Nurse, Heal Thyself!

By Julia Worrall RN

I have been a nurse for over 20 years. And I’ve been exhausted just as long.

Unfortunately I am not alone. Nurses are called upon  to be superheroes…impervious to niggly details like hunger, pain, sadness and fatigue. 

We keep going. I mean what choice do we have? As the years go by we become crusty and curt, a ‘Nurse Ratched’ if you will.  But we keep showing up. Putting aside our fatigue to care for you because, for the most part, in our profession the need for sleep is considered a character flaw…only for the weak. A ‘good’  nurse can churn out shift after shift, even on minimal sleep, because we will never abandon you, our patient. 

Patience with our Patients

We know that hospitalization can be one of the most physically and psychologically stressful events in one’s life, and that this stress has the potential to reduce our patients’ sleep quality, impair recovery and delay discharge. Because patients notoriously complain about the noise we make at the nursing station, their roommates’ snoring, and about how hard it is to get a good night’s sleep, we hand out sleep aids like candy. 

Understandably then, this legitimate concern has made nurses experts at teaching their patients about sleep, sleep hygiene and sleep disorders. 

Right?

Wrong! How I wish this were true, but in general nurses consider sleep promotion a very low priority in their busy practice. Might the shocking fact that the typical nursing student receives just an average of 60 minutes of education about sleep during their entire 4-year program have anything to do with it?

Yes, SIXTY MINUTES. Think about that…. We spend a grand total of one hour discussing what occurs during ONE-THIRD of our patients’ lives! 

No wonder nurses do not place a high priority on sleep! Nurses consider insufficient sleep knowledge as a major barrier to effective sleep management in the clinical setting. In addition, they view discussions about sleep with their patients to be impractical due to a perceived lack of time.

Since nursing is considered to be the most trusted profession, and nurses are the largest group of healthcare professionals, are we not perfectly positioned to effect change for both our patients and ourselves?

Nurses who adopt healthy behaviours themselves act as positive role models. In fact, nurses who enjoy higher quality sleep are more knowledgeable about sleep in general, have a positive attitude toward sleep hygiene, and are much more likely to broach this important subject with their patients.

So before we can address the sleep health of our patients, we need to address our own sleep. 

Nurse, Heal Thyself! 

Many times I have reported for a shift only to hear the nurses lamenting their extreme sleep deficits. We wear our sleep deprivation as a badge of honor. This is foolhardy and explains the lack of resiliency that is creeping into our profession. It is hard to be compassionate toward our patients while we are exhausted, yet managing a never-ceasing flow of patients through our department. Sadly, it is our own lackadaisical attitudes about sleep, our own habits, that are harming our patients. 

It is true that we are pressed in every way for time, but how fantastic would it be if we could have a dedicated Sleep Technologist/Educator to provide inservice training for nurses and to be a resource for the inevitable sleep issues our patients face once admitted? Those issues, in fact, often the root cause of why they are admitted. 

My dream for the future is that sleep education be extensively taught to nurses and that Sleep Techs/Educators be an integral part of the in-hospital multidisciplinary team.  

As the world’s attention turns to consider that occult one-third of our lives, I call upon nurses to collaborate with the sleep educators to discuss strategies for helping  patients’ achieve a solid eight or so hours of restful life-enhancing sleep. 

Sleep and Medical Issues

Sleep has a foundational healing effect on the body. When we sleep, our bodies replenish, heal, and grow in a variety of ways. Sleep boosts our immune system, helps us recover from injury, and improves our mood. When we are feeling ill, we are told to “sleep it off.”  It is our body’s natural means of survival, and although humans can live for weeks without food and days without water, we can only last approximately 36 hours without sleep before our bodies begin to shut down. 

This is important because, for a number of people, sleep can be incredibly difficult to achieve. Chronic insomnia affects 25 percent of adults and 50 percent of the elderly, with 95 percent of Americans experiencing insomnia at some point in their lives. In addition, people with insomnia who sleep less than six hours per night on average have a much higher risk of negative health outcomes. It is not so easy for them to just “sleep it off,” and not only because of psychological or environmental reasons.

Sleep disorders are defined by the Mayo Clinic as a change in the way you sleep, and they affect 50 to 70 million US residents, according to the Centers for Disease Control and Prevention. The CDC has asserted that sleep disorders are connected to many chronic illnesses, including cardiovascular problems and diabetes. The link between sleep and medical issues is undeniable, but let us examine more specific ways in which they relate. 

Breathing: It’s Kinda Important…

One of the most common sleep disorders is sleep apnea, in which breathing during sleep is interrupted by pauses, or apneas, which can last 10 seconds or more. These apneas may occur five to 30 or more times per hour, reducing the amount of oxygen that circulates to the brain. According to the National Institutes of Health, more than 12 million Americans suffer from sleep apnea. It is more common in men, overweight people, and the elderly, as well as African-Americans, Latinos, and Pacific Islanders as compared to Caucasians.

Obstructive sleep apnea is a specific type of sleep-disordered breathing, in which the airway is blocked or collapsed, often by the soft tissue in the back of the throat. In particular, obstructive sleep apnea has been associated with nighttime heart attacks (91 percent), drug-resistant hypertension (83 percent), obesity (77 percent), congestive heart failure (76 percent), diabetes (72 percent), pacemakers (59 percent), and atrial fibrillation (49 percent). The estimated economic cost of undiagnosed obstructive sleep apnea in the United States was nearly $150 billion in 2015

Sleeplessness has very direct results on the body. Sleep insufficiency changes the balance of hormones that regulate appetite and results in greater risks factors for type 2 diabetes, including excessive eating for energy and increased glucose levels and insulin resistance. A lack of sleep may also produces stress hormones that cause people’s bodies to remain in a state of alertness and increases blood pressure. 

Poor sleep makes you more susceptible to illness.

Sleep also produces white blood cells that protect the body from infectious diseases and viruses. A poor night’s sleep could mean catching a cold or something much worse. After only one night with four to five hours of sleep, critical anti-cancer immune cells decrease by 70 percent. In fact, the connection between sleep deficiency and cancer is so strong that the World Health Organization classifies nighttime shift work as a probable carcinogen.

In addition, the role of sleep in cardiovascular health cannot be overstated. During non-REM sleep phases, our heart rate drops and our blood pressure is reduced, which provides the organ with a much-needed break from its vital daytime work. Consequently, insufficient sleep causes blood pressure to increase, and sleeping six hours or less a night makes your risk of a fatal heart attack or stroke skyrocket 200 percent.

Julia Worrall is The Sleep RN, a critical care nurse of 20 years and the program director of the Airway Advocacy group, Foundation for Airway Health. Julia has presented her findings on sleep to the National Commission on Correctional Health Care and continues to push for more comprehensive sleep programs for frontline staff and people in the criminal justice system.