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so we understand the normal response to apneas. As the CO2 in- creases during the apneas the urge to breath increases, effort in- creases, and finally the effort is strong enough to get air in. The CO2 is high so breathing increases until the PaCO2 is low enough for normal breathing to resume. Sometimes the increased breath- ing ("recovery breaths") overshoots and lowers the CO2 too much so a central apnea or hypopnea occurs. When breathing effort starts again, the upper airway is obstructed and the cycle repeats. If that isn’t enough to make one seriously reconsider how we


score and respond to "respiratory events" indicated only by changes in temperature (a thermocouple/thermister) and respiratory effort by chest movements without true physiologic measures, listen to this! The instant we fall asleep our control of breathing changes and allows CO2 to build up about 5 mmHg before stimulating a breath. The instant we wake up we sense the higher CO2 and breathe faster to get it back down and our blood pH back to 7.4. So every time one of our patients falls asleep they have a short cen- tral apnea or hypopnea to let the CO2 build up and every time they arouse, they breathe faster to get rid of the CO2….in non-REM that is. In REM none of these responses is predictable. All the feedback


10 Essentials for Good Presentations


1. Know your environment. Learn where the electrical outlets are, how the lighting works, how good the acoustics are, where the best place to prop up your displays is. Are you expected to pro- vide refreshments, ashtrays, and notepads? At which end of the room should you stand? Check out the room temperature. 2. Don’t overburden yourself technically with audiovisuals. Pre- sentations allow others to size you up, and if you end up looking like a klutz in the process, you’ll definitely do more harm than good. 3. If you use slides, keep them simple and for goodness sake make them east to read (a big mistake as nothing is more frustrating for your audience). Use slides only to illustrate main ideas. A super- detailed slide always gets boring. If it is necessary to go into greater detail, hand out printed supplements. 4. Tailor the presentation to meet the needs of, and to influence the person in the audience most responsible for passing judgment on your ideas, rather than trying to entertain and impress everyone. 5. A crisp and formal style is better than a chatty and informal one to keep your audience focused and to demonstrate your con- trol over the material. 6. Begin by briefly summarizing the points you’ll cover. This will prepare the audience for your material. 7. Do not read from your slides, charts or displays. This wastes time and bores your audience. Rather, coordinate your audiovi- suals with your presentation so that they pictorially illustrate what you are saying. 8. Don’t leave your displays up when you are not referring to them. They’ll only serve as distractions. 9. Pass out handouts after you’ve finished speaking, so your au- dience won’t be reading ahead or shuffling papers. 10. Cover points in increasing order of importance to conclude on a strong note and leave your audience thinking.


mechanisms are blunted and breathing becomes irregular. Short central apneas and hypopneas are normal every time there is a sleep onset. Slight hyperventilation is normal with every arousal to wake. Sleep disordered breathing is normal in REM. AND, when we intervene with therapy and change a patient’s minute ventila- tion we can expect to see changes in their breathing patterns that are normal and expected and should not normally be "treated" by responding with changes in therapy. If a patient’s cardiovascular system is compromised in some way or lung disease is present, re- sponses to changes in minute ventilation, sleep onset, and REM sleep can be blunted or exaggerated. If you consider carotid bodies, stretch receptors and other


physiologic controls that contribute to the control of breathing, it is easy to see why scoring and responding to respiratory events is as much an art as a science. It also explains why even well edu- cated, experienced technologists and physicians review cases and constantly question and challenge their scoring and treatment in- tervention decisions. It’s only one aspect of a job that is grossly underestimated and should not be left to staff with a week or two of training.


Trouble Remembering Names? Remembering a person’s name can often be the ticket to a


friendship, a closed deal or a new relationship – and it generates instant good will like no other courtesy can. Forgetting someone’s name however, can hurt feelings and make you feel socially inept. Even worse, it can create a negative first impression that can work against you long afterward. Here are some tips that can help: 1. Focus – When you first meet a person focus in on the per-


son and the name. Usually we are preoccupied at the moment of introduction with ourselves and how we are “coming off”. Instead, clear your mind and ask that the name be repeated if necessary. 2. Dramatize faces – If you dramatize names and faces with


memorable images, you’ll increase your chances of remembering the name. After you’ve been told a person’s name, focus on the face. Is there something interesting or different about it? Are the eyebrows bushy? The eyes piercing? Connect the name with the visual impression. 3. S.A.L.T. – Say each person’s name as you meet them. Ask


questions. For instance, “Is that S-M-I-T-H or S-M-Y-T-H-E?” Learn by repetition. Say the name again. “Nice day today, don’t you think Mr. Smith?” Terminate the conversation with the name. “It was a pleasure meeting you, Mr. Smith.”


Bring Your Significant-Other to the 2012 FOcuS cOnFerence


Free May 10-12, 2012


The Gaylord Opryland Hotel nashville, Tn www.foocus.com


Focus Journal Spring 2011 15


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