Sleep. Shakespeare called it "nature's soft nurse." Kathy Parker, Ph.D., RN, FAAN, calls it "a miracle that happens every day."
"Why do we sleep? That's the $64,000 question," said Parker, the Edith F. Honeycutt Endowed Chair in Nursing at Emory University's Nell Hodgson Woodruff School of Nursing. "We all do it, but we've only recently begun to study why and how. It's a very young field," she said. For Parker, who is also director of the school's Center for Research Symptoms, Symptom Interactions and Health Outcomes, sleep is her field of study and practice.
Two residents at the University of Chicago first discovered REM sleep. While recording infant sleep patterns, they noticed the rapid eye movement of the infants at frequent intervals. "We now know a lot more about REM sleep. That's when most people dream, for instance," Parker said.
Dr. William C. Dement set up the first sleep disorder center in the country in 1970 at Stanford University, and was a founding member of the first American Association of Sleep Disorders in 1973. "Sleep medicine is an interdisciplinary and burgeoning field, where new research is constantly being done," Parker said. "Currently, 88 sleep disorders have been identified."
Parker became interested in sleep through her work as a nephrologist and nurse practitioner at a Veterans Administration hospital.
"In 17 years, I'd seen a lot of problems with my patients on hemodialysis. We couldn't solve a lot of them, but I thought we could try to do something about one of them," she said. "Many people with kidney problems complained of not being able to sleep at night and of being fatigued during the day."
Parker earned her Ph.D. and began conducting sleep studies. In 1993, she joined Emory's nursing school to continue her research and practice.
Parker discovered that people on dialysis don't usually have a body temperature of 98.6 degrees, but that the machine that filtrates the blood heats it to that temperature.
"Most patients develop a fever that stays up into the evening after treatment. Since people fall asleep as their bodies cool down, and these patients were still hot, they couldn't sleep," she added. Would patients sleep better if they turned the machine dial down a few degrees?
"Yes. We did five years of clinical trials and the data came back very strong. If it continues, our findings could change the way dialysis is administered throughout the country," Parker said.
She is continuing those trials, and has begun to study disturbances of sleep/ wake cycles in patients with chronic illnesses. In addition to helping develop and test population-specific interventions, Parker is studying the effects of pain and the use of opioids on the sleep of cancer patients.
"Traditionally, we give morphine or codeine at night, wanting the patient to be free of pain, but the drug interacts with the normal transmitter system and fragments the patient's nocturnal sleep," Parker said. "We are experimenting with a drug that you can give once a day that offers the same pain relief, but gives a better quality of sleep."
Besides her research, Parker maintains an active practice at the Emory Sleep Center, where she treats patients with sleep apnea, narcolepsy, insomnia and other sleep disorders.
"I've had wives on the verge of divorce drag their husbands in because of sleep disturbances," she said. "There's a lot we can do, and it can make such a difference. If we can manage someone's sleep we can improve his quality of life."
Scientists are proving that some of our popular expressions like "there's nothing like a good night's sleep" and "I can't decide that right now. I need to sleep on it," are more appropriate than we think.
"People look better after a good night's sleep. Their eyes are brighter, more focused and their expression more animated," she said.
Sleep and dreams may be the body's way of creatively processing information, compressing and deleting files, the way a computer does.
"We know that REM sleep increases in times of stress, like a divorce or exams," Parker said.
"We know the state is a respite and that it is rejuvenating. When we get a good night's sleep, it allows the neurotransmitters in the brain to be repleted. Sleep can enhance learning and the lack of it depresses the immune system and is related to other health problems," she said.
Parker is one of five nurses in the country certified in clinical sleep disorders by the American Board of Sleep Medicine. She was recently elected a fellow of the American Academy of Sleep Medicine and appointed to the Institute of Medicine Committee on Sleep Medicine and Research. She's the only nurse on this 15-member, multidisciplinary committee.
"I am absolutely, totally fascinated with this field," Parker said, "and it is ultimately satisfying to be able to help people sleep better."