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Sleep. It’s the first thing to go when nurses
are squeezed by the demands of their professional and
personal lives. But to sacrifice it so easily is a mistake
with career implications, said Denise Howland, RN, who
has made a 23-year career at the Sleep Disorders Center
of Alabama in Birmingham.
The center studies, monitors and treats patients with
insomnia, sleepwalking, sleep talking, restless legs
syndrome and by far the most common problem: obstructive
sleep apnea. Each patient begins with Howland, 45, and
an extensive interview.
Sometimes patients recognize they have a sleep disorder,
but more often than not, it’s a spouse or significant
other who will pick up on snoring or the patient having
trouble breathing, Howland said. “What the patient
notices is how they feel during the day. They recognize
they’re feeling sleepy, they’re feeling
tired, they’re noticing headaches or concentration
problems.”
Disruption of sleep is Howland’s concern, whether
it is the result of a physical disorder, chronic pain
or an ill-advised decision by someone who works shifts
to surrender sleep. Researchers know that shift workers
tend to get fewer hours of sleep and waken more frequently,
she said.
Howland fell into sleep as a specialty as a neonatal
intensive care nurse at Baptist Medical Center in Montclair.
“I would go with babies when we sent them to the
sleep center and monitor them out of the unit,”
she said. “It was fascinating to watch this whole
process of sleep and what went on. You could document
episodes when they were having trouble breathing or
drops in their heart rates. I found myself looking over
the technicians’ shoulders and learning.”
She then educated parents in infant CPR, the use of
monitors and what to expect when they took their preterm
babies home.
“Sleep is vital to good health, both physically
and mentally,” Howland said. “It’s
the time our bodies need to recover. Our joints and
muscles and the body in general get that restorative
nature.”
In the extreme, obstructive sleep apnea patients stop
breathing for 90 to 120 seconds. “Imagine trying
to do that when you’re awake. It’s really
impressive that your body will allow you to do that
during the night,” Howland said. “If it’s
left untreated, someone who has obstructive sleep apnea
is more likely to develop high blood pressure,”
as well as to have a heart attack or stroke.
In terms of treatment, Howland said patients with obstructive
sleep apnea can use a continuous positive air pressure
machine. It keeps the airway open, thereby controlling
snoring and taking stress off the body and the heart.
People with restless legs syndrome, which is characterized
by jerking, twitching or cramping of the legs and sometimes
the arms and hands during sleep, tend to respond to
medication.
Weight loss also may help in some sleep disorders,
Howland said.
For RNs, disrupted sleep often is the result of a necessary
evil: shift work “Some people do really well,
especially people who tend to be night owls,”
Howland said. “But the majority of people on shift
work do not.
“The thing about shift work is that it puts us
in conflict with our body’s own natural rhythm.
Our bodies have a biological clock and there’s
pretty much a certain time every day when that body
wants to go to sleep. When we’re out of synch
with that, especially for the night shift workers—the
ones who work 11 to 7—we’re trying to sleep
when our body naturally wants to be awake and we’re
awake when our body naturally wants to go to sleep.
“You may find you wake up with headaches,”
Howland said. “You may find that you have difficulty
concentrating or difficulty with your memory. You lose
your productivity and accidents may increase because
of decreased alertness.”
Howland has several suggestions for coping with shift
work:
“If you have to rotate shifts, it’s always
better to rotate in a clockwise fashion,” she
said. “If you’re working days, you would
next rotate to evenings and then you would next want
to rotate to nights. You always want to keep in some
way with the body’s natural rhythm, which is hard
to do sometimes.”
If possible, keep the same shift seven days a week.
A lot of patients find they can’t bounce back
to a so-called regular schedule for a day-and-a-half
or two days on the weekend. “You’re constantly
bouncing back and forth, which continues to create problems.”
Make sleep time specifically that. Turn off the telephone
or use an answering machine.
Make your sleep space specifically that. “It’s
not a place to do your bills. It’s not a place
to do TV or anything else.” Keep the room cool
and dark, even if that means using blackout shades.
Try relaxing for 15 minutes vs. “coming in and
trying to plop into bed and your mind is still racing
from whatever you were doing at the hospital. Some people
take a warm bath to try to relax.” Also, avoid
stimulants such as coffee or cigarettes
before turning in.
Contact Phil McPeck at getpjm@aol.com.
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