Founders of the newly opened Sabino Recovery in Tucson, Ariz., believe that a largely unaddressed problem in patients dealing with addiction and/or trauma can facilitate recovery if identified: interrupted sleep. To this end, the self-pay residential program has established an on-site sleep lab where patients can be observed during sleep for issues that may impede their ability to participate fully in treatment during the day.
Sabino Recovery co-founder Nancy Jarrell O'Donnell says sleep hygiene has surfaced as a topic of discussion in her past clinical roles in the field (she has worked at Sierra Tucson and in private practice), but more hands-on services in this area have been lacking in the treatment industry. Prior to Sabino Recovery's founding, she met with polysomnographic technologist George Sirakis, who now operates the facility's sleep clinic.
“A good sleeper will experience five periods of REM sleep, a critical time for people to re-boot,” says O'Donnell, Sabino Recovery's president of clinical services and operations. “Also, this is the time when memory is consolidated. If these things don't happen, people are going to be cognitively impaired, and they're not going to feel good physically.”
That will in turn make it difficult for patients to process the wealth of information shared in a typical treatment day. Sabino Recovery specializes in addressing trauma, seeing addictions and mental health problems in general as symptoms of underlying trauma.
Patients begin to field questions about their sleep even before they arrive for treatment at Sabino Recovery. A brief questionnaire can start to uncover issues, and then follow-up questions are asked in the patient's initial psychiatric evaluation.
A patient may be told early on that he/she is a candidate for being monitored in the sleep lab. “We don't want to do it right away, though,” O'Donnell says. It is more important at first to build trust with the patient affected by trauma, so typically the center will wait around a week or so before scheduling time in the sleep lab.
At the two-bed lab, a patient spends at least six hours of evening time in a sleep study (eight hours is optimal), in a comfortable setting with camera equipment that is not situated intrusively for the patient. Sirakis observes the patient during sleep, and measures of heart rate, brain wave activity, muscle activity and other physical signs are taken and analyzed by an off-site physician who is certified in sleep medicine.
Not all Sabino Recovery patients are referred to the sleep lab, and even some who might benefit from the service could choose to opt out, with one potential reason being that the service presently is not included in the otherwise all-inclusive self-pay rate for treatment at the facility.
One observation that leaders have made since Sabino Recovery's October 2015 opening is that several young male patients who have undergone a sleep study have been found to have previously undetected sleep apnea, O'Donnell says. “This could have been affecting them prior to their acting-out behaviors,” she says.
Several potential treatment strategies are explored for these patients, including emerging alternatives to the cumbersome CPAP (continuous positive airway pressure) device technology, as well as relaxation techniques and medication treatments in some cases.
O'Donnell adds that the Sabino Recovery program emphasizes outdoor activity to take advantage of the sun's benefits and perhaps offset some of the problems that commonly occur in sleep. She hopes that the sleep lab's presence will eventually lead to research data that will improve the field's understanding of the relationship between sleep and recovery.