Introduction
Jump to Chapter 1
The
story is a mixture of events in the physical world and what may be described
as the dream world. Which is reality? A wise Shaman once said "man
is the dream of the dolphin". Whether it contains fiction is your
decision, but for the Sandman it is real and seems like yesterday. Written
20 years ago in Sri Lanka while traveling, few eyes have laid upon it.
You
will be the first to hear, not only the entire story, but it's relationship
to what is going on today. Sandman is dreaming about how to begin zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.
In
the beginning there was sand, silicon, then the silicon valley, where
Sandman finds himself today. The story doesn't begin here. Born in Long
Beach California and living back and forth between Los Angeles and a small
town in Georgia, Sandman remembers the feeling of going back and forth
from one foreign country to another. Finally graduating from the University
of Georgia in 1978 with a degree in Psychology, Sandman set out for the
new frontier. Back to his roots, The Sunshine State, this time to the
bay area, near Stanford. His mission was to find work as a psychologist
assistant in a respected hospital.
After
arriving he found out that to be a psych aid in California you had to
attend a 6 month school no matter what your education. Bottom line he
ended up applying for work in an L clinic. The L clinics were where they
were putting all the hopeless cases. Sandman thought at the time he knew
how to help these lost souls and turn there nightmare into a positive
spiritual experience, typical post graduate euphoria, Sandman has always
been a dreamer. This L clinic was a converted Motel. Lots of patients
were walking around wanting to touch and wanting help. Sandman got to
smell the padded room and see the real world of mental illness. Sandman
decided he could start there until he was told the pay was $2.75 an hour.
Even in late 1978 the bay area was not a cheap place to live. So Sandman
had to pass.
Asking
around Sandman met someone who was going to interview for a job at the
Sandfort Sleep Disorders Clinic. They were hiring several people to watch
people sleep. Wow now that sounded interesting. Visions of spotless clean
rooms with stainless steel beds in the middle of the room, one way mirrors
and wires hanging from the ceiling, cameras everywhere and control panels
like you would find in a submarine. This was Sandfort. Well, visions aren't
always accurate especially this one. Most people after examining this
facility would call it a dungeon. Sandman was still interested in the
idea of learning something new, and coming from an electronics background
in the navy (another story) he didn't feel too uncomfortable about working
with all the technical equipment. Although the place seemed prehistoric,
remember this is 1979 and a lot has changed since then, the data needed
to diagnose patients was gathered with minor difficulties. Many people
had been helped through the first clinical sleep lab in the world. At
this time the lab was located on the 3rd floor of the old original Stanford
Hospital. It was located in the middle of a wing which was used by Sandfort
University for terminally ill patients.
After
a brief training period of about 2 weeks Sandman was left alone all night
with my patients, usually three of them. In the beginning it was very
difficult to hookup and put three patients to bed by 11:00 PM, record
all night and unhook the patients in the morning by himself. But after
a few months it became routine except for the patients themselves. Many
had fascinating stories to tell the Sandman which they would never share
with a physician. The fear of being put away and never being heard of
again was to great. Sandman didn't know why, but they would usually tell
him the Ripley's Believe it or Not Stories with little hesitation. After
a few months he was able to relax and started to enjoy the all-night non-sleep
evening at the sleep lab. Sandman began sensing something in the stories
he was hearing that will play a key role in this book. The best stories
were coming from the narcoleptics and as this book unfolds you will understand
why. So this is where the adventure begins (training in the sleep lab),
hope you enjoy it.
Sandman
Adventures
of a Sleep Technologist
Names and places have been changed.
Copyright
©1999-2004 Sleepnet.com, All rights reserved
Chapter
1
1979
- Up All Night
Week 1
It was
a dark, chilly, and very long night. You could hear the sound of pens
sliding up and down across green paper moving through huge recording devices.
Sort of a swishing sound that would sound so soothing at times but invariably
there would come a clattering of many pens hitting each other moving at
a fast rate. Someone had rolled over.
As I
sat there taking notes, the sleep technologist who was training me continued
to click buttons and turn dials. This was my first night of training and
would turn out to be the first step in many towards a career change that
has lasted to this day.
The
recording devices were called polygraphs and were made by GRASS Instruments.
They stood about 7 feet tall, had 12 separate amplifiers that would monitor
brain wave activity, eye movements, the heart, breathing, leg movements
and oxygen levels. Each amplifier had about 15 knobs, switches and dials
along with red and green lights. They were stacked on top of each other
and sat on top of the base that held the paper. The boxes of paper contained
1000 pages which were creased and folded. At 10 mm per second the paper
would be pulled up on to another level where the pens were moving across
the paper, the paper would flow into a basket and fold itself back up.
It looked like a monster of a machine that might be used in a Frankenstein
movie, but if you understood one amplifier you would know them all. Having
a background in electronics from a tour in the Navy, I was able to understand
what these machines were actually doing, as well as most of the terminology.
I noticed
a box on the wall with 4 lights and eventually one came on. Jamie went
over to the box pressed a button and asked, "How are you doing" and the
box spoke back, "I need to use the toilet." Jamie put the pins on the
polygraph in a neutral position then put a surgical mask on her face and
disappeared. I wondered why she used the mask but didn't want to ask to
many potentially stupid questions yet. I wanted to appear as if I knew
most of what she was doing because I really wanted the job. She returned
in about 5 minutes.
"One
thing you have to keep an eye on is the lights on the box that correspond
to the room numbers," said Jamie. "They make no sound when they come on
so you need to watch them. You have to disconnect the patient from the
connection in the wall in order for them to get up and plug them back
in after they use the rest room."
This
was a Tuesday night and Tuesday nights were apnea patients. I had just
learned that people with Apnea would stop breathing during sleep. It was
called obstructive sleep apnea caused by the collapse of the airway. We
had an extra piece of equipment hooked up to the patients called a Hewlett
Packard ear oximeter that would monitor oxygen levels in the blood during
sleep. This was a big device that used a large earpiece that needed a
head strap to hold it in place.
Every
now and then one of the pens would clog and stop writing. Jamie would
get out a big syringe that had a blunt needle and some elastic tubing
on the end. She would slide the tubing up onto the end of the pen and
pull the plunger on the syringe back until ink started flowing again.
The process could get a little messy, the black ink would get on her hands
easily and end up on the lab coat. I tried to restart a couple of pens
and ended up with ink all over my fingers, went into the rest room to
wash it off and found out this was no ordinary ink, it didn't wash off.
So, this was the reason I saw black ink all over the lab coats, it could
take a couple days of washing before it would come off your hands and
by then there was more.
The
night continued to linger on, by 3am it seemed the clock was moving in
slow motion. It had been years since I had been up all night and the last
thing I wanted to happen on my first night, was to fall asleep in front
of Jamie. Jamie was leaving the clinic to be the chief tech in a new clinic
in Chicago. She had been working at Sandfort University for more than
4 years and was ready for a change. She was also 6 months pregnant and
wanted to get away from working nights.
I didn't
drink coffee at the time but I decided I would need a few cups to get
through this night. The coffee was at the nursing station located at the
end of the wing. I noticed everyone else sitting around drinking the black
stuff. The lab was located in the middle of a ward that was full of long
term hospital inpatients. There were usually 5 nurses there for the night
shift.
The
coffee helped and before I knew it there was a shimmer of light starting
to show outside the window. I thought I would be happy to see that light
but for some reason I wasn't. Still a few hours to go and even though
the coffee helped it made me feel a little queasy. I looked at Jamie and
could see she showed no symptoms of having a problem she even seemed chipper.
Didn't even need coffee to make it through the night and at that moment,
I knew I could handle it. I would become one of the *All Nighters*, the
Sandman.
Morning
finally arrived, the sky was blue & the cold chill turned into a warm
& sunny day. Best of all, it was time to unhook the patients and leave.
I hit the bed at 10am but woke up at 2pm even though I still felt tired.
This
was my first week of training so my job was to watch and ask questions.
The second week I would be hooking up, flipping switches, and unhooking.
I wasn't looking forward to it, Jamie would be watching and there was
so much to learn.
These
were the days when Sandfort University was considered the number one clinical
sleep lab in the world. I thought it was a little crude but it was the
first clinical lab in the world and the doctors were the leaders in the
field. On Monday nights all the patients were there for insomnia, on Tuesday
apnea, and on Wednesday it was narcolepsy followed by Multiple Sleep Latency
Test (MSLT) the next day. Most patients were not from the local area they
came from all over the USA and the world. These patients were usually
suffering from the most severe cases of their disorder. I didn't realize
it at the time, but it would make for some interesting findings and amazing
conversations with some of the patients, especially the narcoleptics.
There
were usually 3 patients per night. My job was to come in at 7pm, hookup
the patients, record all night and unhook in the morning leaving if lucky,
around 9am.
The
first week went by quickly, watching, asking questions and taking notes.
Jamie continued using her surgical mask and I decided to ask her why.
"I wear it to handle the smell" she answered.
"What smell are you talking about," I asked.
"Just be ready to wear a mask when you enter a sleep apnea room, they
have a smell that I can't describe or handle," she responded.
What do you think is causing the smell? I asked.
"I'm not sure," she said, "might be due to the sweating."
My curiosity was immediate, I had to find out what "The Smell" was and
what could be the cause.
Week 2
My turn
to start doing hookups. First, electrodes had to be applied to the scalp,
ears, chin, and each side of the eyes. Next came the EKG (heart beat),
the strain gauges that measure breathing effort by picking up movement,
and then the leg electrodes. The last sensor applied would be the thermistors
that picked up air movement through the nose and mouth by measuring the
change in temperature as the patient inhaled and then exhaled. If the
patients were being studied for sleep apnea, we would also apply the ear
oximeter after the patient got into bed.
In the
beginning, I would fumble around a lot trying to coordinate both hands
and a foot controlling an air pump. The most difficult part was applying
the electrodes to the scalp. First you had to prepare the site where you
were putting the electrode, next you had to take your left hand with a
small device, hold the electrode still while you took your right hand
with an eye dropper to drop collodion on some gauze laying over the electrode,
followed by pressing a foot switch for the air compressor to dry the collodion.
The first few hookups were a little messy but they worked. There was no
air-conditioning in the old hospital where the sleep lab was located and
some nights I would sweat as I rushed to get each patient ready. Each
night I learned new techniques that made the process easier. I knew I
would have to do 3 and sometimes 4 hookups a night so every short cut
that I could think of became part of my technique. It wasn't long before
I was able to do a complete hookup in less than an hour.
Tuesday
night came around, sleep apnea night at the sleep lab and my last night
of training. Everything was going well, I was getting use to being up
all night even though I was still having trouble sleeping during the day.
This night I had to do everything while Jamie just watched. Around 2am
one of the lights came on for a patients room. They needed to use the
rest room & my curiosity antenna immediately went up. Jamie started to
hand me a mask but I said, "no thanks, I want to find out what the
smell is like." When I entered the room, I thought I might have to hold
my breath but realized the odor Jamie spoke about, only became apparent
as I moved closer to the patient. It was sort of a sour smell with a smoky
like aroma. Not real pleasant, but I wouldn't need a mask. The patient
was sweating heavily and I unplugged him so he could use the toilet. The
window was open, but the room was still a little warm so when he returned,
I turned on the fan, plugged him back into the connection in the wall,
and left the room.
It turned
out that just about all the sleep apnea patients that were coming to the
lab had a very severe case of the disorder. They would stop breathing
for up to 3 minutes at times and were desaturating in oxygen to about
20% of a normal level. In addition, all of them had heavy sweats, which
I felt was directly related to the smell. But, I was still curious as
to why the smell was almost identical from patient to patient.
Well,
needless to say I survived my two weeks of training and even though I
wasn't feeling totally comfortable handling everything by myself, I was
looking forward to being on my own without someone looking over my shoulder.
By then, I realized that I had found something to challenge me, never
dreaming that ultimately, it would lead me into the deep world of sleep
disorders where my journey may never end.
Go to Chapter 1, Chapter 2, Chapter 3, Chapter
4, Chapter 5
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©1999-2004 Sleepnet.com, All rights reserved
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