Sleep Navigators: A Roundtable Discussion

The field of sleep health continues to expand into the acute care/inpatient environment. Over the years, more and more hospital leaders have started to see the importance of sleep as a vital component of the hospital experience.

A recent scoping review undertaken by Suen et al. found that undiagnosed obstructive sleep apnea in cardiovascular patients was shown to have a negative effect on outcomes.¹ In addition, those with a diagnosis were seldom provided with continuous positive airway pressure devices.

A very interesting nationwide, single-day study conducted in the Netherlands found that sleep quality and quantity were impacted in hospitalized patients, with the most cited reasons being hospital noise from other patients and medical staff, pain, using the restroom, and medical devices—all of which can potentially be modified to improve sleep for patients.² Another article explored the link between poor inpatient sleep and delirium in older patients, which can impact their ability to perform self-care and rehabilitation.³ These are just a few examples of the data that is emerging in this arena. Many of these realizations have necessitated creating a role for an inpatient sleep navigator.

This article discusses the role of the sleep navigator from the perspectives of several individuals who capture their experiences to share with you. We are happy to provide this vital discussion on this role and know you will enjoy hearing and learning from these individuals. We thank Kelly, Kim, Kier, and Donnie for their time, passion, and contributions to patients’ sleep and well-being.

Kelly Gladden, RRT, RPSGT, RST, CCSH
Sleep Navigator
Wellstar North Fulton
Roswell, GA

How many of you love working directly with patients on the night or day shift and have the desire or passion to broaden your clinical skills? How many of you work the night shift and are at a point in your life where you really would like to work the day shift, but those early-morning hours are not for you, and a later time would work best? As a sleep navigator, one can adjust their eight-hour workday to see patients at the hospital.

If you answered “yes” to any of the above questions, become a sleep navigator or start your own program in the hospital system where you work. My role as a sleep navigator is the best job I have worked during the last 20-plus years of my sleep and respiratory career. Why, may you ask? I use my respiratory clinical and night-shift sleep center assessment skills while educating patients about their comorbidities related to sleep health. There has not been one health condition that I cannot associate with the patient’s overall health improvement. I often make patients laugh or crack a smile despite the pain they may be experiencing.

As technologists working in a sleep clinic, we may have little opportunity to interact with other health team members. As inpatient sleep navigators, we interact with everyone from nursing, respiratory, physical therapy/occupational therapy, radiology, physicians, security, lab techs, social workers, housekeeping, and other department educators. Interacting with all these staff members may be intimidating for some introverts, but do not dismiss the role if you have the passion and love in your heart to help others.

Sometimes, we need to take a leap of faith and come out of our comfort zone to get to where we would like to be. That voice in your head that tells you that you cannot do something or you are unworthy needs to be discarded. If you fail trying to start this program, do not give up. Get back up and try again, either at the same organization or go to another organization where you can thrive. I pitched this sleep navigator role at another organization that did not pan out before I was hired at Wellstar Health System, where our AVP, Massey Arrington, MBA, RPSGT, CCSH, and our medical director,  Hitendra Patel, MD, both had the vision and dedication to create such a role to help our patients.

If you are fortunate enough to have a sleep navigation program at a local hospital in your area or if you are willing to move near a hospital system that has such a program and you have your Certification in Clinical Sleep Health (CCSH), apply for the open position. Or to help get your foot in the door when an open position presents itself, network with the sleep center staff or management team at a hospital that has a sleep navigation program you would like to work with.

Most of you will have to start your own program at your current hospital. For some, this may be an easy endeavor, but for many, you will have to network and get a leader in the hospital system to listen to your idea and understand how your role will help decrease readmissions and improve patient outcomes. Your role will also increase revenue for the sleep center and for the outpatient sleep physicians’ office visits. Once you have secured that buy-in, create your program.

Wellstar Health System uses Epic as our electronic medical record system. Our Epic team investigated other hospital system builds when this role was approved, and there was no one else with a sleep navigation type build that we could use or tweak to what we wanted. If your hospital uses Epic, your Epic hospital team should be able to copy our build to make this easier for you. If your hospital does not use Epic, you can use my book, A Diary: Build and Grow a Hospital Navigation Program, to see how this build occurred. Visit my website, http://www.clinicalsleephealtheducator.com, to find more information about my book as well as a link to purchase the book if you’re interested.

I find joy in helping patients who I know need a sleep study as soon as possible and who may have issues with scheduling or getting into the lab on time. For those patients, I give them my cell number to call me so I can help them if they hit a snag. We are their sleep advocates and with some patients, they need someone to help them get across that finish line and not give up.

I hope to see the sleep navigator as a type of physician extender role in the future. The expanded role would allow the sleep navigator to order the sleep study or sleep consult without having a hospitalist sign off after us or enable us to follow up with non-complicated sleep apnea patients to free up physicians to spend more time with the complicated ones. If you are enthusiastic about helping people become healthier, expand your skill set into sleep navigation. You will not regret your decision.

Kim Balie, RPSGT, RST, CCSH
Sleep Navigator
Wellstar Douglas
Douglasville, GA

As someone who’s been working in the field of sleep medicine for 20 years, I’ve seen a lot. When I started, I wondered how many people had sleep problems and if this job would last. Well, it turns out a lot of people have sleep problems, and it’s not slowing down. Throughout my different roles—from night technologist to manager and now, sleep navigator—each position has offered unique insights. However, the aspect of patient care and the opportunity to enhance patients’ quality of life remains my absolute favorite and the driving force behind my continued dedication.

In my prior roles, patients arrived at the sleep center well aware of their sleep issues, having already discussed concerns with their doctors. However, in my role as an inpatient sleep navigator in a hospital setting, the dynamics differ significantly. I encounter patients at their most vulnerable, struggling with various health issues like heart attacks, strokes, atrial fibrillation, chronic obstructive pulmonary disease (COPD), respiratory failures, and even cyclical vomiting syndrome. Their primary focus is on their current health problems, and thinking about sleep is the last thing on their minds. My role as a sleep navigator allows me to have a conversation about how their sleep health and how sleep at home can affect their current medical conditions.

What I cherish most about being a sleep navigator is the chance to make a difference in each patient’s life. Some patients already know they have sleep problems. Some do great with treatment, but others struggle with positive airway pressure (PAP) therapy, insomnia, and other sleep disorders. This gives us a chance to find out what’s going on and help them in different ways. We can troubleshoot problems or talk about other treatments that might work better. Sometimes, while discussing sleep apnea and sleep health, you witness that aha moment, knowing they will seek testing and treatment. But it’s not always easy—sometimes, we lose patients.

The memory of a particular patient stays with me. Even though he knew he had sleep apnea, he kept putting off scheduling a sleep study. When he eventually decided to schedule it, he passed away the day before the appointment. This loss was devastating and a reminder that we can’t save everyone. It reinforces the importance of persistently advocating for sleep health, planting seeds of knowledge, and supporting those who are willing to be helped.

Sleep medicine is evolving, with home studies and auto PAPs on the rise, accompanied by an increase in complex sleep apnea cases. Despite the increasing awareness of the importance of sleep health, there is a noticeable shortage of sleep technologists and sleep navigators. The field calls for more sleep educators to train the next generation of sleep technologists.

Healthcare systems should prioritize developing comprehensive training programs to meet the growing demand for these professionals. By increasing the number of skilled sleep technologists and introducing the essential role of sleep navigators, we can provide better care and support to individuals struggling with sleep-related disorders, ultimately improving their quality of life. The field of sleep medicine is full of exciting opportunities, making it an attractive option for those looking to pursue a meaningful and fulfilling career in healthcare.

Keir M. Noe, RSPGT, RST, CCSH Sleep Navigator
Wellstar Cobb
Austell, GA

Sleep is an evolving and ever-changing field. I am very excited to be a part of a new role in sleep. A sleep navigator is an essential liaison between the inpatient and outpatient worlds. Our program has been active for over three years now. By screening inpatients for sleep disorders, our team has seen a decrease in readmission for the four groups of patients we have been tracking. We track patients with the following comorbidities: stroke, congestive heart failure, myocardial infarction, and COPD. Of course, all these conditions are worsened by untreated sleep issues, especially obstructive sleep apnea. By tracking and collecting data on these patients, we can show empirical proof that better sleep leads to better health and reduced healthcare costs!

I have been in sleep medicine for over 30 years, and this is my favorite role. Daily interaction with different patients and staff ensures that no day is like the previous one. Teaching is a large part of our daily responsibilities. We educate patients on the importance of good sleep hygiene and sleep health. I often find that I also educate fellow staff members. I have screened patients during therapy or an echocardiogram or at the bedside while they are receiving medications or having some other procedure. Sometimes, the same staff member who was in the room with me would later pull me aside with sleep questions! They may be asking on their own behalf or for a family member or friend for which they have concerns. You never know who is listening and who may benefit from sleep screening.

As the sleep world continues to change and grow, we need to, as a field, create new roles, recruit new sleep professionals to replace the old ones (like me!), and be able to envision a future that includes flexible schedules, new responsibilities, and autonomy in patient care.

Donnie Brown-Hill, MPH, RPSGT, CPC, CCSH
Sleep Navigator
Wellstar Paulding
Hiram, GA

In recent years, hospitals have recognized the critical role of quality sleep in patient recovery and overall well-being. In addressing this vital need, my position as an inpatient sleep navigator emerges as a guiding light, aiding patients in their quest for better health outcomes.

Empowering my patients with knowledge and skills to manage their sleep health post-discharge is a fundamental aspect of my role. Each patient receives targeted educational sessions, which include conducting sleep navigator screening assessments. These assessments involve the consideration of factors like patient medical history, current medications, sleep habits, and the home environment. Gathering this information allows me to create a personalized sleep plan that aligns with the patient’s needs and medical requirements. This guidance empowers patients to actively participate in their sleep health management and overall well-being.

As a sleep navigator, I shine a light on the significance of sleep in the healing process, fostering a more restful and supportive environment for patients, ultimately contributing to improved overall well-being and recovery. In the journey toward holistic patient care, my role as a sleep navigator is a beacon, guiding patients toward the restful nights they need for a healthier tomorrow.

The one thing vital for anyone transitioning from sleep technologist to sleep navigator is the way communication must evolve. I describe the communication as I²CU™. Most days or nights of a sleep technologist involve Interaction + Instruction = I² because once a patient arrives, there will be interaction and then instruction. Sometimes, during the patient’s stay, there can be very little communication, particularly on the night shift. However, an inpatient sleep navigator needs Interactions + Communication +yoU because interactions occur with patients, staff, physicians, and leaders, and you must be able to communicate with everyone. That is why yoU are so vital in the equation because, without yoU, you cannot fully say to others ICU and mean it.

As an inpatient sleep navigator, I represent a pivotal aspect of patient-centered care, recognizing the importance of addressing holistic needs beyond medical treatments. As healthcare continues to evolve, integrating specialized roles like the sleep navigator highlights a commitment to improving patient outcomes and experiences.

Article Introduction: Robyn Woidtke, SleepWorld Magazine Editor

References

1. Suen C, Wong J, Ryan CM, et al. Prevalence of undiagnosed obstructive sleep apnea among patients hospitalized for cardiovascular disease and associated in-hospital outcomes: A scoping review. J Clin Med. 2020 Apr; 9(4):989. doi: 10.3390/jcm9040989.
2. Wesselius HM, van den Ende ES, Alsma J, et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Sep;178(9):1201-08. doi:10.1001/jamainternmed.2018.2669.
3. Farasat S, Dorsch JJ, Pearce AK, et al. Sleep and delirium in older adults. Curr Sleep Med Rep. 2020;6(3):136-48. doi:10.1007/s40675-020-00174-y.