Chapter 2

All by Myself

The first night alone, I was determined to make sure everything went according to my plan. Most of the night I was standing in front of the machines changing sensitivity on the breathing and effort channels. Every time a patient rolled over, they would need adjusting and I found myself working frantically with the pens. Pens were getting clogged left and right. I was working quickly going from one pen to the next pulling the ink through the pens to get them back working. Some were stubborn and would take many tries. Some would continue not to write and were replaced. Perhaps it was the fact that this was my first night alone, but things just weren't working according to my plan. It was a warm night and I had been wiping a little sweat off my forehead from time to time.

In the middle of all this, the phone rang, it was the chief technologist in charge of the lab. Her name was Sheila, a real nice person to work for and I hoped to see more of her. "How are things going," she asked.
"Oh, no problem, they are all asleep and everything seems to be going smoothly," I said, thankful she couldn't see me sweating. I noticed my fingers were all covered with ink and I looked in the mirror and saw ink all over my face.
"You know, I think the lab could use some new polygraph pens, they seem to clog up constantly and some are not responding to the plunger," I said. I really didn't want to tell her about my inky condition.
"Sure thing, I will order new pens for all the machines," she responded.
"Well, I need to get back to the pens but I will let you know how the night turns out when I call tomorrow," I replied. We ended the conversation and I spent the rest of the night working with the pens while trying, as often as possible to wash the ink off my face.

Some nights seemed long some seemed short. My hookup routine got better and better. Three months later I was able to do a complete hookup in less than 30 minutes. This gave me time to talk to the patients without being consumed with what I was doing. I found that some patients needed to talk to keep awake during the hookup, especially the sleep apnea patients. These were also the patients which seemed to need to use the rest room several times during the night making it difficult to keep the sensors in their proper place. Going in and out of their rooms gave me the opportunity to smell that smell which became a tool that I would use in accessing the severity of their disorder which I will explain and go into later. The narcoleptics, which I thought would be the sleepiest, in actuality had fewer problems staying awake and loved to talk. I have to admit I heard some strange stories in the beginning, but didn't pay much attention since I was still busy trying to get my technique perfected. The one thing that seemed consistent was that most of them saw visions early in the morning. They would wake up seeing a person or people around the bed. In the beginning I didn't think much about the stories but later they would become one of the best parts of the long night and would take me into an adventure, the heart of the story, which will never be forgotten.

I found out the hard way, that you don't tell a joke to a narcoleptic while hooking them up after having to catch a couple of them before they hit the floor. This was due to cataplexy, loss of the ability to use muscles, which can happen when they experience some emotion like laughter. That along with daytime sleepiness was the most important symptom of the disorder. The insomniacs were also interesting. Some stating they hadn't slept in years, would usually sleep very well during their stay in the lab. However, to my surprise, many would state "you see what I mean, I never sleep." They would say this even after 7 to 8 hours of sleep according to their brain wave activity. I found out that this was called Sleep State Misperception one of many types of insomnia..

The best part of my job was after lights out and the patients were asleep, I could do just about anything I wanted as long as the recordings were of good quality. Listening to music was out of the question as it might disturb patients in adjourning rooms. I decided to spend most of my time reading, trying to understand more and more about sleep disorders as I found myself emerged and fascinated by this new field of medicine I had found, something I had never given much thought to before.

One night as I was reading a new nurse came in. I had not seen her before. They usually come by a few times a night as the make their rounds but this was a new face to me. The thought crossed my mind that perhaps she works days and just switched to nights.

"How are things going?" she asked, as her face lit up into a smile. She had a look of curiosity in her eyes. As she looked at the equipment I could tell she was not familiar with what goes on in a sleep lab.

"Normal night," I replied. "I haven't seen you here before you must be new, right?"
"Oh yeah, I just passed my registry exam last month and this is my first job as a RN," she said. "So this must the sleep lab, what exactly do you do here?"

"Come with me and I'll show you around, I said. "Tonight we have three patients. This is Mr. Ed," I pointed to the polygraph machine on the far right. "He has periodic leg movements, the other two patients are sleep apnea patients. Did you learned anything at all about sleep in your nursing program?"

"Not really," she replied. "I remember something about REM being when you dream but that's about it". As she finished her sentence her eyes wondered over to the polygraph machine which can look very intimidating and awe inspiring..

"First I'll explain this machine to you," I said, "channel 6 shows the EKG, 7 leg movements, where you can see our friend Ed has been keeping quite busy tonight, 8 shows airflow through the nostrils and 9 shows it through the mouth, 10 and 11 show breathing effort taken from the chest and abdomen and channel 12 shows blood oxygen levels. Now our other 2 patients have been keeping the airflow monitors busy by going flat every 2 minutes and staying that way for about 90 seconds while the effort to breathe continues. That means there is something obstructing their airways which causes their oxygen levels to drop. I've seen it drop to 15% of normal on some patients. They wake up momentarily to breathe but do not remember the next morning."

"What are the first channel for?" she asked.

These first two are for keeping track of the different stages of sleep and are referred to as EEG," I replied. "They tell us exactly what stage each patient is in. Stage 1 is when you first fall asleep. Your brain waves, which is what the channels are tracking , begin to get taller and wider. Stage 2 is just a bit deeper, and 3 and 4 are called slow wave sleep which is the best sleep you can get. Poor Mr. Ed, every time he jerks his leg it disturbs the stage of sleep he's in, resulting in him feeling sleepy the next day because he never gets fully rested. The other type of sleep that you remember is REM sleep and you're right, it is the stage when you dream. It's very different from stages 1-4. You become paralyzed, kind of a built in security system, which keeps you from acting out your dreams. On these channels you can tell when they've reached REM by looking at the eyes as they start moving back and forth rapidly in opposite directions and this channel shows muscle tone which will be at the lowest level during REM sleep."

"Are you going to be working Wednesday night?" I asked.

"Yes, I'll be here," she replied. "I'm off on Thursdays and Fridays why do you ask?"

"Wednesdays are my favorite!" I responded. "We have narcoleptic patients that night. They have great stories and they sleep all night without asking for anything. Most of them say they could sleep 18 hours a day easy if you let them. At first I didn't take their stories seriously but I think I'm beginning to believe some of them."

"I'm sorry", she interrupted, looking at her watch, she seemed startled as she saw the time. "Oh no, I was supposed to be back at my station 10 minutes ago and it is my first night on the job. I've enjoyed talking to you, I'll come back to learn more, Bye."

She spun around and started her way back down the hallway when it dawned on me I never got her name.
"Hey what's your name?" I yelled after her in a partial whisper.
"Angel, what's yours," she replied, looking back over her shoulder.
"Just call me Sandman," I responded.

The remainder of the night I went back to reading and watching the recordings. I sat back listening to the pens on the polygraph, I'd learned to read the sounds they made and could tell if someone's moving around or needed attention without having to look up from my book. Slow wave sleep had the most pleasant sound while REM had a combination of silence and a few fast scratches from time to time. The sounds and smell of sleep were going to play a very important part in my role as the Sandman as you will soon find out.

Go to Chapter 1, Chapter 2, Chapter 3, Chapter 4, Chapter 5

Copyright ©1999-2004 Sleepnet.com, All rights reserved