When asked what word the thought of sleep brings to mind, Liza answered “wonderful”. For those without sleep issues, sleep is served on a silver ‘bed’. You’re tired, you go to bed. When your life enables you to sleep in your own environment and bed consistently, every night, soundly – “you are blessed. But not sleeping is a torture.”
FOR HER PATIENTS AND CHILDREN
Being a sleep technologist, Liza is an important player in her patients’ journey to understand the cause of their restless nights. As she rubs sleep out of her eyes, she would see her patients struggle throughout the night to rest and feel horrible in the morning! Many patients already struggle to get a diagnosis from doctors and have been waiting months, if not years, to see a sleep technologist for a sleep test. Thus, although sleep-deprived, Liza needs to be at her best to ensure that the sleep recording is as clean as possible, so they can investigate whether their issue is sleep-related.
By working back-to-back overnights in a sterile hospital lab, Liza suffered from a similar sleep-deprived schedule. Reflecting on her time – sticking wires onto her patients’ heads and elastic belts around their chests – she noted that she became her own patient. “You really notice how important [sleep] is when you don’t have it anymore.” When she began experiencing sleep issues, Liza felt a deeper empathy for her patients.
Her work started out great, with her taking care of three patients a night on average for 3 or 4 times a week. A regular shift looked like coming into the hospital at 9 pm, and wrapping up at 7 am. She would get home by 8 am and be asleep by 8:15 am for 7 broken hours of sleep.
She was in her 20s, a night owl and had no kids. So for her, overnights were the ideal shift. She had no problems adjusting to that lifestyle!
But as she became pregnant and had her two children, Liza’s sleep problems intensified. She worked night shifts for her patients and day shifts for her babies! She couldn’t sleep until 11 am. She said, “I was lucky if I got 3 hours of sleep. I was exhausted all the time. I realized that I was going to burn out if this continued. There was a time I couldn’t lose the weight, and I could not do anything. I felt groggy, had headaches, became thirsty, sluggish, and started caffeinating early to work at night, and eventually, I would feel okay.” But this wouldn’t last long, and she would be hit with a wave of exhaustion again at night.
Liza worked like this for 10 years.
You are watching people sleep, and you are tired. I felt tortured, just wanting to do what they are doing.
Thankfully, her spouse was very supportive and took care of the child when he could. “If I didn’t have that support, I don’t think I would have been able to do it.” However, “it is hard to say to your newborn baby, ‘Mommy needs to go to sleep’, your baby will need you regardless.”
BECOMING HER OWN PATIENT: A WAKE-UP CALL
At first, Liza’s lack of continuous sleep wasn’t something she felt anxious about. But when new responsibilities got added, it hit her. She recognized the similarities in her conversations with her patients and realized she had a problem. They would tell her how they haven’t slept for many years, feel tired, depressed, and have gained weight.
During her bouts of sleep deprivation, Liza compensated with coffee, food and smoking. “It is hard when you’re tired all the time and trying to fill that lack of sleep.” Having two children, working nights, not taking care of herself, and not eating properly had a compounding effect on her health.
I was just getting sicker and sicker. I felt it. I went through a bit of a depression as well. I realized that if I don’t get this sorted by the time I’m older, I might be one of these patients.
When you’re in the middle of exhaustion, it’s hard to see clearly what specifically is causing these symptoms, and it’s even harder when you are passionate about your job. “It is amazing to see patients with serious sleep apnea, and you put them on treatment when they say the next day, ‘I dreamt for the first time in 20 years’, that was amazing.”
“I just didn’t necessarily think that my job was contributing to me getting sick until I looked at it in retrospect. I was dreading going to work, which is not the point of working.” It’s not obvious until you’re out of it. So she ultimately transitioned out of her job.
Liza reflected,
When I think of what I went through, ‘Wow, why did I put myself through that?’ I apologize to my past self for doing that – I survived but at a cost.
As someone who works overnights myself in a research sleep lab, I definitely resonated with Liza’s story of sleep schedule dysfunction due to her job. I would brew myself tea to stay up throughout the night, and fight the hunger and cold I felt as my body was adjusting to all those hours awake. Then, I would need to be functional for my 8:30 am lectures and other responsibilities throughout the day. Isn’t it ironic that we need to deprive ourselves of sleep to study these disorders?
SIMPLE PLEASURES OF SLEEP
Now, Liza works as an event manager in the CRO, where she has a day job, and the difference is night and day. She can enjoy hard-earned simple pleasures: “Wow, I get to have a true bedtime. I get to wear my pyjamas, get all cuddled in my bed, read a book, sleep a full night, wake up in the morning and feel good. I wasn’t able to do that for many years.”
She’s become almost militant about her bedtime. “This is sacrosanct because I’ve lost so many years of good sleep that I’ll never get back. Sleep is golden.” This comes from my history of treating myself poorly by not sleeping well. Now, “air conditioning, my bed, my cats, all these little comforts that are very necessary for me to feel normal. It feels like self-care.”
A NEED FOR CHANGE
Through her experience as a sleep technologist in multiple settings, and as a former communicator of sleep information to the public at the Canadian Sleep Society, Liza shared a few ways we could support people having sleep issues.
- Organizational support
- Prepare the staff with coping strategies: “A lot of people can work nights for many years, and power to them.” Liza was able to meet the demands of her job as well, but once she had kids, it was a real struggle. She would warn young overnight workers about this change and what they should expect. She said, “The transparency is not always there, and it is hard to know what to anticipate when you sign up for a physically and mentally demanding job like this.” Organizations could inform their labour force of strategies to cope with sleep loss, which could also have an impact on staff retention.
- Better work schedules: “In an ideal world, it would be nice if we did not work more than 1-2 nights a week [with other day shifts]. No full-time night. Unfortunately, some occupations always have that need, and this may not be possible.” Aligning shift schedules with individual chronotypes, along with ensuring sufficient staffing to allow for brief nap opportunities, could help improve outcomes. Organizations should put safeguards in place for regular check-ins and provide mental-health resources for their overnight employees. Sleep health is a key pillar of overall well-being, and as we can see, it affects a lot more than just your energy.
- Prevent drowsy driving: “My home was a 20-minute drive away, so thank God I did not crash. Had it been a longer commute, I couldn’t have done it. I would have slept at work for 30 minutes before driving.” On average, 20% of all crashes in developed countries have been attributed to drowsy driving. Could institutions step in to address this critical safety concern? Could institutions provide taxi vouchers or shuttle services to the night shift workers to arrive home safely and maintain road safety?
2. Sleep education and access to tests
Liza said, “I have seen patients who tell me that they have been on antidepressants for 10 years and only recently has someone mentioned to them about the sleep study. They come to me, and we know it’s a clear case of sleep apnea. I go, ‘Oh my God. If they had intervened early, probably they would not have to start with an antidepressant.’”
Liza shared that the major contributor to the delay in sleep disorder diagnosis is that the doctors often do not ask the right questions or link patients’ complaints to sleep within the 15-minute patient consultation. “Many doctors are not trained to diagnose sleep conditions and/ or even know how to refer their patients to a sleep clinic. They will look at the heart, the blood, but sleep gets put on the back burner.”
Investment is needed to improve awareness, access, and capacity in sleep care. This includes increasing public knowledge about the availability of sleep testing, increasing access to these services, and growing the workforce of trained sleep specialists and technologists.
However, Liza added, “There should be consistency in sharing the information, and we should ensure that the information reaches the people who need it.” Trusted organizations, such as the Canadian Sleep Society, are well-positioned to lead these efforts, as the public is more likely to engage with and respond to these institutions.
3. Use of wearable technology
Wearable technology can be a helpful tool for people struggling with their sleep, and can be a way for patients to advocate for themselves and to own their sleep health. Liza said, “Wearables can guide us. One can say, ‘Hey, there may be something wrong here with my sleep, maybe I should talk to my doctor about this’.” It may prompt the doctor to at least think about sleep and perform a rigorous evaluation. “I would like to see that in an ideal world.”
Liza’s story shows us that even the experts can struggle with recognizing signs that something is wrong, and their sleep quality is the root of the problem. It shows us the importance of solid, uninterrupted sleep, even for people without underlying conditions. Her experiences highlight the importance of regulation and advocacy for employees needing to work at hours defying the natural body clock.
I wish everybody a nice restorative sleep, however much you need.
– Liza
Interviewed by Madhura Lotlikar
