While You Were Sleeping

The Patient

With her wedding approaching, Hallaji hasn’t been sleeping well, and so she has come to spend a night in the Millennium Hotel near West Campus to find out why. Her room is not quite a normal hotel room: It’s been converted by the Duke Sleep Disorders Center, a clinical research lab affiliated with Duke Medicine. The lab has equipped fourteen rooms at the Millennium with monitors to record patients’ sleep, logging brain activity, breathing patterns, and muscle movements—data that can help doctors figure out their patients’ sleep issues. While sleep labs exist in hospitals across the country, Duke’s is one of the few that is housed in a hotel, the idea being that homey surroundings make the experience—that is, attempting to sleep naturally with wires coming out of your head while strangers monitor you on video—slightly less uncomfortable. 

At a prep station, Hallaji sits patiently as Brandi Elliott, a sleep technician, outfits her head and body with electrodes, a meticulous process that takes around fortyfive minutes. As Elliott applies a glue compound into her carefully blow-dried hair, Hallaji groans. She’ll have to wake up earlier than expected to shower the glue out before her 6:30 a.m. shift. (At least she doesn’t have stubble: Male patients with short and spiky beards and hair often require Collodion, a powerful and acrid medical-grade glue, to keep the electrodes in place.) 

Photo above Dream of sleep: Lab patient Aaron Edgley is wired for the night. [Les Todd]

Elliott connects Hallaji’s Medusa-like head of multicolored wires to an EEG headbox known as “the pack.” The pack hangs around her neck as Hallaji makes her way back to her room. She climbs in bed, careful not to dislodge the electrodes on her legs and arms. Overlooking the bed is an oblong glass-encased camera with a dim red light, eerily reminiscent of HAL in 2001: A Space Odyssey. An intercom behind the bed allows communication between the patient and the observation room. Patients must ask to be unhooked if they need to get up to go to the bathroom. Even rolling over can be difficult without yanking something out of place. 

Hallaji is nervous—she hates sleeping with pants on—and momentarily gets selfconscious about the video camera before burrowing under the blankets. Elliott connects the pack to a computer beside the bed and slips a pulse monitor over one of Hallaji’s fingers. Finally, it’s lights out. As Elliott leaves the room, Hallaji reads on her iPhone for a few minutes and then closes her eyes. With any luck, she’ll get at least five hours of measurable, if not uninterrupted, sleep—the minimum needed for a usable study. 

The Tech 

As Hallaji settles in for the night, so does Brandi Elliott. She retreats to a nearby observation room, where she and other technicians confirm the equipment is working properly and continue to monitor their slumbering patients. At Elliott’s workstation, a large computer monitor shows three streams of data—brain activity scrolls along the top, eye and leg movements in the middle, and breathing patterns on the bottom. Overhead, a small black-and-white television shows her patient sleeping. 

On a busy night, seven techs work in the observation room, each observing two patients. This night is a quiet one. As the techs make notes on data readouts, there’s only the faint hum of static over the intercoms. Often, there’s a cacophony of snoring. 

Those techs are adept at quickly reading the data flowing by. Like composers mentally assembling music from a sheet of notes, they synthesize patterns that tell them what stage of sleep each patient is in. Craggy-looking brain waves are a sign of stage 2 sleep, when you’ve fallen away from outside stimuli. Loose, rolling waves indicate stage 3 sleep, a deep sleep more common among teenagers than adults. Eye movements are a dead giveaway for REM sleep. The techs are also good at spotting suspected cases of apnea, one of the most common disorders seen at the lab, and sometimes provide patients with special masks for part of their studies. 

For the most part, though, monitoring sleep is a low-key job. There’s usually time to read or study. Elliott even likes the unusual schedule. She drives to Durham from her home in Hickory, North Carolina, each Wednesday and stays through Saturday morning, sharing a room at the Millennium with another tech. “I wake up by 5:30 p.m., I’m upstairs by 6:20, I go back down in the morning at 7:30 and sleep ten hours. It’s great,” she says. 

The techs find various ways to stay alert during the nights. Some of them hum to themselves while marking up studies. Elliott makes a weekly Kroger run for nighttime snacks. The break-room refrigerator is stocked with ten varieties of two-liter bottles of soda. 

The Doctor 

Everyone can relate to sleep problems, says Rodney Radtke HS ’84, director of the sleep lab, because “everybody does it.” Still, with greater knowledge about the connection of sleep disorders to heart attacks and strokes, people are paying closer attention to the third of our lives we spend sleeping. 

Radtke reads patients’ sleep studies shortly after they are performed and offers his medical diagnosis. The thirty-year-old lab has seen some of the more unusual sleep disorders— parasomnia, for example, in which patients physically act out in their sleep, or disordered sleeping patterns. But the most common problem, by far, is sleep apnea, the involuntary suspension of normal breathing while asleep. Its incidence is increasing in part because of nationally rising obesity rates. 

“When you have a large abdomen, breathing is harder,” Radtke explains. “And men and postmenopausal women have fatter necks, so the airway can collapse.” 

For the most straightforward cases, a sleep doctor will prescribe a CPAP device that fits over the nose and mouth to apply continuous air pressure tailored to the patient so that he or she won’t keep waking up due to breathing abnormalities. But sometimes the problem is behavioral or psychological. In that case, Radtke will refer the patient to an appropriate doctor.

Some people misinterpret the field, thinking a sleep lab can help make sense of strange dreams or lucid sleep, but Radtke is emphatic about his work. “I’m a clinical sleep doctor, not a researcher,” he says. “The purpose of sleep, or REM sleep, or why we dream, we don’t know.”

So whatever is bugging Hallaji’s sleep may show up in the dips and waves of her physiological measurements. And if it does, the lab can diagnose her problem. But then again, it may not. Sleep is still largely mysterious, an internal world that all of us, in the end, navigate alone. Even when we’re being watched.