By Debra Wood, RN, contributor
Sleep. People often take it for granted, but failing to obtain restorative slumber can lead to health problems, daytime drowsiness, impaired driving and reduced quality of life.
Although sleep medicine represents a relatively new field of study, nurses on the front lines enjoy uncovering the cause of the trouble, the counseling and positively affecting patients’ well-being.
“I love the fact we can make an instantaneous change in someone’s life,” said Jim Rogers, RN, clinical director for the North Texas region of Total Sleep Diagnostics, a company that operates 11 hotel-style sleep laboratories.
“We get the opportunity, even in one night, to take a patient who hasn’t slept well in 25 years and has oxygen levels dropping into the 60s and fix that,” Rogers said.
Rogers began his career working in a sleep lab while attending nursing school. He also is a registered polysomnographic technologist.
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Profile: American Sleep Apnea Association (ASAA)
Mission: The American Sleep Apnea Association is dedicated to reducing injury, disability, and death from sleep apnea and to enhancing the well-being of those affected by this common disorder. The ASAA promotes education and awareness, the ASAA A.W.A.K.E. Network of voluntary mutual support groups, research, and continuous improvement of care.
Publication: Wake-Up Call, the bimonthly wellness letter for snoring and apnea.
Web site: http://www.sleepapnea.org/index.html
Telephone: (202) 293-3650
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Registered polysomnographic technologists assist providers in diagnosing and treating sleep disorders by conducting overnight sleep studies that monitor breathing patterns, oxygen levels and sleep patterns. Technicians also help determine the appropriate level of CPAP required to prevent or reduce sleep-apnea events.
“We send them home with continuous positive airway pressure (CPAP) and they thank us in the morning,” Rogers said.
Rogers worked for a couple of years in a neuro-intensive care unit after graduating from nursing school, then returned to sleep medicine. In addition to seeing positive results from his efforts, he enjoys teaching people about sleep disorders and treatments.
Joan Shaver, RN, Ph.D., FAAN, dean and professor at the college of nursing University of Illinois at Chicago, views such education and counseling as an ideal role for nurses.
A Sigma Theta Tau International member, Shaver has conducted extensive sleep research, as it pertains to women’s health, menopause, fibromyalgia and chronic fatigue. A mentor first piqued Shaver’s interest in the topic.
“Nursing gets involved in [providing] the health education and support people need to adhere to the medical prescriptions,” Shaver said. “A lot of people have to adjust their lifestyles and need help to do that.”
Shaver enjoys sleep science’s interdisciplinary approach. She meets with about 100 fellow nurse sleep experts at the American Academy of Sleep Medicine’s annual conferences to discuss the latest findings.
One of the greatest challenges is “keeping up with the research coming out on sleep,” said Margaret Vogelsang, RN, MS, PAC, with the Sleep Disorders Center at St. Francis Medical Center in Peoria, Illinois. “It’s mind boggling, maintaining a busy practice and keeping on the cutting edge.”
Vogelsang diagnoses and treats adults with insomnia, sleep apnea, narcolepsy or one of the other 84 sleep disorders. Each sleep problem requires different interventions. For instance, patients with narcolepsy often benefit from medications to keep them alert during the day, but pills are not the answer for insomniacs.
“The most effective treatment for insomnia is behavioral therapy,” Vogelsang said. Most patients with insomnia have developed some conditioning and bad sleep habits.
Vogelsang began her career 22 years ago and remains passionate about counseling patients to overcome their sleep problems, which may be associated with chronic pain, heart failure or other medical conditions.
“Long-term consequences of untreated obstructive sleep apnea include hypertension and most recently research has shown a correlation with heart attack and stroke,” said Sharon Seleman, MSN, APRN, BC, a provider at The Cleveland Clinic department of epilepsy and sleep disorders.
In addition to CPAP, sleep apnea patients may benefit from weight loss or a dental mandibular advancement device. A multidisciplinary approach includes a nutritionist and endocrinologist for weight loss, a dentist, or an otolaryngologist to evaluate surgical solutions.
Sleep problems are often chronic and may be associated with stress and poor habits. Getting to the root of the problem is a key to success. Selemen said patients often return for follow up looking like a “million bucks” and feeling rested and good about life.
“It only takes a couple of those to make you feel good about what you do,” she said.
Sleep problems also affect children, albeit sometimes the difficulties are related to different medical conditions than adult disorders. Often though, older youngsters are trying to do too much in too few hours, just like adults. Sleep disturbances may manifest themselves as hyperactivity or difficulty at school.
Fran Martinez, PNP, with Children’s Healthcare of Atlanta, who has worked with infants with apnea related to prematurity, recently began treating schoolchildren and teens with sleep disorders and their families.
“Parents often are not aware of how much sleep children need,” said Martinez, adding that school-age children require 10 hours of rest nightly. “That means that children have to be in bed by 7:30 or 8 p.m. and for some families, that can be difficult.”
Children also receive sleep studies to rule out medical causes for the sleep difficulties. But often spending time with the youngsters and their parents can resolve the problem.
From infancy to older adulthood, many people find a full night’s rest elusive. Science has just begun to understand all the mechanisms involved. Sleep science represents a new and growing field with many opportunities for nurses and nurse practitioners.
“Sleep medicine has really taken off,” Vogelsang said. “It has taken a long time to recognize just how important sleep is.”
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