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Sleep Medicine’s impacts on Psychiatry: A Conversation with Dr. Franklin Escobar-Córdoba

May 11, 2022

Neurovirtual: Good morning Doctor. On behalf of Neurovirtual, we would like to thank you for having us in your clinic. Could you tell us a little bit about your professional and academic past?

Dr. Franklin Escobar: Of course. I am a surgeon and graduated from ColombiaNational University. Over time, I specialized in psychiatry. Then I went to Toulouse, in France. At the Paul Sabatier University, I studied for a year of sleep medicine, then returned to Colombia. Here, we created the sleep laboratory at Hospital San Juan de Dios Hospital. I also received my master’s degree in forensic psychiatry, and a doctorate in medicine, and since 2008, I have been at Fundación Sueño Vigilia Colombiana. A sleep center where we care for all types of patients with sleep problems.

NV: How can polysomnography studies help with psychiatric patients’ diagnoses?

Dr. FE: Polysomnography has been used in sleep studies for many years. Not just for psychiatric patients, but for anyone experiencing sleep disturbances. Psychiatric patients have been studied through polysomnography, but there is no particular or specific change found for different disorders. Tests have been carried out in patients with schizophrenia, depression, affective disorder, and bipolar disorder, and have not found elements to determine whether or not polysomnography is useful to distinguish one pathology from the other. In general, polysomnography is used in psychiatric patients to detect primary sleep disorders that may be co-morbid with the underlying psychiatric illness.

NV: Together with other doctors, you published the article “Colombian Association of Sleep Medicine recommendations for practicing sleep medicine during the COVID-19 pandemic in Colombia”. How was this article written?

Dr. FE: This article is a result of the board of the Colombian Association of Sleep Medicine. Seeing the serious situation in the country related to the pandemic, and with the continual need to carry out studies in different sleep laboratories, maintaining all the safety measures that were established to prevent Covid’s spread, we decided to review the medical literature on this subject. Several guides were studied: American, European, and Latin American. Based on these studies, we made an adaptation enabling us to create some recommendations on how sleep labs should function during this period. These recommendations remain. Fortunately, most Colombian sleep labs have adopted it and with that, it was possible to continue with many sleep studies during the pandemic. Thankfully, there have been just a few cases of COVID contamination among our patients.

NV: Do you think that telemedicine and home tests can be good options for diagnosing sleep issues during and after the pandemic?

Dr. FE: This is undeniable. Since the pandemic, everything to do with telemedicine has increased. We were already working on projects like this before, as we have appointments that involve all specialties related to sleep medicine. We have neurologists, otolaryngologists, pulmonologists, pediatricians, and psychiatrists who are part of sleep medicine. In addition to experts in the field. Because of this, we saw the need to offer telemedicine. And with the arrival of the COVID pandemic, this demand has grown. We had to adapt quickly. We worked hard adding to the telemedicine program which we already had for patients who have CPAP (Continuous Positive Airway Pressure) because they suffer from sleep apnea.

During the pandemic, all patients received care via teleconsultation. Sleep medicine, psychiatry, psychology, and even pulmonology were performed. This allowed patients to continue their treatments adequately, without displacement. The pandemic has brought this issue to light and it will now remain. Currently, we continue to do telemedicine, we monitor patients’ adherence to CPAP through the internet, and through different technologies that already exist. This allows us to be sure the patient is wearing their equipment, and if the mask is adequate or if it has leaks.

We also did many home tests with signals transmission through the internet. This also allowed us the knowledge to advance in new polysomnographic techniques.

NV: What is the relationship between psychiatric disorders and sleep medicine?

Dr. FE: There has been a familiar relationship since sleep medicine was discovered. It is born from psychiatry and neurology. Psychiatrists receive most of the patients with sleep problems, due mostly to insomnia. This is either because the person cannot initiate sleep, or he wakes up many times at night, or he wakes up during the night due to certain disorders. They also look to us when the patient sleeps for a long period of time and does not know why. For these reasons, psychiatrists have always dealt with sleep disorders. Which makes the relationship between psychiatrists and sleep disorders, very close.

In recent years sleep apnea has been highlighted, and many people identify this with sleep medicine only, but it is not. Sleep apnea is just one of the disorders found in the sleep disorders international classification. There are roughly 100 – 120 sleep disorders that are managed by those specialists who are dedicated to this.

NV: Doctor, how do you evaluate COVID-19 pandemic consequences associated with social isolation in mental health?

Dr. FE: Also because of the pandemic, at the Colombia National University, we decided to write an article about the consequences that could be generated by the pandemic on patients’ mental health. We worked on this article with some psychiatric patients, and published it in SciElo’s database, and also in a Colombian anesthesiology journal. The article already has more than 300 views on Scielo and more than 240 citations. Contributing to the addition of this knowledge in society is a huge success. In addition, when we look at pandemics in general, the population presents anxiety disorders, depression, insomnia, post-traumatic stress, and increased domestic violence. It was something that was already known, and that is what has been seen and is being noticed during this pandemic.

NV: As for the care of patients with psychiatric disorders, how should the patient’s sleep quality be considered during the diagnosis? Are there any recommendations?

Dr. FE: Yes, always. Any patient should be evaluated by their sleep aspects. However, doctors don’t have the best training in regards to sleep, medical schools either don’t provide it, or it is not in-depth enough. Doctors, don’t always know how to ask about it, they do not diagnose nor do they treat. Psychiatrists are usually trained to find out, at least, what happens to patients’ sleep. Usually, what the psychiatrist does, is treat these changes with medication. Some psychiatrists who know a little more about primary sleep disorders may refer their patients to sleep centers, like the one we have here at Fundación Sueño Vigilia Colombiana. Here, we are dedicated to doing a polysomnographic study, or any sleep studies that usually exist, and offering medical evaluations with the corresponding specialist.

NV: How do excessive daytime sleepiness and insomnia affect people’s lives? What are the long-term consequences for patients suffering from insomnia?

Dr. FE:  Sleep and excessive daytime sleepiness are evils of our time. This also allowed me to produce a book together with the Colombia National University. It was published during the pandemic and you can find it on the University editorial’s page. In it, we describe how insomnia is a current sickness, as the earth’s luminosity has increased – before people slept in caves and trees. Then the light was created and now the internet. People stay up until late at night chatting on their phones, looking at the iPad, or at the computer. There are thousands of screens everywhere. This has been decreasing the sleep hours and, in the long term, causes insomnia or sleep disturbances. The next day, people feel tired, and can’t stay alert, so they tend to fall asleep or fall asleep in unusual places where they should be alert. In fact, insomnia and excessive sleepiness are current ills that must be controlled because of the affect on the quality of life and the affect people’s health.

NV: Doctor, do patients with insomnia and excessive daytime sleepiness suffer more from psychiatric disorders?

Dr. FE: Yes, especially for patients who suffer from excessive daytime sleepiness. People who sleep more hours during the day spend more time in bed and this is closely associated with depression and some personality disorders. While patients who suffer from insomnia tend to suffer from anxiety disorders. That’s because the person goes to bed, puts his head on the pillow, and starts to think about many things, including their day’s problems, work problems, problems with their family or partner, and then can’t get to sleep. Spending the night without sleep. So yes, it has a lot to do with it.

NV: Doctor, how has your experience been working with Neurovirtual’s brand, equipment, and technical support?

Dr. FE: Neurovirtual has been a partner of Fundación Sueño Vigilia Colombiana since it arrived in Colombia. I had the opportunity to meet Ed Farías, and we became good friends. Since he arrived in Colombia, I have worked with him in scientific support for the development of the software that we manage. We have Neurovirtual equipment in our Foundation. We worked with it from the very first system to today’s most modern device and technology, which were acquired this year and are currently in operation. It is excellent equipment.

NV: Doctor, would you recommend Neurovirtual to other colleagues?

Dr. FE: Of course. We highly recommend Neurovirtual, as their superb equipment allows for superb sleep studies. They easily qualify as a brand we recommend and their current software and hardware are stronger and more solid than those of the past. Neurovirtual has a great development team and perfect positioning in the market. In Colombia, almost all of the sleep labs have some kind of Neurovirtual equipment. I know many sleep centers in Latin America that work with the Neurovirtual Brand and have a very good opinion of them, as we do.

NV: Doctor, once again thank you very much for your time.

Dr. FE: I also thank you for coming to Fundación Sueño Vigilia Colombiana. We are a sleep center with several units in Bogotá.  We will likely open a unit in Villavicencio and another one in Ibagué next year. So, all our Colombian patients who have sleep disorders can consult in our specialized center, and receive quality care and adequate treatment.

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