Cindy Brant knows when you’ve been sleeping. And she knows when you’re awake.
Brant spends her nights monitoring patients in the sleep lab at Allen County Regional Hospital and at labs in the Kansas City area. She’s worked as a registered sleep tech, or polysomonographic technician, for 15 years. She’s also been a registered respiratory therapist for 34 years.
“I love sleep,” Brant said. “I have the opportunity in one night to have the most positive impact on someone’s life and it kind of gives them their life back. I like being part of that.”
Brant’s job begins after a physician orders a sleep study, usually because a patient complains about fatigue or excessive daytime sleepiness, or even because a spouse complains about a loved one’s snoring or “choking” during sleep.
Sleep apnea, a disorder that causes someone to stop breathing for short periods of time, most often is the culprit. Apneas can occur between five times an hour in mild cases to more than 30 times an hour in severe cases.
Brant typically oversees two patients at a time, one night a week at ACRH. She’s responsible for hooking patients up to a variety of electrodes on the head, face, legs and chest. Bands wrap around the chest to monitor various functions related to breathing and heart activity. The process takes about 45 minutes, but Brant wants to be thorough so she doesn’t have to wake a patient to reconnect something.
Most patients are able to sleep despite the many wires and electrodes. In another room, Brant watches a camera monitor and various other monitors that track body functions. She makes reports throughout the night.
“I see everything as it’s happening in real time. If the patient starts to have a lot of apneas, the heart can get cranky,” she said.
Most apneas are caused when the throat relaxes and the tongue and fatty tissue fall back, blocking airflow. Oxygen levels drop, which causes the brain to jolt the body to a more wakened state to restart breathing. Most people are unaware of the process, but because sleep is frequently disrupted, the body can’t reach the deeper, more restorative phases of sleep.
That’s called Obstructive Sleep Apnea. Less common is Central Sleep Apnea, when the brain fails to signal the muscles responsible for breathing. Brant can tell the difference simply by observing whether a patient’s abdomen rises and falls. The treatment is the same for both.
She also can tell if someone’s sleep apnea is positional or stage-related. Positional means apneas are more likely depending on the body’s position during sleep, like if someone sleeps on his back.
Stage-related apneas happen during REM sleep, a chaotic stage characterized by rapid eye movements and dreaming. REM stages typically occur every 90 minutes or so and get progressively longer as the night goes by. Someone with stage-related apnea might take longer to diagnose.
BRANT LIKES to joke with patients to help them feel relaxed.
“Patients say ‘It’s been so much fun, like a slumber party, but I hope I don’t have to see you again.’”
She wants them to feel comfortable enough to share information and ask questions.
The most common question: “Am I going to be able to go to the bathroom?” (Yes, the technician needs to disconnect just one cable to allow bathroom breaks.)
The second most common question: “Do I have to turn off the TV?” (Yes, but the technician can set a timer to automatically turn off the TV after you fall asleep.)
And also: “Are you going to be watching me all night?” (No, the technician has a lot of other things to watch. But if you call out or if she hears you moving, she’ll check the camera monitor.)
Brant asks a lot of questions, too. Patients must complete a questionnaire about their sleep and other issues. The answers give Brant insight even before the patient gets in bed.
One of the biggest red flags is a patient who complains of frequent urination. If you get up around the same time each night to use the bathroom and if it happens more than twice in a night, it’s likely because of sleep apnea, she said. Urination typically is suppressed during sleep.
“They’re not waking up because they have to go to the bathroom,” Brant said. “They’re waking up because they stopped breathing.”
IF CERTAIN benchmarks are met — basically, if Brant sees enough evidence of sleep apnea early enough in the night — she can start using a Continuous Positive Airway Pressure (CPAP) machine. The machine must be “titrated,” or adjusted to determine an appropriate airflow for the patient. That process takes time. If it can’t be done before the study ends, the patient will need to come back for a second sleep study.
“That’s every tech’s worst nightmare: I’m not going to get him qualified so I can get him on CPAP,” she said. “Nobody wants to come back twice.”
Patients generally aren’t excited about using the CPAP machine, particularly the mask. Masks must fit snugly over the nose and/or lower face. Brant works hard to find the right mask for a patient, something that fits well and is comfortable. Most people think they want a smaller mask, but a larger mask is easier to tolerate, she said.
With the right mask and a little patience, she said, most patients adapt to the machine and appreciate the improved quality of sleep and health.
“My goal, after I get them on CPAP, is to try to get them the best night’s sleep,” Brant said. “I guarantee you, tomorrow is going to be a different day. You’ll feel so much better. That’s the trade-off.”