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Myers has treated many older patients who have had this condition for 40 to 50 years, and in severe cases, RLS is debilitating if it prevents patients from sleeping at night. The treatment, Myers said, is usually simple and effective: a small dose of a drug used to treat Parkinson’s disease.

Although the sleep disorder may vary from patient to patient, nurses in this field usually spend time educating patients about the basic sleep cycles people go through during the night. The two main phases of sleep are non-REM (rapid eye movement) and REM, said Wendy Moore, RN, the lead nurse in the Mayo Sleep Disorders Center in Rochester, Minn. The deepest and most restorative sleep happens during the later phases of non-REM sleep. Moore believes nurses in particular need to guard their sleep hours because many do irregular shift work that can threaten sleeping routines.

“America is not a society that values people getting enough sleep,” Moore said. “When we wonder why we don’t feel well, it may be because we are sleep deprived. Many nurses have to work challenging shifts for years, and they need to be disciplined about getting enough sleep.”

Marcia Hill, RN, a certified clinical research coordinator at Baylor College of Medicine in Houston, said it is interesting to see how many people do not practice good sleep habits. Some guidelines for getting enough rest include:

> Keep to a regular time of going to bed and waking, even on weekends.
> Do not exercise less than five hours before bedtime.
> Don’t drink coffee or smoke three hours before bedtime.
> Turn the clock away if you struggle with watching the clock.
> Get up at the same time even if you have a poor night of sleep.

Even though these basic tips may work for many people, some of the most difficult cases in sleep medicine include insomnia patients who continue to struggle with getting enough rest.

“The majority of the time, insomnia has to do with a life stressor, and then the problem gets worse because of the stress of not being able to sleep,” Myers said. “The brain forms associations and bed becomes a place where someone can’t fall asleep.”

To treat these patients, Myers tells people to leave their bedroom if they can’t fall asleep after about 15 minutes. If that doesn’t work, he may suggest sleep restriction, or staying awake until 1 or 2 AM. This way the patient is so tired that sleep comes more easily. If this works and sleep becomes less frustrating, then he can help the patient work back to an earlier bedtime.

Shh! Patients sleeping

While most nurses who are interested in sleep medicine work with patients who have disorders, one nurse in Minnesota took a different tack on the subject. Cheryl Cmiel, RN, BAN, a staff nurse at Saint Marys Hospital in Rochester, Minn., had heard patients express discontent with the level of noise and interruptions during sleeping hours at her hospital. To investigate the problem, she decided to conduct a study in 1999. Cmiel and a team of other nurses placed noise dosimeters in three empty patient rooms during a night shift. They found peak dosimeter readings as high as 113 decibels — the equivalent of the noise from a jackhammer — during the shift change around 7 AM.

Cmiel and another nurse also spent a night in the thoracic surgery unit, and she was surprised at what she found. “It was very difficult to sleep,” she said. “I am a light sleeper, and I could hear the noise in the hallway from people talking and moving equipment.” She also was wakened by the sounds of different monitor alarms that sounded, for example, when the monitor couldn’t measure a reading if she moved.

Once Cmiel had identified the reasons for patient sleeping problems, she tackled the problem. She educated fellow nurses about the need to be quiet with equipment and their voices, and she also lowered the volume on the monitor alarms that patients wore.

“The most rewarding part is just getting the information out and hearing other areas are doing the same thing,” Cmiel said. “It was such simple things we did, and it didn’t take a lot of effort.”

Whether nurses are changing hospital routines or teaching patients about how to wear their new CPAP masks, nurses in sleep medicine agree that their work is rewarding.

“It’s very gratifying to talk to the patients when they come back after a month on CPAP, and so many will say, ‘I got my life back,’ ” said Brenda Ball, RN, a staff nurse in the outpatient treatment unit at Lima (Ohio) Memorial Hospital. “So many will say they feel rested, and wonder why it took so long for them to get here. It’s gratifying to know these people have had it make such a difference.”

Ball has become such a believer in what she teaches her patients that she’s changed her own sleeping habits. She used to get four to five hours of sleep per night.

Then she started to get seven to eight hours, and noticed that she felt better.

“Now when I get up, I am not as tired and I can go longer in the day without getting that dragging feeling,” Ball said. “I used to stay up until 11:30 and get up at 5 AM. Now I know those TV programs just aren’t worth it. There are portions of sleep we need or we can’t regenerate to prepare for the next day.”

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