Summer 2014 Sleep Bulletin

Notes from the Chair

Karla Smith, BSRT, RRT, RPSGT

My name is Karla Smith and I have been appointed to serve as interim chair for the Sleep Section. In the short time we have until the next chair election, I would like bring this group together and discuss all things sleep!

I, for one, would love to hear how things are going in the sleep profession in your corner of the world. There is so much we can learn from one another and AARConnect is the perfect place to ask your questions and share your stories.

Also, this is YOUR section, and this is YOUR Bulletin, so I am reaching out to all of you to write articles for this Bulletin. We want to hear your stories, as well as any new processes you are working on. It is great when a colleague can read about your struggles or successes and learn from that story.

One more thing: I am very excited about the upcoming AARC Congress in Las Vegas, Dec. 9-12! Have you had a chance to look at the program? There are so many lectures regarding sleep, and this year there is a pre-course on Mon., Dec, 8 titled Sleep and Wellness 2014. I encourage you all to attend if you can. What a great place to connect with colleagues and friends — you know you will always leave with a boatload of great information to take back home.

So again, I am excited for this time as your chair and I encourage all of you to share your expertise with your fellow sleep RTs and keep this section going strong. Don’t forget to invite other sleep RTs to join as well. We would love to hear from them too!

If you have any questions or concerns, please do not hesitate to email me. I’ll be happy to address your issues.

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Sleep Duration: A Marker for Overall Health

Laura McFarland, RRT, RPSGT
Cambridge Medical Center, Cambridge, MN

Several longitudinal studies have revealed that abnormal sleep duration (<5 hours or >9 hours) is correlated with adverse effects on our health. It is now commonly accepted in the literature that sleeping less or more than normal is associated with conditions such as hypertension, obesity, diabetes, and cardiovascular disease.

Trends for the past 20-30 years reveal an increase in these medical conditions, while sleep duration has decreased by approximately two hours, going from 8.5 to 6.5 hours since 1960. According to the Centers for Disease Control and Prevention (CDC), an estimated 50-70 million U.S. adults have sleep or wakefulness disorders. The CDC goes further, stating that insufficient sleep is a public health epidemic. But one question remains: is insufficient or excessive sleep duration simply related to other medical conditions known to increase the risk of mortality, or does sleep play an independent role in our health?

Studies controlling for other risk factors and medical conditions (age, sex, marital status, employment grade, smoking status, physical activity, ETOH consumption, self-rated health, BMI, systolic BP, cholesterol, physical illness, GHQ score, prevalent CHD) reveal that sleep duration is independently associated with increased mortality risk. These studies report an increased risk ranging from 62% for short sleepers to 206% for long sleepers, independent of other risk factors.

With these results in mind, is it time to consider sleep duration as a marker of our patients’ overall health? Just as we look at blood pressure and BMI, a simple question about sleep duration could provide valuable information and guidance for primary caregivers. Once identified, those patients sleeping more or less than normal could be screened for OSA and referred for a PSG (in the direct referral environment), or sent to a sleep physician or psychologist for further assessment and care.

Whether it causes increased mortality and morbidity or is merely an indicator of health, sleep duration is something we should track as a vital statistic. Change in sleep duration should be like “the canary in the coal mine.” It is a warning that something is going on and it might be significant to health.

Although we don’t know yet if treating sleep duration problems will prevent disease or improve health outcomes, we should err on the side of caution and refer patients with chronic health conditions and sleep duration problems to a qualified professional to treat the sleep problem. At best, it could improve outcomes; at worst, it will improve quality of life.

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Maybe You Have It Too!

David Wolfe, MSEd, RRT-SDS, RPSGT
Crouse Hospital, Syracuse, NY

Hi, my name is David . . . and I have OSA.

Hi, David! The first step is to admit it.

Do you have OSA?

Like many of us who are involved in sleep medicine, I have performed sleep studies, treated patients, and set up patients on PAP therapy at home. Each case has involved educating the patient. Indeed, those of us in the field can recall speaking with patients about their disorder, diagnosis, and treatment countless times. We may verbalize to the patient that we know how he feels, but do we really?

Well, how many of us have put on a pressure transducer or thermistor to realize it tickles the nose? I know many of us have tried an interface to see how PAP therapy feels — for two minutes!

The point is, we know all about sleep disorders and can tell our patients all about the problems associated with untreated sleep apnea. But we don’t know what it’s really like to have these disorders or what it’s like to have them treated. And we may not think about having one ourselves, especially if we don’t fit the usual description of someone with a particular sleep disorder.

That’s where I found myself earlier this year . . .

Exception to the rule

As far back as I can remember, I have had trouble staying awake after lunch. If I am busy, I can usually stay awake. But put me in a meeting and it is all I can do to not fall asleep. The one post-lunch coffee usually helps me through the meeting(s). Reviewing various research and being an educator, I already knew the different theories of why we are somnolent after lunch, so I chalked it up to that, especially since I don’t really have the problem in the morning.

For years, I went on like this while at the same time telling my adult patients that if they sleep 7-8 hours a night and are still tired the next day, they may have a sleep disorder. I relayed this information to patients, but for some reason, didn’t comprehend that this could pertain to me. I religiously get my 7.5 hours of sleep at night, but am tired the following day. But I am the exception, right? Anyone else relating to this scenario?

I snore infrequently, have a normal BMI, eat fairly healthy, and exercise regularly, so, in my mind, I guess there was no way I could have sleep apnea. Recently, though, I started hearing that I stop breathing sometimes while I sleep. So, now the light bulb goes on? Seriously? What have I been thinking the past several years while giving patients the OSA lecture? I finally realized I may have sleep apnea. And, my assumption was correct . . . I do!

Harder than we think

Here comes PAP treatment. I went into it thinking it can’t be that bad since I’ve been able to get most of my patients to wear it throughout the entire PAP titration. I was wrong — it was/is pretty bad. As of this writing in early summer, I’ve been wearing it for two weeks and still find it difficult to use more than an hour or two. I’m trying to take the advice I’ve given to countless patients when it comes to increasing usage, but still no luck. I’ve got humidity, a heated tube, and an interface that is as comfortable as it can be, I guess. But, I’ll keep trying.

So, I’m wondering how many of you who are reading this are in the same situation I am. We help diagnose and treat sleep apnea all of the time, but may not think we have it. With the prevalence as high as it is, and the number of people who still have not been diagnosed, there’s a good chance many of us do have it as well. We need to become role models and practice what we preach; it just may be a lot harder than we think.

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Section Connection

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Bulletin Deadlines: Winter Issue: January 1; Spring Issue: April 1; Summer Issue: July 1; Fall Issue: October 1.

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