Advanced nurse practitioners talk about the importance of early diagnosis of insomnia and other sleep disorders.
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: We’ve talked a little bit about this today, but do you think it’s important that we diagnose these sleep disorders? Now, I’m not just talking about sleep apnea, I’m talking about primary insomnia, acute, chronic. Do you think it’s important that we diagnose these early rather than later? And if so, why is it important that we diagnose them early?
Debra Davis, CRNP: To me, it’s important because I have honestly seen strokes in patients, and I know you said more than sleep apnea, but with untreated sleep apnea. And it’s like you said earlier that that person who didn’t sleep well and gets in a car accident, and then you hear about it. And you think, “Oh my goodness, should I have talked more to them about this? Should I have mentioned this or mentioned that?” And yes, I do feel like we need to bring these up because it is not just sleep apnea or restorative sleep. It really is the “How do you feel the next day? How are things working for you the next day?” And “What all is involved in your life?” But the different disease processes, especially when I hear someone’s had a stroke, I really do think, did they have sleep apnea, and was it being treated. So many times, and I know that this is not my job here, but I do want to ask you when you’re treating sleep apnea and patients tell you, I can’t sleep with that, I rip the mask off at 1 o’clock in the morning, what do you do for that? What do you say to that?
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: It depends upon how long they’ve been trying to use the mask. So, I will say a few things. I will say, “If this is a new apparatus for you, if you can work on trying to use it for 21 to 30 days and see if you could get in the habit.” The other thing I say to them is, “Let’s get the sleep company to work with you, the Durable Medical Equipment company, because it doesn’t have to be a mask. It could be a nasal cannula or a nasal device.” And so, I tell them there are so many options out there now for people that we should be able to find something that works if they are willing to persist with it. Is there something you say differently?
Debra Davis, CRNP: Often I wonder if they don’t do a little better if I give them something short-term, a medication that is meant for sleep, just to get them used to it. And I say, “If I can get you used to sleeping with the mask and you honestly see that your life gets better, then you’ll want to use it.” And I have had patients come back and say, “Even if I take a nap, I put the mask on because it really helps me.”
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: And once they’re used to it, I can attest that people will say, “I cannot sleep without it now.” But I think that’s a great idea. I’ve heard a number of sleep specialists at some of the meetings that I’ve attended say that sometimes they’ll do a week of an orexin antagonist drug, or some of the newer agents that are out to get people onto those CPAP [continuous positive airway pressure] machines.
One other thing that I wanted to add to that is I have looked at some of these trials that have been done on insomnia and it’s amazing to me the length of time the patients have suffered from insomnia when they enter some of these pharmaceutical clinical trials. If anyone out there listening has ever gone a couple of nights without sleeping, I now want you to picture what that’s like if you go to bed every night of the week and you know you’re going to be awake much of the night, and how horrible that feels. I know that in some of the trials, these folks have suffered from insomnia for well over 10 years. And so, I think it’s so important that if they have depression, ask about sleep. Because I firmly believe we are never going to get these people to optimal remission if they’re not sleeping with their depression or anxiety or even some of these other conditions. I think my chronic pain patients, my patients with fibromyalgia, if I don’t help them to sleep, I don’t see a lot of improvement. I think it’s really essential to their overall rehab.
Debra Davis, CRNP: One of the premier guys on fatigue in the United States is Dr Jacob Teitelbaum, Kona Research Center, Kailua-Kona, Hawaii. I had been asked by an oncologist to help with the fatigue of chemotherapy. So I called Dr Teitelbaum because he wrote the book From Fatigued to Fantastic, and he’s amazing with the treatment of fibromyalgia or any of the problems with fatigue. And he said, “Debbie, if you can’t get them to sleep, all bets are off.” He said, “Don’t even try to work on their fatigue and give them different herbs or anything for fatigue if you can’t get them to sleep at night.” He said, “You have got to address that first.” And it made such an impression on me because I didn’t even think about that. Again, like I said, 1 track, the oncologist asked me to work on the fatigue of chemotherapy. Then, why is chemotherapy making them tired? Let’s go down that track and figure this out. And what vitamins do they need? That’s what he asked me to do. And it was Dr Teitelbaum who said, “No. Look at sleep. If they’re not sleeping, then the rest of the stuff that you’re doing does not matter.”
Wendy L. Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Instead of trying to wake them up, let’s get them a good night’s sleep. And they may not need that agent to get them out of bed in the morning.
Debra Davis, CRNP: Exactly.
Transcript edited for clarity