Day or Night, Bad Sleep Is Bad Sleep
I am the day technologist and as you know that would include in my duties performing the MSLTs. MSLTs like anything else, can become somewhat routine once you've done a few hundred of them.
Recently in the lab I had a teenager for MSLT. I always enjoy this patient population. They are typically cooperative and fun to have in the lab. This study was a little different though. The child was cooperative but his affect was extremely flat, almost depressed? It was a STRUGGLE to keep him awake and this is alone is not what was so unusual. The drama started once the nap ops began.
Sleep onset was immediate each time and straight from WAKE to REM, everytime. The drama: not only was he narcoleptic but he had REM behavior disorder as well. OMG!! We had screaming and thrashing and calling out "Help me! Help me!" We had dreams of smoke coming from the vents and of people lost in the room needing help and something to drink. It was without a doubt one of the most interesting MSLTs I've ever done. I will never forget it.
Now I am no newbie and I've seen RBD before and my exposures have been pretty comical. But during the day, with a child this age, seeing the extreme effects it has on the life of those suffering with it is another story entirely. This kid was already on stimulant therapy during the day and an antidepressant at night and still not resting because of the SBD. In fact, no one in the home was getting much rest at night. It was the most dramatic case I've seen so far, barring those at conferences.
The good news and what I love about sleep medicine is: We can fix these people. We can diagnose with a fairly simple, pain free test. We can have results readily available and adjust medications right then. I can see down the road that this kid will be sleeping much better at night and not sleeping through life during the day. There is such an impact to be made. It's so exciting.
What is challenging for me is the contrast between the "day" and "night" patient population. The day patients are almost begging for help and the night patients are so resistant. What's up with that? Bad sleep is bad sleep. Just get it fixed!