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.