Sharing this subject matter from a lecture I gave at a Sleep Society Meeting. It has always been my privilege and honor to speak on behalf of my fellow patients to the medical professional community. Thank you for being as interested in what we have to say as we are learning from you.
One Patient’s Perspective: How to Relieve Patient Anxiety in the Sleep Lab
Undergoing a polysomnogram (PSG) is a seemingly easy procedure. There is no pain involved, just an invitation to spend a night in your sleep lab for observation and the collection of data. Yet many patients are anxiety ridden in anticipation of a PSG or soon are after they walk through your door.
COMMON PATIENT ANXIETIES
FEAR OF THE UNKNOWN
Many patients report that they do not know what to expect prior to arrival at a sleep lab. Most handouts simply state what time to arrive, what sleep attire to bring, what they should or should not consume on the day of the diagnostic procedure.
BEING UNABLE TO SLEEP
Sleep sounds easy enough, yet many patients are concerned that they will be unable to sleep. Even though most can fall asleep at the drop of a hat at home, the thought of having to sleep “on command” seems intimidating. Anyone who has experienced a hospital stay for other medical reasons knows how hard it can be to sleep in that setting. Patients who are already anxiety ridden come with a preconceived notion that they will be unable to sleep, which enhances their anxiety. Others are convinced that they have sleep apnea, feel desperate for the diagnosis and consider the PSG their “one shot” to get help, which heightens their fear being unable to sleep on this one important night.
Questions that may be running through a patient’s mind include: “If I cannot sleep, will I be allowed to have a repeat study? Can I afford to have a repeat study? Will my insurance pay for another study? Will my failure to sleep make the sleep technologist or my doctor mad? Will they lose interest in my care?”
LOSING THEIR PRIVACY
Both men and women express concern about privacy; there is unease at being observed during sleep. Modesty issues can arise when one does not know what to expect: “WillI have to disrobe? Will anyone see me naked?” Many are apprehensive about the availability and privacy of bathroom and shower facilities. Regarding multi-bed sleep labs, patients express concerns such as: “Who will see me in my pajamas? Will I be sharing bathroom facilities with the other patients and hospital staff?”
Whether or not they admit it, most people feel uncomfortable with the thought of being videotaped while they sleep. It’s bad enough knowing that one sleep technologist is going to observe your snoring, drooling, thrashing, night sweating, gasping and other potentially embarrassing behaviors. But to know that this is all being visually recorded is enough to make anyone wonder nervously: “How and why will the videotape be used? Who else is going to see it? Am I being constantly monitored from the time I walk in the door? Is there privacy in the sleeping room when I change my clothing? What happens to those videotapes; are they kept forever? Will mine show up on YouTube?” Many patients are not informed about videotaping until they arrive for the PSG, which can cause anxiety where otherwise there was none. Advance notice is appreciated.
We know that nocturia is prevalent among the OSA population, but most patients don’t realize it. Those who have to make multiple bathroom trips to urinate throughout the night may be embarrassed, and they may be concerned that this activity will result in an invalid sleep study. This anxiety exacerbates both their fear of being unable to sleep and their concern about bathroom privacy. They may be thinking: “I’m worried about how many times I will have to use the bathroom that night. Will I have to walk down a hall to get to the bathroom? Will the sleep technologist have to accompany me each time? Will other patients see me? Will this be considered disruptive?”
GETTING TO WORK
Most PSGs are performed during the middle of the week, and many patients must return to work the following morning. This might lead to a multitude of anxieties: “I’m already worried about being able to sleep; will I be too tired to go to work? Will I have enough time to rush home, eat breakfast, shower, change clothes and get to work on time? Will the sleep lab provide facilities and breakfast so I can get to work on time? How private and clean are the bathroom facilities at the sleep lab; will I even want to shower there?”
HOW TO RELIVE PATIENT ANXIETY IN THE SLEEP LAB
Anxiety can be relieved through patient education.
Proper information will lessen the fear of the unknown. The more they know upfront, the better. Teamwork is the best approach in patient education. Your team should consist of the prescribing physician, the sleep lab staff and the patient. The first opportunity to begin the education process is when a PSG is prescribed. In many cases, the physician is the only person the patient has contact with preceding the scheduled procedure, so the process of education should begin there. Because your patients are likely to be sleep deprived, they may have problems concentrating and thinking clearly. They may not have the foresight to ask questions, or they may not even know what to ask. It is best to assume that your patients may be curious or anxious even if they don’t ask you any questions. You should give your patients a detailed handout that provides an overview of the PSG - in plain language - and addresses common patient anxieties. The educational roles of team members should include:
Provide a detailed handout letting patients know what to expect. It should include an overview of the PSG procedure as well as a description of the sleep lab’s amenities. Provide a comforting assurance that the PSG is a relatively simple and painless procedure. Inform patients of your “team approach,” and tell them that as an important member of the team, their job is to come to the sleep lab relaxed and ready to sleep. Encourage questions to assure their level of comfort and to provide them with the best chance of a valid sleep study.
Inform patients that it is common to have concerns about being unable to sleep in a strange environment. Dispel this worry and discuss how rare it is to need a repeat PSG. Physicians who detect an unusual level of anxiety or suspect the presence of an anxiety disorder might require a patient to tour the sleep lab prior to the scheduled PSG. This will increase the patient’s comfort level and eliminate the fear of the unknown.
SLEEP LAB STAFF
Welcome patients in your sleep lab by allowing them the opportunity to tour the facility prior to their scheduled sleep study. If patients are unable to get an advance tour of the sleep lab, then offer one immediately upon their arrival for the sleep study. Encourage questions as you walk with them through the facility. The patient may be too shy or embarrassed to relay sensitive concerns, so make sure to address all the known anxiety issues and resolve them before lights out. Use the “wire up” time to explain what patients can expect during the night and encourage them to ask questions. Reiterate that their role as a team member is to feel welcomed and relaxed, and to sleep.
The “team approach” will make patients feel less vulnerable and more in control. The team symbolizes a group
effort, which lessens any “performance pressure” that they may feel. The facility tour coupled with the opportunity and encouragement to ask questions are invaluable.