Things I Wish I Could Tell My Patients

[lydy]

1) Please sleep between the sheets.  They are changed after every use; the blanket and comforters...not so much.  

2) When you go to bed and when you get up are not state secrets.  It would also be really helpful if you would answer the questions I ask, rather than the ones you want to answer.  "When do you normally go to bed?" is not the same question as "When do you want to go to bed tonight?"  If they are different, I do want to know the answer to both of them, but to repeatedly answer the second when I ask the first frustrates both of us.  

3) Likewise and also, "What is the latest I can get you up tomorrow without screwing up your day?" is not usefully answered by "I always wake up at five-thirty."  If you have sleep apnea, and if I put CPAP on you, two things we do not currently know, there is absolutely no guarantee you will wake at your normal time.  

4) "It varies," is not an answer.  Values for "varies" ... vary, a lot.  When pressed, people have explained that they mean "between ten and ten-fifteen" or "between nine in the evening and two in and the morning."  Likewise, "late" and "early" are not useful descriptors, late meaning anything from ten in the evening to three in the morning, and early anything from three in the morning to seven in the morning.  I am not being rude when I press you for details, I am trying to get really basic information.

5) Almost everyone has a sleep schedule.  People who truly sleep at entirely random times a) do not hold down jobs and b) are really, really rare.  Please don't tell me "I don't have a schedule."  Tell me your normal range.  

6) I will listen politely to your theories about your sleep.  However, I won't take them very seriously.  The person who knows the least about your sleep is you, because you are unconscious at the time.  I will do my best to sort out actual information from theory, but you make it hard when you mix verifiable facts in with complex theories with no data to back it up.  

7) You are a competent adult, and that means that you have the right to refuse any and all medical interventions, up to and including CPR.  I must, therefore, assume you are in the lab voluntarily.   If you really don't want to be here, why the hell did you show up?

8) I am very sorry your doctor doesn't listen to you.  They don't listen to me either.  Telling me won't help you communicate them. If you really hate your doctor, maybe you should get a different one?  Just spit-balling here.

9) Barring basic social lies, I will tell you the truth.  There are questions I cannot answer, either because I don't know or because I am not allowed to tell you. But everything I tell you about the test, your health, and sleep is, to the best of my understanding, true.  I also won't tell you partial truths to mislead you.  

10) I do exert control over your environment.  I do this to get a good-quality sleep study.  I understand that this isn't how you sleep at home.  I am not trying to measure that.  I am trying to measure biological, intrinsic sleep, and I want to eliminate  environmental factors that might confound the results.  I will try to work with you on psychological issues that may affect your ability to initiate sleep, but I am not just being an authoritarian prick when I tell you you may not have the television on all night.

11) I am not running a scam, and I am insulted by the implication that I am.   However, even if I were, why would I ever admit that to you?  Therefore, accusing me of running a scam is pointless as well as irritating.

12) Please do not attempt to discuss politics or religion with me.  There is a chance that you will be comforted by the fact that the person guarding your sleep is an atheistic anarchist with bisexual leanings, but most of you will not, in fact, find that to be relaxing.  Let's just not talk about it, m'kay?  

13) Do not talk to me about your sex life.  At all.  

14) The wires are not negotiable.  And, yes, if this is a repeat study, they did all of this to you the last time, too.  Just because you don't remember a specific item doesn't mean that it wasn't used last time.  In point of fact, it was.  There are standards, and every accredited lab follows them.

15) If I do my job right, you will be unable to tell if I actually like you, or if I have classed you as a video game, where the win condition is to make you think that I like you.  I actually do like most patients.  It still doesn't matter.   Let's get a good sleep study, and move on with our lives, m'kay?

Comments

[lilysea]

There is a chance that you will be comforted by the fact that the person guarding your sleep is an atheistic anarchist with bisexual leanings

I would definitely have found that really comforting when I did sleep lab tests, as opposed to the staff I actually got, who radiated disapproval about my fat, female body, and my general unkemptness...

[lydy]

I am so sorry. Some of my fellow techs are terrible assholes. So are some of the doctors. Being the subject of a sleep study is to be in a terribly vulnerable position. Techs should work to make this easier, not harder. I do my best.

I guess another thing I wish I could tell my patients is that I don't have any interest in judging them, or their lifestyle, or their appearance.

Also...why on earth would someone bother to become kempt for a sleep study? People! My job would seriously be easier if people didn't people so damn hard, I tell you what.

[bibliofile]

Let's face it, your job would be easier if it had no people in it at all.

Ah well.

[lydy]

inorite? I do sometimes say this in the middle of the night. My co-workers don't really know what to make of me.

[ritaxis]

You do things differently, apparently, from the way they're done here. There was a tv in the room but I didn't understand why. My doctor had told me to bring a book if I usually read in bed, phone, whatever is normal, and to "do my usual routine." But the tech said just to turn out the light and go straight to sleep. Also, they kicked me out before six, which meant I had to go back to sleep when I got home. When I have to do it again, I won't bother bringing anything, because I'll know.

[lydy]

Couple of things. First, depending on work flow, you might be sitting in the room for some time either before or after you were hooked up, but before the study started. A lot of people can't abide a quiet, empty room. Hence, the television. For people who are very stressed about getting wires applied, the television can be a very useful distraction.

Labs and techs vary, but a lot of people need the television to fall asleep. I, personally, discourage this, but will allow it with a sleep timer, if it seems necessary. One of the things doctors want to measure is "sleep latency," which is how long it takes you to fall asleep. Actively reading, watching television, playing on your phone, etc., confound that measurement. So, whenever possible, I like a clean start to the study: lights out, eyes closed, electronics off. But I will negotiate with you if you feel you really need something in order to fall asleep. You might be surprised at the number of people who tell me they cannot fall asleep without the television on who, when asked to do so, fall asleep almost instantly without it. That, by itself, can be a clue that at least some of the patient's sleepiness is do to bad habits rather than an intrinsic disorder.

Assuming that your tech knew what they were doing, they may well have had all the data the needed by six. The point isn't for you to get a good night's sleep, the point is to get enough data to make a diagnosis. Technically, the only thing required for a "complete" sleep study is six hours of recording, regardless of the amount that you actually slept. It's also really desirable to get at least two sleep cycles, where possible. Again, I try not to kick people out too early, hence the questions about when people normally get up and when they absolutely have to get up, but by six in the morning, I am very likely to know everything I need to know about your sleep. Which is not the same as you having had a good night's sleep. As a rule of thumb, we're not looking for your "normal" sleep, but rather representative sleep. In addition to two sleep cycles, the tech would really like to see both sleep on your side and sleep on your back in case you have positional sleep apnea.

I think that sleep studies are more accurate if the tech tries to match, as close as possible, normal bed and rise times, but that may not be possible, depending on the way the lab works. For instance, I don't have day staff some days of the week, so I absolutely have to have patients up and out of the lab by my quitting time. If I have day staff coming in, I can potentially let them sleep in. But even there, I would only do that if I thought there was some useful diagnostic reason. If it is just because you don't want to get out of bed... I actually hate waking people up, but as you point out, you can always go home and get some more sleep.

sleep is interesting

[bibliofile]

re: having all the data needed

I've had one sleep study done, maybe ten years ago. The only thing I wish that had been clearer beforehand what would trigger their waking me up. Then again, I like to know stuff, lots of stuff.

8) Doctors should not only listen to their patients, they should ask leading questions to elicit more, not less, info from the patient. And it should be more like a conversation. If more doctors worked in customers service than in dictatorships, the world would be a healthier place.

Re: sleep is interesting

[lydy]

On the first point: a sleep study is a series of moving targets. There isn't any one, specific thing that triggers getting you up, usually. I have a cascading list of goals as the night progresses. Also, this stuff isn't set out in lab protocols, so you kind of have to learn from experience. What do you get yelled at about? What do older, experienced techs think? What kind of questions do you get asked in the morning the you could have answered if you'd done something different. And that sucks for the tech, and it also sucks for you since your tech may or may not have a clear set of goals, and may or may not be able to clearly articulate them. I find it very difficult to describe my moving goal posts to someone who has no grounding in sleep. To explain "at least two sleep cycles" just by itself can be challenging, depending on what the patient already knows.

The other really tricky part of my job is providing the correct amount of information. Some people want to know a lot, some people don't want to know anything, and not overwhelming the latter can be important to their comfort. Sometimes people know what they want and will tell you. Sometimes, they won't.

I completely agree with you about doctors, but part of the doctor's problem is that insurance companies dramatically limit the amount of time they can spend with patients. And the problem with listening to patients is that they are often full of irrelevant detail and useless theories. If what you've got are fifteen minutes, you need to drill down quickly, which means cutting off their weird-assed theories at the knees. But this eliminates huge amounts of useful information that you could get, if only you had time. And, unfortunately, a tech is not a good substitution for a doctor. I have more time, but do not have the training to notice when the long, painful story about how the patient can't sleep because of a particular trauma has a telling detail. I can listen to the story, but won't be able to see the telling detail.

[haertstitch]

think an chart
with boxes and hours
might be handy?
here is the night in increments
when do you feel tired "t" can be before or after "w
please x where you usually go to bed
and z fir when you actually sleep?
draw aline to when you usually wake "w"
put and A for when you have an alarm set
L for where you would sleep if you forget
to set the "A" ?
A "p" might be useful I woke at 4:44 ;)

(h for heat) time you typically wake up sweating
and shoot all the heat out of the window .
dad's sleep apnea is back.

if they have to fill it out they'd see what you are asking some folks just can't hear right.
it makes sleep more visual
and communicates to a different part of the brain-

mark the things you do to get ready for sleep
1- *
_ shower
_snack
_read__?__hours
_change clothes or make them disappear
_turn down the heat
_put out critters
_chase them out of bedroom
_ turn of or on lights/tv
_check weather

me put dogs out
feed cats snacks
check weather-que up pirates movie(i hear thunder
computer & Lights off..
chase farter out of bedroom-
i have less problems with breathing with the 4 legged allergie out of the room.
put head scarf over neck back
turn over 5-6 times...

things to avoid before bed
news, facebook, talking about family

your requests are valid
people do have trust and control issues
working with those things can be hard.

I'd trust you to be there when I sleep
I'll try not to snore you awake

hugs

[lydy]

Some doctors do have patients fill out a sleep diary for two weeks. Oddly, this doesn't seem to have any correlation with people's ability/willingness to answer simple questions like "when do you normally go to bed?" Don't ask me. I just work here. I suspect that either they are ashamed of the answer, or they don't like to think of their life as predictable.

don't kow why answering questions is a problem

[haertstitch]

do they answer guys easier.
really hate gender bias
but I trust women more than men
I think you'd have a little less problem.

My dad can't tell the difference between waking And sleeping. It's his brain damage. The diet is mostly sugar and he cannot see the correlation. of tiredness and sugar


he falls asleep at the drop of a hat
but has bought several boxes of melatonin
i wonder how many he takes
and it one can OD from it?
tempting to suggest he try mom's pain meds.

Re: don't kow why answering questions is a problem

[lydy]

In general, old white men are more argumentative and less informative, but I get all kinds. One of my favorites was a guy who said, "Ive been sleeping for 75 years. Are you telling me I don't know how to sleep?"

Re: don't kow why answering questions is a problem

[haertstitch]

think its more telling the old A-***
its getting you to 'wake up' that's the problem.

[thewayne]

#5. My wife definitely doesn't. She works irregularly an hour or two before sundown to an hour or so after sunrise, two days typically, every other week. Then she sleeps for 4-5 hours, is up for several hours, crashes again for 4-5 hours. Pretty much her norm. I don't think it's healthy, but apparently it was not an unusual schedule before electricity entered our lives. Me, I sleep a pretty solid 7.5 hours straight.

My sleep study went pretty well, except for a baby deer committing suicide on my two week old car less than a mile from home. That was a little traumatic. My wife, that's a different story. Her first is Russet Jennifer. After the first study, the neurologist filed a report that consistently used male pronouns referring to her. She was not amused. The paperwork clearly had her labeled as female and me as husband, and this was long before marriage equality was passed at the Supreme Court or in New Mexico. For the second study, the technician and my wife whenever they filled in my wife's name put in ", a female person". The second neurologist report continued using male pronouns. So her opinion is that if he couldn't be bothered to get her gender correct, how is she to trust that anything else in the report is correct.

[lydy]

That is a weird-assed schedule, but it is actually a schedule. There's some interesting stuff suggesting that we dramatically changed the way we sleep once electricity was introduced, with people typically (in the Northern Hemisphere) sleeping in two sections, with some awake and activity in the middle of the night. (Activity often but not always sex and prayer.) The article I read said the the drive to consolidate into one 8 hour sleep was driven by the needs of factories. Interesting if true.

I am sorry about the deer.

I always fret about detail errors. However, brains aren't very gender-specific, so getting that detail wrong doesn't suggest as much as it might. I really, really, really hate the move to auto-transcription, because errors like that are not caught, and there is no one checking for inconsistencies If a report mentions a previous study done in 06, and a study done in 96, I can't always tell if we are talking about one or two previous studies. A human transcriptionist would have queried. Without it, the error just enters into your medical record, and stays there. All the said, I'm not sure I support her conclusion. Getting the gender wrong could be a sign that they are terrible at their job, but it could just be a sign that this particular detail was unimportant and the transcription was not proofed.