World Sleep Day, which is on 14 March this year, shines a light on the vital role of sleep, a function of the body that is intrinsically linked to our health.
As someone who often struggles for a good night’s sleep, spending a morning with Royal Brompton’s multidisciplinary team, who care for patients with sleep disorders, was awakening.
I thought I knew what poor sleep was, until I met the patient who sleeps separately from their partner for fear of inflicting injury while ‘acting out’ their dreams. Or the patient whose airways are so restricted during sleep that their oxygen levels dip dangerously low.
Trailing the decisive footsteps of Dr Alanna Hare, consultant physician for the department of sleep and ventilation, we meet patients who have spent the night in hospital being monitored as they sleep… or try to sleep. Dr Hare tells me that many patients with sleep issues can be monitored at home with wearable devices that feed data directly back to clinicians. But some patients’ issues are too complex, or need further investigation. Like the first patient we see, who has difficulty falling asleep, and when he does, he experiences parasomnia, which, in the past, has led him to injure himself.
Overnight he has undergone a video polysomnogram. It’s a sleep study that measures everything from brain waves and heart rate to eye movements and body position. Sensors are positioned on the body and a camera records sounds and movement. Dr Hare advises he will get the results in about 10 weeks’ time. It takes that long because the recording is meticulously analysed by a team of physiologists in 30-second segments. Meanwhile, after some probing questions about his sleep, health and habits, Dr Hare suggests the patient has REM (rapid eye movement) behaviour disorder, which will be confirmed by the polysomnogram results. She explains that when we’re in REM sleep, our brain activity is similar to being awake. We can experience vivid dreams but our body’s muscles are paralysed. For this patient, something is failing to keep his body still while sleeping.
While he waits for his results, Dr Hare gives some pointers on ‘sleep hygiene’ to help ease his symptoms. My ears prick up – could there be hints to help me too? It includes getting up at the same time each morning to anchor the body’s circadian rhythm; setting habits when preparing for sleep to ‘teach’ the body it’s time to sleep, such as avoiding screens and having some winding down time; and going to bed when sleepy rather than trying to force sleep to happen. And for this patient, to continue sleeping separately from his partner to ensure both of their safety.
Our next patient, who is already under the care of heart and lung doctors for other conditions, has been referred from Harefield Hospital. Dr Hare explains that the patient’s upper airway is narrowing during sleep, most likely exacerbated by smoking and a high BMI, and the overnight sleep study confirms she stops breathing about 50 times an hour. She is diagnosed with severe sleep apnoea. This is when the breathing tube in the neck collapses during sleep, restricting the flow of air and causing oxygen levels to drop repeatedly during the night.
The good news is, with CPAP (continuous positive airway pressure) therapy, the patient can be treated immediately. She will be given a machine to use at home, which will gently pump air into a mask, helping her to breathe more easily while asleep. Dr Hare explains it will also help reduce her risk of heart problems, like strokes and heart attacks, which are linked to sleep apnoea.
After patient rounds, the multidisciplinary team (MDT) convenes to discuss all their current admissions. Alongside sleep clinicians are physiotherapists, dietitians, speech and language therapists and nurses. Sleep is an issue that weaves among multiple patients at Royal Brompton, many of whom have complex respiratory issues.
One patient under their care suffered scarring on her lungs from tuberculosis when she was young, and now has pulmonary hypertension, which causes her life-limiting symptoms. The team discusses her treatment options in intricate detail, ensuring none are missed from the medical notes and everything is considered to improve her quality of life.
Royal Brompton has an international reputation for its pioneering work with patients experiencing sleep disorders and our service is one of the largest in Europe. On the morning I spend with the team, a resident doctor is on rotation in the department. He tells me, of all the hospitals to get experience in lung health and sleep disorders, this is where he’ll learn from some of the best.