Abstract
Sleep is an active process; the body undergoes restoration and regeneration. Adequate sleep is essential to health and cognitive function. Sleep is critical for cell repair, a healthy immune system, and hormonal regulation, and aids in the process of learning, memory, and emotion. Inadequate sleep can lead to multiple chronic health and mental conditions over time. The occupational health nurse can be instrumental in screening for two of the most common sleep disorders, insomnia and obstructive sleep apnea, by asking workers key questions and using simple screening tools.
Keywords
A 36-year-old male Environmental Health and Safety officer requested a consult from the onsite Health Services nurse practitioner for complaints of fatigue, difficulty falling asleep and staying asleep, and unrefreshed sleep. The employee stated these symptoms had been present for months; however, symptoms had worsened over the past several weeks. In addition, he reported weight gain, irritability, inability to concentrate, and teeth grinding during sleep. The employee noted his snoring had become very loud over time according to his wife and that she has witnessed numerous episodes when he stopped breathing in his sleep.
The worker’s neck size was 17.5 inches, body mass index (BMI) was 37, and Mallampati score of 4. In addition, the Epworth Sleepiness Scale (ESS; score 16) and the Stop-Bang questionnaire (score 6) revealed this employee was at high risk for obstructive sleep apnea (OSA) and excessive daytime sleepiness.
The Mallampati Score (1-4), a simple noninvasive diagnostic test, is used to identify narrowed or “crowded” airways during physical examinations. Workers are instructed to open their mouths wide and not to make any sounds or strain to open the posterior throat as the clinician shines a bright light into the oropharynx. The faucial pillars, soft palate, and uvula should be visible. When the tongue completely obstructs clear viewing of those structures, the worker is given a score of 4, indicating a greater risk for OSA (Manabe, Iwamoto, Miyawaki, Seo, & Sugiyama, 2014).
The ESS was developed by Dr. Murray Johns in 1990 to assess daytime sleepiness. This brief self-administered eight question survey measures workers’ general levels of daytime sleepiness. The score can range from 0 to 24; the higher the score, the greater the level of sleepiness. A score greater than 10 is considered excessively sleepy (Berry, 2003).
The Stop-Bang questionnaire includes six screening questions and can be self-administered; a score greater than 3 identifies high risk of sleep apnea (Chung et al., 2012).
After the results were discussed with the employee, he recalled that he underwent a sleep study approximately 3 to 4 years ago and was diagnosed with OSA; however, he did not follow through with the prescribed treatment, Continuous Positive Airway Pressure (CPAP) therapy.
The National Heart, Lung, and Blood Institute reported that 50 million to 70 million Americans live with sleep disorders; 33% of U.S. adults are sleepy during the day; 5,000 to 6,000 fatal car accidents are caused by sleepy drivers; and 12 million to 18 million Americans have been diagnosed with sleep apnea (Smith, 2016). A research study published in a 2012 issue of Morbidity and Mortality Weekly report found that 30% (approximately 40.6 million) of workers get fewer than 6 hours of sleep each night.
Sleep is an active process; the body experiences restoration and regeneration. Adequate sleep is essential to health and cognitive function. Sleep is critical for cell repair, a healthy immune system, and hormonal regulation, and aids in the process of learning, memory, and emotion (Conley, 2016).
Inadequate sleep (less than 7 hours per night) can result in a host of chronic health conditions. Heart disease (hypertension, atrial fibrillation), stroke, diabetes, obesity, compromised immune system, cancer, mood changes (depression and anxiety), and erectile dysfunction have been linked to sleep deficiency (Conley, 2016).
Sleep disorders can negatively impact quality of life and increase work-related injuries (Mastin, n.d.). Three Mile Island, Exxon Valdez, and Chernobyl are three examples of transportation and industrial accidents linked to fatigue-related errors that occurred during worktime (Mastin, n.d.). Occupational health nurses should be aware of screening tools for sleep disorders that can be completed in a few minutes in a busy clinic.
This worker was referred to a local Sleep Clinic, and a sleep study confirmed OSA. The employee is currently using CPAP at night, with immediate improvement in symptoms. He is also actively pursuing weight loss goals. In addition, this worker plans to consult with a Sleep Medicine psychologist for cognitive behavioral therapy to treat insomnia.
Occupational health nurses can assist employees improve their sleep by suggesting the following:
Establish a bedtime ritual (e.g., going to bed at the same time every night) allowing for at least 7 to 9 hours of sleep
Use the bed for sleep and sex only; avoid reading, watching television, or using electronic devices in bed as these activities stimulate brainwaves that keep the brain awake.
Keep the bedroom dark and cool. Avoid “watching the clock” and turn cell phones over or off during sleep (Conley, 2016).
Footnotes
The author(s) declared no potential conflicts of interest and received no financial support with respect to the research, authorship, and/or publication of this article.