{"type":"page","slug":"cv","title":"CV","summary":"Walter Spence, RPSGT: 20+ years in sleep medicine, and the AI agent systems I build alongside it.","published_at":"2026-11-02T00:00:00-05:00","revised_at":"2026-11-02T03:55:08-05:00","body_markdown":"**Walter Spence, RPSGT**\nRichmond, VA · [walt@waltspence.com](mailto:walt@waltspence.com) · [LinkedIn](https://linkedin.com/in/waltspence) · [GitHub](https://github.com/waltspence)\n\nRegistered Polysomnographic Technologist with more than 20 years in sleep medicine and over 15,000 studies of every type, focusing on alternative therapies, with a specialty in pediatrics. I lead the hypoglossal nerve stimulation (HGNS) program at St. Mary's Hospital, with nine years of hands-on Inspire HGNS experience, from overnight titration through long-term follow-up. I also build and run AI agent systems and the software around them.\n\nOpen to clinical and engineering roles, remote preferred.\n\n## Clinical experience\n\n### Registered Polysomnographic Technologist, Daytime\nBon Secours Mercy Health, Richmond, VA · July 2025 to present\n\n- Leads the hypoglossal nerve stimulation (HGNS) program at St. Mary's Hospital.\n- Daytime testing operations and physician workflow, including study readiness and documentation.\n- Also covers overnight Inspire titration studies and implanted-patient follow-up.\n- Lab-side clinical reference for implanted patients: device education, comfort and adherence troubleshooting, and escalation to the implanting team.\n\n### Overnight Registered Polysomnographic Technologist\nVirginia Commonwealth University Health, Richmond, VA · 2024 to 2025\n\n- Returned to pediatric sleep medicine, which I had worked in early in my career.\n- Overnight testing in a high-acuity academic medical center, including pediatric patients with complex neurological, genetic, respiratory and behavioral conditions.\n- Accurate physiological data collection, real-time monitoring and protocol compliance for vulnerable patients.\n- Trained and mentored new technologists in electrode application, study protocol, scoring criteria and EMR use.\n- Tracked, calibrated and troubleshot diagnostic equipment.\n\n### Daytime Registered Polysomnographic Technologist\nPulmonary Associates of Richmond, Richmond, VA · 2024\n\n- Multiple Sleep Latency Tests and reports for physician review.\n- Patient education on PAP compliance and long-term therapy, and follow-up for Inspire patients.\n- Scoring and interpretation workflow, including DME setup.\n\n### Overnight Registered Polysomnographic Technologist\nCommunity Health Systems / Bon Secours Mercy Health, Richmond, VA · 2020 to July 2025 (PRN from 2024)\n\n- Overnight Inspire titration studies and implanted-patient care across the full follow-up cycle.\n- Electrode application and overnight monitoring, with attention to scoring protocol and patient comfort.\n- Technical operations of the sleep lab, including equipment readiness and data quality.\n\n### Overnight Polysomnographic Technician\nSleep Clinics of America, Richmond, VA · 2017 to 2020\n\n- Inspire titration studies and implanted-patient follow-up alongside standard diagnostic polysomnography.\n- Diagnostic accuracy and patient comfort across high-volume overnight studies.\n\n### Earlier sleep laboratory roles\n\n- Sleep 360, Austin, TX · 2016\n- Virginia Medical Group, Colonial Heights, VA · 2014 to 2016\n- Bon Secours Health Source, Richmond, VA · 2010 to 2014\n- River City Sleep Medicine (Neurological Associates), Richmond, VA · 2008 to 2010\n- Sleep Disorders Center of VA, Colonial Heights, VA · 2003 to 2008\n\n## Engineering and business\n\n### Independent web developer and consultant\nWeb and AI agent systems · 2004 to present\n\n- Contract web development since 2004; for the last five years, consulting and individual-contributor work on web and AI agent systems alongside sleep medicine.\n- [zap](https://github.com/waltspence/zap): a terminal-native app uninstaller for macOS and Linux. On its first run on my own machine, it freed over 20 GB.\n- Helix: a multi-node fleet of AI agents across Linux and macOS, with a scheduled loop that finds recurring failures, tests fixes and ships them behind a rollback. See [Supposed to Run Itself](/notes/supposed-to-run-itself).\n- [Knowfer](/projects/knowfer): a Rails knowledge base that agents read and write over MCP.\n- [Talkify](/projects/talkify): a Rails and Vue 3 dashboard for running agents.\n- [waltspence.com](/projects/waltspence-com): this site and its publishing desk, on Rails, Vue 3, Redis, and Python and Node workers.\n\n### Founder and CEO\nEnLab, LLC · 2010 to 2016\n\n- Founded a startup focused on a WebRTC meeting project.\n\n## Certifications\n\n- RPSGT, Registered Polysomnographic Technologist (Board of Registered Polysomnographic Technologists)\n- BLS, Basic Life Support\n- Licensed in Virginia and North Carolina\n\n## Education\n\n- Coursework, Richard Bland College of William & Mary, Petersburg, VA\n- High school diploma, Dinwiddie County High School, Dinwiddie, VA\n\n## Skills\n\n- **Clinical:** polysomnography of every study type (adult, pediatric, high-acuity), hypoglossal nerve stimulation (HGNS) titration and follow-up with Inspire, MSLT, PAP therapy and compliance education, AASM scoring\n- **Technical:** neurostimulator titration workflow, electrode application and troubleshooting, diagnostic equipment calibration and maintenance\n- **Software:** Ruby on Rails, Python, JavaScript and Vue, Shell, PostgreSQL, Redis, Docker, Linux and macOS administration, LLM integration and agent systems\n","body_html":"<p><strong>Walter Spence, RPSGT</strong>\nRichmond, VA · <a href=\"mailto:walt@waltspence.com\">walt@waltspence.com</a> · <a href=\"https://linkedin.com/in/waltspence\">LinkedIn</a> · <a href=\"https://github.com/waltspence\">GitHub</a></p>\n<p>Registered Polysomnographic Technologist with more than 20 years in sleep medicine and over 15,000 studies of every type, focusing on alternative therapies, with a specialty in pediatrics. I lead the hypoglossal nerve stimulation (HGNS) program at St. Mary’s Hospital, with nine years of hands-on Inspire HGNS experience, from overnight titration through long-term follow-up. I also build and run AI agent systems and the software around them.</p>\n<p>Open to clinical and engineering roles, remote preferred.</p>\n<h2 id=\"clinical-experience\">Clinical experience<a href=\"#clinical-experience\" aria-label=\"Link to heading 'Clinical experience'\" data-heading-content=\"Clinical experience\" class=\"anchor\"></a></h2>\n<h3 id=\"registered-polysomnographic-technologist-daytime\">Registered Polysomnographic Technologist, Daytime<a href=\"#registered-polysomnographic-technologist-daytime\" aria-label=\"Link to heading 'Registered Polysomnographic Technologist, Daytime'\" data-heading-content=\"Registered Polysomnographic Technologist, Daytime\" class=\"anchor\"></a></h3>\n<p>Bon Secours Mercy Health, Richmond, VA · July 2025 to present</p>\n<ul>\n<li>Leads the hypoglossal nerve stimulation (HGNS) program at St. Mary’s Hospital.</li>\n<li>Daytime testing operations and physician workflow, including study readiness and documentation.</li>\n<li>Also covers overnight Inspire titration studies and implanted-patient follow-up.</li>\n<li>Lab-side clinical reference for implanted patients: device education, comfort and adherence troubleshooting, and escalation to the implanting team.</li>\n</ul>\n<h3 id=\"overnight-registered-polysomnographic-technologist\">Overnight Registered Polysomnographic Technologist<a href=\"#overnight-registered-polysomnographic-technologist\" aria-label=\"Link to heading 'Overnight Registered Polysomnographic Technologist'\" data-heading-content=\"Overnight Registered Polysomnographic Technologist\" class=\"anchor\"></a></h3>\n<p>Virginia Commonwealth University Health, Richmond, VA · 2024 to 2025</p>\n<ul>\n<li>Returned to pediatric sleep medicine, which I had worked in early in my career.</li>\n<li>Overnight testing in a high-acuity academic medical center, including pediatric patients with complex neurological, genetic, respiratory and behavioral conditions.</li>\n<li>Accurate physiological data collection, real-time monitoring and protocol compliance for vulnerable patients.</li>\n<li>Trained and mentored new technologists in electrode application, study protocol, scoring criteria and EMR use.</li>\n<li>Tracked, calibrated and troubleshot diagnostic equipment.</li>\n</ul>\n<h3 id=\"daytime-registered-polysomnographic-technologist\">Daytime Registered Polysomnographic Technologist<a href=\"#daytime-registered-polysomnographic-technologist\" aria-label=\"Link to heading 'Daytime Registered Polysomnographic Technologist'\" data-heading-content=\"Daytime Registered Polysomnographic Technologist\" class=\"anchor\"></a></h3>\n<p>Pulmonary Associates of Richmond, Richmond, VA · 2024</p>\n<ul>\n<li>Multiple Sleep Latency Tests and reports for physician review.</li>\n<li>Patient education on PAP compliance and long-term therapy, and follow-up for Inspire patients.</li>\n<li>Scoring and interpretation workflow, including DME setup.</li>\n</ul>\n<h3 id=\"overnight-registered-polysomnographic-technologist-1\">Overnight Registered Polysomnographic Technologist<a href=\"#overnight-registered-polysomnographic-technologist-1\" aria-label=\"Link to heading 'Overnight Registered Polysomnographic Technologist'\" data-heading-content=\"Overnight Registered Polysomnographic Technologist\" class=\"anchor\"></a></h3>\n<p>Community Health Systems / Bon Secours Mercy Health, Richmond, VA · 2020 to July 2025 (PRN from 2024)</p>\n<ul>\n<li>Overnight Inspire titration studies and implanted-patient care across the full follow-up cycle.</li>\n<li>Electrode application and overnight monitoring, with attention to scoring protocol and patient comfort.</li>\n<li>Technical operations of the sleep lab, including equipment readiness and data quality.</li>\n</ul>\n<h3 id=\"overnight-polysomnographic-technician\">Overnight Polysomnographic Technician<a href=\"#overnight-polysomnographic-technician\" aria-label=\"Link to heading 'Overnight Polysomnographic Technician'\" data-heading-content=\"Overnight Polysomnographic Technician\" class=\"anchor\"></a></h3>\n<p>Sleep Clinics of America, Richmond, VA · 2017 to 2020</p>\n<ul>\n<li>Inspire titration studies and implanted-patient follow-up alongside standard diagnostic polysomnography.</li>\n<li>Diagnostic accuracy and patient comfort across high-volume overnight studies.</li>\n</ul>\n<h3 id=\"earlier-sleep-laboratory-roles\">Earlier sleep laboratory roles<a href=\"#earlier-sleep-laboratory-roles\" aria-label=\"Link to heading 'Earlier sleep laboratory roles'\" data-heading-content=\"Earlier sleep laboratory roles\" class=\"anchor\"></a></h3>\n<ul>\n<li>Sleep 360, Austin, TX · 2016</li>\n<li>Virginia Medical Group, Colonial Heights, VA · 2014 to 2016</li>\n<li>Bon Secours Health Source, Richmond, VA · 2010 to 2014</li>\n<li>River City Sleep Medicine (Neurological Associates), Richmond, VA · 2008 to 2010</li>\n<li>Sleep Disorders Center of VA, Colonial Heights, VA · 2003 to 2008</li>\n</ul>\n<h2 id=\"engineering-and-business\">Engineering and business<a href=\"#engineering-and-business\" aria-label=\"Link to heading 'Engineering and business'\" data-heading-content=\"Engineering and business\" class=\"anchor\"></a></h2>\n<h3 id=\"independent-web-developer-and-consultant\">Independent web developer and consultant<a href=\"#independent-web-developer-and-consultant\" aria-label=\"Link to heading 'Independent web developer and consultant'\" data-heading-content=\"Independent web developer and consultant\" class=\"anchor\"></a></h3>\n<p>Web and AI agent systems · 2004 to present</p>\n<ul>\n<li>Contract web development since 2004; for the last five years, consulting and individual-contributor work on web and AI agent systems alongside sleep medicine.</li>\n<li><a href=\"https://github.com/waltspence/zap\">zap</a>: a terminal-native app uninstaller for macOS and Linux. On its first run on my own machine, it freed over 20 GB.</li>\n<li>Helix: a multi-node fleet of AI agents across Linux and macOS, with a scheduled loop that finds recurring failures, tests fixes and ships them behind a rollback. See <a href=\"/notes/supposed-to-run-itself\">Supposed to Run Itself</a>.</li>\n<li><a href=\"/projects/knowfer\">Knowfer</a>: a Rails knowledge base that agents read and write over MCP.</li>\n<li><a href=\"/projects/talkify\">Talkify</a>: a Rails and Vue 3 dashboard for running agents.</li>\n<li><a href=\"/projects/waltspence-com\">waltspence.com</a>: this site and its publishing desk, on Rails, Vue 3, Redis, and Python and Node workers.</li>\n</ul>\n<h3 id=\"founder-and-ceo\">Founder and CEO<a href=\"#founder-and-ceo\" aria-label=\"Link to heading 'Founder and CEO'\" data-heading-content=\"Founder and CEO\" class=\"anchor\"></a></h3>\n<p>EnLab, LLC · 2010 to 2016</p>\n<ul>\n<li>Founded a startup focused on a WebRTC meeting project.</li>\n</ul>\n<h2 id=\"certifications\">Certifications<a href=\"#certifications\" aria-label=\"Link to heading 'Certifications'\" data-heading-content=\"Certifications\" class=\"anchor\"></a></h2>\n<ul>\n<li>RPSGT, Registered Polysomnographic Technologist (Board of Registered Polysomnographic Technologists)</li>\n<li>BLS, Basic Life Support</li>\n<li>Licensed in Virginia and North Carolina</li>\n</ul>\n<h2 id=\"education\">Education<a href=\"#education\" aria-label=\"Link to heading 'Education'\" data-heading-content=\"Education\" class=\"anchor\"></a></h2>\n<ul>\n<li>Coursework, Richard Bland College of William &amp; Mary, Petersburg, VA</li>\n<li>High school diploma, Dinwiddie County High School, Dinwiddie, VA</li>\n</ul>\n<h2 id=\"skills\">Skills<a href=\"#skills\" aria-label=\"Link to heading 'Skills'\" data-heading-content=\"Skills\" class=\"anchor\"></a></h2>\n<ul>\n<li><strong>Clinical:</strong> polysomnography of every study type (adult, pediatric, high-acuity), hypoglossal nerve stimulation (HGNS) titration and follow-up with Inspire, MSLT, PAP therapy and compliance education, AASM scoring</li>\n<li><strong>Technical:</strong> neurostimulator titration workflow, electrode application and troubleshooting, diagnostic equipment calibration and maintenance</li>\n<li><strong>Software:</strong> Ruby on Rails, Python, JavaScript and Vue, Shell, PostgreSQL, Redis, Docker, Linux and macOS administration, LLM integration and agent systems</li>\n</ul>\n","text":"Walter Spence, RPSGT\nRichmond, VA · walt@waltspence.com · LinkedIn · GitHub\nRegistered Polysomnographic Technologist with more than 20 years in sleep medicine and over 15,000 studies of every type, focusing on alternative therapies, with a specialty in pediatrics. I lead the hypoglossal nerve stimulation (HGNS) program at St. Mary’s Hospital, with nine years of hands-on Inspire HGNS experience, from overnight titration through long-term follow-up. I also build and run AI agent systems and the software around them.\nOpen to clinical and engineering roles, remote preferred.\nClinical experience\nRegistered Polysomnographic Technologist, Daytime\nBon Secours Mercy Health, Richmond, VA · July 2025 to present\n\nLeads the hypoglossal nerve stimulation (HGNS) program at St. Mary’s Hospital.\nDaytime testing operations and physician workflow, including study readiness and documentation.\nAlso covers overnight Inspire titration studies and implanted-patient follow-up.\nLab-side clinical reference for implanted patients: device education, comfort and adherence troubleshooting, and escalation to the implanting team.\n\nOvernight Registered Polysomnographic Technologist\nVirginia Commonwealth University Health, Richmond, VA · 2024 to 2025\n\nReturned to pediatric sleep medicine, which I had worked in early in my career.\nOvernight testing in a high-acuity academic medical center, including pediatric patients with complex neurological, genetic, respiratory and behavioral conditions.\nAccurate physiological data collection, real-time monitoring and protocol compliance for vulnerable patients.\nTrained and mentored new technologists in electrode application, study protocol, scoring criteria and EMR use.\nTracked, calibrated and troubleshot diagnostic equipment.\n\nDaytime Registered Polysomnographic Technologist\nPulmonary Associates of Richmond, Richmond, VA · 2024\n\nMultiple Sleep Latency Tests and reports for physician review.\nPatient education on PAP compliance and long-term therapy, and follow-up for Inspire patients.\nScoring and interpretation workflow, including DME setup.\n\nOvernight Registered Polysomnographic Technologist\nCommunity Health Systems / Bon Secours Mercy Health, Richmond, VA · 2020 to July 2025 (PRN from 2024)\n\nOvernight Inspire titration studies and implanted-patient care across the full follow-up cycle.\nElectrode application and overnight monitoring, with attention to scoring protocol and patient comfort.\nTechnical operations of the sleep lab, including equipment readiness and data quality.\n\nOvernight Polysomnographic Technician\nSleep Clinics of America, Richmond, VA · 2017 to 2020\n\nInspire titration studies and implanted-patient follow-up alongside standard diagnostic polysomnography.\nDiagnostic accuracy and patient comfort across high-volume overnight studies.\n\nEarlier sleep laboratory roles\n\nSleep 360, Austin, TX · 2016\nVirginia Medical Group, Colonial Heights, VA · 2014 to 2016\nBon Secours Health Source, Richmond, VA · 2010 to 2014\nRiver City Sleep Medicine (Neurological Associates), Richmond, VA · 2008 to 2010\nSleep Disorders Center of VA, Colonial Heights, VA · 2003 to 2008\n\nEngineering and business\nIndependent web developer and consultant\nWeb and AI agent systems · 2004 to present\n\nContract web development since 2004; for the last five years, consulting and individual-contributor work on web and AI agent systems alongside sleep medicine.\nzap: a terminal-native app uninstaller for macOS and Linux. On its first run on my own machine, it freed over 20 GB.\nHelix: a multi-node fleet of AI agents across Linux and macOS, with a scheduled loop that finds recurring failures, tests fixes and ships them behind a rollback. See Supposed to Run Itself.\nKnowfer: a Rails knowledge base that agents read and write over MCP.\nTalkify: a Rails and Vue 3 dashboard for running agents.\nwaltspence.com: this site and its publishing desk, on Rails, Vue 3, Redis, and Python and Node workers.\n\nFounder and CEO\nEnLab, LLC · 2010 to 2016\n\nFounded a startup focused on a WebRTC meeting project.\n\nCertifications\n\nRPSGT, Registered Polysomnographic Technologist (Board of Registered Polysomnographic Technologists)\nBLS, Basic Life Support\nLicensed in Virginia and North Carolina\n\nEducation\n\nCoursework, Richard Bland College of William & Mary, Petersburg, VA\nHigh school diploma, Dinwiddie County High School, Dinwiddie, VA\n\nSkills\n\nClinical: polysomnography of every study type (adult, pediatric, high-acuity), hypoglossal nerve stimulation (HGNS) titration and follow-up with Inspire, MSLT, PAP therapy and compliance education, AASM scoring\nTechnical: neurostimulator titration workflow, electrode application and troubleshooting, diagnostic equipment calibration and maintenance\nSoftware: Ruby on Rails, Python, JavaScript and Vue, Shell, PostgreSQL, Redis, Docker, Linux and macOS administration, LLM integration and agent systems","url":"https://waltspence.com/cv","links":{"html":"https://waltspence.com/cv","json":"https://waltspence.com/cv.json","txt":"https://waltspence.com/cv.txt","md":"https://waltspence.com/cv.md","canonical":"https://waltspence.com/cv"},"revisions":[{"at":"2026-11-02T03:55:08-05:00","summary":"Revised"},{"at":"2026-11-02T03:55:07-05:00","summary":"Revised"},{"at":"2026-11-02T02:27:19-05:00","summary":"Revised"},{"at":"2026-11-02T02:27:19-05:00","summary":"Revised"}]}