Medical, dental, and mental health professionals must stay connected and work together to provide the best diagnosis for OSA patients.
by Julia Worrall, The Sleep RN
I have this recurring nightmare where I am standing in a stuffy room full of dentists, psychologists, and physicians, all experts in their fields, milling about chatting enthusiastically.
Gratefully soaking up each of their profound professional secrets, I suddenly realize to my utter shock and horror that each profession seems oblivious to what the other is saying!
It feels as if some kind of mental force field is blocking the very communication that could make all the difference for so many patients urgently needing their help.
Desperate for the groups to wake up and speak with one another, I start to scream…but no sound comes out.
Years ago, when attending my very first sleep conference, I was so excited to learn from Dentists discussing the value of structural and functional airway assessments. They shared science that demonstrated efficacy of successfully treating sleep apnea with Oral Appliances.
Then, when they packed up and left the convention center, Medical Providers moved in and discussed their research demonstrating the value of PAP Therapy, surgical interventions, and medications to treat various sleep disorders.
It was all wonderfully illuminating. Yet my most prominent takeaway was the massive disconnect between the two entities.
I simply could not wrap my head around why these two groups – both passionately dedicated to successfully treating sleep disorders – are not working closely together to share their knowledge with the people who need it!
And I was one of them.
I thought that with all the specialists I had consulted for my sleep and killer migraines, all the tests I had done, all the medications I had tried, that I would have for sure found a successful treatment plan.
After all, as a medical professional I had knowledge, and I had access.
But I never imagined that it would be a DENTIST who held the keys to my freedom from pain and fatigue.
MY MIND WAS TRULY BLOWN, so I set out on a journey of discovery, hungry to learn more.
How could it be that there is this whole world of knowledge out there that we (Medical Model) know nothing about?
I started taking courses and attending conferences in Sleep Medicine. The research, the studies, the data, the experts, the case studies, the assessment skills, the testing, the devices… copious amounts of knowledge were presented that changed my whole mindset.
Everything I had thought I knew about Head-to-toe-Assessments, about Pathophysiology and Treatment, about mind/body and stress response was blown to bits!
And this “aha!” moment changed my life forever.
I was so excited that I naively believed everyone would be yearning for this knowledge.
I went back to work in the Emergency Department, but with the veil lifted, I started to see things in a whole new way.
The man who woke with palpitations and chest pain in the night showing a-fib on the monitor…look at his thick neck, bloated belly, skin colour, ground down teeth, high blood pressure, type 2 diabetes, high cholesterol….
Before, I would have assumed that this gentleman was not careful with his health, making poor choices in his diet, probably sitting around watching TV instead of exercising and not handling stress well.
My considerations all concerning his wakeful hours.
Now, I saw a man who probably tries his best to make good lifestyle choices, but is exhausted from suffocating in his sleep, night after night, and probably has been for years!
He feels shame. He wishes he was healthier, slimmer, more active.
He wishes he didn’t feel so down and is afraid to admit he may be depressed, because he can’t actually explain why he would be depressed.
He has a supportive wife and a loving family. He worked hard at a job he enjoyed and now has the means to travel and enjoy his retirement, except he has no motivation to go anywhere.
He knows his wife is disappointed and had looked forward to travelling but was so embarrassed during the one bus trip they went on because he kept falling asleep and snoring loudly, missing most of the tour so what was the point….
I proudly declared to the ER MD, “This man has sleep apnea!”
That explains all his symptoms.
Sighing in exasperation, the doctor looked at me and said, “He has congestive heart failure. It’s a chronic condition.”
I reply, “Yeah, but sleep apnea can cause congestive heart failure.” He looks at me like I’m an idiot.
He spends the next few hours pouring over lab results, ECGs, x-rays, vital signs, medications and possible interactions.
He will find a way to increase or add meds and then refer this patient to a cardiologist.
The cardiologist will do a stress test, an echo, and add more meds.
I suggest that he refer the patient for a sleep study. He replies that this is an emergency room and that the patient can take that up with his family doctor – except that he won’t.
I advise the patient that he really needs a sleep study and plead with him to ask his family doctor to refer him for a sleep test. “I don’t have a sleep problem. I can fall asleep at the drop of a hat,” he proclaims, “I can sleep anywhere, anytime!”
I try to explain that these are all signs of a sleep breathing disorder, but I can tell he is not hearing me.
I implore him by showing him his vital signs while he was sleeping.
I SHOW him the apneic periods and the drops in his oxygen saturations.
I emphasized again that I had to provide oxygen while he was sleeping, and I even did a few sternal rubs to get him breathing again.
Of course, he doesn’t remember any of this.
He is distractedly looking for his shoes as I speak.
I turn to his wife, “Please, please make sure he gets a sleep test. I am worried about him.”
The wife replies, “All those sleep labs want to do is con us into buying that breathing machine. We’re not falling for that!”
I am flabbergasted.
Three weeks later the wife calls 911 to revive her husband in the middle of the night. They are unsuccessful. I feel sick to my stomach.
Working in the Emergency Department day after day, watching these poor folks inadvertently destroying their lives has become intolerable for me.
I resign. My 20+ year career in Critical Care is over.
My family cannot believe I have walked away from something I was so passionate about.
I LOVE my job. Correction, I LOVED my job.
The reason I loved my job was because I love people. I love helping people.
I am fascinated by the body and its intricacies…how intertwined our experiences, beliefs and choices are in creating health and wellness and conversely illness and disease.
I believe that we can truly help more people by uniting the medical, dental, and mental health communities in addressing what is happening during those elusive eight hours…
As challenging as this path has been, I still believe that we can truly help more people by uniting the medical, dental, and mental health communities in addressing what is happening during those elusive eight hours, or one-third of folks’ lives when THEY ARE UNCONSCIOUS.
THEY are not responsible for what happens during this time. WE ARE. As healthcare providers, we have knowledge readily available to us that the public lacks.
We will look back one day and be horrified that we have treated sleep so lightly. It has been the LAST thing we considered, instead of the FIRST.
As a dedicated Airway Advocate and Expert Sleep Consultant, I look forward to shifting the healthcare paradigm with you, one great night’s sleep at a time!