by James Coburn
April Merrill had made a number of referrals over the years for patients with obstructive sleep apnea during her background focusing on diabetes care. She then learned from her own weight loss surgery in 2009 that she has sleep apnea.
“Mine was related to my weight and I lost 100 pounds, and was able to get rid of my c-pap machine,” said Merrill, RN, doctor of nursing practice at INTEGRIS Sleep Medicine Center, located in NW Oklahoma City.
“I really have a passion for bariatric patients and sleep apnea patients and being able to help them. I can share my story with them,” said Merrill, who earned her advanced degree at Texas Christian University.
Through her work at the Board of Nursing, medical director for INTEGRIS Free Clinic, Dr.. Jonathan Schwartz, MD, asked Merrill to explain advanced practice roles in nursing.
“I’d been trying to help him find somebody to fit into this role and then realized, maybe that would be a good fit for me,” she said. “I’ve been working with him, directly seeing patients since last fall.”
Merrill loves being able to help her patients, beginning when they come to the Sleep Medicine Center for consultation. Patients review their sleep habits and issues they are having.
“Based on that and their symptoms, and their physical exam, then that leads us down the path of do they need a sleep study or not,” Merrill explained.
INTEGRIS has three sleep study labs, including Southwest Medical Center, south of the INTEGRIS hospital in Yukon, and on the campus of INTEGRIS Baptist Medical Center. Studies are conducted every night of the week except Saturdays.
“I can usually get patients a study within a day or two, based on if they’re willing to drive and where they want to go,” Merrill said.
When left untreated, sleep apnea causes weight gain, high blood pressure and can make pain and depression worse, she continued. Ultimately, sleep apnea can lead to heart disease and stroke.
So it’s important to get sleep apnea resolved and treated because of safety risks. Patients with sleep apnea are more likely to fall asleep when driving. This is why the United States Department of Transportation has pushed for drivers who are suspect of sleep apnea to be treated, based on their weight and neck size, especially if they snore, Merrill said.
“Gentlemen with a neck shirt size greater than 17 inches and snoring, are two of the biggest indicators of sleep apnea,” she said.
Obstructive apnea is when the airway is either completely or partially blocked, based on the soft palette of the tongue. Central apnea is a less common form of apnea. It is based on a signal from the brain when somebody takes a breath.
“That can occur with any type of traumatic brain injury,” Merrill said. “You can see it with patients that have severe heart failure, plus patients that take long-term opiate medications.”
BI-level pressure can be a treatment for central apnea. CPAPS can be modified for the type of sleep apnea a patient has been diagnosed with. The machine is like a mini computer. Algorithms built into the machine can sense the type of apnea a patient is having, and then it alters the way it delivers pressure in order to accommodate central or obstructive apnea, Merrill said.
There are also different types of masks. A full face mask will cover the nose and mouth. There is also a triangle-shaped nasal mask for the nose.
“And then we have what is called nasal pillows. They are little cushions that sit right inside the nose,” she said. “That’s going to be the least restrictive, but the way it delivers air can feel different.” She always tells her patients that masks are about them. They need to find on that does not leak and is comfortable enough for them to wear all night.
“It doesn’t do any good to give them a CPAP if their mask is leaking all night, because then they can still have apnea and they don’t get the full benefit of therapy,” she said.
Insomnia and restless legs are the other two biggest complaints from her patients that she treats. Often insomnia can correlate with an untreated apnea, she said. Insomnia patients either have problems falling asleep or staying asleep, Merrill said. When a patient has multiple awakening or disturbed sleep, they probably have apnea, she said. Patients may have multiple sleep disorders as well.
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We might have some untreated apnea going on as well as insomnia,” Merrill said. “So what Dr. Schwartz and I try to recommend is cognitive behavioral therapy for insomnia.”
Merrill enjoys helping people to improve, not only their quality of life but also their long-term outcomes by preventing disease processes.
When away from work, Merrill has a lot of hobbies. She has two teenage daughters and she likes to drag race with her husband at Thunder Valley Raceway Park in Noble.
“My husband has been racing since he was 15. And finally last year I got into it. Now I’m addicted “ Merrill said. “That’s what I live for every weekend. It’s either working on the car or going to the track. The girls in my office have become my fan club.”