

If you have any questions please contact:
Judy Petriella RPSGT, Sleep Education & Training Coordinator
Cleveland Clinic Sleep Disorder Center
Phone: 800.223.2273 ext. 47721
Email: petriej2@ccf.org

Tuition - $1,500

Acceptable forms of payment are either a certified check or money order made payable to Cleveland Clinic Sleep Disorders Center. A non-refundable application fee of $25 is required when the application submitted. The remaining balance will be due by one week prior to the start of the course.

Application Requirements

• Application – Must be completed in full by the applicant for admission.
• Copy of High School Diploma – A copy of your high school diploma must be submitted, but this can be substituted with a copy of your college diploma if applicable.
• Resume – A complete resume is required.
• Application fee – A $25 non refundable application fee in the form of a certified check or money order.
• Statement of Purpose – Submit a short typed, double-spaced essay, minimum 250 words.
• Current AHA CPR Certification

Day 1: Introduction to Sleep and Disorders of Sleep

The student will learn an introduction to the field of clinical polysomnography with emphasis in sleep definitions and functions, the role of the sleep technologist in patient confidentiality and HIPAA regulations, infection control, and patient safety. The course also gives an overview of sleep disorders, circadian rhythms and summarizing the PSG report together with strategies for coping with shift work.

Day 2: EEG and Sleep Staging

The student will learn normal sleep architecture and the characteristics of sleep stages. Non –REM stages Wake, N1, N2, N3 and stage REM will be discussed and polysomnographic examples will show how these variables, viewed collectively, provide diagnostic information regarding normal and/or abnormal sleep. Hands on scoring will comprise a large portion of the course with numerous practice opportunities. The course includes scoring of EEG (brainwave) arousals, Digital Concepts of Analog- to Digital Conversion (ADC), horizontal and vertical resolution and instrument settings together with sampling rate dwell time, aliasing, and bit capacity as it relates to polysomnography.

Day 3: Cardiovascular Monitoring

The student will learn basic cardiac anatomy and physiology as it relates to the field of sleep as well as an introduction to basic ECG signal generation and demonstration of normal and abnormal ECG signals. This knowledge will serve as an initial exposure to identify emergency and non – emergency situations regarding cardiac rhythm disturbances.

Day 4: Respiratory Monitoring

The student will learn the anatomical structures related to breathing and the way that they work together will provide the student with a basis for understanding the more common respiratory abnormalities seen in the sleep lab, and the distinguishing characteristics of respiratory scoring. Instruction in how the brain, chemical composition of the blood, and feedback mechanisms from the chest wall must properly communicate to produce a normal respiratory pattern.

Day 5: Sleep Related Breathing Disorders

The student will learn about the most common disease states that may be present to the sleep lab. Discussion will include the background, clinical presentation, pathology, and diagnosis of Obstructive Sleep Apnea Syndromes, Central Sleep Apnea, and Hypoventilation together with scoring respiratory events.

Day 6: Treatment for Sleep Related Breathing Disorders

The student will learn the basics of the various therapeutic interventions of Positive Airway Pressure (CPAP/ BiLevel), and O2 used during the course of a sleep study. Proper mask fitting techniques, vital to a patient’s tolerance of the interventions, will be reviewed.

Day 7: Sleep Related Movement Disorders and EMG Monitoring

The student will learn an overview of muscular structure and function as it relates to sleep, specifics regarding the lower extremities, chin, and upper airway. This information will be a precursor for the discussion of Periodic Limb Movement Disorder (PLMD) and Restless Leg Syndrome (RLS). A presentation of the criteria for scoring periodic limb movements and how to chart the findings will be discussed in this course.

Day 8: Narcolepsy, MSLT, & MWT, Sleep Related Seizures and Parasomnias

The student will learn about specific sleep disorders, emphasis is put on disorders such as Parasomnias, Seizures, and Narcolepsy or Idiopathic Central Nervous System Hypersomnia as evaluated by the polysomnography. Specific sleep testing protocols used in the assessment of disorders of excessive daytime somnolence. Disorders such as Narcolepsy or Idiopathic Central Nervous System Hypersomnia can be evaluated by the combination of night time polysomnography followed by a Multiple Sleep Latency Test (MSLT) starting the following morning. The test measures the time it takes to fall asleep when the opportunity is presented. An alternative to MSLT is the Maintenance of Wakefulness Test (MWT) which investigates how long wakefulness can be maintained. Electrode placement, complex procedural information and scoring criteria will be discussed.

Day 9: Insomnia, Circadian Rhythm and Psychiatric Disorders

The student will learn about circadian rhythm concepts and how it relates to normal sleep. This course emphasizes on the comprehension of deviations of normal sleep in relation to insomnia, psychiatric and behavioral disorders.

Day 10: Pediatric Polysomnography

The student will learn an adequate differential diagnosis and three types of sleep- related problems in children, insomnias, hypersomnias, and abnormal activity or behaviors during sleep. The course demonstrates the importance of hook-up, acquisition for an overnight study, and scoring basics and differences as it relates to adults.

• Nancy Foldvary-Schafer, DO, MS
  Director, Sleep Disorders Center
• Jyoti Krishna, MD
• Carlos Rodriguez, MD

Petra Podmore RPSGT, REEGT
Sleep Laboratory Manager

Judy Petriella, BD, MS, RPSGT, RST
Education Coordinator and Program Director

Where is the training course held?

The training course is held at our North Olmsted, OH Sleep Center facility.

• Directions to the ASTEP training site

How will I be notified if I have been accepted into the program?

Once your application has been reviewed you will be notified via email or phone that you have been accepted.

Once I have been accepted then what is my next step?

You will then need to make full payment either by money order or certified bank check made out to Cleveland Clinic Sleep Disorders Center then mail it back to:

Judy Petriella
RPSGT/Sleep Education Coordinator
Cleveland Clinic Sleep Disorders Center
9500 Euclid Ave./ FA20
Cleveland, Ohio 44195

I am coming from out of state, will my hotel be provided for me or do I need to make my own arrangements?

You will need to make your own accommodation arrangements. The hotel will offer a discounted rate for those that are enrolled in the course. When calling the hotel you will need to tell them you are enrolled in the ASTEP program so you will receive the discounted rate.

Are meals included?

Meals are not provided and are not included in the cost of the training program. However, within the hotel vicinity there are a variety of restaurants within walking distance.

How long am I able to cancel my enrollment and still receive a full refund?

You will need to cancel as soon as possible. One month notice is preferred.

What happens if I miss a day during the program?

Contact ASTEP Program Director or Technical Director for details at 800.223.2273 ext. 47721.

Will I be working on actual patients?

You will be using an actual sleep lab center but patients will either be volunteers or students within the class.

Who teaches the class?

Cleveland Clinic Sleep Disorders Center staff physicians and RPSGT’s both help give the didactic lectures during the program. Practicals are given by the RPSGT’s.

What is the job market for the sleep technologists?

Sleep Medicine is one of the fastest growing field in health care. Millions of people suffer from any one of the various sleep disorders. There is a demand nationwide for qualified sleep technologists.

• Find the median salary in your area at salary.com

General Information Links

• Directions to training facility
• American Academy of Sleep Medicine
• American Association of Sleep Technologists
• Board of Registered Polysomnographic Technologists
• Accommodations - Courtyard by Marriott in North Olmsted, Ohio 440.716.9977
• Marriott Reservations Page