Is it just me or............?

[eriksoln]

I've been noticing something lately, noticing it going on a lot recently. Maybe its just the pool of pt's coming to my specific hospital or something, IDK.

We all know pt's over react to certain (usually the wrong) things. "OMG, my mashed potatoes are cold" meanwhile their saturating is like 72% and they don't want to hear about putting their oxygen back on until you've heated up those potatoes.

On my unit, the "thing" to over react to seems to be sleep. Now, I understand having an upset sleeping schedule is disturbing beyond belief.........heck, I work nights. But lately, I've had a slew of patients who act like a bad night's sleep is going to land them in the ICU or something. Literally, they are panicked and crying as though a limb was just amputated. They want double and triple dose sleep aids until they are sleeping, regardless of the risks.

I try to tell them "Maybe its not really a medical problem at all, might just be U R not tired". I bite my tongue and thing to myself "Yeah, you lay in bed all day telling the staff to get this and do that..........so why would you be tired? I wasn't aware being waited on was such hard work that it should provide you a good nights sleep."

Last night I literally had a woman go into a full blown panic attack that almost lead to me calling the rapid response team. What stressed her so? Her blood was not done and she wanted to go to sleep........it was going to keep her up and she'd never sleep and then the world tilts on it's axis causing great shifts in the climate (or so she acted/though) and killing millions............................(tongue in cheek).

What gives with the...............poor cooping mechanisms? Seems to be a bad nights sleep just meant you didn't sleep well.

[PostOpPrincess, BSN, RN]

Well, I've just had a rash of pts from the OTHER end of the spectrum. Two patients have now complained about me that I didn't check on them all night.

"She was only in here twice all night, I could have been dead for hours". Apparently on hourly rounds I'm supposed to wake my a/o x 3 patients and ask if they are sleeping okay and if they need anything. I even told these people during my evening assessment that I make hourly rounds but I don't wake them if they are sleeping unless I need give a med or grab some vitals.

Jeez. We can't win, people. Seriously.

.

It shouldn't be a problem unless your manager pays attention to that stupidity. If she/he does...then your unit is the loser for it.

If I were the manager, that's lip service I will give to the patient and then throw that complaint away.

There HAS to be some tone of common sense here.

[PostOpPrincess, BSN, RN]

Yes, true! And it just gives them an excuse to abuse nurses...who, in turn, accept the abuse.

It's time to stand up--because THIS nurse--moi--does NOT accept anyone's abuse.

NOT ONE.

[AprilRNurse]

The OP can have my insomnia any time. I'll be happy to make a gift of it, since he thinks I am less for wanting a night or day's sleep.

Not that I think patient's don't deserve sleep. But- if someone has declared they need to be hospitalized... they certainly are more in need of medical treatment than sleep.

I've only rarely had a problem with truly irrational patient's about this though. When my patient's complain, I give a compassionate smile, and tell them "I'm So sorry I had to wake you. It's defiantely not my favorite part of working nights. However it's very important I xxxxx.... because of xxxx" and they usually understand.

Also- the first time I go into their room for the shift... I lay out the plan for the night. I tell them I can let them sleep until xx time..but then I need to wake them for xxx, but that I will do it as quickly as possibly so they can go back to sleep.

[BluegrassRN]

.

It shouldn't be a problem unless your manager pays attention to that stupidity. If she/he does...then your unit is the loser for it.

If I were the manager, that's lip service I will give to the patient and then throw that complaint away.

There HAS to be some tone of common sense here.

Yes, you're right. And my manager knows it's bogus. She said her response was that she would discuss it with me, but she pointed out to the pt and the family that the pt was on a continuous heart monitor, so he was in fact being continuously monitored, and that if the pt was not awake all night, he might not have noticed me peeking into the room. She informed them that she requests the staff make every attempt not to wake a sleeping patient, because sleep is so important in healing. My manager was once a night shift nurse (I used to work as her aide regularly), so I know she knows how it is. It just bugs me, though, to hear about it.

Erik, you and I should trade pts for a while.

[indigonurse]

On the outside I have noticed a new crop of pharmaceutical drug addicts. People who do not believe they have to suffer from any form of discomfort and an MD who will prescribe otherwise perfectly healthy individuals an unbelievable amount of medication. Antidepressants, anti-anxiety, sleep aids, pain pills. As unbelievable as that seems they throw some alcohol and their medical marijuana into the mix. And still will wake up at the drop of the hat. Put them into the hospital where they can't self medicate and get to the liquor store and you have your hands full.

[mustlovepoodles, RN]

I've been noticing something lately, noticing it going on a lot recently. Maybe its just the pool of pt's coming to my specific hospital or something, IDK.

We all know pt's over react to certain (usually the wrong) things. "OMG, my mashed potatoes are cold" meanwhile their saturating is like 72% and they don't want to hear about putting their oxygen back on until you've heated up those potatoes.

On my unit, the "thing" to over react to seems to be sleep. Now, I understand having an upset sleeping schedule is disturbing beyond belief.........heck, I work nights. But lately, I've had a slew of patients who act like a bad night's sleep is going to land them in the ICU or something. Literally, they are panicked and crying as though a limb was just amputated. They want double and triple dose sleep aids until they are sleeping, regardless of the risks.

I try to tell them "Maybe its not really a medical problem at all, might just be U R not tired". I bite my tongue and thing to myself "Yeah, you lay in bed all day telling the staff to get this and do that..........so why would you be tired? I wasn't aware being waited on was such hard work that it should provide you a good nights sleep."

Last night I literally had a woman go into a full blown panic attack that almost lead to me calling the rapid response team. What stressed her so? Her blood was not done and she wanted to go to sleep........it was going to keep her up and she'd never sleep and then the world tilts on it's axis causing great shifts in the climate (or so she acted/though) and killing millions............................(tongue in cheek).

What gives with the...............poor cooping mechanisms? Seems to be a bad nights sleep just meant you didn't sleep well.

I don't know if you've ever experienced a panic attack when you can't sleep,but I have. It's miserable. Sometimes coping skills aren't enough to pull you out of it, either. I have bipolar disorder and the shortcut to mania is sleep deprivation. Once it gets started, the intrusive thoughts begin--Uh-oh, I'm not sleeping.I'm closing my eyes now, trying to sleep. I'm not sleeping. OMG, what if I don't go to sleep. I'm trying to sleep. What if I can't sleep? Help me, help me, I can't sleep! I'm not sleeping! Help, help!! It's really terrible.

Obviously, going to sleep circumvents this whole cascade. Being in the hospital is very stressful on a good day. The loss of control is overwhelming for some patients. That's why they focus on the things they can control, like their food, their pillows, and their sleep. And frankly, it's hard to get to sleep and stay asleep when you're in the hospital, what with carts rolling down the hall, conversations going on, vital signs. Every time the door opens my body goes on high alert. It a physiological thing related to PTSD. So, if I'm ever your patient, you might as well break out the drugs or it's going to be a long night for both of us..

[RNperdiem, RN]

I do what I have to do for my ICU patients, but I do have sympathy for lack of sleep.

Sleep deprivation will derail all but the strongest coping skills, some patients go completely beserk. I suspect lack of sleep is a factor in so much of the agitation that I deal with.

I try to picture myself 1. sleep deprived and 2. NPO for a few days, and I don't think I would be my usual sweet self either.

[eriksoln, BSN, RN]

i know this is unpopular erik, but i'm sorry.....i may be vein but i too suffer from insomnia and i understand the panic. this is a problem that has developed for me over the past year and although i am completely healthy otherwise i now find myself depending on a sleep aid to rest. the alternative is an entire day of a complete lack of energy, inability to focus or think clearly, muscle aches and headaches. i know this because i've tried several times to stop and practice good sleep hygiene, etc. i can understand how people might become panicked.

yes, there are people who lack coping skills but we often don't know what stressors people are dealing with in addition to their hospitalization. in fact, i find that there is a large segment of the population dealing with incredible challenges financially, emotionally and socially and an illness and a hospitalization is usually the last straw. if you knew what so many of people are going through out there, your jaw might drop. i wish you and more of my colleagues could understand that.

isn't there talk now (well, maybe its old, idk) about a new diagnosis/condition called "sleep anxiety"? where a person is so anxious about sleeping........they can't sleep. i can understand that. i experienced that when i was a student. i would remember the "good studying/test taking" class suggestion that you sleep well before a test.........and worry so much about doing so that i wouldn't be able to sleep. lol

on the outside i have noticed a new crop of pharmaceutical drug addicts. people who do not believe they have to suffer from any form of discomfort and an md who will prescribe otherwise perfectly healthy individuals an unbelievable amount of medication. antidepressants, anti-anxiety, sleep aids, pain pills. as unbelievable as that seems they throw some alcohol and their medical marijuana into the mix. and still will wake up at the drop of the hat. put them into the hospital where they can't self medicate and get to the liquor store and you have your hands full.

yes, i agree. not so sure if this crowd is really "new" though. i think it is more this type of individual who challenges me as a nurse. idk why.

i don't know if you've ever experienced a panic attack when you can't sleep,but i have. it's miserable. sometimes coping skills aren't enough to pull you out of it, either. i have bipolar disorder and the shortcut to mania is sleep deprivation. once it gets started, the intrusive thoughts begin--uh-oh, i'm not sleeping.i'm closing my eyes now, trying to sleep. i'm not sleeping. omg, what if i don't go to sleep. i'm trying to sleep. what if i can't sleep? help me, help me, i can't sleep! i'm not sleeping! help, help!! it's really terrible.

obviously, going to sleep circumvents this whole cascade. being in the hospital is very stressful on a good day. the loss of control is overwhelming for some patients. that's why they focus on the things they can control, like their food, their pillows, and their sleep. and frankly, it's hard to get to sleep and stay asleep when you're in the hospital, what with carts rolling down the hall, conversations going on, vital signs. every time the door opens my body goes on high alert. it a physiological thing related to ptsd. so, if i'm ever your patient, you might as well break out the drugs or it's going to be a long night for both of us..

that helps actually. loss of control = focus on what can be controlled which may be control of something that seems trite to the nurse but is top priority to the pt. guess i'll have to work on that, using the opportunity do something for the pt. rather than just being annoyed by them.

[eriksoln, BSN, RN]

Funny thing. It dawned on me that I began this thread after a night of work. Maybe I shouldn't speak my mind after working since I work nights and have a little bit of fog in the head (:pFrom lack of sleep ha ha ha ha).

As I re-read my post a few days later in the evening after I've slept well, I practically have to do a palm face. Seems I've forgotten I work on a Pulmonary unit...........where steroids are administered in high doses, IV, over a long period of time. Duh, people are anxious and agitated.

Guess IV steroids doesn't explain it completely or take away my annoyance with it but...........guess there might be some patho. behind what I'm seeing too.

[nursel56]

isn't there talk now (well, maybe its old, idk) about a new diagnosis/condition called "sleep anxiety"? where a person is so anxious about sleeping........they can't sleep. i can understand that. i experienced that when i was a student. i would remember the "good studying/test taking" class suggestion that you sleep well before a test.........and worry so much about doing so that i wouldn't be able to sleep. lol

i don't know if they've assigned it a dsmiv code, but it's definitely a real disorder that in my case started in my teenage years. i remember when it started. the night before school resumed after holiday break. it's like other panic disorders with the twist that what you fear most will come upon you (no sleep) will cause that thing to come upon you right away! instantly. i don't think it's possible to sleep when your body is pumped full of fight or flight response. it's awful as anyone who has been through it can testify. for a long time i would obsess during the day and clock-watch as i tried to sleep.

i've managed to coexist with this now mostly by using non-pharmaceutical things such as little mantras i say to myself to break the initial cycle that work most of the time. most are based on paradoxical intent and spiritual phrases ie "i will be ok even if i don"t sleep" and "let go and let god" stuff. i never look at the clock at night anymore. if you have a clock that clicks when a minute passes throw it away now! :)

i have no real objection to ambien or whatever the sleep-aid du jour is (i think they were still using seconal when i started having this problem-yikes!) for out of the ordinary stressors, but i know my baseline anxiety level is pretty high all the time, getting off of them if you have to is a beast, and ambien messes with my memory too much. i have patients who have said they go on shopping binges while taking it and some say it gives them the munchies!

so to sharon h and all who have this boy do i ever understand!! h e l l to go through.

[GHGoonette, BSN, RN]

I have occasionally had something similar to "sleep anxiety"; strangely, it usually happens when I am very tired. If for any reason I can't fall asleep quickly (due to outside noise or unexpected disturbances) I find my mind becomes hyperactive, and flits from one train of thought to the other. It's always exacerbated by the thought that I have to get up at 5h30 or so the following morning. By the time I realize what's happening, it's always 1am or later, so it's too late for me to take medication to help me drop off-unless I fancy being a total zombie at work the next day.

Thankfully, it very rarely happens-and oddly, never if I'm off or booked to work afternoon shift the next day